Pediatric Emergency Playbook
By Tim Horeczko, MD, MSCR, FACEP, FAAP
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You make tough calls when caring for acutely ill and injured children. Join us for strategy and support -- through clinical cases, research and reviews, and best-practice guidance in our ever-changing acute care landscape. Please visit our site at http://PEMplaybook.org/ for show notes and to get involved with the show -- see you there!
||CleanBlunt Head Trauma||PECARN Head CT Decision Tool||11/1/2017||Free||View in iTunes|
||CleanThe Higher Tech Kid in the ED||Comfortable with G-tubes, tracheostomies, and VP shunts? Good. Get ready for the next level: Vagus Nerve Stimulators, Intrathecal Pumps, and Ventricular Assist Devices. Details in Audio: Vagus Nerve Stimulators For intractable epilepsy;...||10/1/2017||Free||View in iTunes|
||CleanVaccine Preventable Illness Part Two||PEMplaybook.org||9/1/2017||Free||View in iTunes|
||CleanThe Pediatric Surgical Abdomen||Abdominal pain is common; so are strongly held myths and legends about what is concerning, and what is not. One of our largest responsibilities in the Emergency Department is sorting out benign from surgical or medical causes of abdominal pain....||8/1/2017||Free||View in iTunes|
||CleanVaccine Preventable Illness Part One||PEMplaybook.org||7/1/2017||Free||View in iTunes|
||CleanMI in Children||Myocardial infarction (MI) in children is uncommon, but underdiagnosed. This is due to two main factors: the etiologies are varied; and the presenting symptoms are “atypical”. We need a mental metal detector! Case examples...||6/1/2017||Free||View in iTunes|
||CleanNeonatal Jaundice||Most newborns will have some jaundice. Most jaundice is benign. So, how can we sort through the various presentations and keep our newborns safe? Pathologic Jaundice When a baby is born with jaundice, it’s always bad. This is pathologic...||5/1/2017||Free||View in iTunes|
||CleanForeign Bodies in the Head and Neck||Children the world over are fascinated with what can possibly “fit” in their orifices. Diagnosis is often delayed. Anxiety abounds before and during evaluation and management. Most common objects:1,2 Food Coins Toys ...||4/1/2017||Free||View in iTunes|
||CleanSupraglottic Airways||When you give only after you're asked, you've waited too long. – John Mason First, learn to bag Place a towel roll under the scapulae to align oral, pharyngeal, and tracheal axes: Karsli C. Can J Anesth. 2015. Use airway adjuncts such as...||3/1/2017||Free||View in iTunes|
||CleanUrine Trouble||When should you commit to getting urine? When can you wait? When should you forgo testing altogether? When do I get urine? Symptoms – either typical dysuria, urgency, frequency in a verbal child, or non-descript abdominal pain or vomiting in a...||2/1/2017||Free||View in iTunes|
||CleanPediatric Pain||N.B.: This month's show notes are a departure from the usual summary. Below is a reprint (with permission) of a soon-to-be released chapter, Horeczko T. "Acute Pain in Children". In Management of Pain and Procedural Sedation in Acute Care....||1/1/2017||Free||View in iTunes|
||CleanBronchiolitis||"By the pricking of my thumbs, Something wheezing this way comes." -- Witches in Macbeth, with apologies to William Shakespeare "Bronchiolitis is like a pneumonia you can’t treat. We support, while the patient heals." -- Coach, still...||12/1/2016||Free||View in iTunes|
||CleanPediatric Elbow Injuries||Johnny has fallen on an outstretched hand, and comes to you with a swollen, painful elbow. Position of comfort, analgesia, xrays, and now what? What am I seeing -- or not seeing -- here? First a refresher on radiographic...||11/1/2016||Free||View in iTunes|
||CleanGI Bleeding in Children||Blood in the vomit. Blood in the stool. Blood in the diaper. How far do I go in my investigation? What do I really have to worry about? The differential diagnosis of GI bleeding in children is broad. (Here is the complete differential...||10/1/2016||Free||View in iTunes|
||CleanPediatric Headache: Some Relief for All||Seemingly vague, but potentially dangerous... common, but possibly with consequences... ...or maybe just plain frustrating. Let's talk risk stratification, diagnosis, and management. Primary or Secondary? We can make headache as easy or as...||9/1/2016||Free||View in iTunes|
||CleanSubcutaneous Rehydration||Have you ever been in any of these situations? ⇒ You have a stable child who just needs fluids, but no laboratory tests ⇒ You’ve tried PO hydration, to no avail, despite anti-emetics ⇒ You’re poking the...||8/1/2016||Free||View in iTunes|
||CleanPlease STOP LIMPING!||"She won't walk", or "He just looks like he's limping". So many things can be going on -- how do we tackle this chief complaint? You’re dreading a big work-up. You almost want to tell the kid – please, STOP LIMPING... STOP LIMPING! S –...||7/1/2016||Free||View in iTunes|
||CleanApproach to Shock||Do we recognize shock early enough? How do we prioritize our interventions? How can we tell whether we’re making our patient better or worse? World wide, shock is a leading cause of morbidity and mortality in children, mostly for...||6/1/2016||Free||View in iTunes|
||CleanAltered Mental Status in Children||How do you approach the child who may be altered? Altered mental status in children can be subtle. Look for age-specific behaviors that range from irritability to anger to sleepiness to decreased interaction. In the altered child,...||5/1/2016||Free||View in iTunes|
||CleanBig Labs, Little People||Troponin, BNP, D-Dimer, and Lactate in Children||4/1/2016||Free||View in iTunes|
||CleanMultisystem Trauma in Children, Part Two: Massive Transfusion, Trauma Imaging, and Resuscitative Pearls||A 5-year-old boy was playing with his older brother in front of their home when he was struck by a car. He sustained a femur fracture, splenic laceration, and blunt head trauma – the so-called Waddell’s triad. On arrival, he was in...||3/1/2016||Free||View in iTunes|
||CleanMultisystem Trauma in Children, Part One: Airway, Chest Tubes, and Resuscitative Thoracotomy||Traumatized children need your full attention. Protocols work well for adults, but trauma in children requires that we exercise our clinical muscles just a bit more. Two main reasons: Children have specific injury...||2/1/2016||Free||View in iTunes|
||CleanVomiting in the Young Child: Nothing or Nightmare||In the young child, vomiting is the great imitator: Gastrointestinal, Neurologic, Metabolic, Respiratory, Renal, Infectious, Endocrine, Toxin-related, even Behavioral. To help us organize, below is a review of can't-miss diagnoses by age. The...||1/1/2016||Free||View in iTunes|
||CleanElectrical Injuries: Hertz So Bad||Victims of electrical injuries present either in extremis or as the seeming well patient with insidious, developing disease. A targeted history usually gets you the information you need. Four main things to find out: 1. Household...||12/1/2015||Free||View in iTunes|
||CleanAdventures in RSI||Pediatric airway management is a skill that integrates the three types of knowledge as described by the ancient Greeks: episteme, or theoretical knowledge, techne, or technical knowledge, and phronesis, or practical wisdom, also called prudence. Here...||11/1/2015||Free||View in iTunes|
||CleanThe Technologically Dependent Child in the ED||EMS is bringing you a child with a VP shunt, port-a-cath, trached on a vent, seizing, hypotensive, and now desaturating – ETA – 3 minutes. Are you ready? Medicine is evolving. As technology advances, we need to meet the challenge of...||10/1/2015||Free||View in iTunes|
||CleanIntranasal Medications||Intranasal medications, if understood and employed properly, are a great choice to avoid and IV or as a bridge until IV access is obtained. Learn the strengths and limits of intranasal fentanyl, midazolam, ketamine, and dexmedetomidine. Pain...||9/1/2015||Free||View in iTunes|
||CleanPediatric Status Epilepticus||Do you have a plan for your little patient when he just won’t stop seizing? What do you do when your typical treatment is not enough? Get up-to-date in the understanding and management of pediatric status epilepticus. Definition of status...||9/1/2015||Free||View in iTunes|
||CleanThe Undifferentiated Sick Infant||You have all of the skills you need to care for an acutely ill infant. Learn a few pearls to make this a smoother endeavor. The Pediatric Assessment Triangle is a rapid, global assessment tool using only visual and auditory clues to make...||9/1/2015||Free||View in iTunes|
Phenomenal podcast! A must listen to for any ER doc or peds doc/resident
Knowledgable - Insightful - Practical
Dr. Horeczko has a servant’s heart and a passion to bring awareness and understanding to the medical community, and to the families involved.
If you’re in the field or connected to PEM in some way, listen to what this man has to say.
Joel and Dr Pei
Husband and wife hosts of ReLaunch
Amazing PEM Podcast
One of the great Peds EM & EM educators in the FOAMed community. Brings a phenomenal podcast with pearls of wisdom. A definite must listen for all EM / PEM / Peds physicians & residents.