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

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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

Podcast #123:  Pediatric Oral Rehydration Therapy

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Author: Christopher Holmes M.D.

Educational Pearls:

  • For children with mild gastroenteritis, one option for treatment is oral rehydration therapy. This is ubiquitously used for children in third world countries as a staple therapy.
  • A group in Canada, looked at 647 patients. Half were given half strength apple juice and half were given electrolyte solutions for treatment. The therapy was considered a failure if the patients had to – get an IV in 7 days, had greater than 3% dehydration, had an unscheduled visit, or were admitted to the hospital within 7 days.
  • They found 16.5% of patient’s therapy failed with the half strength apple juice and 25% of patient’s therapy failed with the electrolyte solution.
  • While the electrolyte solution is theoretically superior for rehydration, it tastes significantly worse than the half strength apple juice. This could possibly lead to less fluids consumed and less hydration for the patient.
  • Half strength apple juice represents a great and potentially more efficacious alternative to electrolyte solutions in some pediatric populations.

Link to Podcast: http://medicalminute.madewithopinion.com/pediatric-oral-rehydration-therapy/

References:  http://www.ncbi.nlm.nih.gov/pubmed/27131100

Podcast #116: Catch a UA in Infants

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Author: Dylan Luyten M.D.

Educational Pearls:

  • An upcoming study in the Journal of Pediatrics, to be published in July, looked at reducing unnecessary urinary catheterization rates in infants.
  • In the study they investigated bagged urines on infants and every infant got a catheter.
  • It was found that if you restricted true positive UA on the bagged kids to those with positive nitrites, and moderate to large leuk esterase; there were no missed UTIs if you only catheterized these kids.
  • This could potentially reduce the number of catheterizations necessary for infants coming to the Emergency Room.

Link to Podcast: http://medicalminute.madewithopinion.com/catch-a-ua-in-infants/

References: http://www.jpeds.com/article/S0022-3476(09)00010-9/fulltext

Podcast #104: Peds Glomerulonephritis

18abcacb-147a-49bf-83cf-59907ed0010eRun Time: 4 minutes

Author: Suzanne Chilton M.D.

Educational Pearls:

  •       The streptococcal strain that causes Impetigo also causes post strep glomerulonephritis.
  •       Symptoms of glomerulonephritis can present themselves up to 1 month after having impetigo including: edema hypertension, coke colored urine w/ red cells and high protein.
  •       The main treatment is supportive care and diuretics – the vast majority goes away in a few weeks on their own and kidney function returns to normal.
  •       More adults in the developed world, specifically white men over 50 with debilitating health conditions such as Diabetes or Alcoholism are being seen with post strep glomerulonephritis – the patient population is at a higher risk of progressive kidney disease.

Link to Podcast: http://medicalminute.madewithopinion.com/peds-glomerulonephritis/

References:  https://www.nlm.nih.gov/medlineplus/ency/article/000503.htm

Podcast #96: BRUE in Infants

9281e629-4719-4b27-8840-fa4aedf66680Run Time: 2 minutes

Author: Dr. Suzanne Chilton

Educational Pearls:

  • The American Academy of Pediatrics changed terminology for ALTE – Apparent Life Threatening Event in infants. The new term is BRUE – Brief Resolved Unexplained Event, which is much less scary. These children are also now divided into high and low risk categories.
  • BRUE encompasses any event of cyanosis or pallor, decreased respiratory drive, and a change in tone or level of consciousness in any child less than one year of age.
  • High risk BRUE has to meet the criteria of less than two months of age, less than 32 gestation, and lengthy or multiple episodes.
  • Low risk BRUE has to meet the criteria of greater than two months of age, greater than 32 weeks of gestation, and only one episode.

Link to Podcast:  http://medicalminute.madewithopinion.com/brue-in-infants/

References:  http://pediatrics.aappublications.org/content/early/2016/04/21/peds.2016-0591