When the intrinsic rhythm is sinus:
I. What was the first beat of the tachycardia?
When the intrinsic rhythm is atrial fibrillation:
Always consider artifact if:
1. Osteomyelitis can be difficult to detect in the ED so always maintain a high suspicion for it in children with refusal to bear weight or persistent pain in a long bone.
2. Bloodwork rarely helps diagnose osteomyelitis, but can be reassuring if normal and you have low suspicion.
3. X-rays help rule-out other causes of pain such as fracture but more definitive imaging (i.e. MRI vs bone scan) are usually needed to diagnose.
- Diffuse, PAINFUL rash after viral prodrome, mucocutaneous lesions
- Severity described by percentage of bulous lesions: SJS at < 10% coverage (10% mortality) vs. TEN at > 30% coverage (30% mortality)
- Treatment: stop offending agent, IVF, supportive care, consider steroids
DVT Negative PE:
- Consider follow-up US in clinically appropriate population of negative lower extremity US.
- In PEA of unknown origin remember Goal Directed Echo to evaluate for PE: RV enlargement, poor RV function, flat or leftward bowing septum.
CODE COOL Update:
- Improvement needed with early vasopressor therapy. Early, aggressive Norepi use for MAP < 70.
- When cooling remember 15 ice packs, cold fluids at 30ml/kg and paralytics.
1. A systematic approach to describing rashes should include the following:
- Identification of primary lesion type with or without secondary changes;
- Lesion color;
- Lesion shape/pattern;
- Lesion distribution
2. Red flag history/exam features, suggestive of life threatening rash, include:
- Immunocompromised status,
- Extremes of age,
- Mucosal involvement,
- Diffuse erythroderma
Family Presence During a Code
ii. Normal EKG and Physical exam
iii. Unlike ALCAPA where the EKG and PE will be abnormal from chronic ischemia
iv. Diagnosed in older children and teens
v. Usually presents with exertional syncope
vi. Needs PEDIATRIC cardiology referral
Exertional syncope is cardiac until proven otherwise!