PEM REVIEW 021: WINTER IS COMING: CROUP // BRONCHIOLITIS // CRP ESR // FRACTURES // ANATOMY // SICKLE CELL

With coughs and sneezes aplenty in the paediatric emergency department (and that’s just the staff) it’s high time for a winter PEM FOAMed review:

cough   BRONCHIOLITIS BARRAGE

Winter just wouldn’t be winter without an influx of bronchiolitic babies. If you are one of the few in the FOAMed world who hasn’t read @sailordoctor’s incredible piece about bronchiolitis vs viral wheeze (and why salbutamol is useless in bronchiolitis), please do spend some valuable minutes doing so. If you’re looking for a podcast to get you up to speed on RSV, look no further than @EMtogether ‘s offering found here.

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seal   CROUP CASCADE

From RSV to parainfluenza: check out @TREKKca ‘s summary of glucocorticoids for treatment of croup. Bottom line: ALL kids with croup should get a dose of steroid, which should improve symptoms within 6 hours, lasts around 12 hours, and shortens hospital stays by 12 hours.

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sicklecell SICKER SICKLERS

In patients with Sickle Cell disease, Acute Chest Syndrome is a potentially devastating complication not to be missed, and not to be confused with pneumonia (although there can be an overlap.) Find out more in @first10EM ‘s review. See also, from @TheSGEM: which febrile children with sickle cell should get a chest XR?

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bottles   CRP, ESR, WTF?

If you don’t know how to interpret an investigation, you shouldn’t be doing it. This goes for EVERYTHING but I think the most common situation this applies to in the ED is ordering a CRP or ESR… ‘because I’m doing bloods anyway’ (cue rage of nearest consultant). @TamingtheSRU gives us some biochemical background on the acute inflammatory markers – CRP, ESR and procalcitonin – and while it might seem particularly nerdy to know the half life of CRP, it might make all the difference in how you interpret your result in the context of a particular case.

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finger   NAILING IT

@AndyNeill’s ever enlightening anatomy podcast series features the anatomy of the fingertip. If you have seven minutes to spare, watch his video and ‘nail’ (sorry) your next fingertip injury referral to Plastics.

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cast2   SPLINT FINISH

Few things are more satisfying in the ED than applying a really professional looking backslab splint to a fractured arm (and this will also earn you massive brownie points with your nursing team!) Pick up some pointers in this brief video by @PEMtweets.

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nsaids   DOGMALYSIS

‘NSAIDS can delay healing of fractures’… I have to admit I was personally unaware of this particular piece of dogma, but if you have been letting it influence your practice it might be time to stop withholding such a useful analgesic. @LWestafer has crunched the literature and found there is a real lack of evidence of harm in otherwise healthy kids with fractures. There may however be room for caution in those on long term steroids, with osteogenesis imperfecta or with other systemic risks for fracture non-union.

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entsho  ENTSHO

And finally a plug for an excellent ENT website, which is written by UK ENT registrars. It has a wealth of advice regarding most problems that we see frequently in the ED – so if it needs referral, at least you can get further management started before the ENT registrar arrives!

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