Podcast #275: Battery Ingestions

Author: Nick Hatch, M.D.

Educational Pearls

  • Unlike coin ingestions, button batteries can cause necrosis of the GI tract.
  • If lodged in the esophagus, removal within 2 hours is important, because they can cause problems such as strictures or esophago-aortic fistula.
  • If the battery is in the stomach or beyond, it may be ok to let it pass but give strict return precautions.
  • Small hearing aid batteries are not as dangerous, but still require close follow-up to ensure the battery passes.
  • Delayed effects (after passage of the battery) are possible.

References: https://www.poison.org/battery/guideline

Podcast #274: Pediatric Sedation

Author: Aaron Lessen, M.D.

Educational Pearls

  • A recent prospective observational study was performed to examine the safety of different sedation medications in the pediatric ED.
  • This study included 6000 children, and looked at the rate of serious adverse events following administration of different sedatives.
  • Overall, the safest drug to use was ketamine alone, with an adverse event rate of about 1%.
  • Propofol, BZDs, and opiates had increased rates of adverse events.

References: https://lifeinthefastlane.com/pediatric-procedural-sedation-with-ketamine/

Podcast #262: Pertussis

Author: Julian Orenstein, M.D.

Educational Pearls

  • Colorado has a high population of unvaccinated children, and is at increased risk for pertussis outbreaks.
  • The causative organism is Bordetella pertussis. It causes  causes respiratory epithelial necrosis leading to congestion of the bronchioles, leading to cough.
  • The cough is unique – it is usually a series of expiratory coughs followed by one deep inspiration
  • The clinical presentation is divided into 3 phases:
    • Catarrhal: cough and congestion with low-grade fever and coryza.
    • Whooping: characteristic cough.
    • Resolution: recovery with persistent cough.
  • Infants may not get this presentation, but may get apnea and nonspecific cough.  
  • Tongue depressor can be used to elicit cough for diagnosis.

References: Tozzi AE, Pastore Celentano L, Ciofi degli Atti ML, Salmaso S. Diagnosis and management of pertussis. CMAJ?: Canadian Medical Association Journal. 2005;172(4):509-515. doi:10.1503/cmaj.1040766.

Podcast #240: Pott’s Puffy Tumor

Author: Suzanne Chilton, M.D.

Educational Pearls

  • Pott’s puffy tumor is a subperiosteal abscess of the frontal bone that arises from hematologic spread or direct infection via the frontal sinuses. The primary symptom is facial swelling.
  • It is much more common in children and adolescents.
  • Treatment involves removal of the frontal bone, reconstructive surgery, and 6-8 weeks of IV antibiotics.

References: Grewal HS, Dangaych NS, Esposito A. A tumor that is not a tumor but it sure can kill! The American Journal of Case Reports. 2012;13:133-136. doi:10.12659/AJCR.883236.

Podcast #228: BB Guns

Author: Jared Scott, M.D.

Educational Pearls

  • BB gun eye injuries are most common in August and September. They most often happen to males aged 16-17 year old. Around 10% of the BB eye injuries lead to eye loss.
  • Accidental firearm injury is common in children and is a common cause of mortality. One-third of homes with children have a firearm.
  • Most accidental pediatric gun injuries happen to young, male children with guns owned by family members. It is important to educate gun owners about proper gun storage.

References: Childhood Firearm Injuries in the United States Katherine A. Fowler, Linda L. Dahlberg, Tadesse Haileyesus, Carmen Gutierrez, Sarah Bacon. Pediatrics Jun 2017, e20163486; DOI: 10.1542/peds.2016-3486

Podcast #218: Estimating Pediatric Weight

Author: Aaron Lessen, M.D.

Educational Pearls

  • Asking parents and Broselow Tape are common options for estimating pediatric weight.
  • Equipment sizes should not be adjusted for under/overweight kids based on Broselow Tape estimates.
  • The finger counting method (see reference) is just as accurate as Broselow Tape method, according to one study.

References: http://handtevy.com/images/Casestudies/Americanjournalofemergencymedicine.pdf

 

Podcast #211: E-cigarettes

Author: Michael Hunt, M.D.

Educational Pearls:

  • Children under age of 6 are at greatest risk of accidental nicotine overdose from ingestion.
  • Biphasic presentation:
    • Hyperadrenergic = nausea, vomiting, tachycardia, flushing.
    • Bradycardia and respiratory depression.

References:

http://www.aapcc.org/alerts/e-cigarettes/

Mayer B. How much nicotine kills a human? Tracing back the generally accepted lethal dose to dubious self-experiments in the nineteenth century. Archives of Toxicology. 2013;88(1):5-7. doi:10.1007/s00204-013-1127-0.

Podcast #193: The Quick Wee

Author: JP Brewer M.D.

Educational Pearls:

  • The “Quick Wee” was a method to get urine out of infants who need to have a UA in the Emergency Department.
  • A randomized-controlled experiment was done with 350 infants between the ages of 1 to 12 months.
  • The “Quick Wee” method is taking a sterile saline gauze with cool saline and rubbing it over the suprapubic abdomen for five minutes. The results were significant, with 31% in the treatment group voided after five minutes, 12% in the control group voided after five minutes.

References:  http://www.bmj.com/content/357/bmj.j1341

Podcast #183: Ventriculoperitoneal Pediatric Shunt Malfunctions

345df232-fab3-44fb-a6fb-b85042e5b19dRun Time:  1:56

Author: Dr. Iverson

Educational Pearls:

  • Placement of a VP shunt is associated with premature delivery, hydrocephalus, or some other kind of injury as a means of draining excess CSF
  • A malfunctioning VP shunt presents with vomiting, headache, altered mental status
  • Workup includes the “shunt series”: xrays, head CT/rapid MRI
  • In rapid MRI, need to take into consideration whether the VP shunt is programmable because the MRI could erase the programming
  • Special attention needs to be given to patients that present with increased ICP.  You can give these patients 3% saline as a bridging measure but they need to be taken to the OR as soon as possible.

Link to Podcast: http://medicalminute.madewithopinion.com/pediatric-vp-shunt-malfunction/

References: http://www.healthline.com/health/ventriculoperitoneal-shunt

https://www.youtube.com/watch?v=Yb9dSjDykpI

Podcast #133: Consent in Minors

d54934c9-718d-4241-8146-ea4aa81742bfRun Time: 4 minutes

Author: Suzanne Chilton M.D.

Educational Pearls:

  • For psych-specific cases where a minor is being transferred for a higher level of care, a judge or department of social services can be engaged to obtain temporary custody of the minor. The same situation as if the minor had acute appendicitis, there is no surgeon available and the parent is blocking transfer.
  • A minor 15 years of age or over can consent for his/her own mental health treatment. The parent has no legal recourse to block transfer or treatment.
  • Other instances that a minor can consent with no restriction on age limit include HIV testing, STD testing, drug or alcohol treatment, as well as reproductive health, minus sterilization.
  • Sometimes a parent will want their kid drug-tested, but this falls under drug and alcohol treatment and the parent does not have to be made aware of the results unless the minor wants that to happen.
  • Pregnant minors have consent for treatment and care of their unborn child, but not their own health, such as appendicitis.

Link to Podcast: http://medicalminute.madewithopinion.com/consent-in-minors/ 

References:  https://www.cde.state.co.us/sites/default/files/documents/healthandwellness/download/school%20nurse/understanding%20minor%20consent%20and%20confidentiality%20in%20colorado.pdf