Board Review: The Pediatric Airway

Originally Published: Modern Resident, Jun/Jul 2010

Original Author: Karen Serrano, MD
University of Wisconsin Dept. of Emergency Medicine

Submitted by: Saadiyah Bilal, Publications Committee, Co-Chair
 
Managing the pediatric airway poses unique challenges for the emergency physician, requiring a good understanding of pediatric anatomy and familiarity with child-specific tools and approaches for emergency airway.
Children are more susceptible to airway obstruction than adults. One millimeter of edema in a small caliber pediatric airway (4mm diameter in a neonate) leads to dramatically increased airway resistance compared to the same amount of swelling in an adult (d=8mm) due to the effect of radius to the 4th power on rate of flow. The relatively large tongue of children can also collapse against the posterior pharynx, resulting in airway obstruction. Maneuvers such as the chin-lift or

EM Today: Updates from the Interview Trail

Originally Published: Modern Resident, February/March 2010

Original Article Author: Alex Fisher, OMS-IV

University of Medicine and Dentistry of New Jersey School of Osteopathic Medicine

Submitted by: Saadiyah Bilal (Publications Committee Co-Chair)

The interview season for EM is over! I'm not going to miss it. Most students would agree that by now, they have had their fair share of traveling, disruption and trying to balance a meager student loan budget with the costs of it all. The good news is there is light at the end of the tunnel, and you are moving one step closer to becoming a brilliant and dashing EM doc!

I Was Just Filling up the Tank, Right? When Erythrocyte Transfusion Goes Awry

Originally Published: Modern Resident, February/March 2010

Original Article Author: Robert Katzer, MD
 Georgetown-Washington Hospital Center

Submitted by: Saadiyah Bilal (Publications Committee Co-Chair)

Despite a large amount of research on the issue, there is no universally followed set of indications. However, the transfusion of blood and blood products is a hazardous activity, and we all agree that there are several dangers associated with it. This article deals specifically with the noninfectious reactions encountered during and after transfusion.

Board Review: Retained Foreign Bodies

Originally Published: Modern Resident, October/November 2010
Original Article Author: Teresa M. Ross, MD
Georgetown-Washington Hospital Center
Submitted by: Rachel Engle, DO (Communications Committee Chair)

A case study: A 59 year old diabetic female was sent to the ED from her podiatrist's office over concern for a retained foreign body (FB) in her toe. Four days prior, she had impaled her right great toe on a blue wooden toothpick. She self-extracted a broken portion of the toothpick, but the toe had become progressively red and swollen, now with inclusion of the distal, dorsal portion of her foot. She complained of a painful FB sensation migrating towards the plantar aspect of the MTP joint of the great toe, worse with walking. She had no fever. At her podiatrist's office, a plain film of the foot was reportedly negative.

In the ED, the toe was obviously cellulitic. No FB was palpable on exam, but a punctuate hemorrhage on the toe seemed to indicate where the initial entry point had been. Bedside ultrasound localized a 1cm long FB penetrating the skin towards the MTP joint, 0.5cm below the skin at its closest point. However, after a successful nerve block, a 20 minute exploration failed to visualize the toothpick. The patient noted that she felt the toothpick had "moved even deeper" after all the probing on exam. The risk of deeper exploration towards the joint was deemed to outweigh the benefits of extraction, and the procedure was terminated.

The patient received a first course of IV Vancomycin. The toe was wrapped for delayed primary closure, and the patient was sent home on clindamycin, levofloxacin and oxycodone for pain. She was instructed to return for wound check and surgical referral in two days. The patient did not return to the ED for wound check, but did follow up in podiatry clinic, where they continued conservative management. Should we have tried harder to remove the foreign body?

Pearl: When to Try, When to Stop

Medical Student Council President's Message: Simple Solutions: Medication Reconciliation

Originally Published: Common Sense, November/December 2008
Original Author: Greg Casey, AAEM/RSA Medical Student Council President

An elderly man sat on the edge of his stretcher, attempting to describe his abdominal pain. He did not even need to speak. Vomiting after a few minutes, I realized that this stoic individual was truly sick. As I thought through a differential, I continued to ask questions. His answers were short, but his wife helped him. When I asked about medications, he was unable to recall any of the therapies his physicians had prescribed. His wife dug through her super-sized pocketbook but was unable to help. When we decided to admit the patient with the working diagnosis of intussusception, I talked to the patient and his wife about the importance of maintaining a list of their medications.