Skip to Main Content
It looks like you're using Internet Explorer 11 or older. This website works best with modern browsers such as the latest versions of Chrome, Firefox, Safari, and Edge. If you continue with this browser, you may see unexpected results.
UMass Chan Medical School, Lamar Soutter Library. Education. Research. Health Care. Empowering the future. Preserving the past.
UMass Chan Medical School Homepage Lamar Soutter Library Homepage

Pediatric Emergency Medicine: Peds PL-1 curriculum

Objectives

Respiratory emergencies

           Airway management

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

§  Demonstrate the steps in management of a compromised airway in a child.

§  Demonstrate use of a bag-valve-mask device.

           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. Ortega R, Mehio AK, Woo A, Hafez DH. Videos in clinical medicine. positive-pressure ventilation with a face mask and a bag-valve device. N Engl J Med. 2007;357(4):e4.

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.