Test Your Knowledge: Seizures in Neonates
June 29, 2020


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Pediatric Emergency Medicine Brainteaser

Neonatal seizures are associated with high morbidity and mortality, but they can be difficult to diagnose because they often present with subtle signs and symptoms. Our June issue, Seizures in Neonates: Diagnosis and Management in the Emergency Department, reviews common presentations and causes of neonatal seizures, considerations for emergency department management, and more. read more

Test Your Knowledge: Acid-Base Disturbances
June 29, 2020


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Acid-base disturbances are physiological responses to a wide variety of underlying conditions and critical illnesses. Homeo-stasis of acid-base physiology is complex and interdependent with the function of the lungs, kidneys, and endogenous buffer systems. Our June issue Acid-Base Disturbances: An Emergency Department Approach outlines several approaches to characterizing disturbances, with a case-based format and algorithms to aid in diagnostic testing and interpretation of arterial blood gases. read more

Test Your Knowledge: Marine Envenomations in Pediatric Patients
June 11, 2020


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Pediatric Emergency Medicine Brainteaser

Marine envenomations can cause a diverse array of clinical syn- dromes. Systemic and life-threatening reactions, as well as delayed presentations, can occur. The pediatric population is at higher risk for serious reactions to envenomations because their greater body surface area and smaller body mass can lead to a higher relative venom load. Although the majority of the literature on marine envenomations is of low quality, the available literature does suggest that management varies depending on the geographic location. read more

Test Your Knowledge: Abnormal Vision in the ED
June 10, 2020


Posted by Andy Jagoda MD in: Brain Tease , 1 comment so far

Emergency Medicine Practice Blog Brain Teaser

Patients present to the ED with visual disturbances that may be painful or painless and may include loss of visual acuity, field cuts, diplopia, and headache. A detailed history and complete ocular examination are essential to obtaining the correct diagnosis and offering expedited treatment and referral.

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Test Your Knowledge: Failure to Thrive
March 24, 2020


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Emergency Medicine Practice Blog Brain Teaser

Failure to thrive (FTT) is a relatively common presentation in the emergency department. Up to 90% of cases of FTT have no identifiable cause and are categorized as nonorganic. Before deciding that FTT is nonorganic, it is imperative to consider and rule out organic causes. Identifying the underlying issues surrounding FTT is essential, as it will likely impact the treatment the patient receives. read more

Test Your Knowledge: Synthetic Drug Intoxication in Children
February 21, 2020


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Pediatric Emergency Medicine Practice Blog Brain Teaser

The continually changing chemical formulations of synthetic drugs makes recognition and diagnosis of intoxication from these substances challenging. When children and adolescents present to the emergency department with agitation or mental status changes, intoxication from synthetic drug use should be in the differential diagnosis. Identifying the responsible compound(s) may be difficult, so asking the patient broad questions and utilizing appropriate diagnostic studies, when indicated, will aid in making the diagnosis and help identify more-serious complications. read more

Test Your Knowledge: Evaluation and Management of Life-Threatening Headaches in the ED
February 6, 2020


Posted by Andy Jagoda, MD in: Brain Tease , 1 comment so far

Emergency Medicine Practice Blog Brain Teaser

Though patients often present to the ED seeking relief from headaches that cause significant pain and suffering, 90% of them can be considered “benign.” It is essential to identify the 10% of headache patients who are in danger of having a life-threatening disorder presenting with a sudden and severe headache to ensure that they are treated quickly and effectively. read more

Test Your Knowledge: Rash and Fever in the Pediatric Patient
January 21, 2020


Posted by Andy Jagoda, MD in: Brain Tease , 1 comment so far

Rash and fever are some of the most common chief complaints presenting in emergency medicine. The evaluation of skin rashes in the febrile pediatric patient includes a broad differential diagnosis and utilizing the signs and symptoms to identify red flags, such as hemodynamic instability, erythroderma, desquamation, petechiae/purpura, mucous membrane involvement, and severe pain, in the history and physical examination that require a high index of suspicion for worrisome disease.

Test your knowledge of characteristics of common rashes in a pediatric patients!

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Review this Pediatric Emergency Medicine Practice issue to get up-to-date on common and life-threatening skin rashes with fever in children, guidance for differentiating the types of infections based on signs and symptoms, indications for diagnostic studies, and recommendations for treatment of pediatric skin rash with fever in the emergency department.

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Test Your Knowledge: Managing Dislocations of the Hip, Knee, and Ankle in the ED
January 9, 2020


Posted by Andy Jagoda, MD in: Brain Tease , add a comment

Dislocation of the major joints of the lower extremities–hip, knee, and ankle–can occur due to motor-vehicle crashes, falls, and sports injuries. These are painful presentations in the trauma ED that must be managed quickly to avoid morbidity, disability, and even possible amputation.

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Need a refresher on the subject? Review the summary below:

Points from Managing Dislocations of the Hip, Knee, and Ankle in the Emergency Department (Trauma CME):

  • 90% of hip dislocations are posterior; 10% percent are anterior.
  • Typically, an AP pelvic radiograph is adequate to diagnose a hip dislocation. Judet views are help­ful in diagnosing associated fractures.
  • Traumatic dislocations of the native hip should be reduced within 6 hours to reduce the risk of avascular necrosis and posttraumatic arthritis.
  • The Allis, Bigelow, Captain Morgan, Rocket Launcher, and East Baltimore Lift techniques can all be used to reduce a hip dislocation. None have proven to be superior to the others; the choice can be made according to provider capability and preference.
  • All hip reduction methods can be used on both native and prosthetic hips.
  • Consider an ultrasound-guided fascia iliaca com­partment block to augment and reduce proce­dural sedation and analgesia.
  • All hip fracture dislocations should be deferred to orthopedic surgery.
  • After reduction of a native hip dislocations, a CT scan should be obtained. The patient will need to be admitted to the hospital.
  • Many knee dislocations spontaneously reduce. Maintain a low threshold of suspicion for this injury, as missing a knee dislocation could have catastrophic consequences.
  • In any knee dislocation with a pulse deficit, perform immediate reduction without imaging. Delays longer than 8 hours have a higher inci­dence of amputation.
  • After reduction of the dislocated knee, patients should be admitted for serial vascular examina­tions or vascular imaging should be obtained. Compartment syndrome is a delayed complica­tion of knee dislocations.
  • Ankle dislocations require immediate recognition and prompt reduction, as they can be associated with significant neurovascular, skin, and soft-tissue complications.
  • Subtalar dislocations are rare, but appear similar to ankle dislocations. Attempting to reduce a subtalar dislocation before imaging may lead to worsening of the dislocation.
  • Emergent orthopedic consultation and post-reduction CT are necessary after reduction of a dislocated ankle.
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    Test Your Knowledge: Pediatric Septic Arthritis and Osteomyelitis Management in the ED
    December 18, 2019


    Posted by Andy Jagoda, MD in: Brain Tease , add a comment

    Septic arthritis and osteomyelitis often present with a subacute course of illness and vague signs and symptoms. Both diagnoses are true emergencies, and these conditions must be promptly diagnosed and treated to avoid adverse sequalae.

    Patients with SA or OM classically present with fever, ill appearance, malaise, pain, and swelling of the involved joint. Given the large differential diagnosis for a limping child, obtaining a thorough history and physical examination is paramount to narrowing the differential diagnosis and to obtain the appropriate testing and treatments.

    Test your knowledge!

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    Review this Pediatric Emergency Medicine Practice issue to get up-to-date evidence-based recommendations for the diagnosis and management of pediatric patients with septic arthritis and/or osteomyelitis and offers guidance for appropriate antibiotic treatment.

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