PEMCast 10th Episode: Dr. Steven Selbst on the Section on Emergency Medicine, and the various nominations & awards. Listen here, or subscribe to us through iTunes.
K12 Research Mentorship / Training Grant program for EM and PEM physicians (NHLBI)
Six centers across the U.S. have available 2-3yr programs to mentor and train upcoming clinician-scientists in the field of Emergency medicine or Pediatric Emergency Medicine beginning July 1, 2012. Applications are available at each of the six institutions. For more details, please go to the PEMNetwork's Research & Grants section.
Mount Sinai School of Medicine (NY)
Oregon Health and Science University (OR)
University of Pennsylvania (PA)
University of California, Davis (CA)
University of Pittsburgh (PA)
Vanderbilt University (TN)
Support for this website provided by the Section on Emergency Medicine from the AAP.
Case of the Month (January 1, 2012 - February 15, 2012) by Dr. Catherine Chung
Submit your case to the PEMNetwork to
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HPI: 12y/o female presents with lower pelvic pain for the past 2 months. She also complains of urinary retention and constipation. She otherwise denies
any weight loss, vomiting, fevers. She denies any sexual activity and has not begun menstruation.
PE: VSS, awake, no pain
Chest: tanner stage 3
CVS: S1/S2, RRR
Lungs: Clear
Abd: Lower abdominal fullness with diffuse mild tenderness in lower quadrants, no rebound
Her bedside ultrasound and further physical examination reveals the diagnosis.
What is her diagnosis?
A.Uterine fibroid
B.Adenomyosis
C.Hematocolpos
D.Endometriosis
E.Ovarian Cyst
Vote using the poll on the bottom of the webpage, below.
Last month's case:
A 10-year-old boy had provoked a dog, which resulted in this large bite wound to the face. It is now 3 hours s/p the injury, and the dog is nowhere to be found in an urban U.S. city. There is no known owner of the dog. There are no other complaints, no other past medical problems. His immunizations are 'up-to-date' but his parents do not know when his last tetanus status is.
The exam is shown on the right. No other injuries are present, and no intraoral nor dental injuries are present. His parents are extremely concerned about rabies disease and asks you about medications to treat rabies.
In addition to primary suture repair, which of the following combinations would you do for this child?
This is a significant dog bite through the vermilion boder of the lip, without photographic evidence of through-and-through penetration into the oral mucosa. Obviously this will require primary suture repair. Some institutions will ask for a plastic surgeon, others will do it as an EM or PEM practitioner.
On the left, we have the results of our poll for the management for this child. Ultimately, we elected to provide oral antibiotics (amoxicillin-clavulonate & TdaP vaccine). No rabies vaccine was offered. The child did fine on wound check and thereafter.
According to the AAP Red Book 2009, tetanus prophylaxis should be provided (TdaP) in a child who has received the primary series (DTaP x 3) at 2, 4, and 6 months, and whose tetanus protection has been greater than 5 years. A ten-year-old child in the U.S. will have had his final DTaP at 4 years of age, consistituting his pre-school vaccines. Therefore, he is 6+ years out from his last tetanus vaccine and is in need of a booster. Without a wound, he would have received his first TdaP vaccine at around 11 years of age, and perhaps with meningococcal / HPV depending on the provider.
Ninety-one percent of respondents opted for antibiotics. Although facial lacerations generally tend to be low-risk for infection due to the generous blood supply, the source of the laceration (animal bite) and large, serrated edges requiring closure makes this a higher-risk wound. There are very few studies on high-risk animal bite infection rates, but most experts would opt for antibiotic coverage. (http://onlinelibrary.wiley.com/doi/10.1111/j.1553-2712.2000.tb00519.x/abstract). Closure should not affect infection risk as long as appropriate local wound irrigation is performed. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1285519/?tool=pubmed)
The Rabies risk is very low in a dog within the United States. There has not been a reported rabid dog in the Washington, DC, area, and the reported risk of rabies in a stray dog is 0.1% in a 1993 study (http://www.nejm.org/doi/full/10.1056/NEJM199311253292208). It was decided not to use the Rabies Human Diploid Cell Vaccine / Rabies Immunoglobulin, which would have committed him to visits on Day 3, 7, and 14.
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with any questions. Happy hiring!
Thanks to those who were at the AAP Section on Emergency Medicine in Boston, MA. Special thanks to those who learned about us at ACEP in San Francisco, CA.
If you haven't joined the American Academy of Pediatrics or the Section on Emergency Medicine, consider doing so. You'll be able to network with the veterans of pediatric emergency medicine as well as the rising stars, and participate in local, regional, and national endeavors to further your career, as well as access exclusive content presented at the conference. Join today at http://www.AAP.org/
