PEM Review 20: FEVER // DISTRACTION // D&V // ANAPHYLAXIS // HAEMATEMESIS // ITP // PRESENTATIONS

20th PEM Review! Thanks for being here for this milestone post ūüôā

FIVE DAYS FEBRILE

This is a great article for those getting to grips with the¬†never ending conveyor belt of hot/warm children processing through ED: @ALIEM gives us a solidly common sense approach to reviewing children with prolonged fever. Did you know the average duration of fever in flu A and flu B is 5 days? (check out the table below). Obviously flu can be a nasty bug with its own host of complications, but just because a fever lasts more than five days doesn’t necessarily mean that you need to assume it’s an occult bacterial infection in a relatively well-appearing child.

fever-table

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baby-chewing-ipad        DRIVEN TO DISTRACTION

This piece, from @songsorstories, might be about how to prepare and approach a child pre-anaesthetic, but so many of the awesome tips here are worth taking note of even if you’re not an anaesthetist, as they are so generalizable to the way we should always treat children in ED. Using honesty, thinking about your body language, taking time and respecting personal space go a LONG way.

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apples  HOW BOUT THEM APPLES?

Dioralyte is horrible. It’s never surprising when a nauseous kid vomits up every millilitre of the disgusting liquid their parent has been carefully giving as a fluid challenge (and then you’re back to square one). So it’s exciting news that this study has found dilute apple juice to be just as effective for rehydration in your mild to moderately dehydrated child. Cheaper, better tasting, and easier to get hold of. See analysis of the paper by @rebelEM. Save the dioralyte for your next hangover instead (true fact, works every time ūüėČ )

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epipen     ADRENALINE. ADRENALINE. ADRENALINE.

In anaphylaxis, A is for Adrenaline. However, there’s some evidence that there are low rates of adrenaline administration pre-hospital by paramedics and parents. So, @EM3 recently ran a simulated anaphylaxis case (which you can see – and possibly ‘borrow’ for your own department’s sim program – here).

Don’t. Delay. The. Adrenaline.

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blood-in-vom¬†¬†¬†¬†¬†¬† ¬† ¬† ‘BLOODY BABY BARF’

Podcast time – it’s @PEMtweets discussing haematemesis in the newborn. A careful history can usually isolate the cause – this presenting problem is common and usually there is nothing sinister going on. Hint – if the baby is breastfed, DON’T forget to examine the mother’s nipples for cracks.

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plts2   INCREDIBLY TRICKY PLATELETS

Here, @emdocsdotnet give us a concise primer on ITP in children. Aside from the classic purpuric skin rash, ITP may present with mucosal bleeds or spontaneous haemarthroses (and intracranial/intrabdominal bleeds are also possible but more rare). The lower the platelet count the more likely admission will be needed – IV steroids (and even IVIG in severe cases) may be necessary.

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aa1     P CUBED

Finally I’d like to point you all towards @ffolliet ‘s new website. The presentation guru has made it his personal mission to banish boring, pointless powerpoint slide presentations, and if you have a presentation of any shape or size coming up (and you’d like your audience to sit up and take notice, rather than grab a few Z’s) I urge you to take a look through his back catalogue of presentation tips.

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