PEM Review 009, 17th June – MINOR INJURIES // ED HACKS // CROUP // MASSIVE TRANSFUSION // CHOREA // NEC FASCIITIS

PEMgeek3Hi FOAMed fans

Bit of a ‘minor injuries’ theme this week (nicely balanced out by ‘majors’ – a piece on massive transfusion management, and another on severe croup). Just your average day in the ED really…

 

finger   1. ‘HANDY’ TO KNOW – Would you like ONE injection in your sore finger, or TWO? Silly question. Your patients might appreciate this – did you know you don’t necessarily need to do two local anaesthetic injections for a digital block? One – in a slightly different place – may be enough.

Demo:dig block

Thank you Meredith Posner Schuh for this  (via PEMblog.com / @PEMtweets)

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fml- roy lichtenstein Girl-Crying_L.jpg      2. UR-EYE-NE DIPSTICK? Run out of eye pH strips, need one urgently? This latest ED hack courtesy of Dr. Eugene Izsak (@pedsemdoc) – using a urine dipstick to check eye pH if the eye has had a chemical splash/burn. A urine dipstick can detect a pH range of 5-8.5.

Demo:eye ph

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plaster     3. WOUND CLOSURE Next patient – small laceration, no skin glue available – what to do? BoringEM has an answer – several studies have found that wound closure strips are as good as tissue adhesive (‘skin glue’) in areas of low tensile strength. Areas with thicker skin or under more tensile strength (elbows, knees, etc) are still likely to need sutures for proper wound closure. HT Patrick Bafuma (@EMinFocus) via @boringEM

Demo:wound_closure_strips_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

blood-bag-tags      4. BLEEDING HELL… on to majors now… massive transfusion after trauma in the paediatric population is not common and needs careful, expert management. Great article by @chrispartyka on dontforgetthebubbles.com. Some useful adjuncts in transfusion are highlighted – tranexamic acid, calcium and factor VII.

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seal     5. SEVERE CROUP sometimes you don’t even need to look at a child to know you need anaesthetics on standby. Have a management strategy prepared in advance – read this excellent summary by @First10EM. Don’t neglect the simple things that can calm the situation- draw the curtains around the child and parent (leaving yourself a gap to watch through), dim the lights slightly, have the absolute minumum of doctors/nurses at any one time (…and explain all this to the parent in case your strategy is so successful they think you’re ignoring their kid). Also, remember to use the Westley score to grade severity of croup.

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chorea    6. CHOREA In honour of a recent patient seen in our ED, here are a couple of videos demonstrating choreiform movements. Poor kid had been told off at school for ‘fidgeting’ (…was not quite as bad as these videos: vid 1 / vid 2)

Differential: post streptococcal infection/rheumatic fever, drugs (eg anticholinergics, anticonvulsants, antidopaminergic agents, antihistamines), metabolic, endocrine and MANY others.

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switch2   7. Necrotizing fasciitis is RARE in children, but it is crucial to act fast if you suspect it. Get to know the signs. This 5 minute presentation is well worth your time – thanks EMin5.com (@ABargren)

Until next time – please share this far and wide and join in the conversation on twitter!

@PEMgeek

 

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