Managing diabetes, in particular DKA, is a staple in the practice of
emergency medicine. The pancreas hasn’t changed since we discovered that
it secreted insulin. So, the treatment has no reason to change either.
Pediatric dehydration continues to be a significant cause of morbidity
and mortality throughout the world and is a frequent issue encountered
in the Emergency Department. Traditionally, IV fluid hydration has
been the mainstay of therapy. However, it is often difficult to obtain
intravenous (IV) access in children who have small, collapsed veins,
and therefore, alternative therapies are being investigated.
While on a recent shift in the ED, I was asked a familiar question by a weekend warrior who had suffered an ankle sprain while playing basketball - “What can I do to get back on the court sooner, Doc?” After explaining the usual RICE protocol (Rest, Ice, Compression, Elevation) my persistent patient asked “What else can I do? What about these platelet rich plasma (“PRP”) injections I hear about?”
Are there any historical or physical examination findings that can help emergency physicians make the diagnosis of UTI? Read the article and take the Quiz for 1 CME credit hour.
There was a time when determining how to sedate a child for a CT of the
head was a major factor to consider in determining the risk-benefit
ratio for obtaining the study. With the speed of today’s new multi-slice
CT machines this decision-making process has all but been eliminated.
However, as in all other areas of medicine, nothing is ever absolute,
and there still are scenarios that will require the sedation of a child
for a diagnostic study.
Children often present to the emergency department with acute pain and the issue of rapid and effective pain control is a top priority for providers. This journal club evaluates the use of nebulized fentanyl as an effective medication that can be administered painlessly prior to the initiation of IVs.
If you want to read a medical fairly tale, pick up an older textbook and read the chapter on lumbar punctures. Although you won’t read about unicorns or dragons, some of the recommendations are no less mythical. Let’s take a shot at disproving these myths with a silver bullet of truth.
As the search for the ideal sedative agent continues, ketamine continues to be a safe and effective choice. This journal club will review the literature on NPO time, anti-emetics, atropine, and head injury in relation to ketamine use.
As I wrap up my emergency medicine residency and enter the “real world”
after so many years of training, I look back and see how my clinical
practices have changed considerably. I no longer place a certain order
just because that is “what you do,” but because the result is
significant in my medical decision-making.
Are steroids necessary for bacterial meningitis? When do urine cultures
become positive in relation to duration of fever? This journal club will
review some key articles on fever in children and will help us with the
management of febrile infants who present shortly after immunizations.