Avoiding Common Errors in Pediatric Emergency Medicine

CONTENTS
Contributors vi
ace xxv
THE CRASHING PATIENT 1
1 Overlooking the Basics and Focusing on Medications That Do Not
Matter During Pediatric Codes ............................................ 1
Michael S. Mitchell, MD and Crick Watkins, DO
2 Placing Provider Comfort Over Family Presence ............................ 2
Michael S. Mitchell, MD and Sarah Bingham, MD
3 Overlooking Opportunity to Help the Family by Saving Crucial Evidence ....... 4
William E. Hauda II, MD, FACEP , FAAP
4 Epinephrine 1:10 000 vs 1:1000: Are You Prepared to Make Sense of This? ........ 5
Samuel J. Spizman, MD, FAAP
IMAGING 7
5 Do Not Scan Head Trauma Based on Your “Gut”—Use Evidence-Based
Guidelines! ............................................................. 7
Anna Schlechter, MD, FAAP
6 Negative Scan—Positive Belly: Do Not Rely Solely on the CT Scan When
Evaluating Children With Blunt Force Abdominal Trauma ................... 8
Anna Schlechter, MD
7 Appreciate Practice Differences in the Approach to Pediatric Nontraumatic
Abdominal Pain ........................................................ 10
Paul Schunk, MD, FAAEM
8 Neuroimaging of Nontrauma Patients..................................... 11
Lekha Shah, MD, FAAP , FACEP
9 To CT or Not to CT: Develop Good Imaging Strategy........................ 13
Stephanie G. Cohen, MD
10 Know the Options: Imaging Modalities for Pediatric Neck Masses ............ 14
Naghma S. Khan, MD, FAAP , FACEP and Kina Le Goodman, MD, FAAP
11 Advanced Imaging—MRI in Children ..................................... 16
Matthew Moake, MD, PhD
12 Pediatric Lung POCUS: An Underutilized Tool for Pediatric Pneumonia ...... 17
Erin Munns, MD13 Do Not Apply the Adult FAST Criteria to Pediatric Trauma Patients ......... 18
Anthony Arredondo, DO, FAAP
14 Cardiac POCUS: Be Able to Distinguish Pericardial Effusions From Their
Mimics ............................................................... 20
Daniel Slubowski, MD
15 Scan First, Irradiate Second: The Error in Jumping to Computed
Tomography........................................................... 21
Robert Vezzetti, MD, FAAP , FACEP
16 Skin and Soft Tissue Infections: Fifty Shades of Grayscale................... 23
Jason Gillon, MD, FAAP
¦ ENVIRONMENTAL/TOXICOLOGY 25
17 Errors to Avoid: Overlooking Potential for Lung Injury in Children
Who Appear Well....................................................... 25
Chad D. McCalla, MD and Ryan J. Reichert, MD
18 Not Aggressively Treating the Hypothermic Drowning Victim ............... 26
Emily Rose, MD, FAAP , FAAEM, FACEP and Mark Zhang, MD
19 Drowning Prevention—Missing the Opportunity to Teach: Prevention
When the Near-Miss Events Happen ...................................... 28
Nicole Barbera, DO and Frederick Place, MD, FACEP , FAAP
20 When Small Bites Matter: The Deadly Potential of a Pill .................... 30
Ryan D. Brown, MD, FAAP and Mary Asal, MD, MPH, FAAP
21 Activated Charcoal: Avoiding Worthless Usage of a Valuable Therapy ......... 32
Jessica Kraynik Graham, MD and George Sam Wang, MD, FAAP , FAACT
22 Underestimating the Damage a Simple Laundry Detergent Pod Can Cause .... 33
David Muncy, DO and Craig T. Carter, DO
23 Not Having a Plan to Safely and Effectively Cool Critically Ill
Patients With Heat Stroke................................................ 35
Shad Baab, MD and James C. O’Neill, MD, FACEP
24 Cold Illness: Be Prepared to Use All the Tricks for Aggressive Rewarming ..... 36
Gena Cooper, MD, FAAP
25 Rabies, It Is More Than Bats: Know Your High-Risk Cases ................... 38
Adam Kochman, MD, FAAP , FACEP
26 Antivenom in Children Is Not Based on the Child’s Weight................... 39
Joshua Siembieda, MD
¦ EAR NOSE THROAT 41
27 Otitis Externa: A Dive Into Swimmer’s Ear ................................ 4128 Acute Otitis Media and Complications .................................... 42
Nehal Bhandari, MD, FAAP and Hannah Y . Lee, MD
29 Don’t Miss Hearing Loss—A Subtle Sign of Serious Pathology................ 43
Haig Setrakian, MD
30 Leaking the Information: Be Prepared to Manage Otorrhea .................. 45
Selina V arma, MD, MPH
31 Punching Up the Management of External Ear Trauma ..................... 46
Adrienne Smallwood, MD and Suzanne M. Schmidt, MD
32 Do Not Miss Middle and Inner Ear Trauma: Not All Ear Drainage
Is Infectious............................................................ 48
Brian Wagers, MD, FAAP
33 Intranasal Foreign Bodies: Optimizing Chances of Successful Removal........ 50
Kristol Das, MD, FAAP and Priya Jain, MD, FAAP
34 Blow by Blow on Nasal Trauma in Children ................................ 51
Anna G. Smith, MD, FAAP and Priya Jain, MD, FAAP
35 Epistaxis: The Nose Knows How to Stop the Leak ........................... 53
Kimberly L. Norris, MD
36 Orbital Fractures: Be Careful to Avoid Getting Trapped ..................... 54
Amanda Price, MD
37 Not Using Absorbable Sutures for Children With Facial Lacerations .......... 56
Emily Greenwald, MD and Nidhya Navanandan, MD
38 Overlooking the Benefits of Regional Anesthesia in Children ................. 58
Jonathan Orsborn, MD, FAAP
39 Using Color of Rhinorrhea As a Justification for Giving Antibiotics ........... 59
Mahnoosh Nik-Ahd, MD, MPH and Andrea Fang, MD
40 Basing Treatment of Strep Pharyngitis Solely on Centor Criteria ............. 60
Crick Watkins, DO and Chad D. McCalla, MD
41 Neck Pain and Fever Does Not Always Mean Meningitis. Think of RPA.
Retropharyngeal Abscess ................................................ 62
Alison Gardner, MD, MS and Kimberly Myers, MD
42 Oropharyngeal Puncture? Do Not Forget That There Is a Big Blood
Vessel to Worry About . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Rachel O’Brian, MD and Adam Kochman, MD, FAAP , FACEP
43 Not Believing the Parent Who Believes the Child Choked on Something ....... 65
Collin Michels, MD and Andrea Fang, MD
44 Do Not Treat Detergent Pods Like Any Other Type of Ingestion............... 66
Rajesh Sood, MD, FAAP and Minal Amin, MD, FAAEM
45 Not Appreciating “Recurrent Croup” to Be a Clinical Sign of
Anatomic Airway Anomalies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6846 Not Having a Strategy in Place to Manage the Patient With
a Posttonsillectomy Hemorrhage ......................................... 69
Mahnoosh Nik-Ahd, MD, MPH and Andrea Fang, MD
47 Attempting to Close Every Intraoral Laceration ............................ 71
Katie Rebillot, DO and Kelly D. Y oung, MD, MS
48 Thinking Ludwig Angina Only Happens in Adults .......................... 72
Jasmin England, MD, FAAP
49 Overlooking Simple Strategies to Manage Pain Related to a Dry Socket ........ 74
Jennifer K. Potter, MD and Sarah N. Weihmiller, MD, FAAP
50 Dismissing Sialadenitis as a Simple Infection and Throwing Antibiotics at It .. 75
Zachary T. Burroughs, MD, FAAP
51 Do Not Forget About the Secondary Teeth While Managing a Primary
Tooth Injury ........................................................... 77
Moon O. Lee, MD, MPH, FACEP
52 Focusing on Only the Teeth When There Is Dental Trauma .................. 78
Michael Hrdy, MD and Simone L. Lawson, MD, FAAP
53 Not Thoroughly Evaluating Facial Fractures ............................... 80
Ioannis Koutroulis, MD, PhD, MBA and Angelica W . DesPain, MD
54 Put Down the Scalpel—A Thoughtful Approach to Neck Masses .............. 81
Nicole Gerber, MD and Adam E. Vella, MD, FAAP
55 Blunt Neck Trauma..................................................... 83
Kara K. Seaton, MD, FAAP
56 Penetrating Neck Trauma ............................................... 84
Rachel Weigert, MD and Kelly R. Bergmann, MD
57 Torticollis: Maybe a T wist but Hopefully Never a Shout...................... 86
Amber M. Morse, MD, FAAP and Heather A. Heaton, MD, FACEP
58 Atlantoaxial Rotatory Subluxation (AARS): When Children
Truly Look Like Little Birds ............................................. 88
Heather A. Heaton, MD, FACEP and Amber M. Morse, MD, FAAP
59 Managing Pediatric Eye Injuries: You Will Shoot Your Eye Out, Kid!........... 90
Kathleen M. Smith, MD, MPH
60 Be Prepared to Manage Eye Lacerations ................................... 92
Nicholas Pokrajac, MD
61 Be Prepared to Care for the Other Pediatric Red Eye: Hyphema............... 93
Mylinh Thi Nguyen, MD
62 Pediatric Vision Loss .................................................... 95
Nicky Amin, MD
63 Be Prepared to Manage Eye Burns—Chemical, UV , Thermal ................. 97
Ashley L. Flannery, DO, FACEP , FAAEM64 Do Not Confuse Orbital Cellulitis With Preseptal Cellulitis .................. 98
Meghan Cain, MD
65 “Eye Spy” Abnormal Pupils: Be Aware That an Abnormal Pupillary
Exam Is Often a Sign of Underlying Problems ............................. 100
Emily Wagner, MD and Geoffrey P . Hays, MD
66 Nasolacrimal Duct Disorders: More Than Just Tears ....................... 102
Meghan Cain, MD
67 Conjunctivitis: A Sight for Sore Eyes ..................................... 103
Yvette Wang, MD and Elise Zimmerman, MD, MS
AIRWAY 105
68 Not Considering an Infant’s Airway as a “Difficult Airway” from the
Beginning ............................................................ 105
Jenna Lillemoe, MD and Ari Cohen, MD, FAAP
69 Not Knowing the Differences Between the Pediatric and Adult
Airways Can Lead to Failure to Intubate the Pediatric Airway ............... 106
James C. O’Neill, MD, FACEP and Shad Baab, MD
70 Get Rid of Your Discomfort With Percutaneous Transtracheal Ventilation .... 108
David Skibbie, MD, MA, FACEP , FAAEM
71 Treating All Noisy Breathing as the Same................................. 110
Emily C. MacNeill, MD and Nicholena Richardson, MD
72 Don’t Rush to Intubate an Infant After PGE1 Administration................ 112
Erica Scott, MD and Kathleen Kinney Bryant, MD, FACEP
73 Thinking Lack of Wheezing Is a Good Finding With Severe Asthma .......... 113
Julia E. Martin, MD, FACEP
74 Giving Albuterol to All Kids With Bronchiolitis............................ 115
Rachel Cafferty, MD and Julia Fuzak Freeman, MD, FAAP
75 Treating Patients With Cystic Fibrosis and Pneumonia With Typical
Treatments for Community-Acquired Pneumonia ......................... 116
Maneesha Agarwal, MD, FAAP , FACEP
76 Not Recognizing Risk Factors for PE in Children........................... 118
Sephora N. Morrison, MBBS, MSCI, MBA, CPE and James Chamberlain, MD
77 Overlooking the Concurrent Injuries in Children With Rib Fractures . . . . . . . . . 120
Anna Handorf, MD and Ari Cohen, MD, FAAP
CARDIOLOGY/DYSRHYTHMIA 122
78 Do Not Miss Undiagnosed Congenital Heart Disease: In Babies With Heart
Disease, Color Matters!................................................. 122
Sean Larsen, MD and Jenny Mendelson, MD79 Poor Feeding, Cough, and Fussiness? Common Complaints Deserve a
Comprehensive Workup for Pericarditis in the Postoperative Congenital
Heart Disease Patient .................................................. 123
Tyler Kingdon, MD and Julia Schweizer, MD, FAAP
80 A Faint Chance of Danger—Do Not Assume Pediatric Syncope Is Just
Orthostasis Without Ruling Out These Diagnoses.......................... 125
Beatrice Leverett, MD and Forrest T. Closson, MD
81 Chest Pain: Do Not Let a Normal Examination Falsely Reassure You......... 127
Erica Marburger, MD and Whitney Minnock, MD
82 T achycardia: Don’t Assume T achycardia Is Just “Stranger Danger” .......... 128
Kristin Kahale, MD and Whitney Minnock, MD
83 Secondary Signs of Endocarditis: Know Them by Heart .................... 130
William Martin, MD and Sean Thompson, MD
84 Viruses Can Be Real Heart Breakers—Do Not Let the Myocarditis
Patient Blend in With All the Respiratory Viral Illnesses .................... 131
Josephine Stout, MD and Jenny Mendelson, MD
85 Remember That Very Little of Pediatric Hypertension Is Cardiac............ 133
Marie Kotenko, MD, MPH and Whitney Minnock, MD
86 Getting to the Heart of the Matter: Do Not Miss These Features of Pathologic
Murmurs ............................................................. 134
Natasha Smith, MD and Mimi Lu, MD
87 Do Not Crash and Burn by Missing Kawasaki Disease ...................... 136
Carly Loner, MD and Kathleen Stephanos, MD, FAAEM
88 Pediatric Electrocardiogram Differences: Know Which Findings Are
Normal in Children and Which Ones Spell Trouble ........................ 137
Andrea P . Anderson, MD and Sabreen Akhter, DO, DTM
89 Do Not Be Shocked! Know the Meaning of the First Three Letters of
a Pacemaker’s Code.................................................... 139
Ryley McPeters, MD and Stephen Mac, MD, FAAP
¦ ABDOMEN 141
90 Be Aware of the Varied Presentation of Pediatric Appendicitis ............... 141
Vishal Naik, MD and Anupam B. Kharbanda, MD, MSc
91 Pyloric Stenosis: Diagnosis the Stenosis Before It Becomes “Classic” ......... 142
Corinne Shubin, MD and Jessica Wall, MD, MPH, MSCE, FAAP
92 The Inception of an Intussusception: Look for the Bowel Within
a Bowel Even if Symptoms Are Not “Classic”.............................. 144
Carl Mirus IV , MD and Kathleen Stephanos, MD, FAAEM
93 GI bleed: Do Not Be fooled by bleeding imposters.......................... 14594 The Hard Truth of Constipation—Do Not Miss the Potentially
Serious Causes ........................................................ 147
Jennifer E. Guyther, MD and Carmen Avendano, MD
95 Pediatric Diarrhea—Hydration Is the Most Important Factor in Treatment ... 148
Neethu M. Menon, MD
96 Dehydration and Electrolyte Problems: Do Not Start IV Fluids in
Children Without a Trial of PO Fluids and Antiemetics .................... 150
Jonathan Higgins, MD, FAAP and Ryan Kearney, MD, MPH
97 Why Is My Baby’s Poop White?: Do Not Forget to Check the Direct
Bilirubin Level for Jaundiced Infants..................................... 151
Dhritiman Gurkha, MD and Whitney Minnock, MD
98 Lets Be Blunt—Do Not Underestimate the Importance of Serial Abdominal
Examinations in Pediatric Blunt Abdominal Trauma ...................... 153
Eva Tovar Hirashima, MD, MPH
99 Oh Heavens…. HUS and Escherichia coli 0157:H7—Do Not Rush
to Give Antibiotics to Children With Bloody Diarrhea ...................... 154
Matthew B. Underwood, MD, FACEP
100 T wist of Fate: Do Not Ignore Bilious Emesis in a Baby...................... 156
Carrie M. Myers, MD and Ashley M. Strobel, MD, FACEP , FAAP
101 Let Your Light Shine!: Do Not Confuse a Hydrocele for a Hernia ............ 157
Kevin Landefeld, MD and Matthew Carlisle
102 Time Is Stoma: G-Tube Dislodgement Is a Time-Sensitive Emergency ....... 158
Ashley M. Strobel, MD, FACEP , FAAP
103 “Not Aggressively Treating Patients With Nephrotic Syndrome
Presenting With Fever” ................................................. 160
Rebecca C. Bowers, MD, FACEP and Vinayak Gupta, MD
GENITOURINARY AND RENAL 162
104 Renal: Nephritis: “Not Having a Strategy to Evaluate Hematuria in a Child” .... 162
Landon A. Jones, MD
105 Overlooking Spontaneous Bacterial Peritonitis in Patients With Nephrotic
Syndrome ............................................................ 163
Jeremiah Smith, MD, FAAP
106 “Urine” Trouble Now—Evidence to Approach Pediatric UTI ................ 165
James (Jim) Homme, MD, FACEP
107 Funny Dermatologic Findings .......................................... 166
Kathryn Kean, MD
108 Vaginitis in the Prepubertal Girl—A Not So Challenging
Discharge Diagnosis ................................................... 168109 GU Torsion (Male and Female).......................................... 169
Quinn Cummings, MD
110 Not Just Adults: Abnormal Uterine Bleeding and Teenage Menstrual Issues... 171
Amy Pattishall, MD and Atsuko Koyama, MD, MPH
111 Straddle Injuries Management: Be Able to Distinguish Accident From Abuse .. 172
Carrie Busch, MD, MSCR
112 A Sticky Situation: Know How to Manage Labial Adhesions ................. 174
Cullen Clark, MD and Kathleen Meadows, MD, FAAP
113 Always Look Under the Diaper: Congenital Abnormalities of
the Genitourinary Tract ................................................ 175
Perry White Mitchell, MD and Matthew Carlisle, MD, MAS
114 Always Check Under the Hood: Do Not Confuse Phimosis and Paraphimosis ... 177
Tseng-Che Tseng, MD and Rebecca Hutchings, MD
¦ DERMATOLOGY 179
115 Neonatal Rashes: Know the Bad From the Not So Bad...................... 179
Denisse Fernandez Goytizolo, MD and Madeline M. Joseph, MD, FACEP , FAAP
116 Be Prepared to Manage the Common Pediatric Rashes ..................... 181
Kayla McManus, DO and Todd Wylie, MD
117 Be Prepared to Manage Common Pediatric Infectious Rashes ............... 183
James Buscher, MD and Madeline Joseph, MD, FACEP , FAAP
118 The Fits and Starts of Atopic Dermatitis: Strategies to Adjusting Treatment .... 185
Sami K. Saikaly, MD and Jennifer J. Schoch, MD
119 Be Prepared to Recognize and Manage the “Bad” Rashes ................... 186
Akhila Reddy Mandadi, MD and Madeline M. Joseph, MD, FACEP , FAAP
120 Do Not Be Tricked Into Missing a Diagnosis of Henoch-Schönlein Purpura ... 188
Ankita T aneja, MD, MPH and Todd Wylie, MD
121 Be Prepared to Accurately Diagnose and Support Your Patients
With Erythema Multiforme............................................. 189
Corey W . Dye, MD and Madeline M. Joseph, MD, FAAP , FACEP
¦ ENDOCRINE 191
122 DKA: Being Overly Concerned About IV Fluids ........................... 191
Nadira Ramkellawan, MD and Frederick Place, MD, FACEP , FAAP
123 Allowing Hypoglycemia to Surprise You in the Pediatric Patient
Presenting With Gastroenteritis ......................................... 192
Lindly A. Theroux, DO and Scott W . Sutton, MD
124 Do Not Forget the Stress-Dose Steroid in Hypopituitarism! ................. 194125 Not Using Hydrocortisone for Treating Congenital Adrenal
Hyperplasia (CAH) .................................................... 196
Mahmoud Hamdan, MD, CDE, ABCL
126 Overlooking the Clinical Scenarios That Place a Child at Risk for SIADH..... 197
Joseph Abraham T anga, MD and Matthew Neal, MD, MBA
127 Forgetting Thyrotoxicosis in Patients With Vague Complaints............... 199
Mahmoud Hamdan, MD, CDE, ABCL
128 Not Considering Rickets as a Cause of New-Onset Seizures in Young
Children ............................................................. 200
Joyce Granger, MD, FAAP
NEUROLOGY 203
129 Not So Simple, or Is It? Prepare to Care for Febrile Seizures in Children ...... 203
James (Jim) Homme, MD, FACEP
130 Status Epilepticus: The Most Common Neurologic Emergency in Children .... 204
Brittany Tyson, MD and Emily Rose, MD, FAAP , FAAEM, FACEP
131 A Lower Threshold to Seize: Understand First-Time Seizure
in Pediatric Patients ................................................... 206
Nicholas Orozco, MD, MS and Emily Rose, MD, FAAP , FAAEM, FACEP
132 Pediatric Headache .................................................... 208
Amy Briggs, MD and Emily Rose, MD, FAAP , FAAEM, FACEP
133 Pediatric Stroke Is Routinely Missed on Initial Presentation:
Do Not Be Routine! .................................................... 209
Danielle Wickman, MD and Emily Rose, MD, FAAP , FAAEM, FACEP
134 “Flaming Hot Pediatric Brains”—Anti-NMDA and Other Forms
of Encephalitis ........................................................ 211
Anna Darby, MD, MPH and Emily Rose, MD, FAAP , FAAEM, FACEP
135 Pediatric Vertigo: Differentiating Life-Threatening From Benign Etiologies .... 213
Daniel L. Johnson, MD, MSEd
136 Be Able to Scrutinize the Causes of Pediatric Ataxia ....................... 214
Kelsey Ford Bench, MD and Emily Rose, MD, FAAP , FAAEM, FACEP
137 Muscular Dystrophy ................................................... 216
Carlee Carranza, DO and Emily Rose, MD, FAAP , FAAEM, FACEP
138 Skull Fractures: When Do We Really Need to Know They Are There? . . . . . . . . . 218
Mark S. Mannenbach, MD
139 When a River Does Not Run Through It—Prepare to Manage Pediatric
Hydrocephalus ........................................................ 219
Flavien Leclere, MD, MA and Emily Rose, MD, FAAP , FAAEM, FACEP
140 Be Prepared to Troubleshoot and Manage Shunts .......................... 221141 Be Prepared to Manage Pediatric Neurologic Technology . . . . . . . . . . . . . . . . . . . 222
Christopher S. Amato, MD, FAAP , FACEP
¦ ORTHOPEDICS 225
142 Fingertip Injuries: Keep It SIMPLE, Do Not Forget to Check the Tendons,
and Use Glue ......................................................... 225
Daniel Scholz, MD, MPH and James (Jim) Homme, MD
143 Supracondylar Fractures ............................................... 226
Joseph Arms, MD
144 It Is Not Just a Sprain: Do Not Miss Cases of Slipped Capital Femoral
Epiphysis and Idiopathic Osteonecrosis (Legg-Calve-Perth Disease) ......... 228
Jonathan Nielson, MD and Kelly R. Bergmann, MD
145 Big Problems in Little Bones: Do Not Miss Physeal Fractures ............... 229
Jana L. Anderson, MD and Mark S. Mannenbach, MD
146 Be Prepared for an Easy ED Fix: Subluxed Radial Head—
The Nursemaid’s Elbow ................................................ 231
Jana L. Anderson, MD
147 Ankle Fracture—Triplane and Juvenile Tillaux Fracture.................... 232
Rahul Kaila, MD
148 Pediatric Cervical Spine Trauma: The Biggest Pain in the Neck
Would Be to Miss One.................................................. 234
Atim Uya, MD and Michael Hazboun, MD
149 SCIWORA: Do You SCIWORA What I SCIWORA? ......................... 235
Ryan Ericksen, MD and Amanda L. Bogie, MD, FAAP , FACEP
150 Overuse Syndromes: When a Good Thing Has Gone Too Far ................ 237
David Soma, MD, CAQSM
151 What to Know About Lumbago.......................................... 238
Jonathan Strutt, MD, FAAP
¦ Infectious Disease 240
152 Everything At Once—Obtain Cultures Quickly But Do Not Delay
Antibiotics for Fever in the First 28 Days.................................. 240
Candace Engelhardt, MD, FAAP
153 Risky Business: Know How to Approach the “What Ifs” in Neonatal
Fever Risk Stratification ................................................ 241
Clifford C. Ellingson, MD, FAAP
154 Fever 2 Months Old and Beyond ......................................... 243
Anne Whitehead, MD, FAAEM156 It Is a Small World After All: Know the Differential for Fever, Diarrhea,
and Rash in the Traveling Child ......................................... 246
Nicholas Sausen, MD and Stephen Mac, MD
157 Diagnose Outpatient Pediatric Pneumonia Clinically and Avoid the X-Ray ... 247
Devan Pandya, MD and Tommy Y . Kim, MD
158 I Thought It Was Just a Cold: Do Not Forget to Consider Sepsis ............. 249
Danielle Dardis, MD and Jennifer Plitt, MD
159 Meningitis—Do Not Delay the Lumbar Puncture in Patients With
High Suspicion for Bacterial Meningitis .................................. 250
Amanda Dupont, MD, Ayush Gupta, MD and Whitney Minnock, MD
160 Pertussis Infection in Infants and Children: Do Not Miss the Early Signs ..... 252
Suzanne E. Seo, MD and Derya Caglar, MD
161 Bronchiolitis: Value Aggressive Airway Clearance Over Nebulizers,
X-Rays, and Steroids in Bronchiolitis .................................... 253
Sarah Becker, DO, FAAP
162 Bad to the Bones—Do Not Let a Child Limp Out of the ED Without
Considering Septic Joint................................................ 255
Seth Ball, MD and Getachew Teshome, MD, MPH
HEMATOLOGY/ONCOLOGY 257
163 Tumor Lysis Syndrome ................................................ 257
Mahnoosh Nik-Ahd, MD, MPH
164 Do Not Get Caught Unaware: Recognizing NEW-ONSET CANCER .......... 258
Alexander Werne, MD, Saharsh Patel, MD and Efrat Rosenthal, MD
165 Sickle Cell Disease Is Not Just Anemia: Be Prepared for Complications
Affecting All Organ Systems ............................................ 260
Gregory Hall, MD, MHA, FACEP and Evan Verplancken, MD
166 Hemolytic Anemia: Think Before You Transfuse .......................... 262
Y ongtian Tina T an, MD, MBA, Rosy Hao, MD, and Carol C. Chen, MD, MPH, FAAP
167 Feeling Blue Despite O
2
?: Consider Methemoglobinemia ................... 264
Morgan J. Sims, MD, FAAP and Benjamin F . Jackson, MD, FAAP , FACEP
168 Pediatric Neutropenia: Worth a Pause, but Not Always Panic ................ 266
Cortlyn Brown, MD and Heidi Werner, MD, MSHPEd
169 Fever and Neutropenia: Be Prepared When That Oncology Patient
Arrives ............................................................... 267
Ian Kane, MD
170 Hemophilia—Do Not Undertreat the Bad Bleeds .......................... 269
William White, MD, MA, Jessica L. Chow, MD, MPH and Dina Wallin, MD
171 How Much Is Too Much: Spotting Abnormal Bleeding Disorders ............ 270 ¦ GENETICS/METABOLISM 273
172 Recognition and Management of Inborn Errors of Metabolism—
The Needle in the Haystack ............................................. 273
James (Jim) Homme, MD
173 Have No Fear; an Inborn Error of Metabolism Is Here! Managing
Patients With Known Inborn Errors of Metabolism ........................ 275
James (Jim) Homme, MD
174 Be Aware of Abnormal Newborn Screens ................................. 277
Cree Kachelski, MD, FAAP and Jason (Jay) Homme, MD, FAAP
¦ NEONATOLOGY 279
175 Umbilical Care: Do Not Confuse the Normal Granulation With
the Purulence of Omphalitis ............................................ 279
Robert Peterson, MD
176 I Am So Hungry! Know the Right Questions to Ask About Feeding
Difficulty in the Neonate ............................................... 280
Katina M. Summerford, MD and Rachel E. M. Cramton, MD
177 Is It Supposed to Look That Way?: Know What Is Normal
Postcircumcision So You Can Reassure Parents............................ 282
Alyssa Bernardi, DO and Rachel E. M. Cramton, MD
178 Skin and Bones, or Normal Growth: Identifying Failure to Thrive ........... 284
Marci Macaraeg, MD and Rachel E. M. Cramton, MD
¦ ALLERGY/IMMUNOLOGY 286
179 Anaphylaxis: It May Come as a Shock, but It Does Not Have
to End in Tragedy… ................................................... 286
Lindsey Retterath, MD and Melissa E. Zukowski, MD, MPH, FACEP ,FAAP
180 Primary Immunodeficiency: Know What to Expect When Cell
Lines Go Awry ........................................................ 287
Monica Hajirawala, MD and Julia Schweizer, MD, FAAP
¦ COMMUNITY/LEGAL 290
181 Do Not Forget to Look for the Five W’s of Cutaneous Injuries ............... 290
Caroline Wang, MD and Julia N. Magana, MD
182 Do Not Miss Abusive Head Trauma! ..................................... 291
Leah Sitler, MD and Julia N. Magana, MD
183 Broken Bones in Broken Homes: When to Get a Skeletal Survey ............. 292184 Sentinel Moments, Sentinel Injuries: Know How to Recognize
the Signs of Abuse ..................................................... 294
Leslie Palmerlee, MD, MPH
185 Cannot Miss: Adolescent Sexual Assault.................................. 295
Molly Hallweaver, MD and Angela Jarman, MD, MPH
186 It Is Normal to Be Normal: Understand Unique Aspects of the Prepubescent
Sexual Assault Examination ............................................ 297
Samantha Kerns, MD and Mary Bing, MD, MPH
187 Treat the Patient, Not the Poison ........................................ 298
Michelle Odette, MD and Daniel K. Colby, MD
188 The Minefield of Minor Consent: Be Sure That You Are Following
Your State’s Legal Statutes ............................................. 300
Rachel J. Heidt, MD and Kendra Grether-Jones, MD
APPLIED PRACTICE 302
189 Evidence-Based Medicine: Have the Tools to Test Wisely ................... 302
Eddie G. Rodriguez, MD and Fernando Soto, MD, FACEP
190 My Baby Turned Blue: Changing the Terminology From ALTE to BRUE ..... 304
Supriya Sharma, MD, FAAP and Marianne Gausche-Hill, MD, FACEP , FAAP , FAEMS
191 The Technological-Dependent Child..................................... 306
Blair Rolnick, MD, FAAP and Christopher S. Amato, MD, FAAP , FACEP
192 Well-Child Care in the Emergency Department Setting: Looking
for “Goldilocks Moments” by Doing Just the Right Amount................. 308
Mark S. Mannenbach, MD
BEHAVIORAL HEALTH 310
193 Psych Outbursts, Pediatric Behavioral Management: Exhaust All
Nonpharmacologic Measures Before Chemically or Physically
Restraining a Child .................................................... 310
Adriana Porto, MD and Whitney Minnock, MD
194 Navigating the Complexity of Autism Spectrum Disorder
in the Pediatric ED—Work With Caregivers to Individualize Care............ 311
Sarah Kleist, MD
PHARMACY 313
195 Avoiding Common Errors in Pediatric Emergency Medicine:
Sedation Adjuncts—Do Not Underestimate the Power of Distraction and
Analgesia for Pediatric Procedures....................................... 313
Anita A. Thomas, MD196 Wait, Are Pediatricians Secretly Mathematicians?: Do Not Forget
That All Dosing in Children Is Weight-Based.............................. 314
Matthew Shapiro, MD
197 May the Dose Be With You… Focus on Communication to Avoid the 10-fold
Dosing Error .......................................................... 316
Elise Milani, MD and Stephen Lim, MD, FAAEM
198 Just a T aste: Be Aware of Bad T asting Medicines That Kids May
Refuse to T ake ........................................................ 317
Rachel Wiltjer, DO and Jennifer E. Guyther, MD
Index 319