PEM Review 018: DIFFICULT DECISIONS // UTIs // EYE EXAMS // SPLENIC INFARCTS // RASHES // FOREIGN BODIES

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Hello again PEM geeks. Without further ado here is a collection of the most recent, best and brightest FOAMped around:

spleen      1.  PLEASE EX-SPLEEN

Splenic infarction is a rare complication of EBV (infectious Mononucleosis) – and while most cases are treated conservatively, it can lead to rupture or splenic abscess, so really is a diagnosis not to miss! Don’t forget to have a higher suspicion in patients with sickle cell disease or thromboembolic conditions who come to you with abdominal pain (with or without a history of EBV). Thanks to @emdocsdotnet for the article.

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scales        2. HOT; BOTHERED?

PEM is all about shades of grey – rarely is there one ‘right’ answer for any scenario, which is why I love the PEM Academy ‘hot seat’ series, in which trainees vote for their preferred course of action in a given scenario. (I’m always fascinated to find out how other people make their difficult decisions!) This week the case involves an 8 day old baby, clinically well with a low grade fever of 37.9 – do you go down the full septic screen route, or would your management be more conservative? Does it depend at all on the family?

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uti       3. TAKING THE PEE

Feverish children with no urinary symptoms but a positive urine culture – they’re ten a penny in the ED. So have you stopped questioning the rationale behind your management? @First10EM author Justin Morgenstern reviews a wide variety of evidence in brief – and might make you rethink some of your assumptions about this group of kids.

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spots        4. RASH DECISIONS

If tiny babies with odd looking rashes puzzle you, you’re not alone. Thankfully @dontforgetthebubbles has rounded up some pictures and descriptions of some very common (and very benign) skin conditions that new parents might panic about (and therefore are likely to pitch up in your emergency department).

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slit lamp      5.  EYE SPY

The slit lamp is a pretty intimidating looking piece of kit to your average PEM doc. This video by @AnnaEMin5 is 5 minutes of your time very well spent if you don’t want to flounder next time you need to use it! You don’t need to be an ophthalmologist to use one (and you’ll definitely stay on the right side of the ophthalmologist you’re referring to if you’ve at least tried to do the basics first 😉 )

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Airway-FB     6. PODCAST OF THE WEEK…

– is this episode of @core_EM. Listen from 4:18 onwards for a discussion on foreign body aspiration in children – dealing with emergency and non emergency management. There is a neat trick for figuring out whether a coin is in the oesophagus or trachea based on the chest X-ray… Listen and find out!

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