CMC Case CONFERENCE - Dr. Nichols

Pediatric pericardial effusion/pericarditis
1) Kids with chest pain also hide gremlins
2) Consider bedside echo for all pediatric chest pain visits!
3) Effusions of 500cc, circumferential, or 2 cm on CT scan are by definition LARGE and likely mandate admission and stat echo looking for tamponade
4) Ultrasound guidance for bedside pericardiocentesis is the new standard
5)  Be vigilant in sign outs, always add an update note

Abdominal pigtail placement
1) Small bore seldinger technique makes abdominal placement more likely, you can't finger sweep
2) Consider clamping the introducer needle at the skin once air is aspirated to avoid unintentional advancement
3) Remember the triangle of safety, go as high as possible with pigtails
4) In the event of an abdominal mishap, scan the region and discuss with surgery

Headache with ICH/IVH
1) Be wary of the "different" migraine
2) Deep brain structure bleeding is associated with intraventricular extension
3) IVH carries a 20-50% in hospital mortality
4) ABCs, potential emergent EVD placement
5) Even though a CT head is negative within the window, the LP may give you additional information that makes the diagnosis (opening pressure, cell counts, etc)

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