Pediatric Emergency Playbook
Pediatric Emergency Playbook is a podcast for healthcare professionals who care for acutely ill and injured children. Hosted by Dr. Tim Horeczko, it offers clinical cases, research reviews, and best-practice guidance to support decision-making in acute care settings. The show aims to provide strategy and support through ever-changing clinical landscapes.
Episodes
Congenital Heart Disease: Cases
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Congenital Heart Disease: Plumbing & Air for the Emergency Physician
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Precipitous Delivery
From the Ashes of SIRS: The Phoenix Sepsis Score
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Torticollis
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Resuscitative Umbilical Vein Catheterization
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Update 2023
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Neonatal Resuscitation
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Stridor, Stertor, and Noisy Breathing
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Brief, Huddle, and Debrief in the PED
https://pemplaybook.org/?p=2760
Fontanelle Facts
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Wound Care at Home
https://pemplaybook.org/?p=2670
The Abdominal Exam in Children
Hemolytic Uremic Syndrome
Push-Dose Epi
pemplaybook.org/podcast/push-dose-epi/
Environmental Injuries in Children
pemplaybook.org/podcast/environmental-injuries-in-children/
PEM Myths
Palms and Soles
https://wp.me/p6B1Mm-F6
The Febrile Infant
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Animal Bites in Children
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Focus On: Maneuvers for Murmurs
Pathologic Murmurs in Children
Benign Murmurs in Children
The Newborn and Infant Neuro Exam
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Eczema
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Sickle Cell Complications
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Focus On: Pyloric Stenosis
Myth: "No olive, no problem" Reality: Rare finding, since we diagnose earlier Pyloric stenosis occurs in young infants because the pyloric sphincter hypertrophies, causing near-complete obstruction of the gastric outlet. More common in boys, preterm babies, first-born. Less common in older mothers. Association with macrolide use. Presentation Young infant arrives with f
Pediatric Vital Signs: What Are We Missing?
https://wp.me/p6B1Mm-Co
Focus On: Gun Shot Wounds in Children
https://wp.me/p6B1Mm-Cd
Syndromes You Should Know
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Focus On: Inguinal Hernias in Children
Hernia Myth: "If it's not strangulated, it's elective" Reality: Unlike in adults, all hernias in children are repaired at the time of diagnosis because: The risk of incarceration and strangulation is high There is a 30% risk of testicular infarction due to pressure on the gonadal vessels It is not worth messing around and "trying to navigate the system" Most groin hernias in children are indirec
Focus On: Pediatric Emergency Eye Exam
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Focus On: Breath Holding Spells
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Overdose: Just Right (?)
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Overdose: Too Cold!
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Overdose: Too Hot!
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Constipation and the way out
Constipation as a diagnosis can be dangerous, mainly because it is a powerful anchor in our medical decision-making. Chances are, you'd be right to chalk up the pain to functional constipation — 90% of pediatric constipation is functional, multifactorial, and mostly benign — as long as it is addressed. We're not here for "chances are"; we're here for "why isn't it?" Ask yourself, could it be: Anat
Pediatric IV Tips and Tricks
Top 10 [details in audio] Set the stage – exude confidence and be prepared Choose the right cannula size – a smaller working IV is infinitely better than none Feeling is better than looking – trust yourself Mark the site – things get wonky when you take your hands off to disinfect Tourniquets can mess you up – try to use a holder's hand to occlude the vein The holder rules – get as man
Vagal Maneuvers In Children
https://pemplaybook.org/?p=2234
Conjunctivitis
Go or No Go: Pediatric Presedation Assessment
https://pemplaybook.org/?p=2211
Caustic Ingestions
https://wp.me/p6B1Mm-zr
Pediatric Hand Fractures
Tuft Fracture Yeh PC et al. Pediatric Hand Fractures. Techniques in Orthopaedics. 2009. Seymour Fracture Nellans et al. Pediatric Hand Injuires. Hand Clin. 2013 November ; 29(4): 569–578 Yeh PC et al. Pediatric Hand Fractures. Techniques in Orthopaedics. 2009. Mallet Fracture Adolescent with mallet finger and Kirschner wire fixation. Nellans et al. Pediatric Hand Injuires. Hand Clin. 2
Heat-Related Illness
A spectrum — but will you recognize the blurry signposts? Temperature (core) Presentation Management Miliaria Crystallina Normal Salt-colored tiny papules, easily burst; not pruritic Modify environment; light clothing; hydration Miliaria Rubra Normal Discrimiate, red papules, not assocaited with follicles; pruritic Above plus cool compresses; calamine lotion; symptomatic tx for
Diarrhea
Traditional Approach: Secretory -- poisoned mucosal villi -- "the sieve" Cytotoxic -- destroyed mucosal villi -- "the shred" Osmotic -- malabsorption -- "the pull" Inflammatory -- edema, motility -- "the push" Lots of overlap, difficult to apply to clinical signs and symptoms. Bedside Approach: Fever/No Fever, Bloody/No Blood Non-bloody, febrile -- most likely viral Non-bloody, af
DKA Like A Boss
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Zen and the Art of Pediatric Readiness
Pediatric Readiness is not just an ideal -- it's a tangible plan, a toolkit, and even better, an attitude How to improve your institution, and your own personal pediatric readiness. National Pediatric Readiness Project (NPRP) Los Angeles County Pediatric Readiness Project
Pediatric Dysrhythmias
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Otitis Media
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Major Burns in Children
Lund and Browder Chart to Estimate Burn Size in Children Parkland Formula for Burns Amount needed in addition to maintenance fluids: 4 mL/kg x BSA% = X Add 1/2 of X to maintenance over the 1st 8 hours Add the other 1/2 of X to maintenance over the next 16 hours Escharotomy Guide and the "Roman
Anemia. Now What?
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Pediatric Sports Injuries
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EtCO2 Masterclass
Neck Masses in Children
The differential diagnosis is long... You need an approach. The Rule of 3s: 3 minutes -- Traumatic 3 days -- Inflammatory 3 months -- Neoplastic 3 years -- Congenital 3 Minutes? Traumatic 3 Days? Inflammatory [caption id="attachment_1777" align="alignnone" width="262"] Cervical Node Chain; Lymphadenopathy[/caption] [caption id="attachment_1773" align="alignnone" width="298"] Bacterial Lym
Intraosseous Devices
https://www.youtube.com/watch?v=cQVKIpLc8bk Selected References Barnard, et al. Rapid sequence induction of anaesthesia via the intraosseous route: a prospective observational study. Emerg Med J. 2014; Jun 24. pii: emermed-2014-203740. Jousi M, Saikko S, Nurmi J. Intraosseous blood samples for point-of-care analysis: agreement between intraosseous and arterial analyses. Scand J Trauma R
Cyanosis
Your eyes may fool you... Keep your differential diagnosis open. Selected References Aravindhan N, Chisholm DG. Sulfhemoglobinemia presenting as pulse oximetry desaturations. Anesthesiology. 2000;93:883–884. Gharahbaghian L et al. Methemoglobinemia and Sulfhemoglobinemia in Two Pediatric Patients after Ingestion of Hydroxylamine Sulfat
Failure to Thrive
Failure to Thrive (FTT) is not just for the clinics. We need to be on the lookout, because if we find it, there is already a big problem. Definitions of Failure to Thrive may quibble on the details, but for us in the ED: Consistently under 2nd percentile in weight over time "Falling off" the growth curve over 2 or more points We can get around the longitudinal requirement by looking at we
Mass Casualty Incident
No one ever wants to find himself in this situation. A factory explodes. A building catches fire. A multi-vehicle traffic collision. Or an act of terrorism. Very quickly, we have to scrap business as usual. We have to adapt to our new circumstances. Definition of a mass casualty incident (MCI): An incident which produces multi
Altered Mental Status in Children (REBROADCAST)
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Myocarditis
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Medical Errors Waiting to Happen
The Notorious VBG
Guess or Process? Abductive Clinical Reasoning: a PEM Primer
List or Gist? Inductive Clinical Reasoning: a PEM Primer
Harpoon or Hook? Deductive Clinical Reasoning: a PEM Primer
Knee Pain
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Anaphylaxis
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Strep Throat
Does Your Patient Have Streptococcal Pharyngitis? No Problem -- I'll just Swab. Not So Fast... Fagan Nomogram for Likelihood Ratios 1. Decide on your pre-test probability of the disease (choose an approximate probability based on our assessment) 2. Use the likelihood ratio that correlates to your exam. 3. Draw a straight line frm your pre-test probability starting point, to the LR of the feautur
Concussion
How do we make the diagnosis? What now? Concussion in Sport Group Guidelines Concussion Recognition Tool (for coaches, trainers on field) Child Sports Concussion Assessment Tool, 5th Ed. (Child SCAT); Ages 5-12 Sports Concussion Assessment Tool, 5th Ed. (SCAT5); Ages 13 and Up This post and podcast are dedicated to the great K Kay Moody, DO, MPH for her stalwart effort to care for both patient a
EKG Killers: Part Two
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EKG Killers: Part One
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Hypertension in Children
References Baracco R et al. Pediatric Hypertensive Emergencies. Curr Hypertens Rep. 2014; 16:456. Belsha CW. Pediatric Hypertension in the Emergency Department. Ann Emerg Med. 2008; 51(3):21-24. Chandar J et al. Hypertensive crisis in children. Pediatr Nephrol. 2012; 27:741-751. Dionne JM et al. Hypertension Canada's 2017 Guidelines for the Diagnosis, Asses
The Fussy Infant
A Social Visit or Your Most Dangerous Presentation Tonight? [Details in Audio] This post and podcast are dedicated to Henry Goldstein, B.Pharm, MBBS for his tireless dedication to all things #FOAMed, #FOAMped, and #MedEd. You are awesome. Make sure to visit Don't Forget the Bubbles! References Cohen GM, Albertini LW. Colic. Pediatr Rev. 2012; 33(7):3
Airway Master Moves
You know how to intubate safely. You can recite all of the Ps backwards and forwards. Until you can't. Real-time trouble-shooting. [Details in Audio] This post and podcast are dedicated to Mads Astvad for sharing his enthusiasm, clinical excellence, and #FOAMed warrior spirit. Tak, min ven! #SMACConia #Vikingeblod
Ovarian Torsion
Ovarian torsion is like the MI of the pelvis. Sometimes all it takes is a good story to investigate. When to worry, when to walk it off, and when to work it up: What is the typical presentation of ovarian torsion? There is none. The presentation varies so much, we need a rule to live by: Unilateral pelvic pain in a girl is ovarian torsion until proven otherwise. This includes the cases in w
Just Say No To (These) Drugs
Dogma often dictates routine care. There are times when we have to attend to paradigm shifts. An easy way to save lives? Just say no to (these) drugs: Codeine Normally metabolized into codeine-6-glucuronide (50-70%) and norcodeine (10-15%). Codeine, codeine-6-glucuronide, and norcodeine have low affinity for the μ (mu) receptor. However, the most active metabolite of codeine is morphine with 20
Blunt Head Trauma
Not all head trauma is minor. Not all minor head trauma is clinically significant. How can we sort out the overtly ok from the sneakily serious? Mnemonics for bedside risk stratification of minor pediatric blunt head trauma, based on PECARN studies: [Details in Audio] Blunt Head Trauma in Children < 2 years of Age Blunt Head Trauma in Children ≥ 2 years of Age Image Gently Camp
The Higher Tech Kid in the ED
Comfortable with G-tubes, tracheostomies, and VP shunts? Good. Get ready for the next level: Vagus Nerve Stimulators, Intrathecal Pumps, and Ventricular Assist Devices. Details in Audio: Vagus Nerve Stimulators For intractable epilepsy; sends retrograde signal up corona radiata Also may be used in: depression, bulimia, Alzheimer, narcolepsy, addiction, and others VNS magnets Are VNS safe in M
Vaccine Preventable Illness Part Two
PEMplaybook.org
The Pediatric Surgical Abdomen
Abdominal pain is common; so are strongly held myths and legends about what is concerning, and what is not. One of our largest responsibilities in the Emergency Department is sorting out benign from surgical or medical causes of abdominal pain. Morbidity and mortality varies by age and condition. Abdominal Surgical Emergencies in Children: A Relative Timeline General Advice Neonate (birth
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