A 3-year-old boy is brought to the ED by his anxious parents following a head injury he sustained while playing in the playground. He was running when he tripped and bumped his head against the metal steps. As you observe him calmly playing on his tablet in the waiting room, his parents are inquiring about the necessity of skull x-rays. You consider the role of such imaging in investigating pediatric head injuries – …
Pediatric Damage Control Resuscitation in the Game of Thrones
Bran Stark, a 10-year-old boy, was exploring Winterfell during King Robert Baratheon’s visit to Winterfell. This patient is the son of Ned Stark, Lord of the North, and heir of the powerful House Stark. As a curious young boy, he wanted to watch the festivities from the view of a tower. This was not unusual for Bran, who “had known ever stone of those buildings, inside and out; he had climbed them all, …
Bimanual technique to reduce pediatric inguinal hernia
A 7-week-old male infant named Johnny presents to the Emergency Department with a bulge in his right scrotum that the parents noticed today, worse when he is crying and upset. On exam you notice an inguinal hernia and try to reduce it but are unsuccessful. What technique could you try next? Incarcerated hernias can often be reduced using a bimanual (two-hand) technique and lots of patience. Place the fingers of your non-dominant hand …
Tiny Tips: The CATCH Rule
Yesterday CJEM tweeted out one of their latest article to become open-access: Review of the CATCH study: a clinical decision rule for the use of computed tomography in children with minor head injury. While I understand that they are not able to make all of their articles open-access due to financial considerations, they have made the effort to make those articles published >1 year ago freely available. This article provides an overview and …