PEM Review 008, June 9th – TECH // GI OBSTRUCTION // METABOLIC DISORDERS // CT // ONDANSETRON // PAIN // GI BLEEDS

PEMgeek3

Hi everyone (especially new twitter followers!) Seven days, seven new things from the PEM world to think about:

         burns            

1. MERSEY BURNS This is the best medical app I’ve seen for ages. It is FREE, very simple to use and once you have entered age and weight, and drawn the area of the burn (it calculates the surface area for you) gives you an instant fluid calculation (resuscitation and maintenance fluids). Definitely worth a download.

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 bile 

2. CASE OF THE WEEK A rare cause of intestinal obstruction – that could easily masquerade as a number of other conditions. I won’t spoil the case by revealing the diagnosis; thank you @pedseducation for this fascinating piece.

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cat scan   

3. A PAIN IN THE NECK? The decision to perform head/neck CTs on a young child who has been involved in trauma is never taken lightly – it is a massive dose of radiation with potentially serious long term consequences.  So it is encouraging to hear that a large 12 year study, involving over 2,900 trauma patients under 5 (abstract here – unfortunately not free open access –summarised by @emlitofnote);  has found an extremely low incidence of cervical spine injury: a grand total of 22 children in the cohort, all of whom had clinical signs suggestive of C-spine injury. The authors conclude that in patients under 5 years, the absence of clinical findings (ie normal neurology, no neck pain, no torticollis, normal GCS) can exclude C-spine injury without the need for CT imaging. What does your department’s current guideline suggest?

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vom         

4. The Skeptics Guide to EM (@theSGEM) team discuss ondansetron use in vomiting kids, with reference to a recent observational study. Turns out that while it is certainly popular amongst ED docs, ondansetron may not have the effects you might expect upon admissions or IV insertions… podcast link here

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5. Few paediatric presentations terrify ED doctors more than metabolic disorders. It’s always 4am, the department is heaving, and suddenly there’s a tiny kid who looks sick as anything and all you can think is how you CAN’T REMEMBER THE UREA CYCLE and you’re cursing the day you gleefully wiped it from your memory after third year exams. Read through this excellent case presentation on @emdocsdotnet and things will seem much less intimidating. (Spoiler – emergency management of any metabolic disorder does not require detailed memory of any of the metabolic cycles!)

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soap-box         

6. RANTHONY: @theSGEM have been really busy this week! Dr Anthony Crocco has a 3 minute youtube rant about paediatric pain management (or rather, the shocking lack of consistent pain management for paediatric patients in our EDs). Don’t be *that* doctor… keep your patients well dosed up and comfortable. No excuses.

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donor    

7. Massive GI bleeds are thankfully rare in the paediatric ED but they DO happen (mostly in patients with other chronic conditions – think liver disease and CF). Be prepared for the worst case scenario; this podcast (courtesy of @pemtweets) recaps the emergency management of these patients – and the finer detail of the gastroenterologist’s role – in 13 minutes flat.

If you are creating any Paediatric #FOAMed, please get in touch, I’d love to help it reach a bigger audience. Until next time,

@PEMgeek

 

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