Category Archives: Ped EM Section Columns

Firecracker and Blast Injuries

Jonathan Eisenberg, MD

As a child, my father told me a story about his neighbor who had a mishap with a firecracker and blew off the second through fourth digits.  He would then hold out his thumb and pinky and wave to me.  This scared me to such an extent that I still have never lit a firecracker, even during my less frontal lobe-oriented teen years.  I now think that this story was a fabrication—but it is not that far off from its realistic basis.

Fireworks are most popular during the month surrounding July 4th in the US.  These colorful combustibles have been around in the US since July 4th, 1777, and we spend more than $700 million dollars per year on them.  There are many varieties and categories from novelty and daytime fireworks (both generally have smaller explosions) to the larger aerial fireworks and a host of nuanced state laws which allow for an all, some, or none approach to sales. read more

Severe Acute Respiratory Syndrome Coronavirus-2 and Multi-system Inflammatory Syndrome in Children: Preliminary Reports

By Nicholas Pokrajac, MD, Co-editor

What is the Multi-system Inflammatory Syndrome in Children (MIS-C)?

Most children infected with Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) have a mild course of illness.1 However, there have been recent reports of a number of children developing a condition with similarities to Kawasaki disease (KD) and toxic shock syndrome (TSS) within epicenters of the SARS-CoV-2 outbreak, including over 200 children in New York, Italy, and the United Kingdom. This condition has been named the Multisystem Inflammatory Syndrome in Children (MIS-C). As of May 14, 2020, the Centers for Disease Control and Prevention (CDC) recommends reporting of suspected cases to their local or state health departments. This article is a brief summary of preliminary reports on MIS-C to serve as a primer for emergency clinicians. read more

Let’s Talk About Sex

Atsuko Koyama, MD, MPH

As an adolescent and pediatric emergency medicine specialist with an interest in reproductive health, I was asked to write about adolescents and sexually transmitted diseases (STDs). So, I’ve put together a potpourri of important, but not as commonly discussed, issues to help improve adolescents’ and your lives, with two caveats. 1) These are NOT recommendations for sexual assault or child abuse cases. 2) There are apps and websites at the end of this article for further information. These tidbits are more for what to think about when caring for an adolescent who might be sexually active… AKA every adolescent. read more

Update on COVID-19 and Pediatric Patients for Emergency Department Physicians

Written by the Pediatric Emergency Medicine Committee of the ACEP Florida Chapter

The COVID-19 pandemic is rapidly evolving and the healthcare challenges are continuing to increase and evolve. Despite the widespread global incidence and increasing number of cases, the epidemiology and clinical presentation of COVID-19 in pediatric patients is not well understood. The majority of children seen for emergency medical problems in the United States are seen in general emergency departments, not pediatric-specific institutions, and this will likely continue with the current pandemic.  The information below is based on current evidence, and is meant to assist in the evaluation and management of pediatric patients with suspected or confirmed COVID-19. However, it must be noted that new information is available on a daily basis, and the understanding of COVID-19 including the epidemiology, clinical presentation, testing recommendations, and clinical management is subject to change. Additionally, the information below does not pertain nor apply to neonates. read more

Physician wellness: Avoid the midseason burn

Jonathan Eisenberg, MD

It’s winter. The waiting room has had to bring in extra chairs to handle the overflow, and you are likely working your way through your 3rd or 4th URI of the season. The new staffing model for extra help during the busy season worked the first day but has since devolved into an extra doc following up on respiratory panels from last week. People are wearing their emotions as the next patient with a cough/congestion chief complaint gets checked in.

Physician wellness and its counterpart, burnout, are two of the buzzwords that have captured the medical zeitgeist of the past decade. Although they may be a little overused, their importance cannot be overstated—especially in these overworked, sun setting at 2pm, cold days. It has become so important that there is now a physician wellness fellowship at Stanford. Multiple research papers and physician groups have identified the issues that seem to affect us all: EMRs, documentation, patient loads, insurance nightmares, emotional exhaustion, and depersonalization. Some ways to combat burnout and promote wellness are obvious but may not feasible—cutting patient loads, taking a walk during lunch, or outsourcing your more nominal daily activities. But we are emergency medicine physicians, we do not have a say in patient loads, and I feel lucky when I can eat a sandwich at my computer on wheels in between patients (don’t take away our food in the ED…). read more