Category Archives: Ped EM Section Columns

2nd place Emage Winner: Subgaleal Hematoma beyond the neonatal period

Deepak Choudhary, MBBS, MRCPCH, MD;  Sarah Dipalma, MD; Jessica Strauss, MD; Mary Emborsky, MD; Frank Carnevale, MD

Department of Pediatric Emergency Medicine, Oishei Children’s Hospital, University of Buffalo, New York

A four-year-old African American female presented to our ED with one day history of bogginess of her scalp. The guardian mentioned there were two unwitnessed falls from a trampoline and bunk bed in the last two days. The family denied behavior changes, headache, neck pain, vomiting, numbness or weakness. No bleeding problems were reported by the child or family. read more

1st Place EMage Winner: A Case of the Venomous Arthropod: A Purple Toe?

Dacia J. Ticas, MD;  Cristina M. Zeretzke-Bien, MD

University of Florida College of Medicine, Department of Pediatric Emergency Medicine, UF Health, Gainesville, Florida

A 13-year-old female presented to an outside emergency room (ED) one day prior with a chief complaint of her left great toe turning purple. She denied any weakness or tingling, any shoe tightness, rubbing, or blistering. She presented to the ED again however as symptoms had not improved. The physical exam was only notable for the left great toes’ plantar surface was a deep hue of purple and black. The toe was non-tender, and was not fluctuant or with increased warmth.  The foot and toes had intact sensory and motor function. The dorsal aspect of the foot was unaffected and had an intact nail and nailbed without any visible trauma.  Pulses were palpable. read more

Summertime, and the Kids are Hungry

Author: Danielle L Cullen MD, MPH – Pediatric Emergency Medicine Fellow at Children’s Hospital of Philadelphia

One in five children in the US do not get the food that they need on a daily basis to lead a healthy, active lifestyle. How is it that in a country of wealth and excess, children’s basic needs for life are not being met?

During the academic year, 21.5 million children receive and rely on free and reduced priced school breakfast and lunch as their primary source of nutrition. While summer should be a carefree time of outdoor play, with the absence of school food programs, it is instead too often a time of hunger. Federal Summer Nutrition Programs through the USDA provide meals to children during the summer months. Unfortunately, due to lack of awareness of these programs, they are severely underutilized. Only one in seven children who receive free or reduced-price school meals also participate in summer meal programs.(1)

As emergency medicine providers, we are at the frontline for impoverished and high-risk families.(2,3) We see the real-time evidence of childhood food insecurity: the infants who are failing to thrive because of watered-down formula, the headaches and stomachaches quickly cured by a sandwich, and the obesity related diabetes due to families’ inability to provide healthy food for their children. We educate families on the importance of appropriate formula mixing, breakfast, and healthy food choices, but without providing the means to obtain enough healthy food on a regular basis, our counseling is wasted.

This summer we can do something different. We can connect families with the programs that they need. If you suspect that your patients are struggling with hunger, ask about it, and find out about the resources available. You or your patient can text “Food” to 877-877 to find free summer meals in your area a help kids get the food that they need to play, grow, and return to school ready to learn.

 

1. Food Research and Action Center, Hunger Doesn’t Take a Vacation: Summer Nutrition Status Report 2016

2.  Hirshon JM, Morris DM. Emergency medicine and the health of the public: the critical role of emergency departments in US public health. Emerg Med Clin N Am. 2006;24(4):815–819.
3. Rodriguez RM, Fortman J, Chee C. Food, shelter and safety needs motivating homeless persons’ visits to an urban emergency department. Ann Emerg Med. 2009;53(5):598–602.

WEIGHING CHILDREN IN KILOGRAMS FOCUS OF NEW PEDIATRIC READINESS INFOGRAPHIC

Author: Kathleen Brown, MD – Children’s National Health System

The Federal Emergency Medical Services for Children (EMSC) Program recently released an infographic based on data from the National Pediatric Readiness Project assessment. The infographic states the importance of weighing children and recording the weight in kilograms, based on a patient safety recommendation from the “Guidelines for Care of Children in the Emergency Department.1

In its report Emergency Care for Children: Growing Pains, the Institute of Medicine also highlighted the need for physicians and other practitioners to weigh children and to record the weight in kilograms only.2 However, the Pediatric Readiness assessment revealed that half the hospitals in the nation do not weigh and record in kilograms. This simple patient safely initiative has been recognized as one of the most important to prevent drug-dosing errors and is one of the top 15 national hospital-based pediatric emergency care performance measures.3 read more