Right for Halloween: Clinical Algorithm for Pediatric Patients with Multiple Injuries October 10, 2019


Posted by Andy Jagoda, MD in: Feature Update , add a comment

When children with multiple serious injuries present to the ED, how do you ensure that you identify and address all of their injuries?

Management of the child with multiple traumatic injuries can be challenging, and important injuries may not be readily recognized. Early recognition of serious injuries, initiation of appropriate diagnostic studies, and rapid stabilization of injuries are key to decreasing morbidity and mortality in the multiply injured pediatric trauma patient. The differential diagnosis for these patients is wide, and treatment is targeted to the specific injuries.

This clinical flowchart provides a systematic approach to the management of pediatric patients with multiple traumatic injuries. Download now.

Clinical Pathway for the Management of a Pediatric Patient With Multiple Traumatic Injuries

Get access to more pathways with an individual or group subscription. Visit www.ebmedicine.net/PEMPinfo to find out more!

Need more information?
Click here to review the issue!

Secondary hypothermia in patients with sepsis and trauma — Brain Teaser. Do you know the answer? January 26, 2019


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

Test your knowledge and see how much you know about treating and managing hypothermia and peripheral cold Injuries in pediatric patients.

Did you get it right? Click here to find out!

The correct answer: C.

Earn CME for this topic by purchasing this issue. 

Skiing with no gloves. How do you handle these cold injuries? — Management of Pediatric Hypothermia January 14, 2019


Posted by Andy Jagoda, MD in: What's Your Diagnosis , add a comment

Case Recap:
A 17-year-old boy comes into your ED complaining of numbness and hardening of his fingers. He is a previously healthy foreign exchange student who is staying with a host family. The symptoms started yesterday after he went snow skiing for the first time. He says he wore gloves, but he was having a hard time holding the ski poles, so he took them off midway through the day. On examination, the fingertips on both of his hands are firm to the touch, have a dark discoloration, and are without sensation. The firmness and discoloration extend only to the distal interphalangeal joint in most of the fingers, but to the proximal interphalangeal joint in the middle finger of his left hand. The thumb on his right hand has a sizeable blister. As you step out of the room, you contemplate the next steps.

How do you classify the severity of his cold injuries? Does his thumb need debridement? Should you consult a hand surgeon and/or the burn center? What is the long-term prognosis for his injuries?

Case Conclusion:
The hands of the 17-year-old boy who did not wear gloves while skiing were placed in a warm water bath at 38°C (100.4°F) and gently rewarmed for 30 minutes. The pain did increase in his hand secondary to reperfusion, and all of his tissues softened except for his thumbs. You left his thumb blister intact, as it was not causing any restriction in movement and was filled with clear fluid. You placed aloe vera gel on all of his digits and loosely wrapped his hands in nonadhesive dressing. You gave him instructions to follow up at the burn center for continued outpatient therapy. He did not lose any digits, but the decreased sensation in his left thumb remained.

Skiing with no gloves. How do you handle these cold injuries? — Management of Pediatric Hypothermia January 7, 2019


Posted by Andy Jagoda, MD in: What's Your Diagnosis , 3 comments

A 17-year-old boy comes into your ED complaining of numbness and hardening of his fingers. He is a previously healthy foreign exchange student who is staying with a host family. The symptoms started yesterday after he went snow skiing for the first time. He says he wore gloves, but he was having a hard time holding the ski poles, so he took them off midway through the day. On examination, the fingertips on both of his hands are firm to the touch, have a dark discoloration, and are without sensation. The firmness and discoloration extend only to the distal interphalangeal joint in most of the fingers, but to the proximal interphalangeal joint in the middle finger of his left hand. The thumb on his right hand has a sizeable blister. As you step out of the room, you contemplate the next steps.

How do you classify the severity of his cold injuries? Does his thumb need debridement? Should you consult a hand surgeon and/or the burn center? What is the long-term prognosis for his injuries?

Come back on Jan 14th to see if you got it right!