The Intoxicated Agitated Patient

Encountering a patient who may have taken a substance resulting in marked agitation is not an uncommon for the pediatric emergency medicine physician. A working knowledge of potential pitfalls associated with certain drugs of abuse may prove integral in the care of a patient who may deteriorate and code in front of you or one that you may be able to successfully stabilize. In this posting, we will look at three cases and and ask you to think about how you would address them. In a later post we will cover the management of the sympathomimetic toxidrome. In all three cases the urine Read more [...]

A tale of the new and the old in bronchiolitis

I recently participated in a pediatric resident educational conference on bronchiolitis and the recently published AAP Clinical Practice Guideline for bronchiolitis. The room was full of academically rigorous, up to date pediatric residents. When polled about interventions they had heard or seen used for the disease, one reluctant resident piped up, “Well, way back I think they used to use racemic epinephrine.” I may have imagined it, but I feel like he may have lowered his voice a little when saying, “racemic epinephrine” as if to disavow himself from the practice. There may have also Read more [...]

How do you tell a parent their child is faking it?

Before we all go crazy from Ebola-palooza, let's go crazy with an often unspoken phenomenon in the pediatric ED.  Children with intentional or unintentional psychosomatization. There is so little written in the emergency medicine literature for children who present with conversion disorder, secondary gain, and even less about guidelines, best practices, or descriptive data on what often occurs in Emergency Departments across the world with these types of patients.  ED Psychosomatization in children is completely different than the adult version, as you now have a potential ally or a potential Read more [...]

The Reasons Why It Is Difficult to Match: A Closer Look at America’s Medical Training Status

Recently I came across an article in the New York Times describing the life of a foreign intern at Woodhull Hospital Center in Brooklyn, New York. The article highlighted many interesting aspects of interns' daily life and revealed the expensive price that individuals pay to become doctors in the United States. Yet far more disturbing were the readers' comments. Some went too far describing foreign doctors like Dr. Sanchez as the reason why some US medical graduates could not match into training. The taboo of US versus International Medical Graduates (IMGs) training in the US is an uncharted Read more [...]

Ebola– how prepared is your PED?

With all of the news about Ebola our ED staff was fearful and concerned that our ED was not ready.  After hearing about nurses in Texas acquiring the disease the staff started to discuss if they would care for a patient with Ebola or call out sick.  Our senior staff remembered the days of similar fear related to caring for patient with HIV. What would we do if we had a parent or patient screen positive at triage?  Where we prepared?  Are we safe?  Do we have PPE?  Can we don? Can we doff?  Do we have each others backs?? We conducted an in-situ simulations to walk through our EDs Read more [...]
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Answer: “Just Roll With It.”

  This post is in response to the post “Just Roll With It.” To summarize, this was a 17-yo male who presented to the ED with worsening visual acuity over the course of a month. There was no history of trauma, environmental exposures, prior vision problems, photophobia, eye discharge or eye redness. While awaiting the ophthalmology consult, a point-of-care ocular ultrasound was performed and the following video clip was obtained which was consistent with a retinal detachment.   Thank you to all of you who took the quiz! Here are your results below: 83% of you Read more [...]
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Just Roll With It.

  This was a 17-yo male with no PMH who presented to the ED complaining of decreasing visual acuity in his left eye that had been worsening over the past month. It had progressed to the point where he could only differentiate between light and dark. He felt like a 'curtain was falling' when he tried to see through his left eye. He denied trauma, environmental exposures, prior vision problems, photophobia, eye discharge or eye redness.   While awaiting the ophthalmology consult, a point-of-care ocular ultrasound was performed and the following video clip was obtained. Image Read more [...]

The Section on Emergency Medicine at the American Academy of Pediatrics National Conference Exhibit

The American Academy of Pediatrics (AAP) Section on Emergency Medicine (SOEM), founded in 1981, is the leading advocate for the care of acutely ill and injured children and a professional home for pediatric emergency physicians and affiliated health professionals. Its mission is to optimize the emergency care of all children and provide a forum for section members to meet, discuss cases and treatment issues, and stimulate research and teaching in the subspecialty.  Membership is open to all AAP and ACEP members.   Benefits of SOEM Membership: € Advocacy (Federal & State) € Scientific Read more [...]