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 […]
Ear Pain
ALERTS Mastoiditis Perforated TM Persistent or recurrent OM AGE CONSIDERATIONS Otitis Media: infant, toddler >school age, adolescent DIFFERENTIAL DIAGNOSIS Ear foreign body Otitis Externa Otitis Media Parotitis Referred pain from oropharynx or teeth Temporomandibular joint pain EVALUATION HISTORY Onset and quality of pain, associated fever, URI, ear drainage, ear trauma, recent activities (i.e. swimming) PHYSICAL […]
Toddlers Fracture
EPIDEMIOLOGY OF TIBIAL SHAFT FRACTURES 15 percent of all pediatric fractures are in the tibial shaft 39% tibial fractures are in diaphysis 30% associated with fibula fracture TODDLERS FRACTURES Non displaced spiral or oblique fracture of tibial shaft only (fibula remains intact) Also known as CAST fracture (childhood accidental spiral tibial fracture) Usually low energy […]
Croup
ALERTS Epiglotitis Bacterial tracheitis Peritonsilar/Retropharyngeal abscess Foreign body Anaphylaxis/allergic reaction Upper airway injury Congenital anomalies AGE OR PREGNANCY CONSIDERATIONS ≤ 4years = Typical presentation Chronic croup can remain in older children DIFFERENTIAL DIAGNOSIS Epiglotitis Peritonsilar/Retropharyngeal abscess Laryngomalacia Foreign body Anaphylaxis/allergic reaction Upper airway injury EVALUATION HISTORY Onset and timing of cough, presence of stridor and […]
Sore Throat
ALERTS Peritonsillar abscess Retropharyngeal abscess – <4yrs Epiglottitis Foreign body Trauma AGE CONSIDERATIONS Strep pharyngitis risk – >2yrs Gonococcal & Chlamydial pharyngitis – Adolescents DIFFERENTIAL DIAGNOSIS Viral pharyngitis Herpangina Coxsackie GABHS pharyngitis EBV Post-nasal drip Gonococcal pharyngitis Chlamydia pharyngitis Peritonsillar abscess/cellulitis Retropharyngeal abscess GERD Epiglottitis PFAPA syndrome (Periodic fever, Aphthous ulcers, Pharyngitis, & cervical adenitis) […]
Headache
ALERTS Cerebral anuerysm Meningitis Encephalitis Abscess Brain Tumor Sinus Venous Thrombosis AGE CONSIDERATIONS Toddlers: may manifest as irritability Unusual complaint in younger children DIFFERENTIAL DIAGNOSIS Tension Migraine Cluster ENT infection (otitis, sinusitis pharyngitis, viral infection,etc) Meningitis Psychogenic Seasonal allergies Vision change- need for glasses Brain tumor Pseudotumor Hypertension Toxins (Carbon monoxide, medications, drugs) Head trauma […]
Foreign Body Ear
ALERTS Button Batteries need immediate removal Sharp object such as glass can lacerate canal Live insects can cause extreme discomfort Food items absorb moisture which can lead to inflammation/infection AGE Typical age between 3 and 8 years DIFFERENTIAL DIAGNOSIS Cerumen impaction Abrasion to ear canal Otitis Externa Tumor EVALUATION History Patient may admit to placing […]
Limp
BASICS DESCRIPTION Limp- either painful (antalgic gait) or nonpainful (Trendelenburg gait) Differential diagnosis can be organized by location, age and duration of symptoms or type of gait abnormality RISK FACTORS Trauma, infection, neoplasia and rheumatologic disorders produce antalgic gait Congenital, developmental or muscular disorders produce Trendelenburg gaits PATHOPHYSIOLOGY Antalgic gait has a shortened stance phase […]