Date: Tue, 4 Aug 1998 21:43:44 -0500
Reply-To: jay pershad <poppy@netten.net>
Sender: Pediatric Emergency Medicine Discuss...
much like late onset GBS disease and other bacterial causes of neonatal
meningitis. You have to cover for the neonatal bug...
> Daniel J. Isaacman, M.D.
>
For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the
message: info PED-EM-L...
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I would apreciate any feedback about this topic.
Thanxs...
Jo=E3o Lu=EDs Barreira, MD
Oporto, PORTUGAL
joaobarreira@mail.t...
think it helps to eliminate another causes of methemoglobinemia.
I'd like to know other opinions. Thaks for your help. Jav...
don't have an "emergency room". The law also applies if a patients seeks
care at a location at the hospital separate from ...
>The URL for the PED-EM-L Web Page is:
> http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
For more inf...
Thank you ever so kindly for your generosity,
I=92ve always relied on the kindness of strangers,
Mark
SURVEY
1. Approximat...
Mark A. Hostetler, M.D.
University of Rochester
Departments of Emergency Medicine and Pediatrics
Division of Pediatric Eme...
basis, would anyone use Chloromycetin (PO chloramphenicol)?
(For those on the list who do not have personal experience or ...
Richard Hemmer wrote: Over the past few years we have seen way too many
cases of
> "aseptic meningitis" that was managed a...
&nbsp;
<P>Richard Hemmer wrote:&nbsp;&nbsp; Over the past few years we have seen
way too many cases of
<BLOCKQUOTE TYPE=CI...
The URL for the PED-EM-L Web Page is:
http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
Date: Sat, 22 A...
If this is the correct inturrpertation of this, then please do let me know
just where it is you pratice at so I can make s...
-----------------------------------------------------------------------------
-
Grant me the ability to give Emergency Car...
Ray Pitetti, MD
Children's Hospital of Pittsburgh
pitettr@chplink.chp.edu
For more information, send mail to LISTSERV@BROW...
me towards some literature? How would the presence of arrhythmias
affect your decision? (Our case patient had had a potass...
think the temporal argument speaks much more conclusively to cause and effect
but when it is 12 or 24 hours later I think ...
Date: Thu, 3 Sep 1998 18:04:53 -0300
Reply-To: Richard Hemmer <rn_medic@msn.com>
Sender: Pediatric Emergency Medicine Disc...
Rich Hemmer
-----Original Message-----
From: Pediatric Emergency Medicine Discussion List
[mailto:PED-EM-L@BROWNVM.BROWN.E...
physicians?? The PCCC ED is staffed by emergency physicians but has a PICU
and intensivists and specialists. Other example...
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message: info PED-EM-L
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personnel, or even have on call specialists that might be needed. It is
the duty of the paramedic or EMT to know what reso...
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message: info PED-EM-L
The URL for the PED-EM-L Web...
Date: Fri, 11 Sep 1998 01:06:02 -0500
Reply-To: jay pershad <poppy@netten.net>
Sender: Pediatric Emergency Medicine Discus...
pharyngitis. However, if the clinical suspicion is strep infection and
the Rapid strep is negative, then one has to procee...
***************
I treat a febrile child with simple febrile seizure like any other child
with fever only: If he looks sick...
<PED-EM-L@BROWNVM.BROWN.EDU>
From: jorge alvarez <jorgealv@netverk.com.ar>
Subject: LP and Strep swabs
Sorry if my opinion...
For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the
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Date: Sun, 20 Sep 1998 02:35:02 -0500
Reply-To: jay pershad <poppy@netten.net>
Sender: Pediatric Emergency Medicine Discus...
who is 9 months old and is now alert and and blowing bubbles at me???
I have been following this thread with avid interest...
The URL for the PED-EM-L Web Page is:
http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
Date: Tue, 22 S...
http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
Date: Fri, 25 Sep 1998 12:07:23 EDT
Reply-To: Robert ...
For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the
message: info PED-EM-L
The URL for the PED-EM-L Web...
http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
Date: Mon, 5 Oct 1998 13:05:10 -0400
Reply-To: Dina A...
drivers
>have a lot in common.
>
>Since 1983, Skip Barber Racing has trained nearly 1/3 of all Indy 500
>competitors
>
>In...
>**The areas and behaviors associated with the most malpractice risk,=
claims,
>and awards in emergency medicine
>**Approa...
>Afternoon: Training in the art of high-performance driving and racing in
>open wheel Formula Dodge race cars
>
>Few track...
>CambridgeHealth Resources
>1037 Chestnut Street, Newton, MA 02464
>voice 617-630-1372/fax 617-630-1325
>jtelerski@chealth...
are - what is your experience with subsequent wound dehiscences?
Jeffrey.
For more information, send mail to LISTSERV@BROW...
I have been using the Histoacryl Blue adhesive for the past 5 years,
usually treating a three or four patients a week, usu...
TITLE: Irrigation in facial and scalp lacerations: does it alter outcome?
AUTHOR: Hollander JE; Richman PB; Werblud M; Mil...
The irrigation and nonirrigation groups were similar with regard to
time from injury to presentation (1.56 versus 1.42 hou...
The URL for the PED-EM-L Web Page is:
http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
Date: Thu, 8 Oc...
> October 1992 and August 1996. Patients with nonbite, noncontaminated
> facial skin or scalp lacerations who presented le...
Patrick,
I agree there is no statistical difference between saline irrigation and no
irrigation in this study. Did the aut...
212 562 3403 phone
212 562 2474 fax
Bellevue Hospital Center
Pediatrics 1 South 6
27th Street and First Avenue
New York, N...
My practice is to not treat AOM if the patient reports <48h of pain. As
this is almost always the case ("Joey has been cry...
"red" hot symptomatic ear. I don't use antibiotics for asymptomatic
effusions for example, or that streaky infiltrqte on c...
Thank you,
Dr. Ray Wiss
Director, Emergency Department
Abitibi Regional Trauma Center
Amos, Quebec, Canada
For more inform...
http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
Date: Sun, 18 Oct 1998 22:48:41 -0500
Reply-To: jay p...
For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the
message: info PED-EM-L
The URL for the PED-EM-L Web...
The URL for the PED-EM-L Web Page is:
http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
Date: Wed, 21 O...
Subject: LP or no LP
I am polling the group.
Q: In the case that follows, would you perform an LP as a first test?
Case: A...
For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the
message: info PED-EM-L
The URL for the PED-EM-L Web...
of crockery apart. The result of the expeiment will demonstrate the
weakness of the glue-tissue bond.
Dermabond (or other ...
Reply-To: Michelle Rotta <rotta@acsu.buffalo.edu>
Sender: Pediatric Emergency Medicine Discussion List
<PED-EM-L@BROWNVM.B...
the matter. On a totally unrelated matter, I am new to the list and =
find everyone's comments helpful and imformative. Th...
<HTML>
<HEAD>
<META content=3Dtext/html;charset=3Diso-8859-1 =
http-equiv=3DContent-Type>
<META content=3D'"MSHTML 4.72.31...
is=20
effective treatment for OM.&nbsp; However, we all agreed that unless =
there was a=20
reason to give the ceftriaxone...
<DIV><FONT size=3D2>2.&nbsp; Green Smm abd Rothrock SG, Singel Dose IM =
Cefriaxone=20
for Acute OM in Children, Pediatric...
Date: Tue, 27 Oct 1998 21:09:38 -0600
Reply-To: kowalesk@swbell.net
Sender: Pediatric Emergency Medicine Discussion List
<...
From: "Martin I. Herman" <MHERMAN@utmem1.utmem.edu>
Subject: Re: Tx of pediatric fever
TO Ray,,
I agree that 30 mg/kg load...
The APA Pediatric Emergency Medicine SIG will be holding it's annual
Spring Session in May (1999). As the SIG leader, I am...
20 York Street
New Haven, CT 06504
203-688-7970
203-688-4195 (fax)
douglas.baker@yale.edu
For more information, send mail ...
>
> Miles Nelson, M.D.
>
> steven szabo wrote:
>
> > All of us who have children at home know by now how miserable they ar...
Reply-To: MARTIN I HERMAN <AMANTES@prodigy.net>
Sender: Pediatric Emergency Medicine Discussion List
<PED-EM-L@BROWNVM.BRO...
failures. Asthma scores demonstrated similar improvement in both groups and
were nearly identical from 24-60 hours after i...
Monaghan Medical Corp.) in 152 children aged two or older presenting with
acute exacerbations of asthma. Children in the M...
BACKGROUND: Several studies have demonstrated clinical improvement in young
children with wheezing when adrenergic therapy...
SO,, is there anyone using MDI's in infants..??
WHat about for bronchiolitis or croup???
Thanks,
Martin
For more informati...
Gary.Joubert@LHSC.on.ca
Thanks
Gary Joubert
For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the
message...
Date: Thu, 5 Nov 1998 23:54:56 EST
Reply-To: JamBTDT@aol.com
Sender: Pediatric Emergency Medicine Discussion List
<PED-EM-...
University Medical Center
1800 W. Charleston Blvd.
Las Vegas, NV 89102
Fax: 702-383-3747
For more information, send mail t...
Date: Sat, 14 Nov 1998 17:51:32 EST
Reply-To: GIORAUSA@aol.com
Sender: Pediatric Emergency Medicine Discussion List
<PED-E...
X-To: "Loren Yamamoto, MD, MPH" <loreny@hawaii.edu>
We started using Dermabond six month ago. We have treated 35 laceratio...
>
> For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the
message: info PED-EM-L
> The URL for the PED-EM...
For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the
message: info PED-EM-L
The URL for the PED-EM-L Web...
Minneapolis Minnesota 55405
Grayx022@tc.umn.edu
GraydocER@aol.com
"I think we're all Bozos on this bus."
For more informat...
1.) Do you have a specific policy directing the use (indications,
nursing interventions, type of ORT solution, length of t...
name="nchristo.vcf"
Content-Transfer-Encoding: 7bit
Content-Description: Card for Norman C. Christopher, MD
Content-Dispos...
http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
Date: Fri, 4 Dec 1998 07:51:39 -0800
Reply-To: David ...
Date: Mon, 7 Dec 1998 07:01:36 -0600
Reply-To: MARTIN I HERMAN <AMANTES@prodigy.net>
Sender: Pediatric Emergency Medicine ...
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  1. 1. Date: Tue, 4 Aug 1998 21:43:44 -0500 Reply-To: jay pershad <poppy@netten.net> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: jay pershad <poppy@netten.net> Subject: Re: Antibiotics for neonatal fever If you read Feigin & Cherry's text book of infectious disease or Oski's textbook, late onset LISTERIA (usually meningitis) can occur upto 3 months of age. Hence if you will remember, the usual treatment of infants prior to the early 90's, was, inpatient management of all infants under 3 months with a diagnosis of FWS, with AMP+Gent. Subsequently, the studies by Baskin, O Rourke, Fleisher & then by Bonadio in 1992-1993, that prospectively looked at selective outpatient management of infants 28-90 days changed this practice. With the arrival of Ceftriaxone and then the controversial "fever" guidelines, outpatient management of the 4-12 week old became quite common, especially if they met "low risk" criteria. Listeria as the offending organism, has never been discussed in the above literature, as the age group for outpatient Mx was lowered. None of these studies reported Listeria as a big offender in the 28-90 days age group presenting as sepsis or as r/o sepsis/OB. My personal ancecdotal experience shares this view. I have dropped Ampicillin in the routine treatment of r/o sepsis after the neonatal age group (>28 days) UNLESS they have meningitis. Listeria is very
  2. 2. much like late onset GBS disease and other bacterial causes of neonatal meningitis. You have to cover for the neonatal bugs until 3 months of age if they present with MENINGITIS. BTW, germaine to all this discussion is the fact that Ampicillin is the only penicillin that covers Listeria and is also synergistic with the aminoglycosides in GBS dis or listeriosis. Hope that helps. Jay Pershad "We care for wee folks" ---------- > From: Isaacman, Daniel M.D. <DIsaacma@CHKD.COM> > One of our former chief residents just asked me a question that I'd like to > throw out for the group. He was trained (not by me) to treat all neonates > with amp and cefotaximine (or ceftriaxone or gent) until 8 weeks of age. > The question is when can the amp be dropped. Various practitioners seem to > differ between 4 and 8 weeks of age. Does anyone have a cutpoint that they > use and a reference that substantiates that particular choice? Thanks. >
  3. 3. > Daniel J. Isaacman, M.D. > For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Thu, 6 Aug 1998 07:51:07 -0400 Reply-To: Shane Curran <scurran@tpgi.com.au> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: Shane Curran <scurran@tpgi.com.au> Subject: Paediatric burns X-To: EMED-L@itssrv1.ucsf.EDU Our local fire crews have offered to give us some money to purchase a new piece of equipment instead of giving it to the tertiary burns unit 500 km away. They have asked that we nominate a piece of equipment that is useful in managemnet of childrens burns. the only thing that i could come up with was a cooximeter seeing as we presently have no means of measuring carboxyhemoglobin at this hospital (or met or sulf haemoglobins either) We have all of the other usual ED acute management tools Can anyone think of anything that would fit the criteria taht a department that sees 30000/year wouldn't or should have? Failing that anyone got any recomendations obn brands of cooximeters and likely prices?
  4. 4. For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Sun, 9 Aug 1998 01:48:41 +0200 Reply-To: João Luis Barreira <mop12446@mail.telepac.pt> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: João Luis Barreira <mop12446@mail.telepac.pt> Subject: Re: Methemoglobinemia X-To: javier benito <jbenito@hcru.osakidetza.net> In a recent personal review about methemoglobinemia at my Pediatric Emergency Department at Oporto's Hospital de S. Jo=E3o I found that all o= f our twelve cases since 1989 were related to percutanous exposure to anyline d= yes used to paint the shoes the children were using. Interestingly in a compehensive review I've done about this topic I couldn't found any serie= s like ours. Does anyone have some experience like this. Is someone using some kind of protocol to investigate and treat children with methemoglobinemia ? I think the idea of searching urinary nitrites i= s worthwhile...
  5. 5. I would apreciate any feedback about this topic. Thanxs... Jo=E3o Lu=EDs Barreira, MD Oporto, PORTUGAL joaobarreira@mail.telepac.pt -----Original Message----- From: javier benito <jbenito@hcru.osakidetza.net> To: Multiple recipients of list PED-EM-L <PED-EM-L@BROWNVM.BROWN.EDU> Date: sexta-feira, 7 de agosto de 1998 16:43 Subject: Methemoglobinemia The most frequent oxidative agent which produce acquired methemoglobinemia in my practice is the enhance contents of nitrates in vegetables from unsuitable manure soil. This kind of methemoglobinemia usually causes minimal clinical problems (range < 30%). In most cases, is not necesary to determinate the level of nitrates in blood or vegetables to confirm the presumptive diagnosis. However it's very easy to colect a urine specimen and performed a dipstick test for nitrites. In the last three cases of methemoglobinemia presumptively caused for vegetables that we attended in our emergency room, the disptick test for nitrites was positive. Although this fact don=B4t change the treatment I
  6. 6. think it helps to eliminate another causes of methemoglobinemia. I'd like to know other opinions. Thaks for your help. Javier Benito. Hospital Cruces. Bilbao. Spain. For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Wed, 12 Aug 1998 17:04:52 -0600 Reply-To: "Charles J. Graham" <cjgraham@worldnet.att.net> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: "Charles J. Graham" <cjgraham@worldnet.att.net> Subject: Re: COBRA Question HCFA has just released new guidelines for their carriers and state agencies to follow in investigating and administering the COBRA/EMTALA law and this issue is addressed directly in those guidelines. I read them today on the ACEP web site (www.acep.org). As I understand it, EMTALA would apply to hospitals with organized emergency departments, but also might apply to other hospitals which provide certain acute care services, even if they
  7. 7. don't have an "emergency room". The law also applies if a patients seeks care at a location at the hospital separate from the ED (they must have a screening exam, stabilizing treatment, etc). -----Original Message----- From: Michael Newdow <mnewdow@POL.NET> To: Multiple recipients of list PED-EM-L <PED-EM-L@BROWNVM.BROWN.EDU> Date: Wednesday, August 12, 1998 12:11 PM Subject: Re: COBRA Question >Daniel E. Kates, M.D. wrote: >> >> > What's a "hospital that has no real ER" mean? COBRA applies to "a >> > hospital that has a hospital emergency department." >> > >> >> This is true to an extent. COBRA applies not only to the ED, but to the >> entire facility. > >Although Dr. Kates is correct that COBRA applies to the entire facility, >I believe it applies to the entire facility only of hospitals that have >hospital emergency departments. > >For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L
  8. 8. >The URL for the PED-EM-L Web Page is: > http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Sat, 15 Aug 1998 14:04:54 -0400 Reply-To: Mark Hostetler <mark_hostetler@urmc.rochester.edu> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: Mark Hostetler <mark_hostetler@urmc.rochester.edu> Subject: Analgesia and Sedation Dear Members: I am interested in finding an approximation for the various methods of analgesia and sedation currently being used for pediatric pts in the ED undergoing painful procedures (fracture reduction, laceration repair, incision and drainage, joint aspiration, etc.). I am NOT interested in those patients requiring sedation alone for nonpainful studies such as CT/MR scanning. For those kind enough to take the 2.237 minutes required to complete this brief survey, you may return them directly to me (email, fax, mail below). I find there is a great deal of institutional variation depending on where one practices, and would like a general estimate.
  9. 9. Thank you ever so kindly for your generosity, I=92ve always relied on the kindness of strangers, Mark SURVEY 1. Approximate number of children seen in your ED/year? ________ 2. Your estimate of approximate number of sedations/month? ________ 3. What percent of the time do you/your faculty use the following drug regimens? IV Ketamine (with or without atropine / versed) ________ IM ketamine (with or without atropine / versed) ________ Rectal ketamine (with or without atropine / versed) ________ IV Fentanyl and Versed________ IV Morphine and Versed________ IV Versed +/- topical/local________ PO Versed +/- topical/local________ PO Fentanyl? ________ Nothing? ________ Other________ Other________ Your name/affiliation (Optional) ____________________________________
  10. 10. Mark A. Hostetler, M.D. University of Rochester Departments of Emergency Medicine and Pediatrics Division of Pediatric Emergency Medicine 601 Elmwood Avenue, Box 4-9200 Rochester, NY 14642 Office: 716/275-2090 Fax: 716/473-3516 E-mail: mark_hostetler@urmc.rochester.edu For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Wed, 19 Aug 1998 10:49:25 -0400 Reply-To: Jeffrey F Linzer <jlinzer@emory.edu> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: Jeffrey F Linzer <jlinzer@emory.edu> Subject: Re: Outpatient management of meningitis X-To: "Daniel E. Kates, M.D." <dkates@primenet.com> In-Reply-To: <35D9A640.281@primenet.com> On Tue, 18 Aug 1998, Daniel E. Kates, M.D. wrote: > ...receive a gram of Rocephin daily... If you were going to treat a patient with meningitis on an outpatient
  11. 11. basis, would anyone use Chloromycetin (PO chloramphenicol)? (For those on the list who do not have personal experience or know the history of this drug, it is the only [as far as I am aware] oral antibiotic that has been shown to sterilize the CSF). Jeff Linzer MD MICP Division of Emergency Medicine Egleston and Hughes Spalding Children's Hospitals jlinzer@emory.edu For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Fri, 21 Aug 1998 09:48:46 -0400 Reply-To: "George L. Foltin, MD" <gf16@is2.nyu.edu> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: "George L. Foltin, MD" <gf16@is2.nyu.edu> Organization: NYU Medical Center Subject: Re: Outpatient management of meningitis X-To: Richard Hemmer <rn_medic@MSN.COM> --------------FE514BE0CFC614A14D90BC0C Content-Type: text/plain; charset=us-ascii Content-Transfer-Encoding: 7bit
  12. 12. Richard Hemmer wrote: Over the past few years we have seen way too many cases of > "aseptic meningitis" that was managed at home that were now admitted to the > PICU. (All of these were referrals from multiple facilities) Most of these > children died. Those that did not die, were left with life long problems > including severe developmental problems, loss of fingers/toes/hands because > of gangrenous processes. > > Sounds like an excellent opportunity to report these observations in a peer review journal.An objective report of this phenomena in this setting would have a strong effect on standard of care. George Foltin --------------FE514BE0CFC614A14D90BC0C Content-Type: text/html; charset=us-ascii Content-Transfer-Encoding: 7bit <HTML>
  13. 13. &nbsp; <P>Richard Hemmer wrote:&nbsp;&nbsp; Over the past few years we have seen way too many cases of <BLOCKQUOTE TYPE=CITE>"aseptic meningitis" that was managed at home that were now admitted to the <BR>PICU.&nbsp; (All of these were referrals from multiple facilities)&nbsp; Most of these <BR>children died.&nbsp; Those that did not die,&nbsp; were left with life long problems <BR>including severe developmental problems,&nbsp; loss of fingers/toes/hands because <BR>of gangrenous processes. <BR>&nbsp; <BR><A HREF="http://www.brown.edu/Administration/Emergency_Medicine/ped-em- l.html"></A>&nbsp;</BLOCKQUOTE> Sounds like an excellent opportunity to report these observations in a peer review journal.An objective report of this phenomena in this setting would have a strong effect on standard of care. <P>George Foltin <BR>&nbsp;</HTML> --------------FE514BE0CFC614A14D90BC0C-- For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L
  14. 14. The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Sat, 22 Aug 1998 21:27:16 -0700 Reply-To: Must have been a Wild Angel <angel111@snark.wizard.com> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: Must have been a Wild Angel <angel111@snark.wizard.com> Subject: Re: outpatient meningitis rx In-Reply-To: <35DF6A16.1DA1@pol.net> > I respectfully dissent: To me it is a money issue and there is no art. > It is (or should be, I believe) simply a matter of arithmetic. We > should agree on how much we can afford to spend, and then use the > dollars where we get the greatest return. What art is there to saving > one life (or case of deafness or whatever) at a cost of $X, when that > same $X could have saved two others elsewhere? Greetings, I rarely reply to this list, but this above paragraph just really burned my back side. So, becuase Child 1 has one type of, oh hell lets say cancer, and Child 2 and 3 have another type, are you aluding to forgo aggressive treatment or management of Child 1's cancer because you can treat #'s 2 and 3 for the same or lesser cost?
  15. 15. If this is the correct inturrpertation of this, then please do let me know just where it is you pratice at so I can make sure I dont move there in the future. Heaven forbid should one of my 3, or any child I throw in the back of my ambulance come down with something. > The "art" (to me) is an excuse for not having (or else ignoring) the > data. The only logical way to practice is to come up with some cut-off > (sort of like Oregon's plan, but more evidence-based) in terms of > badness prevented per dollar. We need to know the probabilities that > admitting a generally well-appearing patient with a given pleiocytosis > will save bad things, and then simply see if the cost of admission is > below or above the cut-off. Hmm, I would have assumed that the only logical means of proceeding would be to allow the physically attending Dr. to base thier decisions upon thier pt's presentation and thier Dx instead of having to make thier decision based upon a phone call to a HMO provider who's only interest is seeing that thier CEO's pocket is lined with at least a 8 figure number that year. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~ Angel111@Wizard.com IRC Admin LasVegas.NV.US.Undernet.org
  16. 16. ----------------------------------------------------------------------------- - Grant me the ability to give Emergency Care. With skillfull hands, and knowledgeable mind, and tender love and care. Help me deal with everything, when lives are on the line. To see the worst, administer aid, and ease a worried mind. So help me as I go today, accept what fate may be. Touch these hands, use this mind, help this EMT...Amen ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~ For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Thu, 27 Aug 1998 16:03:21 -0400 Reply-To: "J. Glustein, MD" <glustein@pop.pitt.edu> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: "J. Glustein, MD" <glustein@pop.pitt.edu> Subject: Back-up plans I know I have seen this question posted before, and I hate to drag it up again, but our department is being asked to come up with a back-up plan to increase staffing in the ED when we are faced with an overwhelming volume of patients. Would anyone be willing to share with us a copy of their plan if they have faced this issue? Also, has anyone faced this issue and not come up with a plan? How did you handle it, if so? Thanks
  17. 17. Ray Pitetti, MD Children's Hospital of Pittsburgh pitettr@chplink.chp.edu For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Tue, 1 Sep 1998 00:20:17 -0700 Reply-To: evered@itsa.ucsf.edu Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: "John O. Evered" <evered@itsa.ucsf.edu> Organization: UCSF Subject: Hyperkalemia in CAH A question for the group: Do you use insulin and glucose in the management of severe hyperkalemia in congenital adrenal hyperplasia (CAH) crisis? The Fleisher/Ludwig peds ER texts state that most neonates with CAH tolerate K's of 10 remarkably well and that most of the time, saline and steroids will resolve the hyperkalemia; and that insulin is contraindicated because of the risk of causing hypoglycemia. Someone responded in conference today that this was nonsense and that you should treat very high K (and all high K with marked EKG changes or arrhythmias) with insulin, as well as calcium, kayexelate, bicarb and other means, as always. I have not been able to find case reports or reviews that help weigh the risks of hypoglycemic seizures vs. hyperkalemic arrhythmias for these babies. Can anyone comment, or point
  18. 18. me towards some literature? How would the presence of arrhythmias affect your decision? (Our case patient had had a potassium of 10 and a brief run of V-tach, for example, but then had a normal 12-lead despite a repeat K of 10). For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Tue, 1 Sep 1998 23:39:18 EDT Reply-To: RCordle@aol.com Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: Randolph J Cordle <RCordle@aol.com> Subject: Herniation ? from LP. Hello, I have been following this unfortunate thread on this and the PICU list and have an academic question for the group. What is the true evidence that the LP in the cases cited actually caused the herniation? Certainly a temporal relationship has been suggested by the literature and I am not saying that cause and effect are not present, but I am not yet convinced that this is the case. Obviously, this has serious medical and legal ramifications. Could it be that the LP just happened to be done at about the time these children were going to herniate? From a pure physics standpoint if you truly create this great lumbar vacuum why doesn't herniation occur immediately? When it does I
  19. 19. think the temporal argument speaks much more conclusively to cause and effect but when it is 12 or 24 hours later I think it is difficult to say. I do not have the citation at my finger tips but I remember one of our pediatric neurosurgeons considering a lumbar, yes lumbar, drain on a pediatric trauma patient with increased uncontrollable elevated ICP because of recent literature demonstrating its ability to lower ICP even in patients with bolts already in the lateral ventricle ( Sorry, I do not remember all the specifics). I do not disagree with some of the suggested diagnostic and theraputic plans only with the evidence on which we may be basing our decisions and the possible legal ramifications to our colleagues who might practice differently based on the same literature. If anyone knows of good literature proving cause and effect or statistically significant differences in outcome in matched cohorts please let me know. Respectfully, Randy Cordle MD Lehigh Valley Hospital Department of Emergency Medicine For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
  20. 20. Date: Thu, 3 Sep 1998 18:04:53 -0300 Reply-To: Richard Hemmer <rn_medic@msn.com> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: Richard Hemmer <rn_medic@msn.com> Subject: Re: Question for the group X-To: Maureen McCollough <mmccoll@ucla.edu> In-Reply-To: <2.2.32.19980903065055.006995a8@pop.ben2.ucla.edu> ||||||||||||||||||||||||||||||||||||||||||||||||||||FLAME SHIELD ON OK.. Let me get into hot water again... I believe that if the child is in severe distress and is not intubated by the paramedic, then the closest facility is the answer. If the child is intubated by the paramedic and there is a clear understanding that the tube is in, (i.e.: SaO2, EtCO2, Chest Rise/Fall, EQUAL Lung Sounds), then I believe that the closest PEDS HOSPITAL is the answer. IF THE DIFFERENCE FROM THE SCENE TO THE PEDS HOSPITAL IS LESS THAN 3-5 MINUTES, THEN THE PEDS HOSPITAL IS THE ANSWER. However, If an Emergency Physician / Medical Control Physician has any doubt as to the airway, then the closest hospital is the ONLY ORDER THAT IS APPROPRIATE AS A TRANSPORT DECISION ORDER!!! If that physician knows the paramedic and feels that his/her pediatric skills are not EXCELLENT, then the transport to the CLOSEST hospital. I have worked on all three aspects.. the paramedic, the community non-peds specialty ER and the Peds ER. This is just my $0.02.
  21. 21. Rich Hemmer -----Original Message----- From: Pediatric Emergency Medicine Discussion List [mailto:PED-EM-L@BROWNVM.BROWN.EDU]On Behalf Of Maureen McCollough Sent: Thursday, September 03, 1998 3:51 AM To: Multiple recipients of list PED-EM-L Subject: Question for the group Question for the group (and I will try to ask it as neutrally as possible). Hypothetical situation - child in "severe respiratory distress" in the field (as per a paramedic's evaluation). Is it better for the child to be transported by paramedics 30 minutes (or many times longer) in order to get to a "Pediatric Critical Care Center" (may not necessarily be soley a "children's hospital") or is it better for the child to be transported only a few minutes to a general emergency department staffed with board certified and/or residency trained emergency
  22. 22. physicians?? The PCCC ED is staffed by emergency physicians but has a PICU and intensivists and specialists. Other examples of cases like this would include a cyanotic child or child in status epilepticus. There are over 80 general emergency departments at your disposal and only 9 Pediatric Critical Care Centers for 10 million people with unbelievable traffic jams at times. Large areas of your county do not have a PCCC and therefore long transport times to PCCC's are the rule, not the exception, for these areas. Existing policy states over 20 minute transport time requires helicopter to be called in which can take significant amounts of time for it to arrive on scene which can extend total transport time. It is proposed that allowable ground transport time to a PCCC be extended to 30 minutes, at which point a helicopter would be called. I am not looking at trauma cases, just medically ill children. Interested in what the group thinks. Remember, I am staying neutral so tone down the hate mail (just kidding - I can take it) Maureen McCollough OliveView-UCLA Medical Center For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
  23. 23. For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Fri, 4 Sep 1998 19:08:33 -0400 Reply-To: Jason Cerovac <jcerovac@panix.com> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: Jason Cerovac <jcerovac@panix.com> Subject: Re: PED-EM-L Digest - 2 Sep 1998 to 3 Sep 1998 X-To: MARTIN I HERMAN <AMANTES@prodigy.net> In-Reply-To: <005901bdd82a$b929eac0$07349cd1@default> On Fri, 4 Sep 1998, MARTIN I HERMAN wrote: > I would agree that transport to the nearest facility would be appropriate > for a child in distress.especially with airway compromise and the other > situations cited.I do have confidence that any residency trained emergency > doc should be able to stabilize a children distress. Telephone consults are > easily obtained and if the emergency physician needed any advice from the > PCCC , he /she could call.. > > Why would anyone leave a patient in jeopardy during along transport when > competent help is nearby?? As a paramedic, I take the position of "transport to the nearest appropriate facility." This sometimes entails passing other hospitals that may be able to provide the care, but in passing them I am going to a hospital that CAN provide the care. Not all ED's staff pediatric
  24. 24. personnel, or even have on call specialists that might be needed. It is the duty of the paramedic or EMT to know what resources a particular hospital has available. If I had a sick child, it would benefit that child to go to an ED with pediatric practioners. If I can provide life-supporting care to facilitate that extended transport, I will. If the care can not be provided, I divert to the nearest facility. In the latter case, if need be, the child can later be transfered to the better facility. As far as telephone consultation goes: In the emergency medical services are specially trained physicians whose job is to provide on-line support for field personnel. These doctors help us determine the best course of treatment, give us orders, and sometimes act as a resourse when we are stumped. Every EMS system has in place a 'medical control' system. Through off-line protocols and on-line support they extend the physician into the field. (A paramedic is a physician extender). My .02 Jason jcerovac@panix.com | I will defend to the death | New York State EMT-P finger for contact | your right to free speech, | Woodstock 94 Medical Team information. | You shall be free | Learn CPR - Ask me how! <All unsolicited E-Mailers (spam) will be charge a $20 processing fee>
  25. 25. For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Tue, 8 Sep 1998 19:52:57 EDT Reply-To: RCordle@aol.com Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: Randolph J Cordle <RCordle@aol.com> Subject: Sore Elbow I am not sure that a sed rate can accurately differentiate sickle cell from infecton in such a case. I wonder how useful ultrasound would be in this case to first show effusion and then give some indication of possible osteomyelitis. Although I do not believe US has great sensitivity in early cases of osteo I believe its specificity is probably better than that of a bone scan in patients with crises, unless possibly if tagged wbc are used. Possibly one of our pediatric radiology colleagues could shed some light on this for us. Randy Cordle MD For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
  26. 26. Date: Fri, 11 Sep 1998 01:06:02 -0500 Reply-To: jay pershad <poppy@netten.net> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: jay pershad <poppy@netten.net> Subject: FU elbow I appreciate you all's input. For those interested in a follow up, I did get a ESR on this patient in the ED. It was 34. Started IVF and gave some MS for analgesia. Eventually ended up admitting her to Hematology, who knew her well. She gradually improved over the next two days with full range of motion with fluids and analgesia and was discharged today. The working diagnosis was vasoocclusive crisis in the left elbow. While in hospital the elbow was not tapped nor was any bone scan/USG done. Jay Pershad, MD For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Mon, 14 Sep 1998 20:24:19 -0700 Reply-To: Henry Ngo <hngomd@pol.net> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: Henry Ngo <hngomd@pol.net> Subject: Rapid Strep test Personally I think Rapid strep is very helpful in the ER esp. if a positive test is in the context of strong clinical suspicion of strep
  27. 27. pharyngitis. However, if the clinical suspicion is strep infection and the Rapid strep is negative, then one has to proceed doing a throat culture. So in essence, the use of Rapid strep is for you to order PCN for total of 10 days with full confidence once the test is positive. If the Rapid test is negative, you may elect to wait for the throat culture to come out and act on it appropriately. Henry Ngo,MD Member,ACP For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Tue, 15 Sep 1998 21:14:10 -0500 Reply-To: Louis Geoffroy <lgeoffroy@videotron.ca> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: Louis Geoffroy <lgeoffroy@videotron.ca> Subject: Re: Febrile seizure parisa arman wrote: > > Hi everybody, > I have a question, How do you decide on doing LP in a febrile child > who presents with seizure? >
  28. 28. *************** I treat a febrile child with simple febrile seizure like any other child with fever only: If he looks sick, if he has stiff neck then I do a LP. Sometimes a period of observation is needed (once the post-ictal state is finished) before I make up my mind... There is no more risk of meningitis among this sub-population. ---- Louis Geoffroy, m.d. Emergency departement Hopital Ste-Justine pour enfants Montreal, Quebec, Canada ---- Si vous recherchez un BON camp de vacances, allez =E0 cette adresse: http://www.odyssee.net/~geoffroy/tekakwitha.html For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Wed, 16 Sep 1998 14:34:28 -0300 Reply-To: jorge alvarez <jorgealv@netverk.com.ar> Sender: Pediatric Emergency Medicine Discussion List
  29. 29. <PED-EM-L@BROWNVM.BROWN.EDU> From: jorge alvarez <jorgealv@netverk.com.ar> Subject: LP and Strep swabs Sorry if my opinion is a little simple.Here at La Plata Children's Hospital we treat suspicious throats with a 10 day pen PO or benzatine injection if the patient is not going to return.We have a pretty good lab facilities but we don't use quick methods, we must plate all swabs.Could anybody describe such quick methods and advantages for me? As to L.P. I've been doing LP to any postconvulsive febrile child who is not clearly a febrile convulsion.I agre with that clinical impression or gestalt as was mentioned as the most sensitive resource we have.Here at Argentina we have a saying that goes like this: "If anyone(doctors or nurses) thought of a LP ,do it"Of course we have done a lot of negative LP but one opportune diagnosis may be life-saving.We often consult a pediatric neurologist who is on call in the Hospital and we have never disagreed. It is good to read your messages,I'm learning a lot and losing my fears to write my owns. Dr.Jorge Alvarez Chief Pediatric Interns Children's Hospital Sor Maria Ludovica La Plata Argentina jorgealv@netverk.com.ar Phone 54-1-522075
  30. 30. For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Thu, 17 Sep 1998 14:06:11 -0500 Reply-To: Harvey Louzon <harvey@Mcs.Net> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: Harvey Louzon <harvey@Mcs.Net> Subject: Re: Rapid Strep test - Why? >Why treat strep with antibiotics at all? Because it's been shown in placebo controlled studies to shorten the duration of illness. How's that for a novel idea? h For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
  31. 31. Date: Sun, 20 Sep 1998 02:35:02 -0500 Reply-To: jay pershad <poppy@netten.net> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: jay pershad <poppy@netten.net> Subject: Re: Febrile seizures Dr Hennes wrote: "The guidelines from the AAP and the ACEP are just guidelines and I hope to God they will stop publishing them. I'm just tired of these so called guidelines which may cause unnecessary risks to kids and is a financial burden for some parents." Mega ditto's Halim!!! The other concern that I have with such promulagations is that they have medicolegal implications for all of us who are practicing real world medicine ( & not "ivory tower" recommendations); I do understand that they are only guidelines that need not be followed in all cases and tend to be conservative in their intent, but when one has a large national organization representing children in our country, come out with a consensus statement, it makes things very awkward indeed. More so, if faced with an outcome that does not follow one's honest clinical judgement.... Emotions aside, where is the clinical data to support this age cut offf??. It seems strange to me that in the "fever" guidelines clinical judgement was recommended to decide need for an LP above the age of 2- 3 months but the same judgement cannot be utilized for a febrile child with a seizure
  32. 32. who is 9 months old and is now alert and and blowing bubbles at me??? I have been following this thread with avid interest and would add the following comments not mentioned: 1. The decision analytic model used by Joffe, Deangelis & Mcormick published in AJDC 1983; 137(12) entitled "Which children with a FC need LP?" is worth reading. They reviewed 300 odd patients presenting (in the pre-Hib era) with fever and seizure. The results had a 100 % NPV for meningitis if these 4 criteria are used (a) presenting with an active seizure to the ED (b) Abnormal neuro exam (c) focal seizure (d) Seen PMD within the last 48 hours. 2. There is enough data out there to suggest that, depending on whom you read, 30 -60 % of these FC are caused by HHV 6 ( same one causing Roseola). A smaller % are also caused by HHV 7, adenovirus etc. 3. Occult meningitis was an issue with febrile kids with HFlu bacteremia. With its virtual elimination, having an age cut off like 12 months makes no sense to me. I would also rely on a careful history & good clinical examination in such cases. Have I caught the wrong end of this burning stick ?? Jay Pershad, MD "Every noble thought in your mind brings you closer to God" For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L
  33. 33. The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Tue, 22 Sep 1998 11:58:01 CST Reply-To: mdavis1@airmail.net Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: "Mark O. Davis" <mdavis1@airmail.net> Subject: Re: T charts X-To: David Soglin <dsoglin@POL.NET> Addressed to: David Soglin <dsoglin@POL.NET> Multiple recipients of list PED-EM-L <PED-EM- L@BROWNVM.BROWN.EDU> ** Reply to note from David Soglin <dsoglin@POL.NET> Tue, 22 Sep 1998 10:53:52 -0700 > What are T-charts? Check out www.tsystem.com. Mark in San Angelo mdavis1@airmail.net 09/22/98, 11:57:59 For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is:
  34. 34. http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Fri, 25 Sep 1998 12:07:23 EDT Reply-To: Robert Wright 525-0352 <rerow@gauss.bwh.harvard.edu> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: Robert Wright 525-0352 <rerow@gauss.bwh.harvard.edu> Subject: re GABHS I am not sure of the value of the previous cost-benefit analysis by Dr. Newdow. If we assume that all ARF is caused by GABHS and that the bacteria is 100% sensitive to antibiotics, then the population attributable risk of "not treating with ABX" is 100%. Since the sensitivity and specifity of combined Rapid strep and culture is quite high, and the prevalence of the disease among the select population (children greater than 5 with sorethroats) is also high, then the positive predictive value should be high. Very few cases will be missed and less needless abx will be prescribed which is of clear benefit to the public. My understanding is that the 1-2 day delay in treatment while waiting for the culture does not increase the risk of ARF. I can think of no argument to justify treating everyone, unless your department refuses to do rapid streps and cannot do follow-up on patients for socioeconmic reasions.
  35. 35. For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Mon, 28 Sep 1998 10:39:07 -0400 Reply-To: Jeffrey F Linzer <jlinzer@emory.edu> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: Jeffrey F Linzer <jlinzer@emory.edu> Subject: Re: pneumovax X-To: jay pershad <poppy@netten.net> In-Reply-To: <199809271514.KAA08407@cedar.netten.net> I think it would be great if this vaccine works as well as the one for H. flu. However did anyone catch the blurb on a national news program on Friday that researchers in Finland are worried about a link showing an increased risk of IDDM in vaccine recipients? Jeff Jeff Linzer MD MICP Division of Emergency Medicine Egleston and Hughes Spalding Children's Hospitals jlinzer@emory.edu For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is:
  36. 36. http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Mon, 5 Oct 1998 13:05:10 -0400 Reply-To: Dina Ann Kouveliotes <dinak@chealth.com> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: Dina Ann Kouveliotes <dinak@chealth.com> Subject: ED Leadership & Skip Barber Racing X-To: EMED-L@ITSSRV1.UCSF.EDU Have the time of your life=85and learn the skills that could save it! > >CambridgeHealth Resources is pleased to announce > >The Leadership Training Series for the >Emergency Physician at the >Skip Barber Racing School > >April 21 & 22, 1999, Lime Rock Park, Lakeville, CT >(only 2 hours from NYC, 1 hour from Hartford, and 2.5 hours from Boston) >Additional venues include the Laguna Seca Raceway, Monterey, CA, dates in >May or June TBA > >For more information or reservations please email jtelerski@chealth.com or >call 617-630-1372. > >Long hours. Grueling schedules. Great successes. Adrenaline Rushes. >Reliance on a skilled team=85ED physicians and professional race care=
  37. 37. drivers >have a lot in common. > >Since 1983, Skip Barber Racing has trained nearly 1/3 of all Indy 500 >competitors > >In 1997 & 1998, CambridgeHealth has educated over 2,000 ED Physicians. > >Join the nation=92s premier ED physicians in an educational experience that >you will not soon forget. Limited to 30 attendees each, CambridgeHealth= has >developed a program that will teach you the skills you need to enhance your >leadership skills in the ED. > >Approved for CME Credit > >Day One: April 21, 1999 > >Half-day ED Leadership Intensive 8:00am-Noon >*Situational Leadership Skills >*Creating the Cost-Effective Emergency Department >**Streamline patient and paper flow >**Optimize staffing >**Increase productivity >**Optimize clinical and billing data capture >*Advanced Risk Management
  38. 38. >**The areas and behaviors associated with the most malpractice risk,= claims, >and awards in emergency medicine >**Approaches to effectively manage risk in emergency medicine >**Strategies to reduce risk while lowering costs >*Speed in the Emergency Department >**Avoiding common time wasters in the ED >**Strategies to become more efficient in the care of your patients >**Identifying processes in your ED that create inefficiency > >Half-day Trauma Management Update 1:00-5:00 >*Mechanisms of Injury >**The impact of mechanism of injury on trauma morbidity and mortality >*Trauma Radiology: Diagnoses that are easy to miss >**Test your skills in reviewing trauma x-rays with subtle abnormalities >*Cervical Spine Injuries >**Clinical presentations of spinal injuries >**Utilization of plain radiographs, CT scans, and MRI >**Interventions for the unstable cervical spine injury >*Case Studies in Trauma Care > >Day Two: April 22, 1999 > >Full Day Racing at Lime Rock Park >Morning: Classroom training followed by an advanced driving skills course >in Dodge Vipers and Dodge V-8 Dakotas=20
  39. 39. >Afternoon: Training in the art of high-performance driving and racing in >open wheel Formula Dodge race cars > >Few tracks are as well known and loved as Lime Rock Park. This classic >1.53-mile, 7-turn course, nestled in the Berkshire Mountains, has= challenged >some of the world's best drivers since 1957. > >Experience the excitement and challenge of high-performance and race car >driving combined with outstanding professional instruction at the world=92s >best racing and driving school. > >You will learn important techniques that not only enhance your driving >abilities but will challenge your personal limits and build your= confidence. >You come away with an in depth understanding of vehicle dynamics, skid >control, and proper braking methods. The Skip Barber professional >instructors train you in the art of high-performance driving using open >wheel Formula Dodge race cars, powerful Dodge Vipers, and Dodge V-8= Dakotas. > > > >***** >Jason Telerski >Director of Programming
  40. 40. >CambridgeHealth Resources >1037 Chestnut Street, Newton, MA 02464 >voice 617-630-1372/fax 617-630-1325 >jtelerski@chealth.com >"Visit us on the web!" -- http://www.cambridgehealth.com >***** > > For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Wed, 7 Oct 1998 09:22:58 -0400 Reply-To: Jeffrey Mann <jmann@blast.net> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: Jeffrey Mann <jmann@blast.net> Subject: Re: Dermabond topical adhesive To those of you who have been using the Dermabond adhesive in the ED - how are ensuring adequate wound irrigation without using local anesthesia? Secondly, are you using Dermabond for lacerations that are gaping more than 5mm (which is an apparently widely accepted threshold indicating that the wound is under significant static tension forces); and if you
  41. 41. are - what is your experience with subsequent wound dehiscences? Jeffrey. For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Thu, 8 Oct 1998 16:21:13 +1000 Reply-To: Patrick Linehan <plinehan@cyberus.ca> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: Patrick Linehan <plinehan@cyberus.ca> Subject: Re: Dermabond topical adhesive In-Reply-To: <199810080407.AAA14294@listserv.brown.edu> >Date: Wed, 7 Oct 1998 20:59:18 -0400 >From: sudha-russell <sudha-russell@email.msn.com> >Subject: Re: Dermabond topical adhesive > >I have been using LET (whenever appropriate and feasible), prior to >irrigation. > >What 's the group's experience, with potential complications such spillage, >and "unintended" application, of the Dermabond adhesive in children where >the restraints may not hold? > >Sue
  42. 42. I have been using the Histoacryl Blue adhesive for the past 5 years, usually treating a three or four patients a week, usually without irrigation,and in that time I have never seen a wound infection. In order to get a good result you have to stop the flow of blood and so I usually apply LET or lidocaine with epi for 10 minutes. Once or twice I have glued the tip of a glove to a child's face. If I am repairing a laceration near the eye I usually cover the eye with gauze to make sure no glue falls in. Histoacryl is supposed to be dropped on according to the manufacturer, but I found it looks less clumpy and more professional if you "paint" it on. Histoacryl comes in a single dose container, but everyone in Canada converts it to a multidose container by putting a 25 or 28 G needle over the tip of the container. The cost for a vial is about $25 and you can usually treat 4 or 5 patients per vial. The edges of the laceration will not be everted using glue, the direction of forces are parallel to the suface of the skin and so won't pull the wound margins upward. I think the reason that I haven't seen many wound infections is due to selection of wounds: if a wound needs to be cleaned due to contamination (dirt, dogbite etc.) I would freeze the wound up and irrigate or debride and then either suture or leave open. I think there is a good case for not irrigating clean small wounds:
  43. 43. TITLE: Irrigation in facial and scalp lacerations: does it alter outcome? AUTHOR: Hollander JE; Richman PB; Werblud M; Miller T Huggler J; Singer AJ AUTHOR AFFILIATION: Department of Emergency Medicine, University Medical Center, State University of New York at Stony Brook, USA. jholland@mail.upenn.edu ABSTRACT: STUDY OBJECTIVE: Animal and human studies suggest that irrigation lowers the infection rate in contaminated wounds, but there is no evidence that this common practice is beneficial for "clean" lacerations. We tested the null hypothesis that there is no difference in the infection rate for noncontaminated lacerations to the face and scalp that are irrigated before primary closure compared with similar wounds that are closed primarily without irrigation. METHODS: We performed a cross-sectional study of consecutive patients presenting to a suburban, academic emergency department between October 1992 and August 1996. Patients with nonbite, noncontaminated facial skin or scalp lacerations who presented less than 6 hours after injury were included. Structured, closed-question data collection instruments were completed at the time of laceration repair and at suture removal. The primary outcome parameters were the incidence of wound infection and the short-term cosmetic appearance of lacerations in patients who did or did not receive irrigation. RESULTS: A total of 1,923 patients were included in the study group; 1,090 patients received saline irrigation, and 833 patients did not.
  44. 44. The irrigation and nonirrigation groups were similar with regard to time from injury to presentation (1.56 versus 1.42 hours, respectively), frequency of linear wound morphology (82% versus 88%), frequency of smooth wound margins (72% versus 82%), number of layers of closure (1.14 versus 1.26), number of skin sutures applied (4.98 versus 4.65), number of deep sutures applied (.70 versus 1.05), and use of oral antibiotic prophylaxis (2.8% versus 4.0%). With respect to outcomes, the incidence of wound infection was not significantly different between the two treatment groups (.9% versus 1.4%, respectively; P = .28). Likewise, the percentage of patients who had an "optimal" cosmetic appearance was similar in the two groups (75.9% versus 81.7%, respectively; P = .07). CONCLUSION: Irrigation before primary closure did not significantly alter the rate of infection or the cosmetic appearance in our study population with clean, noncontaminated facial and scalp lacerations. SOURCE: Ann Emerg Med 1998 Jan;31(1):73-7 With regards to the anecdote about a facial cellulitis following Dermabond glue dehiscence I suspect that the issue was wound cleaning and wound care rather than type of closure. Patrick Linehan, MDCM now far from frigid Canada in sunny Saipan. For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L
  45. 45. The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Thu, 8 Oct 1998 12:06:09 -0400 Reply-To: "Michael G. Tunik" <mt12@is2.nyu.edu> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: "Michael G. Tunik" <mt12@is2.nyu.edu> Subject: Re: Dermabond topical adhesive ......I think there is a good case for not irrigating clean small wounds: >TITLE: Irrigation in facial and scalp lacerations: does it alter outcome? >AUTHOR: Hollander JE; Richman PB; Werblud M; Miller T > Huggler J; Singer AJ >AUTHOR AFFILIATION: > Department of Emergency Medicine, University Medical Center, State > University of New York at Stony Brook, USA. jholland@mail.upenn.edu >ABSTRACT: > STUDY OBJECTIVE: Animal and human studies suggest that irrigation > lowers the infection rate in contaminated wounds, but there is no > evidence that this common practice is beneficial for "clean" > lacerations. We tested the null hypothesis that there is no > difference in the infection rate for noncontaminated lacerations to > the face and scalp that are irrigated before primary closure compared > with similar wounds that are closed primarily without irrigation. > METHODS: We performed a cross-sectional study of consecutive patients > presenting to a suburban, academic emergency department between
  46. 46. > October 1992 and August 1996. Patients with nonbite, noncontaminated > facial skin or scalp lacerations who presented less than 6 hours > after injury were included. Structured, closed-question data > collection instruments were completed at the time of laceration > repair and at suture removal. The primary outcome parameters were the > incidence of wound infection and the short-term cosmetic appearance > of lacerations in patients who did or did not receive irrigation. > RESULTS: A total of 1,923 patients were included in the study group; > 1,090 patients received saline irrigation, and 833 patients did not. > The irrigation and nonirrigation groups were similar with regard to > time from injury to presentation (1.56 versus 1.42 hours, > respectively), frequency of linear wound morphology (82% versus 88%), > frequency of smooth wound margins (72% versus 82%), number of layers > of closure (1.14 versus 1.26), number of skin sutures applied (4.98 > versus 4.65), number of deep sutures applied (.70 versus 1.05), and > use of oral antibiotic prophylaxis (2.8% versus 4.0%). With respect > to outcomes, the incidence of wound infection was not significantly > different between the two treatment groups (.9% versus 1.4%, > respectively; P = .28). Likewise, the percentage of patients who had > an "optimal" cosmetic appearance was similar in the two groups (75.9% > versus 81.7%, respectively; P = .07). CONCLUSION: Irrigation before > primary closure did not significantly alter the rate of infection or > the cosmetic appearance in our study population with clean, > noncontaminated facial and scalp lacerations. >SOURCE: Ann Emerg Med 1998 Jan;31(1):73-7 >Patrick Linehan, MDCM
  47. 47. Patrick, I agree there is no statistical difference between saline irrigation and no irrigation in this study. Did the authors do a power analysis ? To find a differences between 2% infection and 1% infection (a decrease of 1%) with a power of 80% that if the difference is there it will be found, you would need a sample size of 2300 in the treatment AND the control groups. This is a much larger sample than I have seen published for minor wound infection rates with or without saline or other interventions (antibiotics). Clearly the infection rate is low for both control and intervention groups...the real question is IF a diffidence of 1 % exists, especially for facial lacerations, is it worth using saline lavage for 99 patients to prevent one episode of cellulitis? This study has not answered that question. Mike Tunik Michael Tunik, MD Associate Director Pediatric Emergency Medicine Bellevue Hospital Center/NYU School of Medicine
  48. 48. 212 562 3403 phone 212 562 2474 fax Bellevue Hospital Center Pediatrics 1 South 6 27th Street and First Avenue New York, NY 10016 For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Fri, 9 Oct 1998 10:27:31 -0500 Reply-To: jay pershad <poppy@netten.net> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: jay pershad <poppy@netten.net> Subject: AOM** reply In a personal communication, I received this: " Parents don't care about antibiotic resistance. They want symptomatic relief ASAP." But aren't WE supposed to care about resistance? I believe infectious diseases will be the bane of our existence in another decade or so, with patients dying from what should have been sensitive infections.
  49. 49. My practice is to not treat AOM if the patient reports <48h of pain. As this is almost always the case ("Joey has been crying for the last 30 mins!!"), my approach has been to manage the pain aggressively with codeine 1-1.5 mg/kg q3h and to see the child in 24h. If pain persists or if the re-exam looks worse, I treat. Since I started doing this, my use of Abx for AOM has dropped by maybe 90%. The data you quote would seem to indicate that I am not placing my patients at undue risk by doing this. _____________________________________________________________________ I see your point. I would also agree that the data I have presented and from some other European studies does not suggest a higher rate of mastoiditis or meningitis with the conservative option. However, it appears that the relief of fever and pain is shortened by a day or so by adding abx. Also, I am uncomfortable witholding abx in the younger infant and toddler for the reasons I mentioned in my original posting. Your approach, in an older child, may be one way to go, if the parents are with you on this. Unfortunately, in an ED setting (without prior rapport with the family) as Dr. Sutton had stated, I must say, I too have a difficult time changing parent's mindset on antibiotics in AOM. Especially, when that is the very reason that prompted that 2 AM visit. The issue of abx resistance is always there. My approach to that is, yes, we do owe it to society at large to be responsible with our antibiotic usage, but I would not choose to withold abx in this specific scenario of a
  50. 50. "red" hot symptomatic ear. I don't use antibiotics for asymptomatic effusions for example, or that streaky infiltrqte on chest radiograph etc etc. My secret hope is one day we will have a revolutionary non invasive device that could quickly tell us which AOM's are viral and which bacterial!!! Would welcome further comments...... For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Sat, 11 Oct 2098 17:03:20 -0400 Reply-To: Ray Wiss <ray.traumanord@sympatico.ca> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: Ray Wiss <ray.traumanord@sympatico.ca> Subject: Visit to Asia Dear Fellow Members, I will be vacationing in Hong Kong and Singapore during the first two weeks of December/98. I would be very interested to visit Emergency Departments in these two cities and would very much appreciate hearing from anyone who could help make this possible.
  51. 51. Thank you, Dr. Ray Wiss Director, Emergency Department Abitibi Regional Trauma Center Amos, Quebec, Canada For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Thu, 15 Oct 1998 16:29:34 -0400 Reply-To: Edward Conway <conway@aecom.yu.edu> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: Edward Conway <conway@aecom.yu.edu> Subject: Re: Classification of ED's X-To: Kenneth Frumkin <kfrumkin@HEC.netbox.com> In-Reply-To: <3.0.5.32.19981013220640.007c2680@HEC.netbox.com> I am curious if anyne out there is familiar with a program that has a Divison of Pediatric Emergency and Critical Care services as a combined program. I have heard that there are 1 or 2 adult programs like this. Pleae e amil me directly or voice 2128709692. Thanks in advance. Ed Conway For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is:
  52. 52. http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Sun, 18 Oct 1998 22:48:41 -0500 Reply-To: jay pershad <poppy@netten.net> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: jay pershad <poppy@netten.net> Subject: Re: Epi I presume you are talking about SQ epinephrine. I reserve it as initial therapy for the acutely dyspneic asthmatic while I am setting up the albuterol aerosol. There is no reason to repeat it and favor its (non selective beta agonist) use over the more selective beta2 agents. If you were in an office setting say, where you may not have the facility to quickly administer a nebulization, the dose of SQ epi may be repeated in 15 minutes. (see NIH guidelines on BA management form April 1997). Maximum dose is 0.3 ml/dose of the 1:1000 preparation. [I am not sure if "rebound" is an really an issue as with croup. The mode of action of epi in BA unlike in croup, is not primarily the alpha/vasoconstrictor effect but its beta effect on bronchial smooth muscle] Hope it helps Jay Pershad, MD "Safe kids are no accident"
  53. 53. For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Tue, 20 Oct 1998 21:26:26 -0500 Reply-To: MARTIN I HERMAN <AMANTES@prodigy.net> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: MARTIN I HERMAN <AMANTES@prodigy.net> Subject: Jobs I am beginning to explore the possibilities of expansion.. Will need about 5-6 PEM docs to share with our group the responsibilities to provide expanded coverage at some surrounding community ED's and may also need docs who have significant pediatric experience and are comfortable with adults to staff in urgent care or minor medical centers.. Anyone interested in more details contact me via private email or by phone 901 572 3010 or by fax 901 572 5025.. I would be glad to discuss our opportunities with anyone.. Martin Herman, M.D. Assistant Medical Director LeBonheur Children's Medical Center Assistant Professor of Pediatrics , UT College of Medicine For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L
  54. 54. The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Wed, 21 Oct 1998 13:43:34 -0400 Reply-To: "Allen R. Walker" <awalkera@welchlink.welch.jhu.edu> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: "Allen R. Walker" <awalkera@welchlink.welch.jhu.edu> Subject: Re: LP or no LP X-To: Doug Baker <douglas.baker@yale.edu> Given the description of "remarkably irritable", the uncertain history of fever, the (assumed) lack of other physical findings to go with the irritability, and the fontanel which is open and not bulging, I would tap first then scan. I don't believe that the possibity of hydrocephalus represents any contraindication. I believe the LP to be the first test in this situation; I can't think of another test (peripheral WBC, for example) which would alter the necessity of tapping this child. Allen R. Walker, M.D. Pediatric Emergency Medicine Johns Hopkins (410) 955-6143 ---------- From: Doug Baker[SMTP:douglas.baker@yale.edu] Reply To: Doug Baker Sent: Wednesday, October 21, 1998 7:44 AM To: Multiple recipients of list PED-EM-L
  55. 55. Subject: LP or no LP I am polling the group. Q: In the case that follows, would you perform an LP as a first test? Case: A hypothetical 6 month old boy with a CC of fever at home today, and irritability. No Vomiting, Diarrhea, Rash, or other Sx. Drinking OK. PMH of BGS meningitis as a one month old, requiring a three week hospital stay, resulting in some amount of developmental deficit (the extent unclear from the mother's history). PE: Alert and drinking a bottle at tiage, but intermittently irritable and lethargic in the exam room. T=37.8C. Unclear if he had an antipyretic. Anterior fontanelle open (2cm), and full, but not bulging. Crying when examined; appears remarkably irritable. Remainder of HEENT exam grossly unremarkable, but head appears generous in size (no measurement made). Chest, Abdomen, Skin, Extremities are grossly normal. What do you test first? If you suspect the child might have hydrocephalus, is a tap to rule out meningitis contraindicated prior to obtaining a scan? Thanks in advance for repies. Doug Baker
  56. 56. For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Sat, 24 Oct 1998 08:42:17 -0400 Reply-To: Jeffrey Mann <jmann@blast.net> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: Jeffrey Mann <jmann@blast.net> Subject: Re: Dermabond Hi Connie, I am not suprised that the dermabond wound partially dehisced when the child fell and impacted the area of the laceration. Dermabond is nothing more than 'Crazy glue' which I have used extensively over the years to repair household items. The glue has little strength - not because the dried glue is not srong - but simply because of the limited strength of the bond between the glue and the glued object. Try a simple experiment:- Next time you dermabond a wound, use the remaining dermabond adhesive to glue together two pieces of broken crockery and then test how strong the glue-crockery bond is by pulling the two pieces
  57. 57. of crockery apart. The result of the expeiment will demonstrate the weakness of the glue-tissue bond. Dermabond (or other tissue adhesives) works well for lacerations where the lacerations are linear, where the edges are flat and not overlapping/inverted and where the wound edges lie in close apposition with no gaping of the wound edges at rest. If you have to manually pull the edges together with forceps, that should be a clue that the wound is under significant static forces that will put the laceration at risk of future dehischence. If you need to evert the edges of a laceration, that means that the laceration is not suitable for dermabonding. The wound edges should lie naturally flat and in close apposition. A partially dehisced dermabonded laceration can be treated with repeated layers of dermabond (expensive at $25 for one vial) or with steristrips (few $'s). Steristrips will not really weaken the adhesive when it is already dry - despite the opinions/admonitions of the ethicon reps, who discourage the application of any other adhesive or lubricant to the dermabonded wound. For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Mon, 26 Oct 1998 14:34:39 -0500
  58. 58. Reply-To: Michelle Rotta <rotta@acsu.buffalo.edu> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: Michelle Rotta <rotta@acsu.buffalo.edu> Subject: otitis and ceftriaxone This is a multi-part message in MIME format. ------=_NextPart_000_000D_01BE00ED.C36B7080 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable It is always a relief when I read a message on the list and find it is a = similar problem our department is trying to evaluate. We had a pow wow = of sorts with falculty from Ped EM, Infectious disease, and ENT to = discuss the use of Rocephin to treat OM. We were curious to the = following given that OM is not an exclusion criteria to an occult = bacteremia work up and came up with the following: 1) we do an OB work = up (CBC and blood Cx) even for kids with a hot ear (so to speak) and if = the WBC is < 15,000 we treat it with an oral antibiotic 2) same kid with = a hot ear, WBC > 15,000, give the ceftriaxone and no further = antibiotic. We did a literature review and the support is there that = one dose of ceftriaxone is effective treatment for OM. However, we all = agreed that unless there was a reason to give the ceftriaxone (increased = WBC or patient won't take po) we would not use such a broad spectrum = antibiotic to treat a disease that is likely viral. Here's the = articles we reviewed. I hope this helps but it probably just confuses =
  59. 59. the matter. On a totally unrelated matter, I am new to the list and = find everyone's comments helpful and imformative. Thanks.=20 Shelley Rotta,MD=20 Pediatric Emergency Medicine at The Children's Hospital of Buffalo =20 1. Varsano I, Frydman M, Amir J, Gershon A, : Single IM Dose of = Ceftriaxone as Compared to 7-Day Amoxicillin Therapy For Acute OM in = Children,Chemotherapy 34, suppl.1,pp39-46 (1988). 2. Green Smm abd Rothrock SG, Singel Dose IM Cefriaxone for Acute OM in = Children, Pediatrics 1993;Vol.91 No.1pp23-30. 3. Chamgerlain JM, Boenning DA, Waisman Y,Ochsenschlage DW, Klein BL, = Single dose Ceftriaxone Versus 10 Days of Cefaclor for OM, Clinical = Pediatrics, Nov. 1994, pp642-646. 4. Barnett ED et al, Comparison of Ceftriaxone and = Trimethoprim-Sulfamethoxazole for Acute OM, Pediatrics, Jan. 1997, vol = 99 No. 1, pp23-28. 5. Varsano I et al, IM Ceftriaxone compared with oral = amoxicillin-clavulanate for treatment of acute OM in children, Eur J Ped = (1997) 156: 858-863. ------=_NextPart_000_000D_01BE00ED.C36B7080 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable <!DOCTYPE HTML PUBLIC "-//W3C//DTD W3 HTML//EN">
  60. 60. <HTML> <HEAD> <META content=3Dtext/html;charset=3Diso-8859-1 = http-equiv=3DContent-Type> <META content=3D'"MSHTML 4.72.3110.7"' name=3DGENERATOR> </HEAD> <BODY bgColor=3D#ffffff> <DIV> <DIV><FONT color=3D#000000 size=3D2>It is always a relief when I read a = message on=20 the list and find it is a similar problem our department is trying to=20 evaluate.&nbsp; We had a pow wow of sorts with falculty from Ped EM, = Infectious=20 disease, and ENT to discuss the use of Rocephin to treat OM. We were = curious to=20 the following given that OM is not an exclusion criteria to an occult = bacteremia=20 work up and came up with the following: 1) we do an OB work up (CBC and = blood=20 Cx) even for kids with a hot ear (so to speak) and if the WBC is &lt; = 15,000 we=20 treat it with an oral antibiotic 2) same kid with a hot ear,&nbsp; WBC = &gt;=20 15,000, give the ceftriaxone and no further antibiotic.&nbsp; We did a=20 literature review and the support is there that one dose of ceftriaxone =
  61. 61. is=20 effective treatment for OM.&nbsp; However, we all agreed that unless = there was a=20 reason to give the ceftriaxone (increased WBC or patient won't take po) = we would=20 not use such a broad&nbsp; spectrum antibiotic to treat&nbsp; a disease = that is=20 likely viral.&nbsp; Here's the articles we reviewed. I hope this helps = but it=20 probably just confuses the matter.&nbsp; On a totally unrelated matter, = I am new=20 to the list and find everyone's comments helpful and imformative. = Thanks.=20 </FONT></DIV> <DIV><FONT color=3D#000000 size=3D2>Shelley Rotta,MD </FONT></DIV> <DIV><FONT color=3D#000000 size=3D2>Pediatric Emergency Medicine at The = Children's=20 Hospital of Buffalo</FONT></DIV> <DIV><FONT color=3D#000000 size=3D2></FONT>&nbsp;</DIV> <DIV><FONT color=3D#000000 size=3D2></FONT><FONT size=3D2>1.&nbsp; = Varsano I, Frydman=20 M, Amir J, Gershon A, : Single IM Dose of Ceftriaxone as Compared to = 7-Day=20 Amoxicillin Therapy For Acute OM in Children,Chemotherapy 34, = suppl.1,pp39-46=20 (1988).</FONT></DIV>
  62. 62. <DIV><FONT size=3D2>2.&nbsp; Green Smm abd Rothrock SG, Singel Dose IM = Cefriaxone=20 for Acute OM in Children, Pediatrics 1993;Vol.91 = No.1pp23-30.</FONT></DIV> <DIV><FONT size=3D2>3.&nbsp; Chamgerlain JM, Boenning DA, Waisman = Y,Ochsenschlage=20 DW, Klein BL, Single dose Ceftriaxone Versus 10 Days of Cefaclor for OM, = Clinical Pediatrics, Nov. 1994, pp642-646.</FONT></DIV> <DIV><FONT size=3D2>4.&nbsp; Barnett ED et al, Comparison of Ceftriaxone = and=20 Trimethoprim-Sulfamethoxazole for Acute OM, Pediatrics, Jan. 1997, vol = 99 No. 1,=20 pp23-28.</FONT></DIV> <DIV><FONT size=3D2>5.&nbsp; Varsano I et al, IM Ceftriaxone compared = with oral=20 amoxicillin-clavulanate for treatment of acute OM in children, Eur J Ped = (1997)=20 156: 858-863.</FONT></DIV></DIV></BODY></HTML> ------=_NextPart_000_000D_01BE00ED.C36B7080-- For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
  63. 63. Date: Tue, 27 Oct 1998 21:09:38 -0600 Reply-To: kowalesk@swbell.net Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: Kevin Kowaleski <kowalesk@swbell.net> Organization: Southwestern Bell Internet Services Subject: Re: Treatment of pediatric fever X-To: Jeffrey Mann <jmann@blast.net> In my experience, it has often been helpful to treat the child in triage with antipyretics so as to facilitate the assessment of the child in the exam room, as the child will have often defervesced by then. Even if the child is not irritable or drowsy in triage, it is not unusual for such a child to look somewhat worse by the time the physician sees him/her. Kevin Kowaleski Toledo, Ohio > The URL for the PED-EM-L Web Page is: > http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Thu, 29 Oct 1998 07:51:48 -0600 Reply-To: "Martin I. Herman" <MHERMAN@utmem1.utmem.edu> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU>
  64. 64. From: "Martin I. Herman" <MHERMAN@utmem1.utmem.edu> Subject: Re: Tx of pediatric fever TO Ray,, I agree that 30 mg/kg loading dose of acetaminophen is more efficacious, I would caution that it is difficult to feel completely comfortable because you can never be entirely sure that there has not been any antecedent use.SO the daily dose of 150 , may have in fact already been given.. More over, there have ben cases of toxicity with regular use of APAP AT THERAPEUTIC DOSAGES. MIH, Memphis For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Fri, 30 Oct 1998 11:50:26 -0500 Reply-To: Doug Baker <douglas.baker@yale.edu> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: Doug Baker <douglas.baker@yale.edu> Subject: APA Spring Meeting Planning Committee <underline>APA PEM SIG PLANNING COMMITTEE NEEDS VOLUNTEERS... </underline>
  65. 65. The APA Pediatric Emergency Medicine SIG will be holding it's annual Spring Session in May (1999). As the SIG leader, I am still looking for volunteers to participate as Planning Committee members. I have had a few inquiries, and will contact those people soon. However, we need more interested participants. This is a fun job, which provides some national exposure for those involved. Please contact me if you are interested in participating as a Committee member. Thanks, Douglas Baker, M.D. PEM SIG Chairperson Pediatric Emergency Medicine Yale-New Haven Children's Hospital
  66. 66. 20 York Street New Haven, CT 06504 203-688-7970 203-688-4195 (fax) douglas.baker@yale.edu For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Sat, 31 Oct 1998 11:36:13 +0000 Reply-To: mnelson@nmol.com Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: Miles Nelson <mnelson@nmol.com> Subject: Re: treatment of pediatric fever X-To: mdszabo@WORLDNET.ATT.NET Miles Nelson wrote: > I musta skipped that day in medical school cause I don't recall any contraindication for the use > of ibuprofen in varicella. What exactly is the risk? I don't believe Reye has been observed.
  67. 67. > > Miles Nelson, M.D. > > steven szabo wrote: > > > All of us who have children at home know by now how miserable they are when > > febrile and how wonderful is having some Ibuprofen at hand ...Triage > > protocols are usually for Tylenol because of fear of using Ibuprofen in > > case of varicella or the possibility of surgery(coagulation). > > I think antypiretics were invented to treat fever and I am all for it at > > triage. There is nothing wrong "treating" the parents as well...after all > > they are the ones judging the quality of care given ( and paying the bill > > too..) > > Steven Szabo, M.D. > > > > For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L > > The URL for the PED-EM-L Web Page is: > > http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Sun, 1 Nov 1998 14:29:57 -0600
  68. 68. Reply-To: MARTIN I HERMAN <AMANTES@prodigy.net> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: MARTIN I HERMAN <AMANTES@prodigy.net> Subject: Aerosols I am puzzled.. How many are using MDI with spacers for infants and kids < 5? the literature seems to support the use of MDI.. 1. RANDOMISED TRIAL SPACER V. NEBULISER FOR ACUTE ASTHMA Parkin, P.C., et al, Arch Dis Child 72(3):239, March 1995 METHODS: This randomized, prospective study, from the Hospital for Sick Children in Toronto compared outcomes in 60 children aged one to five hospitalized for moderate acute asthma who were treated after initial stabilization with IV or oral steroids plus albuterol with ipratropium bromide given by either MDI/spacer or nebulizer. For children treated with the MDI/spacer, the dose of albuterol was four puffs (400mcg), five puffs, or six puffs for those weighing less than 12kg, 12-16kg, or 16kg or more, respectively, and the dose of ipratropium was two puffs (40mcg). For children treated with the nebulizer, the doses of albuterol and ipratropium were 0.15mg/kg and 125mcg, respectively. RESULTS: The baseline asthma score (on a scale of 1-10) was higher in the MDI/spacer group (5.7 vs. 4.8, p=0.02). Nine of the 30 MDI/spacer patients were ultimately treated with nebulized bronchodilators, but only four were considered to be MDI/spacer
  69. 69. failures. Asthma scores demonstrated similar improvement in both groups and were nearly identical from 24-60 hours after initiation of treatment. The mean total number of doses administered was 20 in the MDI/spacer group and 17 in the nebulizer group, and the mean time to discharge was 53 and 46 hours, respectively. Treatment was assessed by nurses to be easier and better tolerated in the MDI/spacer group. There were no significant differences between the two groups in the percentage of patients who were asymptomatic at seven and fourteen days. CONCLUSIONS: As has been observed in adults and older children, administration of bronchodilators by MDI/spacer appears to be as effective as administration by nebulizer in preschool age children with moderate acute asthma. 6 references *Copyright 1995 by Emergency Medical Abstracts - All Rights Reserved 07/95 - #34 2. METERED-DOSE INHALERS WITH SPACERS VS. NEBULIZERS FOR PEDIATRIC ASTHMA Chou, K.J., et al, Arch Ped Adol Med 149(2):201, February 1995 BACKGROUND: Patients with acute exacerbations of asthma are frequently treated with nebulized bronchodilators. However, studies conducted in adults have shown that delivery of beta agonists by metered dose inhaler (MDI) with an attached spacer, which eliminates the need for coordination of breathing and MDI actuation, is as effective as more labor-intensive nebulizer therapy. METHODS: This randomized, prospective study, from the Bronx Municipal Hospital Center in New York, compared the effects of standard nebulized albuterol (0.15mg/kg to a maximum of 5mg given in 3ml of normal saline), and albuterol delivered by MDI with a spacer (Aerochamber,
  70. 70. Monaghan Medical Corp.) in 152 children aged two or older presenting with acute exacerbations of asthma. Children in the MDI/spacer group received standard doses of three 90mcg puffs per dose. Each puff was dispensed into the spacer, after which the child was instructed to breathe normally five times through either the mouthpiece of the spacer or the spacer mask (for children under the age of five). In both groups, doses were given at 20- minute intervals. RESULTS: There were no significant differences between the two groups in changes in asthma severity scores or PEFR, oxygen saturation, number of treatments administered, use of steroids during acute treatment, or percentage of patients who required hospitalization. Mean treatment time in the emergency department was 66 minutes in the MDI/spacer group compared with 103 minutes in the nebulizer group (p<0.001), while patients in the nebulizer group had a higher incidence of vomiting (20% vs. 8%, p<0.04) and a greater mean increase in heart rate (15% vs. 5%, p<0.001). CONCLUSIONS: These findings suggest that in children, as in adults, MDIs with spacers are as effective as nebulizer therapy for the management of acute exacerbations of asthma. 21 references *Copyright 1995 by Emergency Medical Abstracts - All Rights Reserved 06/95 - #35 3. RESPIRATORY ASTHMA PEDIATRIC ALBUTEROL DELIVERED VIA METERED-DOSE INHALER WITH SPACER FOR OUTPATIENT TREATMENT OF YOUNG CHILDREN WITH WHEEZING Hickey, R.W., et al, Arch Ped Adol Med 148(2):189, February 1994
  71. 71. BACKGROUND: Several studies have demonstrated clinical improvement in young children with wheezing when adrenergic therapy was administered subcutaneously or via nebulization. METHODS: This double-blind, prospective, placebo-controlled crossover trial, from the Children's Hospital of Pittsburgh, examined the clinical efficacy of albuterol delivered via metered-dose inhaler with a spacer for the treatment of acutely wheezing infants aged 1-18 months. Forty-two infants were randomized to two groups. One group received two albuterol treatments (two puffs, 180mcg) followed by two placebo treatments, and the second group received two placebo treatments followed by two albuterol treatments. The treatments were administered every 20 minutes via a MDI and a "homemade" spacer. The MDI-spacer was held over the child's mouth and nares for six breaths following each puff. Clinical assessment (heart and respiratory rates, wheezing and retraction scores, and oximetry) was performed prior to each treatment and 20 minutes after the last treatment. RESULTS: Both groups demonstrated a statistically significant improvement in wheezing scores after two treatments with albuterol, and the second group showed a statistically significant improvement in retraction scores. There were no significant changes in heart rate or oxygen saturation. CONCLUSIONS: Treatment of acutely wheezing infant outpatients with albuterol via a MDI and spacer decreases the severity of retractions and wheezing. Thus, albuterol therapy with a MDI and spacer may be as efficacious as more expensive and cumbersome nebulization therapy. 41 references *Copyright 1994 by Emergency Medical Abstracts - All Rights Reserved 07/94 - #38
  72. 72. SO,, is there anyone using MDI's in infants..?? WHat about for bronchiolitis or croup??? Thanks, Martin For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Mon, 2 Nov 1998 11:22:30 -0500 Reply-To: Gary Joubert <Gary.Joubert@LHSC.ON.CA> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: Gary Joubert <Gary.Joubert@LHSC.ON.CA> Subject: Rash Photos I am presenting a talk at an acedemic day in emergency medicine. The group of learners will include family doctors, ER MD's, residents and ER nurses. Does anyone know of a good source of photographs of rashes that can be down loaded and used as slide? Or does anyone in the group have some material that they are willing to share? If you do please send to
  73. 73. Gary.Joubert@LHSC.on.ca Thanks Gary Joubert For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Tue, 3 Nov 1998 10:21:44 EST Reply-To: S77L82@aol.com Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: S77L82@aol.com Subject: info on KED I have just started attending a paramedic program, and I am looking for information about the KED. Are there any printed articles that you know of that may be of assistance? Mark Bruno emt email S77L82@aol.com For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
  74. 74. Date: Thu, 5 Nov 1998 23:54:56 EST Reply-To: JamBTDT@aol.com Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: Jackie Mador RN CEN <JamBTDT@aol.com> Subject: Observation Units X-To: EM-NSG-L@ITSSRV1.UCSF.EDU X-cc: pediatricERnurses@onelist.com We are in the process of opening a 7 bed Observation Unit as part of our Pediatric Emergency Department for the 23 hour admits. It is located adjacent to the current department (separated by a hallway) and will have dedicated nursing staff. I am looking for any words of wisdom from others who have opened similar units. Specifically about things like a) do you use inpatient documentation standards and forms? b) what are your inclusion/exclusion criteria? c) how do you determine nurse:patient ratios? d) are there any rules and regs specific to observation units that I should be aware of? Any information would be greatly appreciated. Thank you. Jackie Mador RN CEN Unit Manager, Pediatric Emergency Department
  75. 75. University Medical Center 1800 W. Charleston Blvd. Las Vegas, NV 89102 Fax: 702-383-3747 For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Tue, 10 Nov 1998 17:26:31 -0500 Reply-To: Ray Wiss <ray.traumanord@sympatico.ca> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: Ray Wiss <ray.traumanord@sympatico.ca> Subject: pneumothorax Dear Joe et al, For pneumothoraces <15%, I attempt needle drainage first. If I am able to drain the pneumothorax, I then observe for twelve hours, re-xray, and d/c if no recurrence. Ray For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
  76. 76. Date: Sat, 14 Nov 1998 17:51:32 EST Reply-To: GIORAUSA@aol.com Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: Gil Winnik <GIORAUSA@aol.com> Subject: Re: Tx of pediatric fever I apologize for commenting on this so late, but since I just got to read my Email after a long hard week I must relate the following: A mother who brought the child to our ER last week was contacted by the resident for F/u (this is our routine...) she reported that the child WAS STILL FEBRILE and she gave the child during his febrile period acetaminophen q4h the "same dose that was given in the ER" (AND WORKED SO WELL THERE) In the ER the dose the dose was given by a doctor who believes in a high dose: 40mg/kg. Here lies the danger: what are we going to tell the parent, are we going to remember to instruct them to give different dose that the one given in the ER? For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Thu, 19 Nov 1998 11:15:17 -0800 Reply-To: Francisco Javier Benito Fernandez <jbenito@hcru.osakidetza.net> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: Francisco Javier Benito Fernandez <jbenito@hcru.osakidetza.net> Subject: Re: Dermabond Misadventures
  77. 77. X-To: "Loren Yamamoto, MD, MPH" <loreny@hawaii.edu> We started using Dermabond six month ago. We have treated 35 lacerations with good results in 31 cases. Two cases shown a foreing body like reaction, one of them with intermittent spontaneous drainage. Other two cases shown laceration dehiscence secundary to a new trauma over the same place. In both we used Dermabond again. Javier Benito Chief , Division Pediatric Emergency Medicine Hospital de Cruces. Bilbao. Spain Loren Yamamoto, MD, MPH wrote: > Anyone have any experiences with poor outcomes, adverse reactions, or > other misadventures using Dermabond? If so, please send me your > experiences by E-mail. I would like to put these cases together in a > collection to report on these misadventures. If you can send me at least > three new misadventures (that I've not already heard of), I would like to > include you as a co-author on this report. Otherwise, proper > acknowledgement for the contribution will be included in the report. > Thank you very much. > Sincerely, > Loren Yamamoto, MD, MPH > Professor of Pediatrics, Univ. Hawaii John A. Burns School of Medicine.
  78. 78. > > For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L > The URL for the PED-EM-L Web Page is: > http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Fri, 20 Nov 1998 00:23:06 EST Reply-To: JulianBO@aol.com Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: "<Julian Orenstein>" <JulianBO@aol.com> Subject: Re: Croup In a message dated 11/19/98 2:30:40 PM Eastern Standard Time, lgeoffroy@videotron.ca writes: > >4) Is there any scientific evidence to suggest that prednisone can be > >readily substituted for decadron? > > ********** Not that I am aware of but there is no reason why an equivalent > dose would not work (2 mg/kg) Invariably, they all throw it up. Never fails.
  79. 79. For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Mon, 23 Nov 1998 17:30:07 -0600 Reply-To: "Richard O. Gray MD." <Richard.O.Gray-1@tc.umn.edu> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: "Richard O. Gray MD." <Richard.O.Gray-1@tc.umn.edu> Subject: medical students X-To: "EMED-L -- a list for emergency medicine." <EMED-L@ITSSRV1.UCSF.EDU> I have just been charged with revamping our medical student curriculum and would be MOST grateful for any words of wisdom from those who have been there and done that. How much of a core curriculum can one cover in a month? We currently do a lab and one to two lectures/wk in addition to the clinical time which has and will be the heart of the experience we offer. How do people handle the fact that different schools have different dates for their rotations? Please respond to me directly so that we don't clutter the list. Rich -- Richard O. Gray MD. FAAEM Assistant Professor Emergency Medicine Hennepin County Medical Center 701 Park Avenue South
  80. 80. Minneapolis Minnesota 55405 Grayx022@tc.umn.edu GraydocER@aol.com "I think we're all Bozos on this bus." For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Mon, 30 Nov 1998 15:02:10 -0500 Reply-To: "Norman C. Christopher, MD" <nchristo@ix.netcom.com> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: "Norman C. Christopher, MD" <nchristo@ix.netcom.com> Organization: Children's Hospital Medical Center of Akron Subject: Survey of Oral Rehydration Therapy in your ED This is a multi-part message in MIME format. --------------DA9731D283F0FCE7E3F9B29C Content-Type: text/plain; charset=us-ascii Content-Transfer-Encoding: 7bit In preparation for a "debate" at the Spring SAEM meeting, I would like to survey those who subscribe to this list about their use of Oral Rehydration Therapy in children with mild to moderate dehydration. These questions refer to children managed in the emergency department only.
  81. 81. 1.) Do you have a specific policy directing the use (indications, nursing interventions, type of ORT solution, length of therapy in the ED, disposition criteria, etc etc) of oral rehydration therapy for children WHILE IN YOUR ED? 1a.) Do you have a formal observation unit in your ED, staffed by the ED physicians? 2.) Do you use ORT on an informal basis in your ED (for example, as a trial prior to initiating IV therapy - "let's try something by mouth first, and if he vomits again, we'll start an IV...")? 3.) In what hospital/program are you practicing? 4.) Do you have residents in your ED on a regular basis? 5.) Do you have currently fellows as a part of your EM program? Thank you - I will summarize the responses and report to this list. You may respond to me directly (preferred) to minimize clutter on the list, or you may respond to the list. Thank you - Norm Christopher --------------DA9731D283F0FCE7E3F9B29C Content-Type: text/x-vcard; charset=us-ascii;
  82. 82. name="nchristo.vcf" Content-Transfer-Encoding: 7bit Content-Description: Card for Norman C. Christopher, MD Content-Disposition: attachment; filename="nchristo.vcf" begin:vcard n:Christopher, MD;Norman C. tel;fax:(330) 258-3761 tel;work:(330) 379-8452 x-mozilla-html:FALSE org:Chairman, Department of Emergency Medicine, Northeastern Ohio Universities College of Medicine version:2.1 email;internet:nchristo@ix.netcom.com title:Director, Emergency/Trauma Services, Children's Hospital Medical Center of Akron adr;quoted-printable:;;One Perkins Square=0D=0A;Akron;OH;44308; x-mozilla-cpt:;19776 fn:Norman C. Christopher, MD end:vcard --------------DA9731D283F0FCE7E3F9B29C-- For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is:
  83. 83. http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Fri, 4 Dec 1998 07:51:39 -0800 Reply-To: David Soglin <dsoglin@pol.net> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: David Soglin <dsoglin@pol.net> Organization: Cook County Children's Hospital Subject: GI Decontamination The reference for the consensus statement is... Clinical Toxicology, 35(7), 699-762, 1997. It is very useful and is actually 5 statements one each on ipecac, cathartics, charcoal, lavage and WBI. David _____________________________________________________________________ David F. Soglin, M.D. Chairman, Pediatric Emergency Medicine Cook County Children's Hospital Chciago, IL For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
  84. 84. Date: Mon, 7 Dec 1998 07:01:36 -0600 Reply-To: MARTIN I HERMAN <AMANTES@prodigy.net> Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: MARTIN I HERMAN <AMANTES@prodigy.net> Subject: Re: PED-EM-L Digest - 5 Dec 1998 to 6 Dec 1998 I am inclined to go to IVF instead of OR when working in the ED as Gloria has indicated, it is more expedient..BTW I would argue that a child that is 5-8 & is much sicker and deserves IVF,, Most kids with dry mouth, decreased mouth wetness, decreased urine output are more like 3-4%. The nephrology papers on rehdration will bear this out.. The actual recovery of body weight has indicated that we way over estimate degree of dehydration.. The old paradigm of 5-10-15 is actually too generous and we should scale back to 3-6-9 %... IMHO Martin Herman,M.D> For more information, send mail to LISTSERV@BROWNVM.BROWN.EDU with the message: info PED-EM-L The URL for the PED-EM-L Web Page is: http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html Date: Tue, 8 Dec 1998 10:40:45 EST Reply-To: SSFreedman@aol.com Sender: Pediatric Emergency Medicine Discussion List <PED-EM-L@BROWNVM.BROWN.EDU> From: "Scott H. Freedman, MD" <SSFreedman@aol.com> Subject: Re: Asthma, Hypercapnia and Airway Resistance

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