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.
Is there benefit to routine hospital admission in children with blunt abdominal trauma who have a negative abdominal CT? Do we really have to worry about children with a “seat belt” sign? Are there physical examination findings that can help identify children at risk for intra-abdominal injury?
Eight hours ago, the 80-year old female in room one arrived from home
pleasant and cooperative after suffering a standing-level fall. She’d
been ambulating to the bathroom during the commercials for her favorite
evening TV show, Wipe Out.
The patient is a 46-year-old male who presents to the ED at night with
agitation and delusional episodes lasting several hours. During these
episodes, he has sensations of hair growth on his face, trunk, and arms.
Occasionally, he becomes convinced that the hair growth is real. He thinks
these changes will make him appear to be a wolf, and avoids seeing his
face or body whenever possible.
Parents and caregivers are becoming more involved in healthcare
discussions and the internet era has led to significant concerns for
providers as a little knowledge is worse than no knowledge at all.
Parents will often have predetermined expectations of what the ED visit
should entail and will already have their own differential diagnosis and
treatment plan in mind...