Avoiding Common Errors in Pediatric Emergency Medicine, 1e

Dale P. Woolridge

Dale P. Woolridge, Sean M. Fox, James (Jim) L. Homme, Aaron N. Leetch, Timothy K. Ruttan

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Section I: The Crashing Patient

p1-6

Expandable section
- 1: Overlooking the Basics and Focusing on Medications That Do Not Matter During Pediatric Codes
  
  p1-2
- 2: Placing Provider Comfort Over Family Presence
  
  p2-3
- 3: Overlooking Opportunity to Help the Family by Saving Crucial Evidence
  
  p4-5
- 4: Epinephrine 1:10 000 vs 1:1000: Are You Prepared to Make Sense of This?
  
  p5-6
Section II: Imaging

p7-24

Expandable section
- 5: Do Not Scan Head Trauma Based on Your “Gut”—Use Evidence-Based Guidelines!
  
  p7-8
- 6: Negative Scan—Positive Belly: Do Not Rely Solely on the CT Scan When Evaluating Children With Blunt Force Abdominal Trauma
  
  p8-9
- 7: Appreciate Practice Differences in the Approach to Pediatric Nontraumatic Abdominal Pain
  
  p10-11
- 8: Neuroimaging of Nontrauma Patients
  
  p11-13
- 9: To CT or Not to CT: Develop Good Imaging Strategy
  
  p13-14
- 10: Know the Options: Imaging Modalities for Pediatric Neck Masses
  
  p14-15
- 11: Advanced Imaging—MRI in Children
  
  p16-17
- 12: Pediatric Lung POCUS: An Underutilized Tool for Pediatric Pneumonia
  
  p17-18
- 13: Do Not Apply the Adult FAST Criteria to Pediatric Trauma Patients
  
  p18-19
- 14: Cardiac POCUS: Be Able to Distinguish Pericardial Effusions From Their Mimics
  
  p20-21
- 15: Scan First, Irradiate Second: The Error in Jumping to Computed Tomography
  
  p21-22
- 16: Skin and Soft Tissue Infections: Fifty Shades of Grayscale
  
  p23-24
Section III: Environmental/Toxicology

p25-40

Expandable section
- 17: Errors to Avoid: Overlooking Potential for Lung Injury in Children Who Appear Well
  
  p25-26
- 18: Not Aggressively Treating the Hypothermic Drowning Victim
  
  p26-28
- 19: Drowning Prevention—Missing the Opportunity to Teach: Prevention When the Near-Miss Events Happen
  
  p28-29
- 20: When Small Bites Matter: The Deadly Potential of a Pill
  
  p30-31
- 21: Activated Charcoal: Avoiding Worthless Usage of a Valuable Therapy
  
  p32-33
- 22: Underestimating the Damage a Simple Laundry Detergent Pod Can Cause
  
  p33-34
- 23: Not Having a Plan to Safely and Effectively Cool Critically Ill Patients With Heat Stroke
  
  p35-36
- 24: Cold Illness: Be Prepared to Use All the Tricks for Aggressive Rewarming
  
  p36-37
- 25: Rabies, It Is More Than Bats: Know Your High-Risk Cases
  
  p38-39
- 26: Antivenom in Children Is Not Based on the Child's Weight
  
  p39-40
Section IV: Ear Nose Throat

p41-104

Expandable section
- 27: Otitis Externa: A Dive Into Swimmer's Ear
  
  p41-42
- 28: Acute Otitis Media and Complications
  
  p42-43
- 29: Don't Miss Hearing Loss—A Subtle Sign of Serious Pathology
  
  p43-45
- 30: Leaking the Information: Be Prepared to Manage Otorrhea
  
  p45-46
- 31: Punching Up the Management of External Ear Trauma
  
  p46-48
- 32: Do Not Miss Middle and Inner Ear Trauma: Not All Ear Drainage Is Infectious
  
  p48-49
- 33: Intranasal Foreign Bodies: Optimizing Chances of Successful Removal
  
  p50-51
- 34: Blow by Blow on Nasal Trauma in Children
  
  p51-53
- 35: Epistaxis: The Nose Knows How to Stop the Leak
  
  p53-54
- 36: Orbital Fractures: Be Careful to Avoid Getting Trapped
  
  p54-55
- 37: Not Using Absorbable Sutures for Children With Facial Lacerations
  
  p56-57
- 38: Overlooking the Benefits of Regional Anesthesia in Children
  
  p58-59
- 39: Using Color of Rhinorrhea As a Justification for Giving Antibiotics
  
  p59-60
- 40: Basing Treatment of Strep Pharyngitis Solely on Centor Criteria
  
  p60-62
- 41: Neck Pain and Fever Does Not Always Mean Meningitis. Think of RPA. Retropharyngeal Abscess
  
  p62-63
- 42: Oropharyngeal Puncture? Do Not Forget That There Is a Big Blood Vessel to Worry About
  
  p63-65
- 43: Not Believing the Parent Who Believes the Child Choked on Something
  
  p65-66
- 44: Do Not Treat Detergent Pods Like Any Other Type of Ingestion
  
  p66-67
- 45: Not Appreciating “Recurrent Croup” to Be a Clinical Sign of Anatomic Airway Anomalies
  
  p68-69
- 46: Not Having a Strategy in Place to Manage the Patient With a Posttonsillectomy Hemorrhage
  
  p69-70
- 47: Attempting to Close Every Intraoral Laceration
  
  p71-72
- 48: Thinking Ludwig Angina Only Happens in Adults
  
  p72-74
- 49: Overlooking Simple Strategies to Manage Pain Related to a Dry Socket
  
  p74-75
- 50: Dismissing Sialadenitis as a Simple Infection and Throwing Antibiotics at It
  
  p75-76
- 51: Do Not Forget About the Secondary Teeth While Managing a Primary Tooth Injury
  
  p77-78
- 52: Focusing on Only the Teeth When There Is Dental Trauma
  
  p78-79
- 53: Not Thoroughly Evaluating Facial Fractures
  
  p80-81
- 54: Put Down the Scalpel—A Thoughtful Approach to Neck Masses
  
  p81-82
- 55: Blunt Neck Trauma
  
  p83-84
- 56: Penetrating Neck Trauma
  
  p84-86
- 57: Torticollis: Maybe a Twist but Hopefully Never a Shout
  
  p86-88
- 58: Atlantoaxial Rotatory Subluxation (AARS): When Children Truly Look Like Little Birds
  
  p88-90
- 59: Managing Pediatric Eye Injuries: You Will Shoot Your Eye Out, Kid!
  
  p90-92
- 60: Be Prepared to Manage Eye Lacerations
  
  p92-93
- 61: Be Prepared to Care for the Other Pediatric Red Eye: Hyphema
  
  p93-95
- 62: Pediatric Vision Loss
  
  p95-96
- 63: Be Prepared to Manage Eye Burns—Chemical, UV, Thermal
  
  p97-98
- 64: Do Not Confuse Orbital Cellulitis With Preseptal Cellulitis
  
  p98-100
- 65: “Eye Spy” Abnormal Pupils: Be Aware That an Abnormal Pupillary Exam Is Often a Sign of Underlying Problems
  
  p100-102
- 66: Nasolacrimal Duct Disorders: More Than Just Tears
  
  p102-103
- 67: Conjunctivitis: A Sight for Sore Eyes
  
  p103-104
Section V: Airway

p105-121

Expandable section
- 68: Not Considering an Infant's Airway as a “Difficult Airway” from the Beginning
  
  p105-106
- 69: Not Knowing the Differences Between the Pediatric and Adult Airways Can Lead to Failure to Intubate the Pediatric Airway
  
  p106-107
- 70: Get Rid of Your Discomfort With Percutaneous Transtracheal Ventilation
  
  p108-109
- 71: Treating All Noisy Breathing as the Same
  
  p110-111
- 72: Don't Rush to Intubate an Infant After PGE1 Administration
  
  p112-113
- 73: Thinking Lack of Wheezing Is a Good Finding With Severe Asthma
  
  p113-114
- 74: Giving Albuterol to All Kids With Bronchiolitis
  
  p115-116
- 75: Treating Patients With Cystic Fibrosis and Pneumonia With Typical Treatments for Community-Acquired Pneumonia
  
  p116-117
- 76: Not Recognizing Risk Factors for PE in Children
  
  p118-120
- 77: Overlooking the Concurrent Injuries in Children With Rib Fractures
  
  p120-121
Section VI: Cardiology/Dysrhythmia

p122-140

Expandable section
- 78: Do Not Miss Undiagnosed Congenital Heart Disease: In Babies With Heart Disease, Color Matters!
  
  p122-123
- 79: Poor Feeding, Cough, and Fussiness? Common Complaints Deserve a Comprehensive Workup for Pericarditis in the Postoperative Congenital Heart Disease Patient
  
  p123-125
- 80: A Faint Chance of Danger—Do Not Assume Pediatric Syncope Is Just Orthostasis Without Ruling Out These Diagnoses
  
  p125-126
- 81: Chest Pain: Do Not Let a Normal Examination Falsely Reassure You
  
  p127-128
- 82: Tachycardia: Don't Assume Tachycardia Is Just “Stranger Danger”
  
  p128-130
- 83: Secondary Signs of Endocarditis: Know Them by Heart
  
  p130-131
- 84: Viruses Can Be Real Heart Breakers—Do Not Let the Myocarditis Patient Blend in With All the Respiratory Viral Illnesses
  
  p131-132
- 85: Remember That Very Little of Pediatric Hypertension Is Cardiac
  
  p133-134
- 86: Getting to the Heart of the Matter: Do Not Miss These Features of Pathologic Murmurs
  
  p134-135
- 87: Do Not Crash and Burn by Missing Kawasaki Disease
  
  p136-137
- 88: Pediatric Electrocardiogram Differences: Know Which Findings Are Normal in Children and Which Ones Spell Trouble
  
  p137-139
- 89: Do Not Be Shocked! Know the Meaning of the First Three Letters of a Pacemaker's Code
  
  p139-140
Section VII: Abdomen

p141-161

Expandable section
- 90: Be Aware of the Varied Presentation of Pediatric Appendicitis
  
  p141-142
- 91: Pyloric Stenosis: Diagnosis the Stenosis Before It Becomes “Classic”
  
  p142-143
- 92: The Inception of an Intussusception: Look for the Bowel Within a Bowel Even if Symptoms Are Not “Classic”
  
  p144-145
- 93: GI bleed: Do Not Be fooled by bleeding imposters
  
  p145-146
- 94: The Hard Truth of Constipation—Do Not Miss the Potentially Serious Causes
  
  p147-148
- 95: Pediatric Diarrhea—Hydration Is the Most Important Factor in Treatment
  
  p148-149
- 96: Dehydration and Electrolyte Problems: Do Not Start IV Fluids in Children Without a Trial of PO Fluids and Antiemetics
  
  p150-151
- 97: Why Is My Baby's Poop White?: Do Not Forget to Check the Direct Bilirubin Level for Jaundiced Infants
  
  p151-152
- 98: Lets Be Blunt—Do Not Underestimate the Importance of Serial Abdominal Examinations in Pediatric Blunt Abdominal Trauma
  
  p153-154
- 99: Oh Heavens…. HUS and Escherichia coli 0157:H7—Do Not Rush to Give Antibiotics to Children With Bloody Diarrhea
  
  p154-155
- 100: Twist of Fate: Do Not Ignore Bilious Emesis in a Baby
  
  p156-157
- 101: Let Your Light Shine!: Do Not Confuse a Hydrocele for a Hernia
  
  p157-158
- 102: Time Is Stoma: G-Tube Dislodgement Is a Time-Sensitive Emergency
  
  p158-160
- 103: “Not Aggressively Treating Patients With Nephrotic Syndrome Presenting With Fever”
  
  p160-161
Section VIII: Genitourinary and Renal

p162-178

Expandable section
- 104: Renal: Nephritis: “Not Having a Strategy to Evaluate Hematuria in a Child”
  
  p162-163
- 105: Overlooking Spontaneous Bacterial Peritonitis in Patients With Nephrotic Syndrome
  
  p163-164
- 106: “Urine” Trouble Now—Evidence to Approach Pediatric UTI
  
  p165-166
- 107: Funny Dermatologic Findings
  
  p166-168
- 108: Vaginitis in the Prepubertal Girl—A Not So Challenging Discharge Diagnosis
  
  p168-169
- 109: GU Torsion (Male and Female)
  
  p169-170
- 110: Not Just Adults: Abnormal Uterine Bleeding and Teenage Menstrual Issues
  
  p171-172
- 111: Straddle Injuries Management: Be Able to Distinguish Accident From Abuse
  
  p172-173
- 112: A Sticky Situation: Know How to Manage Labial Adhesions
  
  p174-175
- 113: Always Look Under the Diaper: Congenital Abnormalities of the Genitourinary Tract
  
  p175-176
- 114: Always Check Under the Hood: Do Not Confuse Phimosis and Paraphimosis
  
  p177-178
Section IX: Dermatology

p179-190

Expandable section
- 115: Neonatal Rashes: Know the Bad From the Not So Bad
  
  p179-180
- 116: Be Prepared to Manage the Common Pediatric Rashes
  
  p181-183
- 117: Be Prepared to Manage Common Pediatric Infectious Rashes
  
  p183-184
- 118: The Fits and Starts of Atopic Dermatitis: Strategies to Adjusting Treatment
  
  p185-186
- 119: Be Prepared to Recognize and Manage the “Bad” Rashes
  
  p186-187
- 120: Do Not Be Tricked Into Missing a Diagnosis of Henoch-Schönlein Purpura
  
  p188-189
- 121: Be Prepared to Accurately Diagnose and Support Your Patients With Erythema Multiforme
  
  p189-190
Section X: Endocrine

p191-202

Expandable section
- 122: DKA: Being Overly Concerned About IV Fluids
  
  p191-192
- 123: Allowing Hypoglycemia to Surprise You in the Pediatric Patient Presenting With Gastroenteritis
  
  p192-194
- 124: Do Not Forget the Stress-Dose Steroid in Hypopituitarism!
  
  p194-195
- 125: Not Using Hydrocortisone for Treating Congenital Adrenal Hyperplasia (CAH)
  
  p196-197
- 126: Overlooking the Clinical Scenarios That Place a Child at Risk for SIADH
  
  p197-199
- 127: Forgetting Thyrotoxicosis in Patients With Vague Complaints
  
  p199-200
- 128: Not Considering Rickets as a Cause of New-Onset Seizures in Young Children
  
  p200-202
Section XI: Neurology

p203-224

Expandable section
- 129: Not So Simple, or Is It? Prepare to Care for Febrile Seizures in Children
  
  p203-204
- 130: Status Epilepticus: The Most Common Neurologic Emergency in Children
  
  p204-206
- 131: A Lower Threshold to Seize: Understand First-Time Seizure in Pediatric Patients
  
  p206-207
- 132: Pediatric Headache
  
  p208-209
- 133: Pediatric Stroke Is Routinely Missed on Initial Presentation: Do Not Be Routine!
  
  p209-211
- 134: “Flaming Hot Pediatric Brains”—Anti-NMDA and Other Forms of Encephalitis
  
  p211-212
- 135: Pediatric Vertigo: Differentiating Life-Threatening From Benign Etiologies
  
  p213-214
- 136: Be Able to Scrutinize the Causes of Pediatric Ataxia
  
  p214-216
- 137: Muscular Dystrophy
  
  p216-218
- 138: Skull Fractures: When Do We Really Need to Know They Are There?
  
  p218-219
- 139: When a River Does Not Run Through It—Prepare to Manage Pediatric Hydrocephalus
  
  p219-221
- 140: Be Prepared to Troubleshoot and Manage Shunts
  
  p221-222
- 141: Be Prepared to Manage Pediatric Neurologic Technology
  
  p222-224
Section XII: Orthopedics

p225-239

Expandable section
- 142: Fingertip Injuries: Keep It SIMPLE, Do Not Forget to Check the Tendons, and Use Glue
  
  p225-226
- 143: Supracondylar Fractures
  
  p226-227
- 144: It Is Not Just a Sprain: Do Not Miss Cases of Slipped Capital Femoral Epiphysis and Idiopathic Osteonecrosis (Legg-Calve-Perth Disease)
  
  p228-229
- 145: Big Problems in Little Bones: Do Not Miss Physeal Fractures
  
  p229-230
- 146: Be Prepared for an Easy ED Fix: Subluxed Radial Head—The Nursemaid's Elbow
  
  p231-232
- 147: Ankle Fracture—Triplane and Juvenile Tillaux Fracture
  
  p232-233
- 148: Pediatric Cervical Spine Trauma: The Biggest Pain in the Neck Would Be to Miss One
  
  p234-235
- 149: SCIWORA: Do You SCIWORA What I SCIWORA?
  
  p235-237
- 150: Overuse Syndromes: When a Good Thing Has Gone Too Far
  
  p237-238
- 151: What to Know About Lumbago
  
  p238-239
Section XIII: Infectious Disease

p240-256

Expandable section
- 152: Everything At Once—Obtain Cultures Quickly But Do Not Delay Antibiotics for Fever in the First 28 Days
  
  p240-241
- 153: Risky Business: Know How to Approach the “What Ifs” in Neonatal Fever Risk Stratification
  
  p241-242
- 154: Fever 2 Months Old and Beyond
  
  p243-244
- 155: Hot to the Touch: Differentiate Between Fever Without a Source and Fever of Unknown Origin
  
  p244-245
- 156: It Is a Small World After All: Know the Differential for Fever, Diarrhea, and Rash in the Traveling Child
  
  p246-247
- 157: Diagnose Outpatient Pediatric Pneumonia Clinically and Avoid the X-Ray
  
  p247-249
- 158: I Thought It Was Just a Cold: Do Not Forget to Consider Sepsis
  
  p249-250
- 159: Meningitis—Do Not Delay the Lumbar Puncture in Patients With High Suspicion for Bacterial Meningitis
  
  p250-252
- 160: Pertussis Infection in Infants and Children: Do Not Miss the Early Signs
  
  p252-253
- 161: Bronchiolitis: Value Aggressive Airway Clearance Over Nebulizers, X-Rays, and Steroids in Bronchiolitis
  
  p253-254
- 162: Bad to the Bones—Do Not Let a Child Limp Out of the ED Without Considering Septic Joint
  
  p255-256
Section XIV: Hematology/Oncology

p257-272

Expandable section
- 163: Tumor Lysis Syndrome
  
  p257-258
- 164: Do Not Get Caught Unaware: Recognizing New-Onset Cancer
  
  p258-260
- 165: Sickle Cell Disease Is Not Just Anemia: Be Prepared for Complications Affecting All Organ Systems
  
  p260-262
- 166: Hemolytic Anemia: Think Before You Transfuse
  
  p262-264
- 167: Feeling Blue Despite O₂?: Consider Methemoglobinemia
  
  p264-265
- 168: Pediatric Neutropenia: Worth a Pause, but Not Always Panic
  
  p266-267
- 169: Fever and Neutropenia: Be Prepared When That Oncology Patient Arrives
  
  p267-268
- 170: Hemophilia—Do Not Undertreat the Bad Bleeds
  
  p269-270
- 171: How Much Is Too Much: Spotting Abnormal Bleeding Disorders
  
  p270-272
Section XV: Genetics/Metabolism

p273-278

Expandable section
- 172: Recognition and Management of Inborn Errors of Metabolism—The Needle in the Haystack
  
  p273-275
- 173: Have No Fear; an Inborn Error of Metabolism Is Here! Managing Patients With Known Inborn Errors of Metabolism
  
  p275-276
- 174: Be Aware of Abnormal Newborn Screens
  
  p277-278
Section XVI: Neonatology

p279-285

Expandable section
- 175: Umbilical Care: Do Not Confuse the Normal Granulation With the Purulence of Omphalitis
  
  p279-280
- 176: I Am So Hungry! Know the Right Questions to Ask About Feeding Difficulty in the Neonate
  
  p280-282
- 177: Is It Supposed to Look That Way?: Know What Is Normal Postcircumcision So You Can Reassure Parents
  
  p282-283
- 178: Skin and Bones, or Normal Growth: Identifying Failure to Thrive
  
  p284-285
Section XVII: Allergy/Immunology

p286-289

Expandable section
- 179: Anaphylaxis: It May Come as a Shock, but It Does Not Have to End in Tragedy…
  
  p286-287
- 180: Primary Immunodeficiency: Know What to Expect When Cell Lines Go Awry
  
  p287-289
Section XVIII: Community/Legal

p290-301

Expandable section
- 181: Do Not Forget to Look for the Five W's of Cutaneous Injuries
  
  p290-291
- 182: Do Not Miss Abusive Head Trauma!
  
  p291-292
- 183: Broken Bones in Broken Homes: When to Get a Skeletal Survey
  
  p292-293
- 184: Sentinel Moments, Sentinel Injuries: Know How to Recognize the Signs of Abuse
  
  p294-295
- 185: Cannot Miss: Adolescent Sexual Assault
  
  p295-296
- 186: It Is Normal to Be Normal: Understand Unique Aspects of the Prepubescent Sexual Assault Examination
  
  p297-298
- 187: Treat the Patient, Not the Poison
  
  p298-299
- 188: The Minefield of Minor Consent: Be Sure That You Are Following Your State's Legal Statutes
  
  p300-301
Section XIX: Applied Practice

p302-309

Expandable section
- 189: Evidence-Based Medicine: Have the Tools to Test Wisely
  
  p302-303
- 190: My Baby Turned Blue: Changing the Terminology From ALTE to BRUE
  
  p304-305
- 191: The Technological-Dependent Child
  
  p306-307
- 192: Well-Child Care in the Emergency Department Setting: Looking for “Goldilocks Moments” by Doing Just the Right Amount
  
  p308-309
Section XX: Behavioral Health

p310-312

Expandable section
- 193: Psych Outbursts, Pediatric Behavioral Management: Exhaust All Nonpharmacologic Measures Before Chemically or Physically Restraining a Child
  
  p310-311
- 194: Navigating the Complexity of Autism Spectrum Disorder in the Pediatric ED—Work With Caregivers to Individualize Care
  
  p311-312
Section XXI: Pharmacy

p313-318

Expandable section
- 195: Avoiding Common Errors in Pediatric Emergency Medicine: Sedation Adjuncts—Do Not Underestimate the Power of Distraction and Analgesia for Pediatric Procedures
  
  p313-314
- 196: Wait, Are Pediatricians Secretly Mathematicians?: Do Not Forget That All Dosing in Children Is Weight-Based
  
  p314-316
- 197: May the Dose Be With You… Focus on Communication to Avoid the 10-fold Dosing Error
  
  p316-317
- 198: Just a Taste: Be Aware of Bad Tasting Medicines That Kids May Refuse to Take
  
  p317-318

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