Category Archives: Ped EM Section Columns

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

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

Third Place: Not Just Your Typical Newborn Rash

Matthew Cully, DO

Benjamin F. Jackson, MD

A three-day-old term female infant presented to the emergency department with a two-day history of rash to the back of her right leg. The family noticed the rash shortly after hospital discharge and described the rash first as just a few red spots. However, the following day, the rash spread on her right leg and was now described by the family as multiple red and fluid filled spots. No maternal history of herpes simplex virus (HSV) or varicella at time of delivery. The infant was otherwise well, afebrile with appropriate waking, alertness, a3rd Place Pic 1ppetite, voiding and stooling. On physical examination, she appeared well, active and in no acute distress. A linear, vesicular rash with surrounding erythema extended from right posterior mid shin to upper thigh (Image 1 and 2). Pediatric dermatology was consulted and a full neonatal sepsis evaluation including urine, blood and cerebrospinal fluid (CSF) was performed. read more

An Emergency Medicine Program for High School Students: My Experience.

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Jason Lowe DO

Assistant Clinical Professor

Stanford University

Department of Emergency Medicine

I would like to tell you that you have inspired me to change my career goal from being a cardiologist, to an ER doctor. I want to help people when they need it most urgently. When I grow up, I want to be just like you. –Kashika Bharol

In the summer of 2016, I was approached with an opportunity to do something completely out my scope of practice and I said yes.

No, I was not asked to initiate ECMO on an emergency department patient. read more