Risk Management Pitfalls in the ED: Diagnosis and Management of Pediatric Primary Bone Tumors
June 16, 2021


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

Our recent issue Diagnosis and Management of Pediatric Primary Bone Tumors in the Emergency Department reviews the specific signs, symptoms, and unique presentations the emergency clinician should know when evaluating a pediatric patient with musculoskeletal pain. read more

Test Your Knowledge: The Child With a Syndrome
April 20, 2021


Posted by Andy Jagoda MD in: Brain Tease , 2 comments

Children with syndromes often access emergency services and they may present unique challenges for emergency clinicians. Our recent issue The Child With a Syndrome: Considerations for Management in the Emergency Department reviews 3 pediatric syndromes—spina bifida, Down syndrome, and Marfan syndrome—each of which are associated with unique emergent conditions. read more

Test Your Knowledge: Rhabdomyolysis
January 4, 2021


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Rhabdomyolysis is a life-threatening pathological process that must be treated as early as possible to avoid potentially life-threatening sequelae. Much of the evidence that informs the management of rhabdomyolysis is retrospective research, often reported from mass disasters, and many practices that have been implemented as standard treatment are based on small studies published more than 30 years ago. read more

What’s Your Diagnosis? Evidence-Based Management of Rhabdomyolysis in the ED
November 16, 2020


Posted by Andy Jagoda MD in: What's Your Diagnosis , 2 comments

Welcome to this month’s What’s Your Diagnosis Challenge!

But before we begin, check to see if you got last month’s case on Traumatic Hemorrhagic Shock in the Emergency Department right. read more

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.

Test Your Knowledge

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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 help?ful 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 com?partment block to augment and reduce proce?dural 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 inci?dence of amputation.
  • After reduction of the dislocated knee, patients should be admitted for serial vascular examina?tions or vascular imaging should be obtained. Compartment syndrome is a delayed complica?tion 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.
  • read more

    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.

    Already a subscriber? Earn CME for this topic by logging to take your CME test.

    Pitfalls To Avoid With Septic Arthritis And Osteomyelitis In Pediatric Patients
    December 11, 2019


    Posted by Andy Jagoda, MD in: Feature Update , 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.

    Septic arthritis and osteomyelitis in pediatric patients represent true emergencies, and can quickly threaten life and limb. A high index of suspicion should be maintained, as these conditions often present with a subacute course of illness and vague signs and symptoms. Septic arthritis and osteomyelitis can occur concurrently, so suspicion for one should also prompt investigation for the other.

    The diagnostic evaluation should include blood work as well as samples from the infected joint or bone for culture. Management with antibiotics is a standard approach, but the duration of antibiotic therapy is controversial.

    These risk management pitfalls will help you avoid unwanted outcomes in pediatric patients with septic arthritis and osteomyelitis in your ED.

    1. ?The patient did not have a fever, so I attributed the pain to minor aches and pains.? read more

    What’s Your Diagnosis? A 4-year-old with fever, right leg pain, and difficulty walking
    November 29, 2019


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

    But before we begin, check out if you got last month’s case right, about a 7-year-old boy after a generalized seizure lasting 2 minutes Click here to check out the answer! read more

    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!

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    Click here to review the issue!