The last 40 years have seen enormous changes in the way the healthcare system handles psychiatric patients. The first shift transitioned psych patients from the inpatient to the outpatient setting, which led to a reduction in the number of available inpatient psychiatric beds. The total number of inpatient psych beds has decreased by 62% since 1970 and the total number of state and county beds decreased by 89%.

With the flu and gastroenteritis season in full swing, the use of ondansetron use in the emergency department can help decrease the need for intravenous hydration. As more patients flood our already busy hospitals and with the new norovirus strain infections, it is increasingly more important for us to begin oral rehydration therapy as soon as possible.

Sometimes you wish you were a pediatrician; other times you don’t. When you walk into the room and your patient immediately starts crying like you are a scary monster, you gain a new appreciation for your adult patients. But when everything you do elicits a smile or a giggle, you wish all your patients were three years old.

While most syncopal events in children are benign, there are certainly serious syncope conditions which exist, mainly involving the cardiovascular system. Fifteen to 20 percent of children will have one episode with neurogenic syncope being the overall most common cause. The physical examination is normal in up to 96% of children.

A 2-year-old child is brought to the ED on a cold December evening by frantic parents one hour after swallowing several mistletoe berries at home. The parents had placed the mistletoe plant over the door entryway secured by a piece of scotch tape. During a large family holiday gathering, the mistletoe fell to the floor causing the curious toddler to ingest several of the scattered berries.

When kids present with lacerations, we have choices as to how to stitch them up. This journal club reviews the literature on the appropriate selection of sutures in children, and pits tissue adhesive head-to-head against adhesive strips.

Don’t look now, but that gentle lapping at your toes is the first hint of the “silver tsunami” coming soon to an emergency department near you. Of the 313 million people currently living in the United States, 12% are over the age of 65 years, and one million are over 100 years old. More sobering, as of January 1, 2011, the first baby boomers started to qualify for Medicare.

For those of you who may have missed the most recent press release from the CDC on August 14th, the incidence of the potentially deadly West Nile Virus is back with a vengeance. 

Think you know everything about the lowly abscess? Think again. New research suggests you might want to use ultrasound before you lance, and suture before you pack. 

(ALTEs) are a common presenting complaint to the emergency department. According to the National Institutes of Health 1986 definition – which remains the current definition – an ALTE is an episode that is frightening to the observer and is characterized by some combination of apnea, color change, change in muscle tone, and choking or gagging. In pediatrics, the observer sometimes fears that the infant has died.