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Title: Intussusception
Author: Seth Ball Keywords: abdominal pain, intussusception, vomiting, diarrhea Reference Article: Suh D, Lee JH, Oh S, Kwon H, Hwang JE. Development of a Clinical-Based Prediction Model for Pediatric Intussusception: A Prospective Observational Study. J Emerg Med. 2025 Aug 6;78:19-27. doi: 10.1016/j.jemermed.2025.07.037. Epub ahead of print. PMID: 40945392. |
Bottom Line: I don't think this adds a whole lot, to be honest. There aren't too many children in whom I'm considering intussusception that don't already have intermittent pain/irritability. I am surprised by the high adjusted odds ratios of both RUQ tenderness and absence of diarrhea, so the presence of these findings in a kid I'm already considering intussusception will heighten my suspicion. When in doubt, just order the ultrasound.
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Title: Neonatal Hypothermia
Author: Seth Ball Keywords: fever, infant, neonate, hypothermia Reference Article: Julie K. Wood, Annalise Van Meurs, Kathryn Westphal, Vignesh Doraiswamy, Erinn O. Schmit, Stephanie Berger, Saylor McCartor, Meredith Mitchell, Clifton Lee, John M Morrison, Monica D. Combs, Kira Molas-Torreblanca, Sumeet L. Banker, Jennifer Lee, Joni K. Evans, Nicholas M. Potisek, Elizabeth E. Halvorson; Significant Pathology in Young Infants Presenting With Hypothermia: A Multicenter Study. Hosp Pediatr 2025 |
Bottom Line: Never trust a neonate, especially when they are hypothermic. Work up the infectious etiologies as per the standardized recommendations, but keep your differential BROAD.
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Title: Midazolam vs Lorazepam for Status Epilepticus
Author: Seth Ball Keywords: seizures, status epilepticus, benzodiazepenes Reference Article: Ezzi, Suzana et al. “Effectiveness and safety of midazolam versus lorazepam for pediatric status epilepticus: A systematic review and meta-analysis.” Seizure, vol. 132 4-12. 12 Aug. 2025, doi:10.1016/j.seizure.2025.08.013 |
Bottom Line: Get your preferred benzo on board as quickly as possible. While this study shows no significant difference between the 2 groups in rate of seizure cessation, time from medication administration to seizure cessation, and adverse events, it does show that generally we can get IN midazolam in the quickest.
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Title: Sports-related TBIs
Author: Seth Ball Keywords: concussion, TBI, sports Reference Article: Davis, Angelina R et al. “Memory outcomes and interventions after sports-related traumatic brain injuries in pediatric and young adult athletes: a scoping review.” Journal of pediatric psychology, jsaf075. 25 Aug. 2025 |
Bottom Line: This study highlights the disparity in the more common problems associated with sports related TBI and the research into interventions that might help kids more quickly return to their baseline functional status, especially in regards to memory. Clinically, for me this study reiterates the importance of warning parents and patients about the multitude of symptoms and importance of simple home-based interventions (hydration, sleep, reducing screen time) that MAY be beneficial.
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Title: Zofran in Gastroenteritis
Author: Rusty Walker Keywords: vomiting, diarrhea, ondansetron, acute gastroenteritis Reference Article: Freedman SB, Williamson-Urquhart S, Plint AC, et al. Multidose Ondansetron after Emergency Visits in Children with Gastroenteritis. N Engl J Med. 2025;393(3):255-266 |
Bottom Line: There were modest improvements overall with PRN Zofran use after discharge, with significant improvements in severity scoring of gastroenteritis overall. This study validates our prescribing of PRN Zofran for acute AGI.
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Title: UTI in Well-Appearing Febrile Infants 60-90 days old
Author: Seth Ball Keywords: fever, infant, urinary tract infection Reference Article: Suárez-Bustamante Huélamo M, Alonso-Cadenas JA, Trujillo Montoro A, et al. Fever Severity and Urinary Tract Infection Risk in Well-Appearing Febrile Infants Aged 61-90 Days. Acta Paediatr. Published online August 9, 2025 |
Bottom Line: while there was a higher prevalence in those with higher temperature, there was still a very high percentage of infants with a lower temperature that had UTI. Lower temperature alone is not enough to rule out UTI in these infants**. Additionally, consider obtaining a blood culture in infants found to have a UTI given the high prevalence of concurrent bacteremia.
**remember- these are well-appearing infants in whom a thorough history and physical does not yield a source! Read more... |
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Title: Foreign Body Ingestion
Author: Seth Ball Keywords: foreign body, button battery Reference Article: Di Siena A, Melli P, Rodofile F, Rodaro C, Marino M, Castriotta L, Beorchia Y, Pedduzza A, Di Giorgio A, Cogo P. Foreign Body Ingestion in Children: A 16-year Experience. Pediatr Gastroenterol Hepatol Nutr. 2025 Jul;28(4):215-223. doi: 10.5223/pghn.2025.28.4.215. Epub 2025 Jul 7 |
Bottom Line: have a high suspicion for foreign body ingestion given the relatively high prevalence and the lack of a clear constellation of symptoms. The number that jumps out to me is the 10% of button batteries that were asymptomatic- YIKES. Grab that x-ray if your gut is telling you something seems off.
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Title: Febrile Neonates
Author: Ami Shah Keywords: fever, neonates Reference Article: Kuppermann N, Dayan PS, Levine DA, Vitale M, Tzimenatos L, Tunik MG, Saunders M, Ruddy RM, Roosevelt G, Rogers AJ, Powell EC, Nigrovic LE, Muenzer J, Linakis JG, Grisanti K, Jaffe DM, Hoyle JD Jr, Greenberg R, Gattu R, Cruz AT, Crain EF, Cohen DM, Brayer A, Borgialli D, Bonsu B, Browne L, Blumberg S, Bennett JE, Atabaki SM, Anders J, Alpern ER, Miller B, Casper TC, Dean JM, Ramilo O, Mahajan P; Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN). A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections. JAMA Pediatr. 2019 Apr 1;173(4):342-351. |
Bottom Line:
Clinical Implications-
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Title: Complex Febrile Seizures
Author: Seth Ball Keywords: fever, seizure, febrile seizure Reference Article: Buscher, James F. MD, MHPTT*,†; McConnell, Chelsey R. MD*,†; Ortmann, Laura A. MD*,†; McLean, Courtney MD, MS*,†; Kerns, Ellen PhD, MPH*,†; Flores, Ricky BS†; Lyden, Elizabeth MS‡; Ma, Jihyun MS, MA‡; Yi, Jina BA§,‖; Goodrich, Nathaniel P. MD*,†; Simonsen, Kari MD, MBA*,†; Deschamp, Ashley MD*,†; Koh, Sookyong MD, PhD*,†; Nabower, Aleisha M. MD, MHPTT*,†. Trends in the Management of Complex Febrile Seizures Across Children’s Hospitals. Pediatric Emergency Care ():10.1097/PEC.0000000000003413, June 3, 2025. |
Bottom line: decreased resource utilization with no increased re-admissions and no increased "serious" diagnoses to me says complex febrile seizure does not ALWAYS require labs, imaging, or even admission. A thorough H&P should guide your decision making as most kids with a serious infection or other intracranial pathology will demonstrate findings to suggest these diagnoses.
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Title: Dietary Changes for GERD
Author: Seth Ball Keywords: GERD, reflux, diet, abdominal pain Reference Article: Alnaim AA. Effectiveness of dietary interventions in managing pediatric gastroesophageal reflux disease: a comprehensive systematic review. Eur J Med Res. 2025 Jul 2;30(1):549. doi: 10.1186/s40001-025-02784-0. PMID: 40604920; PMCID: PMC12219262. |
Bottom Line(s): In patients with GERD, identifying the trigger and eliminating it is still probably your best route. Those struggling to make this change may need to make a more sweeping change and can make comprehensive changes to their diet, such as going solely plant based. These large scale changes can lead to improvement in conditions frequently associated with GERD, such as obesity, asthma and metabolic syndrome.
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Title: Whole Blood Transfusion
Author: Seth Ball Keywords: trauma, transfusion Reference Article: Campwala I, Dorken-Gallastegi A, Spinella PC, Brown JB, Leeper CM. Whole blood to total transfusion volume ratio in injured children: A national database analysis. J Trauma Acute Care Surg. 2025 Feb 1;98(2):287-294. doi: 10.1097/TA.0000000000004443. Epub 2024 Sep 13. PMID: 39269259. |
Bottom line: When available to you, consider using whole-blood as your first choice in transfusion of the traumatically injured child.
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Title: Biphasic Anaphylaxis
Author: Seth Ball Keywords: allergy, anaphylaxis, epinephrine Reference Article: Ellis AK, Hossenbaccus L, Linton S, Botting H, Badawod E, Burrows A, Garvey S. Biphasic anaphylaxis in a Canadian tertiary care centre: an evaluation of incidence and risk factors from electronic health records and telephone interviews. Allergy Asthma Clin Immunol. 2025 Feb 8;21(1):7. doi: 10.1186/s13223-024-00919-2. PMID: 39923108; PMCID: PMC11806842. |
Bottom line: Biphasic anaphylactic reactions do occur with some frequency (prior literature says anywhere from 1-20%). This study demonstrates that they generally happen later and are more mild than the original reaction. A shorter observation (such as the 2 hours stated on the list-serv) is likely fine, but it is imperative to tell parents about the potential for recurrent symptoms and give very good return precautions!
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Title: Pediatric BCVI
Author: Michael Naegle Keywords: trauma, neck injury, BCVI Reference Article: Schulz M, Weihing V, Shah MN, Cox CS Jr, Ugalde I. Risk factors for blunt cerebrovascular injury in the pediatric patient: A systematic review. Am J Emerg Med. 2023 Sep;71:37-46. doi: 10.1016/j.ajem.2023.06.006. Epub 2023 Jun 8. PMID: 37327710. |
Bottom Line: Though no single risk factor was found to be statistically significant in every study, the risk factors most found to be statistically significant for BCVI were cervical spine fracture (10/16 studies), skull fracture (9/16), maxillofacial fractures (7/16), depressed GCS score (5/16), and stroke (5/16).
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Title: Probiotics and Fever Duration
Author: Seth Ball Keywords: fever, URI, probiotics Reference Article: Bettocchi S, Comotti A, Elli M, De Cosmi V, Berti C, Alberti I, Mazzocchi A, Rosazza C, Agostoni C, Milani GP. Probiotics and Fever Duration in Children With Upper Respiratory Tract Infections: A Randomized Clinical Trial. JAMA Netw Open. 2025 Mar 3;8(3):e250669. doi: 10.1001/jamanetworkopen.2025.0669. Erratum in: JAMA Netw Open. 2025 May 1;8(5):e2516123. doi: 10.1001/jamanetworkopen.2025.16123. PMID: 40085083; PMCID: PMC11909606. |
Bottom line: While this study has several significant limitations, the authors found that use of probiotics was statistically significantly associated with a decreased fever duration in children with a presumed viral upper respiratory infection.
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Title: Ketamine for Intubation
Author: Michael Naegle Keywords: ketamine, intubation Reference Article: Conway JA, Kharayat P, Sanders RC Jr, Nett S, Weiss SL, Edwards LR, Breuer R, Kirby A, Krawiec C, Page-Goertz C, Polikoff L, Turner DA, Shults J, Giuliano JS Jr, Orioles A, Balkandier S, Emeriaud G, Rehder KJ, Kian Boon JL, Shenoi A, Vanderford P, Nuthall G, Lee A, Zeqo J, Parsons SJ, Furlong-Dillard J, Meyer K, Harwayne-Gidansky I, Jung P, Adu-Darko M, Bysani GK, McCarthy MA, Shlomovich M, Toedt-Pingel I, Branca A, Esperanza MC, Al-Subu AM, Pinto M, Tallent S, Shetty R, Thyagarajan S, Ikeyama T, Tarquinio KM, Skippen P, Kasagi M, Howell JD, Nadkarni VM, Nishisaki A; National Emergency Airway Registry for Children (NEAR4KIDS) and for the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI). Ketamine Use for Tracheal Intubation in Critically Ill Children Is Associated With a Lower Occurrence of Adverse Hemodynamic Events. Crit Care Med. 2020 Jun;48(6):e489-e497. doi: 10.1097/CCM.0000000000004314. PMID: 32317603 |
Bottom line: This study shows that ketamine has fewer adverse events for tracheal intubations than other agents.
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Title: Ketamine for Status Epilepticus
Author: Seth Ball Keywords: ketamine, seizure, status epilepticus Reference Article: Othman AA, Sadek AA, Ahmed EA, Abdelkreem E. Combined Ketamine and Midazolam Versus Midazolam Alone for Initial Treatment of Pediatric Generalized Convulsive Status Epilepticus (Ket-Mid Study): A Randomized Controlled Trial. Pediatr Neurol. 2025 Jun;167:24-32. doi: 10.1016/j.pediatrneurol.2025.03.011. Epub 2025 Mar 22. PMID: 40186980. |
Bottom line: Ketamine has been on the rise as a potential abortive medication in status epilepticus. This study adds to this literature, but has its limitations in terms of broad application. Consider reaching for ketamine early with refractory seizures, and especially in patients in status with more tenuous hemodynamics.
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Title: Epi vs Norepi in Septic Shock
Author: Seth Ball Keywords: pressors, sepsis, shock Reference Article: Eisenberg MA, Georgette N, Baker AH, Priebe GP, Monuteaux MC. Epinephrine vs Norepinephrine as Initial Treatment in Children With Septic Shock. JAMA Netw Open. 2025 Apr 1;8(4):e254720. doi: 10.1001/jamanetworkopen.2025.4720. PMID: 40214988; PMCID: PMC11992602. |
Bottom line: while this was a smaller, retrospective review, there was a statistically significant difference seen in the use of norepinphrine as the first line agent in children with septic shock. This matches adult guidelines as their recommended first-line pressor in sepsis is also norepinphrine. Hopefully this leads to larger prospective studies, but something to consider in the meantime!
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Title: Projected Lifetime Cancer Risks From Current Computed Tomography Imaging
Author: Rusty Walker Keywords: radiation, CT scan, radiology Reference Article: Smith-Bindman R, Chu PW, Azman Firdaus H, et al. Projected Lifetime Cancer Risks From Current Computed Tomography Imaging. JAMA Intern Med. Published online April 14, 2025. doi:10.1001/jamainternmed.2025.0505 |
Bottom Line: We have to do CT’s, there is no way around it, as it can be lifesaving. But we need to recognize the risks and do our best to mitigate them. This data did show that Children receive far less CT scans than adults overall, which we should be proud of. But this study is a reminder that when imaging, we still need to think twice, be judicious, use alternate imaging modalities when available, and use your evidence based guidelines to try and mitigate possible harm.
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Title: Dental Pain
Author: Seth Ball Keywords: toothache, dental pain, medication management, analgesia Reference Article: Mohn A, Maggitti A, Tripodi R, Chiarelli F, Cosi A, Tripodi D. Dental pain in children: pharmacological management. Eur J Paediatr Dent. 2025 Apr 1:1. doi: 10.23804/ejpd.2025.2190. Epub ahead of print. PMID: 40207859. |
Bottom Line: dental pain is a common problem and can be quite uncomfortable. The current best analgesic recommendations are for ibuprofen and acetaminophen. Antibiotics are indicated only if there are active signs of infection or if patient has increased risk for developing an infection (delay to seeing dentist or immunocompromised)
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Title: Emergence Reactions
Author: Seth Ball Keywords: Procedural sedation, medication side effects Reference Article: Wang Z, Wang X, Yang Y, He X, Jia W, Yao X, Sheng X, Jiao H. The effect of repeated maternal voice orientation on postoperative emergence agitation in children following tonsillectomy and adenoidectomy: A randomized controlled trial. J Clin Anesth. 2025 May 2;104:111851. doi: 10.1016/j.jclinane.2025.111851. Epub ahead of print. PMID: 40318514. |
Bottom Line: repeated maternal voice orienting a child to their surroundings can be an effective way to decrease the incidence and severity of emergence agitation in children after sedation. While this study was focused on children undergoing general anesthesia and overall had a much higher incidence of agitation compared to what is reported in procedural sedation literature, it is a safe and easy intervention that I think can be regularly implemented in our procedural sedation practices in the PED.
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Title: Antibiotic Hypersensitivity
Author: Ami Shah Keywords: Antibiotics, allergies, infectious disease Reference Article: Banerji A, Solensky R, Phillips EJ, Khan DA. Drug Allergy Practice Parameter Updates to Incorporate Into Your Clinical Practice. J Allergy Clin Immunol Pract. 2023 Feb;11(2):356-368.e5. doi: 10.1016/j.jaip.2022.12.002. Epub 2022 Dec 20. PMID: 36563781. |
Bottom Line: With a history of non-anaphylactic reaction to either cephalosporin or PCN, there is no need to consider cross-sensitivity or to hold off on the use of the other drug. In case of anaphylactic reactions, skin testing is recommended before the drug use.
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Title: Development of PNA after Negative CXR
Author: Seth Ball Keywords: Chest x-ray, pneumonia, infectious disease Reference Article: Hirsch AW, Wagner A, Lipsett SC, Monuteaux MC, Neuman MI. Risk of Subsequent Pneumonia After a Negative Chest Radiograph in the ED. Pediatrics. 2025 Apr 7:e2024069829. doi: 10.1542/peds.2024-069829. Epub ahead of print. PMID: 40189217. |
Bottom Line: Development of pneumonia after a negative chest xray is quite rare (0.27% based on this relatively large study). Watch out for specific findings such as tachypnea, hypoxemia, and signs of dehydration. I think this also highlights the importance of REALLY GOOD RETURN PRECAUTIONS. Tell parents to come back if their child develops X, Y or Z, "or if anything else changes that you're concerned about."
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Title: IV Fluids in DKA
Author: Seth Ball Keywords: Diabetes, DKA, IV fluids Reference Article: Agarwal A, Jayashree M, Nallasamy K, Dayal D, Attri SV. 0.9% Saline versus Ringer's lactate as initial fluid in children with diabetic ketoacidosis: a double-blind randomized controlled trial. BMJ Open Diabetes Res Care. 2025 Apr 7;13(2):e004623. doi: 10.1136/bmjdrc-2024-004623. PMID: 40194836 |
Bottom Line: In this smaller study out of India (generalizability?), pediatric patients presenting in DKA had faster resolution of DKA when Lactated Ringers was used as the initial fluid for resuscitation/rehydration compared to 0.9% NS.
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Title: Dextrose in IVF
Author: Seth Ball Keywords: gastroenteritis, vomiting, diarrhea, IV fluids, hypoglycemia Reference Article: Santamaria, Christina MD*; Péloquin, Fannie MD, FRCPC†; Mousseau, Sarah MD, FRCPC*; Gravel, Jocelyn MD, MSc, FRCPC*. Impact of the Amount of Intravenous Glucose Administration on Hospitalization for Acute Gastroenteritis in a Pediatric Emergency Department. Pediatric Emergency Care 41(3):p 176-182, March 2025 |
Bottom Line: in this retrospective cohort study, for every 100mg/kg increase of dextrose given in the patients' IVF rehydration, there was a decrease in the likelihood of hospitalization and return visit.
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Title: Testicular Torsion Scoring
Author: Seth Ball Keywords: Testicular Torsion, male GU Reference Article: Schultz-Swarthfigure CT, Kelly AM. UnTWISTing the BALS: A study of predictive accuracy of clinical scoring tools for testicular torsion identification in adults. Emerg Med Australas. 2025 Feb;37(1):e14479. doi: 10.1111/1742-6723.14479. Epub 2024 Aug 12. PMID: 39129651. |
Bottom Line: The TWIST score performed slightly better. A TWIST score ≥3 had a 92% sensitivity, and a score of 6-7 had 80% PPV. A BAL score ≥2 also had a sensitivity of 92% with a slightly lower specificity. The negative predictive value of each of these was 97% and 95%, respectively.
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Title: Management of Streptococcal Pharyngitis
Author: Sandra Horning Keywords: Group A strep, Pharyngitis, antibiotics Reference Articles: -Group A Streptococcal Tonsillopharyngitis in Children and Adolescents: Clinical Features and Diagnosis; UpToDate: January 2025 (Ellen R. Wald, MD) -Treatment and Prevention of Streptococcal Pharyngitis in adults and Children; UpToDate: January 2025 (Michael E. Pichichero, MD) -Accuracy and Precision of the Signs and Symptoms of Streptococcal Pharyngitis in Children: A Systematic Review; Shaikh N, Swaminathan N, Hooper EG, Journal of Pediatrics 2012; 160:487. |
Bottom Line: Recent discussions on Group A Streptococcus (GAS) treatment in children emphasize evidence-based indications for antibiotic use, including confirmed symptomatic cases in children over age 3, suspected or confirmed acute rheumatic fever, and symptomatic infants with household GAS contacts. Recommended first-line treatment is amoxicillin, with alternatives like azithromycin or clindamycin for those with allergies or resistance concerns.
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Title: Furosemide to Fill the Bladder in Suspected Ovarian Torsion
Author: Seth Ball Keywords: ovarian torsion, ultrasound Reference Article: Jersey C, Heggland A, Moote D, Brimacombe M, Chicaiza H. Furosemide use to expedite bladder filling in pediatric females with suspected ovarian torsion: A randomized controlled pilot study. Am J Emerg Med. 2025 Jan 31;90:205-209. doi: 10.1016/j.ajem.2025.01.082. Epub ahead of print. PMID: 39922106. |
Bottom Line: In this small pilot study, in pediatric patients presenting with concern for ovarian torsion, IV Lasix at 0.1mg/kg (max of 5mg) significantly decreased time to full bladder, time to completion of radiology-performed ultrasound, and time to official radiology read. Consider using this method next time you find yourself ordering fluids for the patient awaiting a full bladder for pelvic US.
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Title: Elbow DIslocations
Author: Seth Ball Keywords: elbow dislocation, reduction technique, musculoskeletal injury Reference Article:s -Gottlieb M. Managing Elbow Dislocations. Ann Emerg Med. 2022 Nov;80(5):460-464. doi: 10.1016/j.annemergmed.2022.04.029. Epub 2022 Jun 16. PMID: 35717272. -Journal Feed article summarizing the above article: How to Perform Seven Elbow Dislocation Reduction Techniques https://journalfeed.org/article-a-day/2022/how-to-perform-seven-elbow-dislocation-reduction-techniques/ |
Bottom Line: consider the hanging-arm technique for elbow dislocations. Note- I did not prone my most recent patient- once sedated with ketofol we sat him up straight and put his elbow over the bedrail hanging at 90 degrees and applied traction while flexing the hand back toward his body.
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Title: IV Ondansetron Effect on QT Interval
Author: Seth Ball Keywords: gastroenteritis, nausea and vomiting, EKG, QT prolongation Reference Article: Yürük Mısırlıoğlu H, Öztürk İnce E, Akkaş M. The effect of intravenous ondansetron on QT interval in the emergency department. Am J Emerg Med. 2024 Nov;85:7-12. doi: 10.1016/j.ajem.2024.08.011. Epub 2024 Aug 10. PMID: 39153265. |
Bottom Line: IV Ondansetron caused a rapid, brief and mild QT prolongation (average 8ms, peak effect at 5 min) in this large ADULT study.
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Title: 1st Generation Antihistamines and Seizures
Author: Rusty Walker Keywords: seizures, Antihistamines, medication side effects Reference Article: Kim JH, Ha EK, Han B, et al. First-Generation Antihistamines and Seizures in Young Children. JAMA Netw Open. 2024;7(8):e2429654. doi:10.1001/jamanetworkopen.2024.29654 |
Bottom Line: Kids who got prescriptions for 1st generation antihistamines had a 22% higher risk of seizures in this Korean Cohort study.
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Title: Post-Tonsillectomy Hemorrhage
Author: Seth Ball Keywords: Bleeding, hemorrhage, tonsillectomy, TXA Reference Articles: -Maksimoski M, McCauley M, Osoba M, Pirotte M, Liddy W. Treatment of Post-Tonsillectomy Hemorrhage With Nebulized Tranexamic Acid: Initial Investigation of a Novel Therapeutic Modality. Ann Otol Rhinol Laryngol. 2024 Aug;133(8):729-734. doi: 10.1177/00034894241254697. Epub 2024 May 27. PMID: 38801210. -Shin TJ, Hasnain F, Shay EO, Ye MJ, Matt BH, Elghouche AN. Treatment of post-tonsillectomy hemorrhage with nebulized tranexamic acid: A retrospective study. Int J Pediatr Otorhinolaryngol. 2023 Aug;171:111644. doi: 10.1016/j.ijporl.2023.111644. Epub 2023 Jul 6. PMID: 37423163. |
Bottom Line: Nebulized TXA (500mg-1g) for post-tonsillectomy hemorrhage can help prevent need for operative intervention and can decrease rates of rebleeding.
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Title: Laceration Repair
Author: Seth Ball Keywords: laceration repair, sutures, dermabond, steri-strips Reference Article: Barton MS, Chaumet MSG, Hayes J, Hennessy C, Lindsell C, Wormer BA, Kassis SA, Ciener D, Hanson H. A Randomized Controlled Comparison of Guardian-Perceived Cosmetic Outcome of Simple Lacerations Repaired With Either Dermabond, Steri-Strips, or Absorbable Sutures. Pediatr Emerg Care. 2024 Oct 1;40(10):700-704. doi: 10.1097/PEC.0000000000003244. Epub 2024 Aug 2. PMID: 39141836; PMCID: PMC11560696. |
Bottom Line: in this small, randomized trial, Dermabond showed non-clinically signifcant improved outcomes compared to stitches and steri-strips in terms of pain, patient satisfaction and cosmetic results at 3 months as interpreted by parents for simple lacerations. Keep using dermabond for these simple lacs, and have this data in your back pocket to reassure parents when needed.
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Title: Lactated Ringers vs Normal Saline in Sickle Cell Crisis
Author: Rusty Walker Keywords: IV Fluids, sickle cell, vaso-occlusive crisis Reference Article: Alwang, A. K., Law, A. C., Klings, E. S., Cohen, R. T., & Bosch, N. A. (2024). Lactated Ringer vs Normal Saline Solution During Sickle Cell Vaso-Occlusive Episodes. JAMA Internal Medicine. |
Bottom Line: Multicenter cohort study in adults showed that Lactated Ringers is better than Normal saline in fluid management for sickle cell vaso-occlusive episodes.
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Title: UTI cutoffs
Author: Ami Shah Keywords: Urinary Tract Infections, UTI, urine culture Reference Article: Shaikh N, Lee S, Krumbeck JA, Kurs-Lasky M. Support for the Use of a New Cutoff to Define a Positive Urine Culture in Young Children. Pediatrics. 2023 Oct 1;152(4):e2023061931. doi: 10.1542/peds.2023-061931. PMID: 37691613; PMCID: PMC10914346. |
Bottom Line: Conventional culture remains an accurate method of diagnosing UTIs in young children; however, these data suggest that a cutoff of 10,000 CFU/mL provides the optimal balance between sensitivity and specificity for children undergoing bladder catheterization.
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Title: Teaching Kids CPR
Author: Seth Ball Keywords: CPR, bystander CPR, out-of-hospital cardiac arrest, outreach Reference Articles: -Schroeder DC, Semeraro F, Greif R, et al. KIDS SAVE LIVES: Basic Life Support Education for Schoolchildren: A Narrative Review and Scientific Statement From the International Liaison Committee on Resuscitation [published correction appears in Circulation. 2023 Jul 4;148(1):e1. doi: 10.1161/CIR.0000000000001166]. Circulation. 2023;147(24):1854-1868. doi:10.1161/CIR.0000000000001128. -Borovnik Lesjak V, Šorgo A, Strnad M. Retention of Knowledge and Skills After a Basic Life Support Course for Schoolchildren: A Prospective Study. Inquiry. 2022 Jan-Dec;59:469580221098755. doi: 10.1177/00469580221098755. PMID: 35652386; PMCID: PMC9168916. |
Bottom Line: CPR should be introduced to elementary school children and yearly or twice yearly training can aid in knowledge retention.
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Title: High Dose Magnesium in Severe Asthma
Author: Rusty Walker Keywords: asthma, Wheezing, magnesium Reference Article: Irazuzta, J. E., Paredes, F., Pavlicich, V., & Domínguez, S. L. (2016). High-Dose Magnesium Sulfate Infusion for Severe Asthma in the Emergency Department: Efficacy Study. Pediatric Critical Care Medicine, 17(2), e29–e33 |
Bottom Line: Small study in 2016 showed that high dose Mg (50mg/kg/hr over 4 hours) in the pED decreased admissions, upgrades, and healthcare costs for severe asthma exacerbations.
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Title: Femoral IO
Author: Seth Ball Keywords: Intraosseous line, IO insertion, resuscitation Reference Articles: -Zitek T, Antevy P, Garay S, Thorn M, Buckley E, Coyle C, Scheppke KA, Farcy DA. Evaluating the Success Rate of Distal Femur Intraosseous Access Attempts in Pediatric Patients in the Prehospital Setting: A Retrospective Analysis. Prehosp Emerg Care. 2024 Sep 4:1-8. doi: 10.1080/10903127.2024.2398185. Epub ahead of print. PMID: 39230342. -https://dontforgetthebubbles.com/intraosseous-access/ |
Bottom Line: This study showed the distal femur to be a good option for IO insertion, comparable in both success rates and complications when compared to the proximal tibia. Dont forget to consider distal femur as a location for IO insertion if distal tibia is unsuccessful or otherwise contraindicated.
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Title: Cushing Syndrome
Author: Ami Shah Keywords: Cushing Syndrome, hypertension Reference Article: Parish A, Cheung C, Ryabets-Lienhard A, Zamiara P, Kim MS. Cushing Syndrome in Childhood. Pediatr Rev. 2024 Jan 1;45(1):14-25. doi: 10.1542/pir.2022-005732. PMID: 38161162. |
Bottom Line: Consider Cushing Sydndrome in pediatric patients presenting with hypertension
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Title: C-Spine Injury in Children
Author: Rusty Walker Keywords: pediatric trauma, cervical spine injury, PECARN C-spine Reference Article: Leonard JC, Harding M, Cook LJ, Leonard JR, Adelgais KM, Ahmad FA, Browne LR, Burger RK, Chaudhari PP, Corwin DJ, Glomb NW, Lee LK, Owusu-Ansah S, Riney LC, Rogers AJ, Rubalcava DM, Sapien RE, Szadkowski MA, Tzimenatos L, Ward CE, Yen K, Kuppermann N. PECARN prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study. Lancet Child Adolesc Health. 2024 Jul;8(7):482-490. doi: 10.1016/S2352-4642(24)00104-4. Epub 2024 Jun 4. PMID: 38843852; PMCID: PMC11261431. |
Bottom Line: CSI in children remains uncommon but potentially devastating; however indiscriminate neck imaging after trauma unnecessarily exposes children to ionizing radiation. Hopefully this prediction rule will help to mitigate both risks. If they are in a bad way, scan them. If the exam is nuanced, start with an x-ray. If there is no risk, take off the collar.
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Title: Pneumonia and Wheezing
Author: Yaron Ivan Keywords: pneumonia, Wheezing Reference Article: Mathews B, Shah S, Cleveland RH, Lee EY, Bachur RG, Neuman MI. Clinical predictors of pneumonia among children with wheezing. Pediatrics. 2009 Jul;124(1):e29-36. doi: 10.1542/peds.2008-2062. PMID: 19564266. |
Bottom Line(s):
1. Among the “historical Features”, Fever was the only one that was statistically significant AND had a positive LR. - so asking the parents about fever is important. 2. Among the examination findings - Respiratory distress was useless (not statistically significant) but the higher temp clearly correlated with findings of Pneumonia on CXR. (Look at the P value and the value of the LR) 3. Triage oxygen sat also correlated with pneumonia (if the pt was less than 92% or 90%). Read more... |
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Title: Pediatric Appendicitis
Author: Seth Ball Keywords: appendicitis, ultrasound Reference Article: Pernía J, Cancho T, Segovia I, de Ponga P, Granda E, Velasco R. Predictive values of indirect ultrasound signs for low risk of acute appendicitis in paediatric patients without visualisation of the appendix on ultrasound. Emerg Med J. 2024 Jul 22;41(8):475-480. doi: 10.1136/emermed-2023-213466. PMID: 38729752. |
Bottom Line: even if the appendix is not visualized, US can be helpful in ruling out appendicitis in patients with an Alvarado score under 7, no free fluid, and no peri-appendiceal fat inflammation.
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Disclaimer: The information in this writing is the opinion of the authors and does not necessarily represent the official opinion of the University of Nevada- Las Vegas School of Medicine or the Department of Emergency Medicine at the University of Nevada-Las Vegas School of Medicine.
For Health Care Practitioners: This writing is provided only for medical education purposes. Although the authors have made every effort to provide the most up-to-date evidence-based medical information, this writing should not necessarily be considered the standard of care and may not reflect individual practices in other geographic locations.
For the Public: This writing is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Your physician or other qualified health care provider should be contacted with any questions you may have regarding a medical condition. Do not disregard professional medical advice or delay seeking it based on information from this writing. Relying on information provided in this writing is done at your own risk. In the event of a medical emergency, contact your physician or call 9-1-1 immediately.
For Health Care Practitioners: This writing is provided only for medical education purposes. Although the authors have made every effort to provide the most up-to-date evidence-based medical information, this writing should not necessarily be considered the standard of care and may not reflect individual practices in other geographic locations.
For the Public: This writing is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Your physician or other qualified health care provider should be contacted with any questions you may have regarding a medical condition. Do not disregard professional medical advice or delay seeking it based on information from this writing. Relying on information provided in this writing is done at your own risk. In the event of a medical emergency, contact your physician or call 9-1-1 immediately.
