Pediatric Status Epilepticus
BASICS DESCRIPTION Ongoing generalized tonic clonic seizures > 5 minutes; or Recurrent seizures without recovery of mental status in between; or 3 or more seizures within one hour. EPIDEMIOLOGY Incidence 120-180,000 cases per year in U.S. 4-8 children per 1,000 will experience SE before age 15 RISK FACTORS Epilepsy Fever Developmental delay GENERAL PREVENTION Antiepileptic […]
First Look and Red Flag List
A – Airway, Age of patient Noisy breathing Less than 6 weeks old Allergic reaction B – Breathing Significant difficulty breathing for any reason C – Circulation (blood) Active bleeding for any reason (DO NOT REMOVE BANDAGES) D – Disability (Trauma and neuro) Injury Neck injury Chest and abdominal trauma Fracture with obvious deformity […]
Transient Synovitis
BASICS Transient hip pain presenting with unilateral limp EPIDEMIOLOGY Incidence Most common in school-aged children (ages 3-10) Prevalence 3% of all children Male preponderance RISK FACTORS Usually preceded by a non-descript viral infection PATHOPHYSIOLOGY Hip pain caused by autoimmune synovial irritation ETIOLOGY Post-viral autoimmune inflammation COMMONLY ASSOCIATED CONDITIONS DIAGNOSIS HISTORY Preceding history of viral infection […]
Crying (Excessive Crying in Infants)
ALERTS FINDINGS NOT TO MISS Sepsis Meningitis Intussusception IMMEDIATE CONSIDERATIONS Concern for the above should prompt immediate transfer Consider antibiotics AGE CONSIDERATIONS Infants under < 3 months at highest risk for sepsis/meningitis Intussusception 3mo-3 years DIFFERENTIAL DIAGNOSIS Broad and ranges from serious to benign BENIGN Anal Fissure Colic Corneal abrasion Feeding Difficulties Gas Hair tourniquet […]
Bronchiolitis
Winter is the time for bronchiolitis! There are many diagnostic and pharmacologic interventions that are not recommended by the American Academy of Pediatrics (AAP), but continue to be routinely ordered for patients with bronchiolitis. The AAP 2014 bronchiolitis guideline does not support the use of viral tests, chest radiography, blood cultures, or complete blood counts. […]
Shoulder Subluxation
BASICS DESCRIPTION Subluxation (partial dislocation) or dislocation occurs when the humeral head is displaced from the glenoid fossa of the shoulder Shoulder is prone to subluxation/dislocation because of its inherent instability, particularly anteriorly (90% of subluxations/dislocations occur anteriorly) RISK FACTORS Prior shoulder subluxation or dislocation Contact sports in adolescents PATHOPHYSIOLOGY/ETIOLOGY Anterior dislocation usually occurs when […]
Torticollis
DESCRIPTION Lateral twisting or rotation of neck; also called wryneck This chapter will focus on acquired torticollis, not congenital PATHOPHYSIOLOGY Injury or inflammation of sternocleidomastoid (SCM) or trapezius muscle Most common in school age children Acute infection with referred pain to SCM or compensatory muscle spasm ETIOLOGY Minor trauma/inflammation most common Viral myositis Viral or […]
Septic Arthritis
BASICS DESCRIPTION Infectious inflammation of synovial space that can affect any joint. In children, more commonly progresses to osteomyelitis because of presence of intracapsular metaphyses. RISK FACTORS Recent fractures or injuries can provide an entry point for infection. Consider gonococcal arthritis in sexually active patients. PATHOPHYSIOLOGY Infectious agents enter joint space allowing for infection. Infection […]
Urinary Tract Infection
ALERTS Urosepsis Pyelonephritis STI’s Renal abnormality Testicular Torsion Inguinal Hernia Infants < 2 months Female > male incidence AGE OR PREGNANCY CONSIDERATIONS Infants < 1yr – Urosepsis risk Adolescents – STI risk DIFFERENTIAL DIAGNOSIS Occult bacteremia in febrile infant without source Non-specific vulvovaginitis Urethritis STI – Urethritis/Epididymitis Constipation Vaginal foreign body Group A strep Kawasaki’s […]
Emergencies In Urgent Care
SCOPE OF PRACTICE Defining scope of practice for your Urgent Care will depend on several factors including distance to local emergency department, availability of subspecialty consultation and transport resources. Walk in care offers the advantage of convenience for families, but requires increased vigilance of the provider. While most families are able to recognize emergent conditions […]