November 15th Conference Pearls

Brought to you by Lucia Somberg and Maninder Singh

EM-CCM Interdisciplinary Rounds (Dr. Haidorfer and Dr. Ehson):

Vent management – use DOPES to diagnose ventilator problems
- Displaced tube
- tube Obstruction
- Pneumothorax
- Equipment — try a BVM
- Stacked breaths
Always use lung protective ventilator strategies – 4-8 cc/kg ideal body weight tidal volume, and low pressures
ARDS — Best interventions:
- Low tidal volumes
- Prone positioning
- ECMO
- Paralysis
- Recruitment maneuvers

Neonatal Fever (Dr. Maureen Nemetski):

Fever = self-regulated response to infection, can’t “fry brain”
Hyperthermia = non-regulated from external heat or toxins, CAN “fry brain”
Risk of serious bacterial infection in febrile infants under 2 months about 20-25% in CHAM population, most are well appearing
- Meningitis most worrisome
- UTI most common
Thorough history and exam:
- Birth history: Full term? Maternal serologies (especially GBS and HSV)?
- Pre-, per-, or neonatal complications?
- Feeding? Urine output? Activity level?
- Focal exam findings? (URI, PNA, rash, abscess…)
Fever <28 days:
- Blood, Urine, CSF
- Antibiotics and Acyclovir
- Admit
Fever 28-56 days:
- Blood, Urine
- If well appearing, home and close follow-up with PMD
- If ill appearing, lumbar puncture/antibiotics/admit
Other studies to consider:
- RSV/Flu
- CXR
- Stool Culture
CHAM and other protocols are used to risk stratify who needs full sepsis workup and abx
If an infant looks ill, do everything…regardless of age!

Pediatric Abdominal Ultrasound (Dr. Joni Rabiner):

Intussuception: bedside ultrasound by trained provider just as sensitive and specific as radiology. Look for target sign. Can come and go
Appendicitis: easiest strategy is to look at point of maximum tenderness, if there is a positive this can expedite care
Pyloric stenosis – Most common at 2-6 weeks of age. Give Pedialyte and look for “hot dog” sign at pylorus.

Organophosphate Poisoning (Dr. Barajas):