Abdominal
Hom J, Kaplan C, Fowler S, Messina C, Chandran L, Kunkov S. Evidence-based diagnostic test accuracy of history, physical examination, and imaging for intussusception: a systematic review and meta-analysis. Pediatr Emerg Care 2020 Sep. doi: 10.1097/PEC.0000000000002224. Epub ahead of print. PMID: 32941364.
- According to Hom et al., when the combination of crying, abdominal mass, pallor, and vomiting was present, the odds of intussusception was ___________________%. When only abdominal mass was present the odds were ___________________%.
- ___________________ showed the highest diagnostic test accuracy among all diagnostic elements.
- When compared to radiology-performed ultrasound, point-of-care ultrasound had ___________________ accuracy.
High-Risk Pediatric Emergencies
- In children with Severe Acute Respiratory Syndrome Coronavirus 2, ___________________ and ___________________ were the most common radiologic findings.
- Children of any age infected with SARS-CoV-2 were noted to have ___________________ symptoms.
Edwards BL, Dorfman D. High-risk pediatric emergencies. Emerg Med Clin North Am 2020 May;38(2):383-400. doi: 10.1016/j.emc.2020.01.004. PMID: 32336332.
- More than half of all pediatric malpractice cases arise from the ___________________.
- The most common diagnoses included in ED malpractice claims in 0 to 2 year-olds is ___________________, 6 to 11 year-olds is fractures, and in 12 to 17 year-olds is ___________________.
Medication Dosing Safety
Pediatric Committee of NAEMSP adopted by NAEMSP Board of Directors. Medication dosing safety for pediatric patients: recognizing gaps, safety threats, and best practices in the emergency medical services setting. A position statement and resource document from NAEMSP. Prehosp Emerg Care 2021 Mar-Apr;25(2):294-306. doi: 10.1080/10903127.2020.1794085. PMID: 32644857.
- As many as ___________________% of pediatric patients have an inaccurate weight estimate in the out-of-hospital setting.
- Commonly used length-based tapes may result in ___________________ of patient weights, with attendant errors in medication dosing.
Pain Management
Oliveira J E Silva L, Lee JY, Bellolio F, Homme JL, Anderson JL. Intranasal ketamine for acute pain management in children: a systematic review and meta-analysis. Am J Emerg Med 2020 Sep;38(9):1860-6. doi: 10.1016/j.ajem.2020.05.094. PMID: 32739857.
- Compared to intranasal fentanyl, intranasal analgesic dose ketamine has been found to be as ___________________ in the management of moderate to severe acute pain for children in the emergency department.
- A recent meta-analysis showed that children who received intranasal ketamine experience ___________________ the rate of non-serious adverse events compared to children who received fentanyl.
Pediatric Resuscitation
Sanders JE, Spina LA. Supraglottic airway devices for pediatric airway management in the emergency department. Pediatr Emerg Med Pract 2020 Oct;17(10):1-20. Epub 2020 Jul 2. PMID: 33001595.
- Supraglottic airways are a group of airway devices used to secure a patient’s airway or as an aid to facilitate ___________________.
- Many children with a history of difficult intubation have a ___________________ or ___________________ known to be associated with a difficult airway.
- For pediatric out-of-hospital cardiac arrest, advanced airway interventions offered ___________________ outcome advantage over bag-mask ventilation.
- Critical post cardiac arrest care should include ___________________.
- In nonshockable rhythms, early administration of ___________________ showed increased survival.
Rash and Fever
Philopena RL, Hanley EM, Dueland-Kuhn K. Emergency department management of rash and fever in the pediatric patient. Pediatr Emerg Med Pract 2020 Jan;17(1):1-24. Epub 2020 Jan 2. PMID: 31855328.
- Most well-recognized childhood exanthems are caused by ___________________ etiologies.
- When a pediatric patient presents to the emergency department with fever and rash, the first step is to determine whether ___________________ precautions are needed.
Sepsis
Cruz AT, Lane RD, Balamuth F, Aronson PL, Ashby DW, Neuman MI, et al. Updates on pediatric sepsis. J Am Coll Emerg Physicians Open 2020 Jul;1(5):981-93. doi: 10.1002/emp2.12173. PMID: 33145549.
- The most common pathogen affecting previously healthy children with sepsis is ___________________.
- Early ___________________ is critical to reversing shock in pediatric patients and antibiotics should be administered ideally within ___________________ of recognition.
- In children with suspected sepsis and access to intensive care fluid administration, guidelines suggest ___________________.
- Administration of antibiotics for sepsis should be ___________________ over other interventions such as fluid boluses, antipyretics, and lactate measurement.
Social Determinants of Health
Janeway H, Coli CJ. Emergency care for transgender and gender-diverse children and adolescents. Pediatr Emerg Med Pract 2020 Sep;17(9):1-20. Epub 2020 Sep 2. PMID: 32805092.
- An ED-specific survey of transgender patients showed that ___________________% of transgender patients avoided the ED and ___________________% had specifically negative experiences.
- While caring for TGD patients, many will not want to use their given name and refer to it is as their ___________________.
- Studies show that adolescent TGD youth have a much higher rate of ___________________.
Trauma
Boutis K. The emergency evaluation and management of pediatric extremity fractures. Emerg Med Clin North Am 2020 Feb;38(1):31-59. doi: 10.1016/j.emc.2019.09.003. PMID: 31757254.
- ___________________ should be considered in any infant who is not walking and presents with a fracture.
- The ligaments of children are ___________________ compared to adults and can tolerate mechanical forces better than the ___________________.
Solove M, Benedict FT. Ankle injuries in the pediatric emergency department. Pediatr Emerg Care 2020 May;36(5):248-54. doi: 10.1097/PEC.0000000000002097. PMID: 32355069.
- In the examination of an injured ankle in a pediatric patient, a positive anterior drawer test is demonstrated by ___________________ anterior displacement of the heel compared to the uninjured ankle.
- Ankle sprains benefit from early initiation of ___________________.
Abdominal
- According to Hom et al., when the combination of crying, abdominal mass, pallor, and vomiting was present, the odds of intussusception was 95%. When only abdominal mass was present the odds were 21%.
- Point-of-care ultrasound (POCUS) showed the highest diagnostic test accuracy among all diagnostic elements.
- When compared to radiology-performed ultrasound, point-of-care ultrasound had comparable accuracy.
High-Risk Pediatric Emergencies
- In children with Severe Acute Respiratory Syndrome Coronavirus 2, bronchial thickening and ground glass opacities were the most common radiologic findings.
- Children of any age infected with SARS-CoV-2 were noted to have mild symptoms.
- More than half of all pediatric malpractice cases arise from the emergency department.
- The most common diagnoses included in ED malpractice claims in 0 to 2 year-olds is meningitis, 6 to 11 year-olds is fractures, and in 12 to 17 year-olds is disorders of male genitalia.
Medication Dosing Safety
- As many as 20% of pediatric patients have an inaccurate weight estimate in the out-of-hospital setting.
- Commonly used length-based tapes may result in underestimation of patient weights, with attendant errors in medication dosing.
Pain Management
- Compared to intranasal fentanyl, intranasal analgesic dose ketamine has been found to be as efficacious in the management of moderate to severe acute pain for children in the emergency department.
- A recent meta-analysis showed that children who received intranasal ketamine experience twice the rate of non-serious adverse events compared to children who received fentanyl.
Pediatric Resuscitation
- Supraglottic airways are a group of airway devices used to secure a patient’s airway or as an aid to facilitate endotracheal intubation.
- Many children with a history of difficult intubation have a syndrome or congenital abnormality known to be associated with a difficult airway.
- For pediatric out-of-hospital cardiac arrest, advanced airway interventions offered no outcome advantage over bag-mask ventilation.
- Critical post cardiac arrest care should include targeted temperature measurement.
- In nonshockable rhythms, early administration of epinephrine showed increased survival.
Rash and Fever
- Most well-recognized childhood exanthems are caused by viral etiologies.
- When a pediatric patient presents to the emergency department with fever and rash, the first step is to determine whether isolation precautions are needed.
Sepsis
- The most common pathogen affecting previously healthy children with sepsis is Staphylococcus aureus.
- Early diagnosis is critical to reversing shock in pediatric patients and antibiotics should be administered ideally within one hour of recognition.
- In children with suspected sepsis and access to intensive care fluid administration, guidelines suggest 40 to 60 mL/kg in 10 to 20 mL/kg boluses over the first hour.
- Administration of antibiotics for sepsis should be prioritized over other interventions such as fluid boluses, antipyretics, and lactate measurement.
Social Determinants of Health
- An ED-specific survey of transgender patients showed that 21% of transgender patients avoided the ED and 52% had specifically negative experiences.
- While caring for TGD patients, many will not want to use their given name and refer to it is as their deadname.
- Studies show that adolescent TGD youth have a much higher rate of suicidal ideations, nonsuicidal self-injury, and suicide.
Trauma
- Abuse should be considered in any infant who is not walking and presents with a fracture.
- The ligaments of children are stronger compared to adults and can tolerate mechanical forces better than the physis.
- In the examination of an injured ankle in a pediatric patient, a positive anterior drawer test is demonstrated by greater anterior displacement of the heel compared to the uninjured ankle.
- Ankle sprains benefit from early initiation of range-of-motion exercises.