PEM Review 019 – ANAPHYLAXIS // FGM // METABOLIC // INTUBATION // FRACTURES

It’s been way too long since my last post (sorry!) – so let’s jump right in. Loads of great resources for your perusal:

  FGM

Awareness of female genital mutilation has hugely increased in recent years – but tragically the practice is still going strong in some cultures. As UK paediatricians know, it has been MANDATORY to report any incidences to the police since October 2015. This article from ADC is an amazing summary of the history, classification, management and long term complications of FGM in children. Understanding more about FGM, which has historically been surrounded by secrecy, is the first step towards prevention.

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help   METABOLIC MASTERY

You don’t have to be a genius to manage suspected metabolic conditions in the ED. Honestly. The most important thing is to have a metabolic diagnosis on your radar – you might save a life. Wonderfully simple management guide on @RCEMFOAMed

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champ  CHILDREN’S CHAMPIONS

I won’t dwell on how jealous I am of you lucky people who went to ICEM this year. In particular the ‘paediatric marketplace’ sounded like a buzzing environment for new ideas. If, like me, you missed out, take some pearls from this piece (@baombejp) on how we should all be strong advocates for making ED an easier place for our smallest patients.

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intubation   VID-TUBATION

Such a fan of this collection: over on paediatricemergencies.com, paediatric intensivist @csflannigan is building a library of real-life videos demonstrating paediatric procedures – from intubating the neonate to insertion of arterial lines and much, much more in between (intubation of a child with Pierre-Robin sequence anyone?) Will be keeping an eye out for more.

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take 2  DEJA VU…

It’s really important to have biphasic anaphylaxis in the back of your mind when treating (or thinking about discharging) a kid who has had an anaphylactic reaction. The following are predicting factors…

  • Age 6 to 9 years
  • Delay in presentation to the ED >90 min after the onset of the initial reaction
  • Wide pulse pressure at triage
  • Treatment of the initial reaction with >1 dose of adrenaline
  • Treated with inhaled β-agonists in the ED

The recurrence of anaphylaxis symptoms is typically within 4-6 hours but can be up to 24-72 hours later in rare cases. Thanks to @PEMblog. Get more detail here.

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panda   PANDAmonium

Strep is a nasty, mischievous bug. Out of its list of well known associations (eg glomerulonephritis) PANDAS is less well known, and much less understood. PANDAS – Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infection. The diagnostic criteria include a new (acute) onset of OCD/anxiety/neuropsychiatric symptoms alongside neurological symptoms such as choreiform movements or tics, affecting a prepubertal child who has had a recent group A strep infection (usually within 6 weeks).

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cast2  SUMMER BREAKS

In time for summer i.e. peak trampoline season, here’s @TamingtheSRU ‘s guide to interpreting those tricksy elbow and forearm X-rays. The six ossification centres of the elbow develop throughout childhood – starting with the capitellum at around 2 years of age. Each new centre follows on roughly 2 years apart each time. CRITOE is the mnemonic to mnemorise (sorry).

 

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