Background: There is a shifting paradigm towards shorter durations of antibiotics in pediatric infections. Conflicting international guidelines recommend treatment of urinary tract infection (UTI) with antibiotic courses ranging from just 3 days to 7–14 days.1–4Antimicrobial resistance is a global health crisis, underscoring the importance of antibiotic stewardship. Investigators in the SCOUT Trial examine the impact of short-course (5 day) antibiotic therapy in UTI, with potentially far reaching implications. Paper: Zaoutis T, Shaikh N, Fisher BT, et al. Short-Course Therapy for Urinary Trac ..read more

A 5-year-old boy is brought in by his parent for a dental injury. The patient was walking his dog when it ran after a squirrel. The patient was pulled forward, causing him to hit his tooth on the asphalt. His parent noticed a dental problem and immediately brought the patient to the ED. The physical exam is shown below. Which of the following is the best next recommendation? Follow up with the dentist in the morning Reinsert the tooth and avoid solid food Reinsert the tooth and stabilize it with a bridge Remove the tooth and repair the gingival laceration Remove the tooth and wrap it in sa ..read more

Background: Sports-related concussions are among the most common injuries in children and adolescents, affecting millions of youth athletes annually.1 Given their prevalence in this population, providers must be up to date on diagnosis and management. Historical practice recommends rest to prevent adverse outcomes; however, evidence suggests strict rest is harmful. Relative rest (activities of daily living and reduced screen time) is indicated for the first 12-48 hours, followed by light-intensity physical activity (walking or stationary cycling while avoiding the risk of contact, collision ..read more

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