Pediatric Emergency Medicine: A Practical Approach to ED Challenges

Day 1

Approach to Febrile Infants and Toddler. (Seiden)

Upon completion of this session, using published guidelines and evidence-based medicine, the participant should be able to: ^{EBM, GL, COMP}

1. Assess the risks of various management strategies of febrile infants less than 2 months of age.
2. Appraise recent data concerning the clinical approach to febrile young infants.
3. Appraise data concerning the diagnostic evaluation of febrile children 3-24 months of age.
4. Recognize the changing epidemiology of invasive bacterial infections secondary to widespread vaccination practices.

Head Injuries in the Pediatric Patient. (Seiden)

Upon completion of this session, using evidence-based medicine and guidelines from the 4th International Symposium on Concussion in Sport, the participants should be able to: ^{EBM, GL, COMP}

1. Describe the pathophysiology and, using evidence-based medicine, develop clinical strategies for the emergency treatment of severe head injury in childhood.
2. Apply an evidence-based medicine approach to decisions regarding obtaining a CT scan in children after minor head trauma.
3. Recognize the signs and symptoms of concussions in pediatric patients.
4. Demonstrate use of currently recommended management approaches in children with concussion.

 Acute Management of Childhood Asthma. (Seiden)

Upon completion of this session, using published practice guidelines and Cochrane EBM sources, the participant should be able to: ^{EBM, GL, COMP}

1. Determine the appropriate use of albuterol by metered-dose inhaler, intermittent nebulizer, and continuous nebulizer for children with moderate and severe asthma exacerbations.
2. Appropriately apply the evidence regarding levalbuterol as compared with albuterol in the treatment of childhood asthma.
3. Employ recent data and recommendations for the use of steroids, magnesium sulfate, terbutaline, and ipratropium bromide in the treatment of acute asthma exacerbations.
4. Recognize indications for inpatient hospitalization in children with acute asthma exacerbations.

Blunt Abdominal Trauma in Children. (Seiden)

Upon completion of this session, using evidence-based medicine and published guidelines, the participant should be able to: ^{EBM, GL, COMP}

1. Recognize injury mechanisms and clinical findings that are characteristic of solid organ injury and hollow viscus injury in children.
2. Integrate the role of various laboratory and radiologic tests in the diagnosis of solid organ injury and hollow viscus injury in children.
3. Develop and employ appropriate management strategies for children with significant intra-abdominal injuries.
4. Appraise recent data regarding the utility of focused abdominal sonography in trauma (FAST) in pediatric trauma.

 Diagnosis and Misdiagnosis of Appendicitis in Childhood. (Seiden^MJ)

Upon completion of this session, using evidence-based medicine, the participant should be able to: ^{EBM COMP}

1. Review the pathophysiology of appendicitis.
2. Associate the pathophysiology of appendicitis with the signs and symptoms.
3. Analyze various diagnostic approaches to appendicitis in childhood.
4. Criticize the care provided in several cases of appendicitis missed at the time of initial ED evaluation.

Day 2

Life-Threatening Pediatric Infections. (Belfer R.)

Upon completion of this session, using national Evidence Based Medicine sources including Cochrane Collaboration and published guidelines from sources including the American Academy of Pediatrics, the participant should be able to: ^{EBM, GL, COMP}

1. Conclude that as newer immunizations eradicate many serious infections, we are still faced with certain pathogens that can cause severe morbidity and mortality.
2. Recognize, diagnose and manage the following diseases:
   1. Toxic Shock Syndrome;
   2. Meningococcemia;
   3. Rocky Mountain Spotted Fever;
   4. Kawasaki
3. Develop an approach to the patient who presents with fever and a rash.

 Non-Traumatic Surgical Abdominal Emergencies. (Belfer R.)

Upon completion of this session, using national Evidence Based Medicine sources including Cochrane Collaboration and published guidelines from sources including the American Academy of Pediatrics, the participant should be able to: ^{EBM, GL, COMP}

1. Recognize pediatric abdominal processes that require surgical intervention.
2. Formulate and prepare initial emergency room management of specific abdominal surgical emergencies.

Abdominal Pain (Belfer R.)

Upon completion of this session, using national Evidence Based Medicine sources including Cochrane Collaboration and published guidelines from sources including the American Academy of Pediatrics, the participant should be able to:^{EBM COMP}

1. Develop a broad and ER focused differential diagnosis for the child with abdominal pain
2. Determine the best imaging modalities for the emergent care of a child with abdominal pain

Orthopedic Conditions Above the Hip. (Belfer, R.)

Upon completion of this session, using national Evidence Based Medicine sources including Cochrane Collaboration and published guidelines from sources including the American Academy of Pediatrics, the participant should be able to: ^{EBM, GL, COMP}

1. Interpret radiographs that demonstrate Salter-Harris fractures in the pediatric patient.
2. Initially manage fractures of the upper extremity and recognize when to refer to an Orthopedic Surgeon.
3. Develop management plans for fractures; assess the need for urgent orthopedic consultation.

 The Child with a Limp. (Belfer, R.)

Upon completion of this session, using national Evidence Based Medicine sources including Cochrane Collaboration and published guidelines from sources including the American Academy of Pediatrics, the participant should be able to: ^{EBM, GL, COMP}

1. Discuss the importance of age to specific hip pathology.
2. Differentiate etiologies of limp in the pediatric patient.
3. Review management of specific orthopedic conditions.

Day 3

Pediatric Poisonings. (Seiden^MJ)

Upon completion of this session, using AAP guidelines and evidence-based medicine, the participant should be able to:  ^{EBM, GL, COMP}

1. Review data on pediatric poisonings including recent trends.
2. Employ appropriate gastrointestinal decontamination in a variety of pediatric ingestions.
3. Discuss management of several specific poisonings.

 Dilemma of the Foreign Body – Aspirated or Ingested. (Seiden^MJ)

Upon completion of this session, using evidence-based medicine, the participant should be able to: ^{EBM, COMP}

1. Distinguish the epidemiology and clinical presentation of aspirated versus ingested foreign bodies.
2. Analyze the rationale for radiographic evaluation of children with a history of foreign body ingestion.
3. Review the diagnostic approach and radiographic interpretation of children with aspirated foreign bodies.

Pediatric Seizures I. Status Epilepticus, II. Febrile Seizures. (Belfer, R.)

Upon completion of this session, using national Evidence Based Medicine sources including Cochrane Collaboration and published guidelines from sources including the American Academy of Pediatrics, the participant should be able to: ^{EBM, GL, COMP}

1. Demonstrate appropriate medications to treat pediatric status epilepticus.
2. Utilize the literature concerning epidemiology of febrile seizures in educating patients’ families.

 Visual Diagnosis: You Make the Call. (Belfer, R.)

Upon completion of this session, using national Evidence Based Medicine sources including Cochrane Collaboration and published guidelines from sources including the American Academy of Pediatrics, the participant should be able to: ^{EBM, GL, COMP}

1. “Make the correct call” on slides representing interesting physical examination findings of pediatric patients.
2. Evaluate the visual presentation of over 25 different conditions to determine the DDx, lab, imaging and/or their respective treatments or referral as indicated.  Some conditions to be covered include:
   1. Testicular Torsion
   2. Herpes Zoster
   3. Periorbital Cellulitis
   4. Mastoiditis
   5. Erythema Multiforme (Minor)
   6. Pre-Auricular Adenitis
   7. Lap-Belt Complex
   8. Hematuria

    
   COVID in Pediatrics. (Belfer, J.)

   Upon completion of this session, using national Evidence Based Medicine sources including Cochrane Collaboration and published guidelines from sources including the American Academy of Pediatrics, the participant should be able to:^{COMP, EBM, GL}

   1. Describe the unique presentation of COVID disease in infants and children
   2. Diagnose the rare but life-threatening complications of COVID disease, specifically, Multi-system inflammatory syndrome in children [MIS-C]

Day 4

Upper Airway Emergencies in the Pediatric Patient. (Belfer, J.^RB)

Upon completion of this session, using national Evidence Based Medicine sources including Cochrane Collaboration and published guidelines from sources including the American Academy of Pediatrics, the participant should be able to: ^{EBM, GL, COMP}

1. Recommend medication therapy for selected upper airway emergencies.
2. Interpret the most recent evidence-based literature in the approach to the child with croup.
3. Distinguish and discriminate among the varied presentations of pediatric stridor.

 The Septic Appearing Infant. (Belfer, J.^RB)

Upon completion of this session, using national Evidence Based Medicine sources including Cochrane Collaboration and published guidelines from sources including the American Academy of Pediatrics, the participant should be able to: ^{EBM, GL, COMP}

1. Conclude that an infectious etiology is not the only cause of a “toxic” appearing child.
2. Differentiate neurologic, hematologic, toxin, and cardiac causes of the ill child.

Judicious Use of Antibiotics in Outpatient Setting. (Belfer, R.)

Upon completion of this session, using national Evidence Based Medicine sources including Cochrane Collaboration and published guidelines from sources including the American Academy of Pediatrics, the participant should be able to: ^{EBM, GL, COMP}

1. Identify antibiotic prescribing patterns, outcomes, and expenditures for common pediatric conditions.
2. Differentiate between common pediatric infections and those that require antibiotic treatment.
3. Develop a clinical approach to the diagnosis and therapy of sinusitis.

Pearls from 25 Years in the Pediatric ED.(Belfer, R.)

Upon completion of this session, using national Evidence Based Medicine sources including Cochrane Collaboration and published guidelines from sources including the American Academy of Pediatrics, the participant should be able to:^{COMP, EBM, GL}

1. Obtain a great understanding of how the care of specific disease states such as DKA, meningitis, sepsis, foreign body ingestions has evolved over the last few decades in emergency pediatric care
2. Describe how imaging has evolved to play an integral role in the diagnosis and treatment of many pediatric emergency conditions including, bone/joint infections, abdominal emergencies and resuscitation

Articles That Change the Way We Practice Pediatric Emergency Medicine. (Belfer, R.)

Upon completion of this session, using national Evidence Based Medicine sources including Cochrane Collaboration and published guidelines from sources including the American Academy of Pediatrics, the participant should be able to: ^{EBM, GL, COMP}

1. Analyze the latest Emergency Medicine literature to bring improved care to the bedside.