updating site

I'm working on changing this over to a website. The blog (with regards to new posts) will be down for the next 1-2 weeks. Thanks for your patience.

Dealing with patient death

A legendary patient died in our ED last night. Some of our providers cared for this child as Interns and then as Residents and now as an Attending. Personally, I cared for him during my PICU rotation as a Fellow. When we were done, I realized that most of our nurses and staff were involved in the resuscitation, not because we needed the extra hands, but because they know the family and wanted to be there for support. While the concept of parents or family members being present during resuscitations is controversial, I personally support it completely. My belief was again confirmed by watching this young boy's family find comfort in knowing that everything possible was done for their son. In the end, they chose to stop the resuscitation and we supported their decision.

Check out: Knazik SR - The death of a child in the Emergency Department. Ann Emerg Med - 01-OCT-2003; 42(4): 519-29

I digress

In addition to this blog, I have started to do some writing for the AAP COCM site. While working on this month's contribution, I learned about National Stay at Home Week. Initially, it sounded like a nice idea, must be an event to encourage family activity, right? I couldn't have been more wrong. This is an add campaign by ABC to encourage people to stay home, in front of the TV and watch their new Fall line-up. Gross!

I encourage everyone to stay at home, turn the TV off and talk with your family. Maybe have a week of family Olympics (games, reading, cooking dinner competitions, etc.)

My work also brought me to an interesting article about the use of the Internet to help prevent violence among teens. Check out Walton et al. Internet Referrals for Adolescent Violence Prevention: An Innovative Mechanism for Inner-city Emergency Departments in this month's Journal of Adolescent Health.

The study is very limited and advancing the groundwork started in this investigation would make a great PLC project for one of our Residents!

Overcrowding

(Providers) No time for blogging recently as we have been incredibly busy in our local Peds ED. It is easy to complain about the people who are not really sick and should be visiting their primary care physician instead of coming to the ED. However, lately, we have seen an amazing number of truly sick children in need of emergency care. They say that misery loves company. I found this nice review of the overcrowding experiences nationwide. At least it is nice to know that we are not alone in this.

Check out: Systematic Review of Emergency Department Crowding: Causes, Effects, and Solutions. Annals of Emergency Medicine - Volume 52, Issue 2 (August 2008)

Child Abuse

(Providers) Some topics are important to review time and time again. Management of suspected child abuse is one of those topics.
Let's review some of the basics:
As health care providers, we are mandated reporters of suspected abuse. This does not mean that we have to prove that abuse occured, just that we have a concern. If you think you might need to report something, then you probably should be reporting it.
Locally, we have the REACH clinic with providers on-call 24 hours per day. They prefer to hear about cases sooner versus later so, do not hesitate to call the REACH provider.
If you are seeing a patient in a clinic or off site facility, you need to ensure they reach the ED/Hospital for evaluation. This might mean an ambulance ride to the ED, but at least you know they will arrive at the intended destination.
Nationwide, neglect is the most common type of abuse.

There are many articles on the topic. A relatively new one that provides for an interesting take on the evaluation of suspected abuse is Campbell, K.A., et al., Cost-effectiveness of Head Computed Tomography in Infants With Possible Inflicted Traumatic Brain Injury. Pediatrics, 2007. 120(2): p. 295-304.

I'm back

I apologize for the lack of postings over the past month. However, the new academic year is underway and the site will be back up and running. Welcome to the new Residents. We hope you enjoy your experience in the Pediatric ED!

EMS week

This is national EMS week, which this year includes a Pediatric EMS day. Most of your local agencies will be hosting open house celebrations. This is a great time to review summer safety with your children (practicing home fire drills is always a good idea too!). Take time to thank those in your area that give their time to help provide for a safe community.

Articles

(Providers)
Acute Abdomen
Leung AKC, Sigalet D. Acute Abdominal Pain in Children. Am Fam Physician. 67:2321-6, 2003.

Congenital Heart Disease
Savitsky E, Alejos J, Votey S. Emergency department presentations of pediatric congenital heart disease. Journal of Emergency Medicine. 24 (3): 239-245, April 2003.

Croup
Bjornson CL. Johnson DW. Croup. Lancet. 371(9609):329-39, 2008 Jan 26.

Common Pediatric Fractures
Kleigman et al. Nelson Textbook of Pediatrics, 18th edition. Chapter 682 – Common Fractures. (Copied and saved as a word document and also available online from MDConsult.com)

It's Spring

(All) So Spring is here again (we're never sure it will arrive to upstate NY) and the lawnmowers were in full gear this past weekend. I couldn't help but remember some of the worst trauma cases I've seen over the years, children injured by lawnmowers and tractors. We know that approximately 9400 children (those under 18 yrs) are seen in the ED every year for mower-related injuries (AAP statistics, American Academy of Pediatrics). About one quarter of those children are less than 5 years old. Surprisingly, only 20% are due to riding mowers, the rest are from the walk-behind models!

As with most things Pediatric, prevention is the key. The AAP suggests the following:

• Children under 6 years of age should stay inside while a mower is in use.
• Children should not be allowed to ride as a passenger on a mower and they should not be permitted to play on the mower when it is in storage.
• Children should be at least 12 years old to operate a walk-behind mower and 16 years to operate a riding mower

Did you know that most riding mowers can cut while in reverse! Removal of this feature would go a long way in reducing the number of injuries. After all, do you really need to cut the grass while going backwards?

Here we go......

So what is this blog all about? My hope is that it provides information for both medical providers (especially those in training) and parents. To make life a little easier, I will mark each post indicating the best audience (Providers, Parents, All).

For the Residents using this site: Your reading list will be updated periodically. It will be listed under the title articles (not very creative, I know). Feel free to post any questions that you may have. Remember that this is a semi-public site and therefore patient information must be anonymous.

Let's get started....

Disclaimer

This site is not intended to represent a patient-physician relationship. Under no circumstances should the information presented be used to replace the information obtained from your personal physician. The authors assume no liability with regard to the use of the information contained on this site.