Opioid Policies and Pediatrics: When the Pendulum Swings Children Will Get Hurt

Even if you have turned off all news sources over the past two years, it would be hard to escape the urgent alarms regarding opioid misuse in the US.  The statistics are remarkable.

  • Since 1999, overdose deaths involving opioids quadrupled.1
  • 2000-2015: greater than half a million people died from drug overdoses.
  • 91 Americans die every day from an opioid overdose.
  • 1999 to 2010: number of prescription opioids sold to pharmacies, hospitals, and doctors’ offices nearly quadrupled. 2,3

This is compelling evidence that we have a problem—perhaps some more than others.  Opioid addiction is a frequent challenge for those caring for adults in the Emergency Department with some centers (e.g., rural) seeing more of this than others. Those who care for injured and ill children are left with two important questions:  (1) What is the evidence regarding opioid addiction in children? (2) To what extent is the management of acute pain in the Emergency Department contributing to an increase in opioid related morbidity and mortality? read more

From the Chair

Has it been a month since ACEP already?

Inconceivable.

As the days shorten and we move into the winter holiday season, most of us take some time to reflect upon the year and take stock of where we are and where we will head come January 1st.

For myself, this happens to include the pediatric emergency medicine section.

Mike Greenwald, the outgoing chair, has really gotten me off to a great start with the formation of workgroups/subcommittees.  We will use these groups, Education, Research, Advocacy, and Clinical/Quality to generate new microsite content, produce section grants and leverage as outreach for new members. read more

Help support the thousands of children affected by Hurricane Harvey

The EMS for Children Innovation & Improvement Center recently reached out to the Texas Pediatric Society Foundation (TPSF) to request that they set up an Emergency Relief/Recovery giving category targeting the special needs of children post disaster. The mission of the TPSF is to enhance the well-being of Texas children by supporting efforts to help improve their health, safety and education and to make a positive impact on their lives and futures.

The funds collected by the TPSF for Emergency Relief/Recovery will be provided in the form of grants to emergency relief and recovery efforts conducted by physicians, community advocates and other child advocacy organizations in Texas during times of a natural disaster such as a hurricane, flood, fire, earthquake and other emergency events. To find out more about the TPSF visit their website at https://txpeds.org/tps-foundation. To make a donation to the TPSF Emergency Relief/Recovery giving category use the online form. read more

First Place: White Hair and Big Belly

Ryan J Reichert, MD, PGY3

Stephanie F Moses, DO PEM Fellow PGY6

Case Presentation:

6-day-old term Haitian male presented to the Emergency Department (ED) for abdominal distension. Per mother, the patient was born at home and delivery was uncomplicated. History revealed the patient was able to pass stool and urinate in the first day of life. He tolerated frequent breastfeeding until day of life 3 when he developed increased fussiness, feeding intolerance, and constipation without emesis. Abdominal distension developed and increasingly worsened over the next 48 hours. Although there were no prenatal medical visits, mother stated that there were no fevers or known infections during pregnancy. read more

Second Place: Generalized Flushing Followed by a Bulla

Patrick McLaughlin, MD, MS

Case Presentation

A three month old male born at 39 weeks gestation, with a history of a possible seizure disorder, presents two hours after a large fluid-filled lesion developed on his left forearm. Immediately before he developed this lesion his entire body became red and flushed for 15 minutes then spontaneously resolved. The fluid-filled lesion shown developed on top of a skin lesion that had previously been present since 1 week of life. At 2 months of age he experienced these exact symptoms for which he was hospitalized overnight at another institution. During that admission, the bulla’s fluid was cultured for bacteria but was negative for growth. He completed a 10 day course of oral clindamycin and topical mupirocin without resolution of the lesion. Family denies any fever, purulence from the lesion, sick contacts, burns, pets or changes in the patient’s behavior. read more