Febrile Seizures
  • Simple (All features must be present)
    • Age 6 months – 5 years
    • Febrile
    • Lasts less than 15 minutes
    • Only one seizure in 24 hour period
    • No focal neuro deficits on exam
    • Generalized seizure (must have LOC)
      • Treat with acetaminophen and reassurance
  • Complex
    • Does not meet ALL of the criteria for a simple febrile seizure
      • Consider full workup including lumbar puncture
Pediatric Abdominal Pain
  • Intussusception
    • Classic history
      • Severe emesis
      • INTERMITTENT severe abdominal pain
    • Common causes
      • Meckles diverticulum
      • Henoch-Schonlein purpura
    • Diagnose with abdominal ultrasound
      • Look for target sign
    • Treat with air enema
  • Malrotation with Volvulus
    • Classic symptoms
      • Bilious emesis
      • Projectile
      • CONSTANT severe abdominal pain
      • Peritonitic abdominal exam
    • Common tests (if stable)
      • Upper GI Series
        • Corkscrew sign
        • Coffee-bean sign
  • Necrotizing Enterocolitis
    • Classic symptoms
      • Premature neonate
      • Bloody stool
    • X-Ray shows pneumotosis intestinalis
      • (Air in the bowel wall)
  • Hirschsprungs Disease
    • Delayed passage of meconium
    • Diagnosis
      • Contrast enema (not typically done in ED)
        • Look for distal transition point
      • Rectal suction biopsy (DEFINITELY not done in the ED)
        • Gold standard for diagnosis
Bronchiolitis
  • Commonly caused by RSV
  • Initial fever and URI
    • Progresses to respiratory distress
Croup (laryngotrachealbronchitis)
  • Commonly caused by parainfluenza
  • Initial fever and URI
    • Progresses to stridor
    • Barky cough
  • Neck xray will show “steeple sign” (subglottic narrowing)
  • Treatment
    • Steroids
    • Nebulized epinephrine
Epiglottitis
  • Commonly caused by Haemophilus influenzae¬†
  • Classic symptoms
    • Fever
    • Sore throat
    • Drooling
    • Muffled voice
  • Treatment
    • Keep the child calm
    • Intubation in a controlled environment
    • Antibiotics
Additional Reading