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
Two-month-old male presented with unknown duration of respiratory distress. He had been “breathing fast since birth” with no acute fevers, vomiting, or sick contacts. Review of systems is notable for diffuse muscle weakness and chronic coughing with feeds. Developmental history is significant for lifelong decreased movement and inability to lift head when prone. No family history of motor delay or decreased tone.
Vitals: afebrile, HR 163, RR 68, PO2 92%. Patient is ill-appearing with minimal response to tactile stimuli. The evident tachypnea is associated with increased abdominal muscle use with retractions and grunting. Neurological exam has open, flat, anterior fontanelle with profound head lag and “frog-legging” of lower extremities. Deep tendon reflexes cannot be elicited. Skin exam is negative for rashes or hematomas.read more
Recently, the lay press reported a promising breakthrough in decreasing the frequency of peanut allergies in children at high risk for peanut allergy by early introduction of peanuts. (1) In the study “peanuts” were introduced to infants between the ages of 4 and 11 months. (1) The research shows promise to combat the increasing prevalence of peanut allergy in Western countries. (1) Although, not discussed in news reports, the peanut product given to infants in the study was not whole peanuts. Infants were given “Bamba,” a peanut butter flavored puffed maize product. (1) Some news reports, although not all, discussed that early introduction of peanuts should be done under a physician’s care. The general public should also be reminded about the choking risk of peanuts especially in children 3 and under and that babies in this study were not given whole peanuts. Choking is a leading cause of mortality and morbidity in children 3 and under with food, toys and coins most often the culprits. (2) Small children are vulnerable to choking in many ways. A child’s airway occludes easily with small objects because of the small diameter of the airway and young children often can’t cough with enough force to dislodge a foreign body. (2) Additionally until molars erupt, children are unable to sufficiently chew food into smaller portions adequate for swallowing. (2) Finally, even though children at age 3 to 4 have molars, they are still learning to chew and are easily distracted which can lead to choking. (2) Approximately 1 child every 5 days in the United States dies from choking on food. (2) High risk foods for choking include hot dogs, hard candy, peanuts, nuts and seeds, whole grapes, raw carrots, apples, popcorn, marshmallows, chewing gum and globs of peanut butter. (2) In conclusion, lets take this opportunity to educate the public regarding choking risks in children along with enthusiasm for promising research on peanut allergy prevention.read more
After years of steady decline in smoking among young people, we are now seeing a significant rise in the use of e-cigarettes or “vaping.” In December the AAP, AAFP, ACP, and ACOG joined the AMA in issuing a public statement of support for a Surgeon General report highlighting the increased use and dangers of e-cigarettes in young people. At the same time there is a widespread counter message seen in advertisements and social media claiming the benefits of e-cigarettes and attacking the efforts of the CDC, Surgeon General and FDA. All physicians should become educated about the issues and be prepared to discuss them with their patients. What are the facts?read more
Just a few weeks after the 2016 ACEP Scientific Assembly and I’m still enjoying the academic high I get after the conference each fall. So many terrific speakers and topics—and I’m very grateful to have access to their slides as I struggle to recall their many pearls of wisdom. From the high fidelity Code Black simulations to my final session “Wilderness Medical Improvisation: What Would MacGyver do?” I couldn’t get enough.
Equally inspiring was the turnout for our annual section meeting. We had such a diverse group taking the time to meet after a long day of lectures. Our section enjoys the continuity of veterans such as Madeline Joseph, Sharon Mace, and Lee Benjamin, as well as newer faces such as Jessica Wall, Kurtis Mayz, and Nadia Pearson. The Pediatric section is remarkable not only because of its robust numbers (over 900!) but because of its diversity and welcoming atmosphere. This is a great way to get involved in addressing the challenges we all face in caring for children in emergency medicine.read more