I can vividly remember my first day as a REAL doctor. I started on the pediatric pulmonology service, and recall spending what felt like an hour, deliberating whether I could order Tylenol for my patient. Would it interact with the Pulmozyme treatment? Fortunately, I had very patient senior resident who calmed my nerves and was empathetic to my intern anxiety. July is an exciting, terrifying, rewarding and sometimes frustrating month, as we celebrate a new “medical year.” Whether or not you subscribe to the controversial premise of the July effect, there is no doubt that during this time you can leave a pivotal educational footprint in the life and career of a young doctor.read more
Procedural sedation is often required in the pediatric emergency department for a variety of chief complaints, including abscess incision and drainage, fracture reduction, laceration repair and burn management. While there have been numerous advances in the field of procedural sedation as well as updates to practice guidelines, there are often no guidelines for indications for sedation or medications for particular patient types.
Miller et al describes patient care variability in the setting of procedural sedation in the pediatric emergency department. The objective of this study was to describe sedation trends over time as well as to quantify the variation in procedural sedation in terms of rate of use, patient characteristics, indications and choice of agents. A retrospective, cross-sectional study was performed. Data were obtained using the Pediatric Health Information System (PHIS) database. This database contains emergency department, inpatient, ambulatory surgery and observation encounter-level data from 45 tertiary care hospitals in the Unites States. Inclusion criteria consisted of children who presented to a participating emergency department between January 1, 2009 and December 31, 2014 and were younger than 19 years of age. The authors identified patients who would potentially receive procedural sedation based on the following diagnostic categories: fractures, lacerations, abscesses, dislocations, and other (burns, amputations, etc.). Patients with chronic comorbid conditions, patients who received paralytics (these were likely used for intubation) and patients receiving sedation medications in the operating room were excluded. Administration of the following medications were considered to constitute procedural sedation: propofol, ketamine, ketamine and propofol, midazolam and fentanyl, dexmedetomidine, etomidate, chloral hydrate, pentobarbital, methohexital, meperidine, promethazine, and chlorpromazine. Single agent use of an opiate or benzodiazepine was not considered procedural sedation.read more
From conception and design through to production, safety is built into every aspect of every toy before it reaches store shelves – and the hands of children. With about 3 billion toys sold in the U.S. each year (and new toys invented all the time), the toy community is committed to working with pediatricians and other medical professionals, government, consumer groups, and child development experts in the continual review and revision of our country’s most important toy safety standard – ASTM F963, Standard Consumer Safety Specification on Toy Safety.read more
Influenza is a relatively common, usually self-limited and seasonal illness. The influenza season this year has seen quite an impact on multiple populations throughout various parts of the United States. The Center for Disease Control (CDC) has reported that 2018 in particular has been one of the worst in recent history. As we see the confluence of our peak respiratory season for infants, children and teenagers merge with this influenza epidemic, we thought it appropriate to review influenza facts, tips and recommendations.read more
Assistant Professor of Pediatric Emergency Medicine, Emory University
Two years ago one of my colleagues sent a reminder that June 21st is ASK day and that we clinicians should support this day as Pediatric Emergency Medicine Physicians. ASK (Asking Saves Kids) is a day that the American Academy of Pediatrics and the Brady Center to Prevent Gun Violence have promoted to encourage parents to ask about the presence of unlocked guns in the homes where their children play. ASK day is held annually on the first day of summer, a season where children spend a lot of time in the homes of others. As a PEM Physician I am very cognizant of safety. I ensure that my children are always buckled into car seats with whomever drives them, I ask about swimming pools and pets when they visit others homes and ensure that grandparents medicines are put up when we visit. But I had never asked about the presence of unlocked guns in the homes my children visited. I embarked with trepidation and asked the parent of my son’s best friend. After I completed this uncomfortable conversation I began to reflect if this was a difficult conversation for me a pediatric emergency medicine physician who has seen multiple children harmed by firearms imagine the difficulty for other parents without a similar perspective.read more