The post REBEL Review 106: Infant Wheezing – What Could It Be? appeared first on REBEL EM - Emergency Medicine Blog ..read more

Background: There is a shifting paradigm with persuasive evidence favoring a shorter duration of antibiotics for outpatient management of community-acquired pneumonia (CAP) in children. The SAFER and CAP-IT trials found that short-course antibiotic therapy was not inferior to standard duration therapy. The SCOUT-CAP Trial found that short-course antibiotic therapy was superior to standard therapy. The pooled estimates extrapolated from these randomized control trials bolster the evidence favoring short-course antibiotics in children with CAP. Paper: Kuitunen I et al. Antibiotic treatment ..read more

Background: Respiratory support is a common intervention in pediatric ICUs and can include HFNC and CPAP/BPAP to avoid invasive mechanical ventilation.  HFNC has become more popular due to its ease of use, perceived patient comfort, and the ability to discharge patients still receiving HFNC out of the ICU.  Despite its growing popularity there is limited randomized clinical trial evidence to support the use of HFNC as a 1st line modality in acutely ill children. Paper: Ramnarayan P et al. Effect of High-Flow Nasal Cannula Therapy vs Continuous Positive Airway Pressure Therapy on Lib ..read more

Background: The standard approach to treating pediatric community-acquired pneumonia (CAP) is a 10-day course of antibiotics. However, two high-quality randomized control trials challenged this standard within the last 12 months. The SAFER Trial [reviewed here] and CAP-IT Trial [reviewed here] found treatment for CAP in children with a shorter duration of antibiotic therapy to be noninferior to standard treatment duration. The SCOUT-CAP trial differs from previous RCTs by using a novel combination of clinical response, the persistence of symptoms, and antibiotic-assoc ..read more

Background: Unintentional injuries remain the leading cause of mortality in children. While traumatic brain injuries and thoracic traumas are the top two causes of mortality and morbidity, abdominal traumas are the third most common cause.  Additionally, children are at higher risk for clinically significant intra-abdominal (IAI) injuries as a result of their anatomy in comparison to adults. Therefore, it is critical that emergency clinicians accurately diagnose IAI that requires intervention. Given the sensitivity of abdominal CTs for detecting IAI, emergency clinicians may be susceptib ..read more

Background/Introduction: The commonly cited duration of antibiotic therapy (7-14 days) for community-acquired pneumonia (CAP) has historically been based on arbitrary timelines extrapolated from a desire to prevent treatment failures and avoid under-treatment rather than evidence-based medicine. Even the original literature on the treatment of pneumococcal pneumonia all reported effective duration of antibiotic treatment to be 2 to 4 days: 1943 Keefer et al. 500 patients with the majority recovering in 2-3 days. 1944 Dawson et al. 100 patients with the majority recovering within 2 days ..read more

There are generally 3 main congenital heart diseases presentations that young children between ages of 0 days to about 3 months will present with.  Often times you will see experts split these congenital heart lesions into 2 categories: Cyanotic vs Acyanotic lesions. Either is an acceptable approach as long as you split the acyanotic lesions into 2 categories as their presentations vary widely as I will describe. REBEL Crit Cast Ep5.0 – Conquering Congenital Cardiac Lesions Click here for Direct Download of the Podcast Before we focus on the child with congenital heart lesions it’s imp ..read more

In this 16-minute lecture from Rebellion in EM 2021, Dr. Hilary Fairbrother focuses on the description of PECARN, CHALICE, and CATCH algorithms with best practices for use in pediatric patients with head trauma. Hilary Fairbrother, MD, MPH, FACEPMcGovern School of Medicine University of Texas Health Houston Department of Emergency Medicine Vice Chair of Education Houston, TX Twitter: @hilaryfair Objectives Define and review the PECARN, CHALICE, and CATCH algorithms Accurately apply and use the PECARN, CHALICE, and CATCH pediatric head injury algorithms to better utilize computerized t ..read more

Take Home Points Once you figure out the neonate that presented to your ED is sick, run through a differential of why then can be sick so you don’t anchor. I like to use TIMOT (Trauma, Infection, Metabolic, Organs, Tox) but use whatever works for you. Use your detailed history looking for risk factors to help you narrow the differential down. Do a good hands-on physical exam. Work them up more than you would a standard baby and do things like you would to an adult such as a bedside US. These will all lead you to the diagnosis of a congenital cardiac disease You have two options now: they eith ..read more

In this 16-minute presentation from Rebellion in EM 2021, Dr. Hilary Fairbrother, MD describes the Clinical Decision Rule formulated and validated in the PECARN network for fever in patients who are less than 60 days old. She reviews the rule and goes over the different elements of the patient that are required to use the rule. She concludes with a recent validation study that raises concerns on the initially reported accuracy of the rule and speaks briefly about the consequences of missed cases vs. procedural complications from neonatal sepsis workups. Hilary Fairbrother, MD, MPH, FACEPMcG ..read more