Pediatric Emergency Med Rotation

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Siverhideo1985

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Any recommendations for reading material for this rotation? We get an elective in third year and I'm interested in the field but I'll be short internal med and surgery rotation, so I feel like I should read up on it more than I would for other rotations.

Any advice on reading material/pocket guides and/or advice for the rotation itself would be much appreciated!

Thanks!
 
Learn the following ahead of time if you want to impress:

Pediatric Head Injury Guidelines (when to scan, when not to scan)
Salter-Harris classification of fractures
Guidelines for evaluation of febrile infants (specifically when you do a full w/u for sepsis, and when you don't)

In addition:
always check your ears and throats of febrile kids, regardless of CC
check throats of your belly pains (could be strep)
always remark if a kid is playful/interactive or not.
always have a disposition in mind when presenting (discharge, admit, observe).
Don't be dependent on the WBC. Not a strong marker of sick v. not sick in the ED setting.
 
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Learn the following ahead of time if you want to impress:

Pediatric Head Injury Guidelines (when to scan, when not to scan)
Salter-Harris classification of fractures
Guidelines for evaluation of febrile infants (specifically when you do a full w/u for sepsis, and when you don't)

In addition:
always check your ears and throats of febrile kids, regardless of CC
check throats of your belly pains (could be strep)
always remark if a kid is playful/interactive or not.
always have a disposition in mind when presenting (discharge, admit, observe).
Don't be dependent on the WBC. Not a strong marker of sick v. not sick in the ED setting.

Thanks! Do you have a book source that may be helpful in reading up on these (not that I can't google this stuff, but I wouldn't mind a reference material).
 
Thanks! Do you have a book source that may be helpful in reading up on these (not that I can't google this stuff, but I wouldn't mind a reference material).

A book probably isn't going to be your best learning guide as they tend to get dated quickly and may not hit the right target of depth of learning for an interested medical student (more likely to be too superficial if geared to med studs and may be too in depth if from a large text). Up To Date and emedicine are often good sources. There are some practice guidelines which are well worth reading. There is a Tarascon pediatric EM pocket book which is good for quick lookups of things that might not come immediately to memory.

Learn the following ahead of time if you want to impress:

Pediatric Head Injury Guidelines (when to scan, when not to scan)
http://www.aan.com/professionals/practice/guidelines/pda/Concussion_sports.pdf

Salter-Harris classification of fractures
You should be able to look this up easily. Here's one: http://emedicine.medscape.com/article/412956-overview

Guidelines for evaluation of febrile infants (specifically when you do a full w/u for sepsis, and when you don't)
This is actually a tough one as this is a constantly moving target. An article written five years ago may be dated. Understand some basic concepts, but understand the challenge, especially in infants aged 30-90 days. Also understand that local practice patterns and individual practice will heavily influence the management in this age group. Cincinatti has some nice EBM guidelines that they follow locally and are good reads (In the past I have especially liked the fever, asthma, gastroenteritis, and bronchiolitis guidelines. Others may be very worth reading.) http://www.cincinnatichildrens.org/...vidence-based-care/evidence-based-guidelines/

In addition:
always check your ears and throats of febrile kids, regardless of CC
check throats of your belly pains (could be strep)
Also understand the ages in which strep usually is present and in which rheumatogenic strains might be present. Also note that viral illnesses (esp. EBV) can cause (and often do) the oropharyngeal PE findings that look like strep pharyngitis (i.e. PE sucks for diagnosing strep). Up to 20% of people can be asymptomatic carriers of strep. Knowing what symptoms/signs tend not to go along with strep pharyngitis is helpful as sore throat is a common CC esp. with those seeking primary care in the peds ED.
always remark if a kid is playful/interactive or not.
always have a disposition in mind when presenting (discharge, admit, observe).
Don't be dependent on the WBC. Not a strong marker of sick v. not sick in the ED setting.

I think Rendar's advice is solid.

I would also add:
Bronchiolitis-read the Cincinatti PDF and the AAP guidelines (I don't think guidelines are always that good, but this one is) http://aappolicy.aappublications.org/cgi/reprint/pediatrics;118/4/1774.pdf

Febrile seizure: http://web.squ.edu.om/med-Lib/MED_CD/E_CDs/CHILD NEUROLOGY/docs/ch16.pdf (2205 review) and http://pediatrics.aappublications.org/content/127/2/389 (haven't read this one, but it's very fresh)

First non-febrile seizure: http://www.aan.com/professionals/practice/pdfs/gl0081.pdf (I think this is still considered the practice guideline)

Review treatment of status epilepticus.

Review treatment of asthma exacerbation in the ED (Cincinnati's guide is good).

DKA. There may be local flavors of protocols, but review the basics. If you want to read one in-the-weeds-article on an interesting topic, dig this one out: http://www.nejm.org/doi/full/10.1056/NEJM200101253440404

If you are in an area with a large African American population review sickle cell disease and treatment of acute pain crisis and acute chest syndrome. Learn how to take an appropriate history for a patient with SCD presenting to you.

Some thoughts.
 
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