This week’s VOTW is brought to you by the UST~ A 9 month old female infant was brought into the Pediatric ED two days after a fall from a high chair. The infant vomited once after the fall but was otherwise acting normally since then. The patient was brought to the ED 48hrs after the fall for a boggy left parietal scalp hematoma. The patient had a normal physical exam apart from the hematoma.  A POCUS was performed which showed... Clip 1 shows an oblique disruption in the cortex of the skull, indicative of a fracture. The bones have an “overlapping” appe ..read more

Today’s VOTW is brought to you by Dr. Fagan, Dr. Davitt and Dr. Lat! A 2 year old male presented with abdominal pain and vomiting x1 day as well as cough and nasal congestion x2 days. On exam, he was clutching his abdomen in discomfort. A POCUS was performed which showed… Clip 1 shows an abdominal ultrasound in the RUQ showing the classic “target sign” measureing 3.5cm, concerning for intussusception. You can visualize a smaller circular structure within a larger circular structure representing a part of bowel telescoping into the next part of the bowel. In the center, there are smal ..read more

We’ll be going over a few high yield topics pertaining to NALS today.  It’s 7:30 AM, and you’ve just unwrapped your BEC sandwich and taken your first sip of coffee. You’re settling into the morning getting ready for your 12 hour peds shift… until the phone rings, and you get a note:  “Mother 38w delivered her baby at home 30 minutes ago. Baby is having labored breathing, and is bradycardic. EMS will be here in 2 minutes.” Take a deep breath. First, remember the basics. If you’re in a facility that has Peds/NICU, call them immediately. Call respiratory. Call pharmacy. Call Hector. Use ..read more

Infant < 28 days: Do everything & give empiric Abx (Ceftazidime, Acyclovir (HSV) & Ampicillin) ^ CBC, BMP, Blood Cx (1 set), UA, Urine Cx, LP, RVP* ^There are new guidelines regarding patients who are between 3-4 weeks of age where LP may be deferred. There is a lot of controversy still regarding its adoption. 28 days to 2 months / 1st set of vaccines: Do everything however LP & Abx dependent on PECARN Rule for Low Risk Fever CBC, BMP, Blood Cx (1 set), UA, Urine Cx, RVP*, Pro-Calcitonin PECARN Rule for Low Risk Fever: LP if any of the following is positive: Pro-Cal > 0.5, A ..read more

This POTD is inspired by a case I saw from the periphery while in the Peds ED. I'll be discussing hair tourniquets! Toe-tourniquet syndrome, also called Hair-thread tourniquet syndrome (HTTS), is a rare and commonly misdiagnosed condition caused by hair or fiber wrapped around digits (fingers and toes), penis, or even clitoris. It usually affects infant and children. Prompt diagnosis is needed as ischemia can result. This is a diagnosis often missed because the presentation is so vague. Often the only complaint is a crying and inconsolable infant. This is why the physical exam is so important ..read more

This POTD is inspired by a common occurrence in the pediatric ED and a question that routinely shows up on board questions. History: Mom and Dad are spring cleaning the apartment when 1 year old Freddy Boy starts having sporadic episodes of gagging or choking, and has vomited once. Parents report an episode where he looked like he was breathing faster and almost looked like he was struggling to catch his breath, which has since resolved. Mom and Dad panic and bring F.B. to your ED. Physical exam reveals a happy looking kid, vitals WNL, and a benign exam. Nothing in the back of the throat. Norm ..read more

Last week, we went over the REMAC protocol for asthma, but in a cliffhanger not seen sinceAvengers: Infinity War, we were all left wondering what NYC EMS does with asthmatic/wheezing kids. Well worry not, faithful readers, because this week we’re taking a look at Protocol 554 – Pediatric Asthma/Wheezing! There are a bunch of pediatric-specific protocols (remember that for the NYC REMAC, pediatric means up to 15 years of age), each with certain differences from its adult counterpart. Some differences are subtle, some not, so it’s worthwhile to at least have some awareness that these peds protoc ..read more

Retropharyngeal Abscess What is it? Polymicrobial abscess in space between posterior pharyngeal wall and prevertebral fascia Adults: Usually due to direct extension of local infection (ex. ludwig's angina, pharyngitis, dental abscess etc.) Peds: Usually due to suppurative changes in local lymph nodes from an infection in the head or neck Can also be caused from trauma- falling with pencil in mouth Presentation: Patients may prefer to lay down to prevent abscess from collapsing the airway. If your suspicion is high enough, don't sit these patients up! Patients will complain most ..read more

What is it? Paraphimosis: the penile foreskin becomes retracted around the coronal sulcus (= the circumference at the base of the glans penis), leading to vascular congestion and glans edema Phimosis: the foreskin is retracted over the glans This is only an emergency if it is causing acute urinary retentionKeep in mind most uncircumcised infants have normal phimosis Why do we care?  If left untreated, paraphimosis can lead to some awful complications, such as necrosis or gangrene of the glans penis which can then necessitate a partial amputation of the penis  For phimosis causing uri ..read more

Today’s Pediatric grand rounds was given by Dr. Prashant Mahajan, MH, MPH, MBA.  Professor and Vice-chair of the department of Emergency Medicine; Professor of Pediatric Medicine, Division Chief of Pediatric Emergency Medicine, Professor of Pediatrics at the University of Michigan For those that don’t know him- He’s really smart and has done a ton of research on febrile infants and he's proposing a new model to rule out serious bacterial infections in infants <60 days old.  TL:DR Serious Bacterial Infection (SBI) can be ruled out febrile infants from 29-60 days old ..read more