PEM Review 011 – UPPER AIRWAY OBSTRUCTION // FEBRILE INFANT // COMMUNICATION // TEACH THE TEACHER // POISONING

PEMgeek3

PEM #FOAMed roundup for the week of July 21st:

zebra  1. HEAR HOOFBEATS, THINK ZEBRAS..?

In a sea of croup and viral wheeze, don’t forget the weird and wonderful.  This article from @ADC_BMJ (free, open access #journalFOAM !) discusses three unusual cases of upper airway obstruction and how each was diagnosed and managed.

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ceh  2. PARENT INFORMATION

The Childrens e-Hospital website (@ehospital1) is the result of a collaboration between medical professionals and parents, and it contains well written, easy to understand information for parents about common childhood conditions (there is scope for many other topics to be covered, so hopefully as the site gains popularity the content will grow!) Parents and carers can get all the resources in the parent information section without having to register – ideal for them to access at home after discharge from ED. Here is the information page for bronchiolitis, as an example.

There is also a professionals section for which you do have to register (this is free as well).

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ecg  3. ECG OF THE WEEK

A 15 year old female with dizzy spells – what does the ECG show, and what’s the possible diagnosis?

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baby_fever    4. (ANOTHER) INFANT WITH A FEVER…

Bread and butter of the paediatric ED, and potentially a very sick child (risk of bacteraemia – as quoted in this podcast – approximately 3%). This @PEMtweets podcast goes back to basics, discussing the management of febrile infants (under 28 days, and up to 2 months) – and also touches on neonatal HSV.

Bottom line – you need an EXTREMELY good reason not to send a raft of cultures and admit this child for empiric antibiotics.

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bedside   5. TEACHING THE BEDSIDE TEACHER

Most teaching in ED is – necessarily – opportunistic bedside teaching, which at its best can give a student first hand experience of a condition or patient that they might remember for their whole career. Bedside teaching is a skill in itself, but how many of us have ever been taught how to run a good session? If you are involved in teaching at any level, this presentation from @EMedCoach is full of inspiration for your next session (including how to ‘diagnose your learner’ and when it helps to ‘think like a sniper’)…

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newsboy_megaphone   6. COMMUNICATION

The over-prescription of (possibly unneccessary) antibiotics is a problem. We all acknowledge this, and yet most doctors have probably, at some point, prescribed antibiotics for a child whose main indication for the prescription is probably ‘presence of anxious parent’. (Guilty, here).

This paper (free, open access journal article) is an interesting read. Looking at how doctor-parent communication in consultations can influence the decision to treat a child with antibiotics, the authors found that ‘many parental communication behaviours (eg expression of concern or information seeking) were interpreted by clinicians as pressure for antibiotics’ – even if the parent had made no explicit request. Bottom line – ‘clinician perception of parental expectation of antibiotics is not associated with actual parent expectations’. Find out parents’ expectations at the start of a consultation to check if you’re all on the same page.

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smoking  7. WHAT’S YOUR POISON?

A warning from @emlitofnote about the dangers of e-cigarette refills. The lethal dose of nicotine is only 1mg/kg, meaning that a child could easily ingest this concentration from an average e-cigarette refill cartridge (which could contain 10ml of 35mg/ml concentration liquid… = 350mg nicotine  😮

Symptoms of poisoning include vomiting, diarrhea, salivation, bronchorrhea, seizures, rhabdomyolysis, and respiratory failure (nicotinic and muscarinic toxic symptoms).

Original journal article here (unfortunately not free open access)

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Back soon with more. Thanks for reading, please share, comment and interact!

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