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Pediatric Emergency Medicine: EM PL-1 curriculum

Objectives

Respiratory emergencies

           Airway management

§  Describe the assessment of the airway and breathing in a pediatric patient.

§  Describe the anatomical differences between the pediatric and adult airway.

§  Describe the process of rapid sequence intubation in the pediatric patient.

           Asthma

§  Describe how to determine the level of severity of an acute asthma exacerbation.

§  Describe steps in emergency department management of an acute asthma exacerbation according to severity.

§  Determine which patients with asthma exacerbations should be admitted to the hospital and which patients may be discharged home safely.

          Bronchiolitis

§  Describe the causes and pathophysiology of bronchiolitis.

§  Describe emergency department management of bronchiolitis.

§  Identify risk factors for severe disease and need for hospitalization.

           Croup

§  Determine the severity of croup.

§  Describe the ED management of croup, and determine which patients require hospital admission.

           Pneumonia

§  Describe the clinical presentation of children with pneumonia.  What signs and symptoms are most helpful?

§  Describe the ED diagnostic workup for an infant or child with suspected pneumonia.

§  Choose initial antibiotic therapy for infants and children with pneumonia.

§  Identify which children with pneumonia should be admitted to the hospital.

           Upper airway obstruction

§  List the differential diagnosis for upper airway obstruction and describe how to distinguish between the different diagnoses.

Fever

§  Describe the diagnostic workup and management for well-appearing infants younger than 28 days with fever without source.

§  Describe the diagnostic workup and management for well-appearing infants 28 to 90 days with fever without source.

§  Describe the diagnostic workup and management for well-appearing infants and children older than 90 days with fever without source.

§  Instruct caregivers on home management of fever.

Head Trauma/Concussion

§  Assess the Glasgow Coma Scale in injured infants and children.

§  Determine which patients with head injuries should have a CT scan performed.

§  Describe the signs and symptoms of a concussion.

§  Describe how to counsel families on the outpatient management of a child with a concussion

Seizures

§  Define simple and complex febrile seizures.

§  Choose the appropriate diagnostic evaluation for a child who presents after a simple febrile seizure.

§  Counsel parents on home management of a child who has been evaluated for a simple febrile seizure.

§  Determine which patients with complex febrile seizures should undergo lumbar puncture.

§  Describe the ED evaluation of a child who present with a first afebrile seizure.

§  Describe the steps in the management of a pediatric patient in status epilepticus.

Abdominal Pain

§  Identify the most common and the serious causes of abdominal pain and vomiting in the infant.

§  Describe the ED workup for the infant with vomiting and abdominal pain.

§  List the differential diagnosis for abdominal pain in the child, including the most common medical and surgical diagnoses, as well as extra-abdominal illnesses that cause abdominal pain.

§  Choose appropriate laboratory and imaging studies for patients with abdominal pain.

§  Calculate the Pediatric Appendicitis Score for a patient with suspected appendicitis.

Gastroenteritis/Dehydration

§  Assess the degree of dehydration in infants and young children based on clinical signs and symptoms.

§  Choose method of rehydration (oral vs. IV) and use it appropriately.

§  Counsel parents on home management of vomiting, diarrhea and dehydration.

Common Infections

           Otitis media

§  Describe the appearance of the tympanic membrane in a patient with acute otitis media.

§  Choose appropriate initial antibiotic therapy for a child with acute otitis media.

§  Choose appropriate therapy for a patient with acute otitis media who has not improved in 48-72 hours.

§  Describe the complications of acute otitis media.

           Urinary tract infections

§  Assess the likelihood that a febrile infant has a urinary tract infection and perform the appropriate diagnostic evaluation.

§  Interpret the urinalysis of a febrile infant.

§  Choose appropriate initial antibiotics for a pediatric patient with a urinary tract infection.

           Abscesses

§  Demonstrate how to perform incision and drainage of an abscess.

§  Decide if antibiotic therapy is needed for an abscess or cellulitis and choose an appropriate antibiotic regimen.

           Meningitis

§  Determine when to suspect meningitis in a pediatric patient.

§  Demonstrate how to perform a lumbar puncture, including description of contraindications.

§  Describe the other components of the diagnostic evaluation of a patient with suspected meningitis.

§  Identify criteria to distinguish bacterial from aseptic meningitis.

§  Choose appropriate antimicrobial therapy for patients with suspected bacterial meningitis.

           Lyme disease

§  Describe early and late manifestations of Lyme disease and their clinical evaluation

§  Choose appropriate therapy for early, early-disseminated and late Lyme disease.

§  Describe how to decide if a pediatric patient should receive antibiotic prophylaxis after a tick bite.

           URI/Sinusitis

§  Identify which children have suspected bacterial rhinosinusitis and describe treatment.

 

Suggested Reading

Respiratory emergencies

         Airway management     

1. Coussa M, Tucker JE. Pediatric rapid sequence intubation. Pediatric Emergency Medicine Reports. 01/01; 2012/10 2009.  

2. Santillanes G, Gausche-Hill M. Pediatric airway management. Emerg Med Clin North Am. 2008;26(4):961-975.              

          Asthma   

1.  Altamimi S, Robertson G, Jastaniah W, et al.  Single-dose oral dexamethasone in the emergency management of children with exacerbations of mild to moderate asthma. Pediatr Emerg Care. 2006;22(12):786-793

 2.  Dotson K, Dallman M, Bowman CM, Titus MO.  Ipratropium bromide for acute asthma exacerbations in the emergency setting:  A literature review of the evidence. Pedatri Emerg Care. 2009;25(10):687-692; quiz 693-695.

 3.  Gorelick M, Scribana PV, Stevens MW, Schultz T, Shults J.  Predicting need for hospitalization in acute pediatric asthma. Pediatr Emerg Care. 2008;24(11):735-744.

4.  National Asthma Education and Prevention Program.  Expert panel report 3 (EPR-3): Guidelines for the diagnosis and management of asthma-summary report 2007. J Allergy Clin Immunol. 2007;20(5 Suppl):S94-138. (pages S131-S137 cover acute asthma exacerbations)

            Bronchiolitis

1.  Zorc JJ, Hall CB. Bronchiolitis: recent evidence on diagnosis and management. Pediatrics. 2010;124(2): 342-349

            Croup

1.  Cherry JC.  Clinical practice. CroupNew England Journal of Medicine. 2008;358(4): 384-391.

            Pneumonia

1. Bradley JS, Byington CL, Shah SS, et al. Executive summary: The management of community-acquired pneumonia in infants and children older than 3 months of age: Clinical practice guidelines by the pediatric infectious diseases society and the infectious diseases society of america. Clin Infect Dis. 2011;53(7):617-630.

2. Haines C, Soon A, Mercurio D. Community-acquired pneumonia in pediatric populations. Pediatric Emergency Medicine Reports. 2012;17(4):37. 

 

            Upper airway obstruction

1. D'Agostino J. Pediatric airway nightmares. Emerg Med Clin North Am. 2010;28(1):119-126.

 Fever

1. Hernandez DA. Fever in infants < 3 months old: What is the current standard? Pediatric Emergency Medicine Reports. 01/01/2011 

2. Baraff LJ. Management of infants and young children with fever without source. Pediatric Annals. 2008;37(10):673-679.

3. Byington CL, Reynolds CC, Korgenski K, et al. Costs and infant outcomes after implementation of a care process model for febrile infants. Pediatrics. 2012;130(1):e16-24.

4. Section on Clinical Pharmacology and Therapeutics, Committee on Drugs, Sullivan JE, Farrar HC. Fever and antipyretic use in children. Pediatrics. 2011;127(3):580-587.

Head Trauma/Concussion

1. Halstead ME, Walter KD. Council on Sports Medicine and Fitness. American academy of pediatrics. clinical report--sport-related concussion in children and adolescents. Pediatrics. 2010;126(3):597-615.

2. Kuppermann N, Holmes JF, Dayan PS, et al. Identification of children at very low risk of clinically-important brain injuries after head trauma: A prospective cohort study. Lancet. 2009;374(9696):1160-1170.

3. Schunk JE, Schutzman SA. Pediatric head injury. Pediatr Rev. 2012;33(9):398-411. 

4. CDC:  concussion in sports. 

Seizures

1. Hampers LC, Spina LA. Evaluation and management of pediatric febrile seizures in the emergency department. Emerg Med Clin North Am. 2011;29(1):83-93.

2. Kimia A, Ben-Joseph EP, Rudloe T, et al. Yield of lumbar puncture among children who present with their first complex febrile seizure. Pediatrics. 2010;126(1):62-69.

3. Sharieff GQ, Hendry PL. Afebrile pediatric seizures. Emerg Med Clin North Am. 2011;29(1):95-108.

4. Subcommittee on Febrile Seizures, American Academy of Pediatrics. Neurodiagnostic evaluation of the child with a simple febrile seizure. Pediatrics. 2011;127(2):389-394.

Abdominal Pain

1. Abdominal pain and vomiting in the infant. Pediatric Emergency Medicine Reports. 10/01; 2012/10 2011.

2. Marin JR, Alpern ER. Abdominal pain in children. Emerg Med Clin North Am. 2011;29(2):401-28, ix-x.

3. Samuel M. Pediatric appendicitis score. J Pediatr Surg. 2002;37(6):877-881.  

Gastroenteritis/Dehydration

1. Colletti JE, Brown KM, Sharieff GQ, Barata IA, Ishimine P, ACEP Pediatric Emergency Medicine Committee. The management of children with gastroenteritis and dehydration in the emergency department. J Emerg Med. 2010;38(5):686-698.

2. King CK, Glass R, Bresee JS, Duggan C, Centers for Disease Control and Prevention. Managing acute gastroenteritis among children: Oral rehydration, maintenance, and nutritional therapy. MMWR Recomm Rep. 2003;52(RR-16):1-16.

Common Infections

            Otitis media

1. American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media. Diagnosis and management of acute otitis media. Pediatrics. 2013 Mar;131(3):e964-99.

2. Leskinen K. Complications of acute otitis media in children. Curr Allergy Asthma Rep. 2005;5(4):308-312.

3. Shaikh N, Hoberman A, Kaleida PH, Ploof DL, Paradise JL. Videos in clinical medicine. diagnosing otitis media--otoscopy and cerumen removal. N Engl J Med. 2010;362(20):e62.

            Urinary tract infections

1. Bhat RG, Katy TA, Place FC. Pediatric urinary tract infections. Emerg Med Clin North Am. 2011;29(3):637-653.

2. Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management, Roberts KB. Urinary tract infection: Clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics. 2011;128(3):595-610.

            Abscesses

1. Fitch MT, Manthey DE, McGinnis HD, Nicks BA, Pariyadath M. Videos in clinical medicine. abscess incision and drainage. N Engl J Med. 2007;357(19):e20.

2. Liu C, Bayer A, Cosgrove SE, et al. Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant staphylococcus aureus infections in adults and children: Executive summary. Clin Infect Dis. 2011;52(3):285-292.

            Meningitis

1. Ellenby MS, Tegtmeyer K, Lai S, Braner DA. Videos in clinical medicine. lumbar puncture. N Engl J Med. 2006;355(13):e12.

2. Mann K, Jackson MA. Meningitis. Pediatr Rev. 2008;29(12):417-29; quiz 430.

3. Nigrovic LE, Malley R, Kuppermann N. Cerebrospinal fluid pleocytosis in children in the era of bacterial conjugate vaccines: Distinguishing the child with bacterial and aseptic meningitis. Pediatr Emerg Care. 2009;25(2):112-7; quiz 118-20.

            Lyme disease

1. Stanek G, Wormser GP, Gray J, Strle F. Lyme borreliosis. Lancet. 2012;379(9814):461-473.

2. Wormser GP, Dattwyler RJ, Shapiro ED, et al. The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: Clinical practice guidelines by the infectious diseases society of america. Clin Infect Dis. 2006;43(9):1089-1134.

            URI/Sinusitis

1. Chow AW, Benninger MS, Brook I, et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis. 2012;54(8):e72-e112.