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.

Management of Aggression in Emergency Departments is more than just PRNs

Anik Jhonsa, MD

In recent years pediatric emergency departments have seen a dramatic rise in the number of children and families presenting seeking mental health treatment.  As a child and adolescent psychiatrist primarily working in the emergency room, I’m often asked by my Emergency Medicine colleagues to develop an “agitation plan” for patients who are deemed at risk of acting out in an aggressive manner.  Most often these requests tend to focus on the PRN medication plan should a child become aggressive or upset.  However, most successful agitation plans begin well before any medication needs to be administered. read more

A Case for Ketofol in the Pediatric ED

Imagine it’s a warm day in June when an 18-month old male with a complicated facial laceration involving the oral mucosa from a dog bite presents to your emergency department (ED). His parents are requesting that his lacerations be repaired by a plastic surgeon.   You recognize their concern and are happy to oblige. You want to ensure the best outcome so you decide to do procedural sedation for the repair. You reach for your handy dandy procedural sedation hammer Ketamine. However, while your patient has obviously achieved a dissociative state, he seems to be periodically moving and tongue thrusting. Your consultant is not very pleased at that thought of attempting a delicate repair on a moving child. What can be done? read more

Toxicology Notes: Considerations for Cyanide Treatment in the Emergency Department

While working the overnight shift a child is brought in to your emergency department from a house fire. His burns are minor, but he was found in the house and likely had a significant smoke inhalation. The paramedics have started oxygen therapy, and as an astute emergency physician you add a blood gas with cooximetry, lactate and cyanide level to your initial orders. You are preparing to administer the CYANOKIT (hydroxocobalamin) but you pause for a moment to ask, “Should I be sending additional labs before I give this medications? Will this affect management in the next 24 hours? Are there other options?” read more

Emergency management of concussion in children: How much rest is too much?

March has arrived and the temperatures in the northeast are rising. With the warm weather come spring and summer sports seasons, and a new batch of concussions in the pediatric and young adult populations. Nearly 4 million sports-related traumatic brain injuries occur each year. The number of children seen in emergency departments for concussion has nearly tripled in the past decade. Over the past 10 years, concussion safety laws have been passed in every state, requiring that children be seen by a medical professional prior to returning to sports. As our awareness of the diagnosis of concussion increases, more and more children will continue to present to emergency departments across the country. read more

Find your Coach’s Cap

Michael Greenwald, MD
Associate Professor, Pediatrics and Emergency Medicine
Emory University/Children’s Healthcare of Atlanta

Physicians wear many hats. At times we are teachers and other times psychotherapists. We are asked to diagnose and also to counsel. With experience each of us learns when to switch hats. But there is one important role that we sometimes fail to recognize and embrace: the role of “coach.”

Coaching is very similar to teaching but there are important differences. read more