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admin 06.06.2014

Herpes Simplex Virus Type-2 (HSV-2) IgM Enzyme-Linked Immunosorbent Assay (ELISA) Diagnostics Test Kit , Manufacturers from Jei Daniel Biotech Corp. Originally published at Pediatric EM Morsels on October 12, 2015. Reposted with permission. 2 Morsels ago (Yes you can mark the passage of time in “Morsels”) [HSP and Testicular Pain] we addressed some common themes of the Ped EM Morsels.  This week will highlight one of these themes again – Clinical Examination is more important in determining patient management than a collection of test results. In rare cases of “masked mastoiditis,” where there is no evidence of AOM, a CT would be needed. There has been a change in practice making the management of Mastoiditis more conservative and less aggressive.
Parental Antibiotics combined with myringotomy and incision and drainage of subperiosteal abscess has proven to be as efficacious as traditional mastoidectomy. The Conservative approach leads to no greater complication rates and yields earlier hospital discharge. SO, IF YOU THINK THAT THE CHILD CLINICALLY HAS MASTOIDITIS AND HAS AN OTHERWISE NORMAL NEUROLOGIC EXAM, GIVE THE KID IV ANTBIOITCS, PAIN MEDICATIONS, AND CALL THE ENT PHYSICIAN.  DISCUSS HOW YOU ARE AWARE THAT THEIR OWN LITERATURE WOULD BE AGAINST THE UNNECESSARY IRRADIATION OF THE PATIENT AND… AWAIT COLLEGIAL CONVERSATION THAT WILL ENSUE. There are many causes of syncope (don’t forget the pregnancy test!) to consider… like Hair Grooming Syncope. Originally published at Pediatric EM Morsels on January 24, 2015. Reposted with permission. Since there are two arterial supplies, even with significant and prolonged torsion,there still may be arterial flow. Younger children often reported has being more likely to have neoplasm, but actually most likely to have normal ovaries.

Infants may have been diagnosed in utero with ovarian cysts by ultrasound.  Ask about this when evaluating abdominal pain. Vomiting that occurs with pain is concerning for it (60% of patients have been documented with this).
Appendicitis and Ovarian Torsion overlap in presentation and are difficult to distinguish on exam. While I am not a huge advocate for these tests for appendicitis, they may be helpful when considering other entities. Or, if your evaluation for appendicitis is negative, you can also make yourselfreconsider Ovarian Torsion. Originally published at Pediatric EM Morsels on November 13, 2015. Reposted with permission. Remaining vigilant for the child with a subtle presentation of a severe illness is part of our job in the Ped ED; however, sometimes, the illness is not subtle and the child requires critical actions (ex, Damage Control Resuscitation, Mechanical Ventilation,Optimize Chest Compressions)  .
Access two major veins (ex, IJ, Femoral Vein) or uses a double-lumen catheter to access one major vein (ex, IJ). Provides oxygenation, but because oxygenated blood returns to venous side, the oxygenation level will be lower compared to VA. While it is the last option, considering it at the last minute will not help, as it requires time to coordinate with the teams and time to gain access and set up the system. American Heart Association lists it as an option for In-Hospital Cardiac Arrest if condition is thought to be reversible or amenable to heart transplantation.
ECMO is not commonly needed in the ED, but on the rare occasion that it will be helpful, the means to initiate it need to already been known, as time is critical.

Having a protocol in place (hopefully, never to be needed) to help with patient selection and streamline the activation of the “ECMO Team” may literally save a child’s life. Posner JC1, Osterhoudt KC, Mollen CJ, Jacobstein CR, Nicolson SC, Gaynor JW.Extracorporeal membrane oxygenation as a resuscitative measure in the pediatric emergency department. Click the blog post title to navigate to the original article and blog; Click the author name or blog name in the credits to navigate to all archived posts on FOAMEM. This site showcases the best of global FOAM and gives the reader an opportunity to read, find and locate new sources of high quality medical education.
We are also aware of potential complications of AOM and the need to vigilantly search for patients at risk for complications (Cochlear Implants) and signs of complications (Gradeningo’s Syndrome).  But once you discover a complication what needs to be done?  Acute Mastoiditis is the most common complication of AOM – how do you diagnose it and how does the ENT physician manage it?
When we are thinking outside of the box, make sure we keep Ovarian Torsion on our DDx list for the young girls.
Pediatric Extracorporeal Membrane Oxygenation: An Introduction for Emergency Medicine Physicians. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. One such, potentially life-saving, critical action is Extracorporeal Membrane Oxygenation (ECMO). This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.

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