Category Archives: Cutting Edge PEM

Learn what is hot in the realm of pediatric emergency medicine. What is the latest research say and how might that help you optimize your patient management? What are the latest patient care products? This column will help you and your patients.

DON’T BE BASIC—Caustic Ingestions

Jonathan Eisenberg, MD

It would seem a poor idea to take medical advice from non-medical professionals, for example a president with no formal scientific background, in the realm of toxic and caustic ingestions. Although cola soda should be considered caustic, the true dangers lie mostly underneath the kitchen sink and bathroom. Acid and Base ingestions are reported to be in the range of 5-15 thousand cases per year. There is a bimodal distribution of age groups affected—those under 6 year of age making up a large portion and the other being greater than 21 years of age. The pediatric and adult populations generally have different motivations behind the ingestion—exploration versus self-harm—in the vast majority of cases. Given the difference in volumes ingested in accidental cases, children have lower fatality rates than teenagers or adults. The absence of singular severe symptoms (e.g., oral lesions, vomiting, drooling, dysphagia, hematemesis, dyspnea, abdominal pain) does not reliably indicate future injury or pathology but the presence of three or more symptoms is associated with a higher likelihood of significant injury. read more

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

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

Is it time to rethink fasting times in the emergency department?

Chumpitazi, CE, Camp, EA, Bhamidipati, DR, et al. “Shortened Preprocedural Fasting in the Pediatric Emergency Department.” The American Journal of Emergency Medicine, vol. 36, no. 9, 2018, pp. 1577–1580.

Carmen D. Sulton, MD

The relationship between pre-procedural fasting times and aspiration and/or pulmonary complications are often a topic in anesthesia and sedation literature. In particular, fasting or nil per os (NPO) guidelines for urgent procedures outside of the operating room continue to be vague.  Prolonged fasting times can often be difficult for both emergency providers and families to manage. The American Society of Anesthesiologists (ASA) guidelines focus on 2 hours of fasting for clear liquids and up to 8 hours for full fatty meals. The American College of Emergency Physicians (ACEP) states that procedures in the emergency department (ED) setting should not be delayed based on fasting times alone. Many studies looking specifically at fasting times and adverse events often are under-powered, or may not focus specifically on patients in the ED setting.  read more