Category Archives: Ped EM Section Columns

It’s July, again

Maybelle Kou MD, Fellowship Director, The Altieri PEM Fellowship at Inova Children’s Hospital.

For some medical educators June and July can conjure up feelings reminiscent of Bill Murray’s character in the movie “Groundhog Day”. You’ve probably laughed at the scenes where he goes to extremes of self- injurious behavior before waking up the next morning in exactly the same place. No matter what time of year, this can feel like a daily ritual in the Emergency Department. The environment is massively complex with patient and practitioner variability, team interpersonal dynamics, regulatory and local administrative mandates,  all of which contribute to the chaos. Add workforce regulations and it seldom seems as though one works with the same learner more than once or twice during a rotation. 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

Medical Training & Physician Wellness: No More Drowning

Recent studies have shed light on a concerning trend among physicians in-training:   un-wellness.  This is manifest in increased burnout, depression and suicide rates seen among those undergoing medical training when compared to other professions. This crisis becomes cyclic when physicians with low baseline levels of wellness are unable to give optimal patient care, which in turn detrimentally influences their poor levels of wellness.  Historically physician wellness has not been a focus of medical training.  New endeavors are hampered by inadequate structure, funding and resources. 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