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...
A 33-year-old female presented to the ED after ingesting the mercury contained in 2,500 thermometers (about 1000 mL). It took the patient one month to purchase the thermometers in drugstores and nine hours to extract the mercury by breaking the thermometers and filtering the mercury with gauze... What do you do? A case-driven report on the treatment of massive overdoses.
Children often present to our emergency departments with buckle fractures, non-displaced fractures and minimally angulated fractures. They are often placed in casts which can be difficult to care for and then patients return to the ED for cast-related issues. This journal club will review the latest articles on the use of removable splints for fracture care in children.
It’s a bustling Saturday night and the patient in room 4 looks like a
hot appy. As she near syncopized when you suggested rectal contrast,
you’re now contemplating a non-contrasted CT scan (NCC) versus a long
drink oral contrast scan (OCC). That NCC is mighty tempting. It would
get her to the OR before the surgeon hits REM sleep and the bars close,
and there is even that recent Annals meta-analysis that suggests its
sensitivity is about 93% for appendicitis ...
Contrast protocols, including intravenous, oral and/or rectal contrast,
are just not necessary for abdominal CTs. From my perspective, the only
emergent CTs that warrant IV contrast administration are CT pulmonary
angiograms to identify pulmonary emboli, chest or abdominal CTs to
investigate suspicion for aortic dissection and perhaps for blunt
Ultrasound in the emergency medicine field has rapidly advanced over
the last few years, and its use has become standard practice for many
centers. Unfortunately, the pediatric emergency medicine world is
lagging in the advancement of ultrasound use in children.
“Doctor, I have the sickle cell.” Your eyebrows raise as the
complications of sickle cell disease run through your mind. “You mean
the disease?” you clarify. “No, I have sickle cell trait,” she
While it’s technically not a “disease,” it may be an important risk factor in the emergency department.