ED Educational Resources

Educational resources for ACH Emergency Department.

Dr. Abramo’s Journal Articles of the Month – August 2015

Dr. Abramo



Etiology of Childhood Bacteremia and Timely Antibiotics Administration in the Emergency Department

Adam D. Irwin, Richard J. Drew, Philippa Marshall, Kha Nguyen, Emily Hoyle, Kate A. Macfarlane, Hoying F. Wong, Ellen Mekonnen, Matthew Hicks, Tom Steele, Christine Gerrard, Fiona Hardiman, Paul S. McNamara, Peter J. Diggle and Enitan D. Carrol.

Pediatrics 2015;135;635; originally published online March 9, 2015; DOI: 10.1542/peds.2014-2061


Isolated Linear Skull Fractures in Children With Blunt Head Trauma

Elizabeth C. Powell, MD, MPH, Shireen M. Atabaki, MD, MPH, Sandra Wootton-Gorges, MDc, David Wisner, MDd, Prashant Mahajan, MD, MPH, MBA, Todd Glass, MD, MS, Michelle Miskin, MS, Rachel M. Stanley, MD, MHSA, Elizabeth Jacobs, MD, Peter S. Dayan, MD, MScl, James F. Holmes, MD, MPH, Nathan Kuppermann, MD, MPH.

Pediatrics 2015;135;4, April 2015


Pediatric Traumatic Brain Injury and Attention Deficit

Marsh Königs, MSc, Hugo A. Heij, MD, PhD, Johannes A. van der Sluijs, MD, PhD, R. Jeroen Vermeulen, MD, PhD, J. Carel Goslings, MD, PhD, Jan S.K. Luitse, MD, Bwee Tien Poll-Thé, MD, PhD, Anita Beelen, PhD, Marleen van der Wees, PhD, Rachèl J.J.K. Kemps, PhD, Coriene E. Catsman-Berrevoets, MD, Jaap Oosterlaan, PhD

Pediatrics; originally published online August 3, 2015; DOI: 10.1542/peds.2015-0437


Use of Serum Bicarbonate to Substitute for Venous pH in New-Onset Diabetes

Julia von Oettingen, MD, PhD, MMSc, Joseph Wolfsdorf, MB, BCh, Henry A. Feldman, PhD, Erinn T. Rhodes, MD, MPH

Pediatrics 2015;136;e371; originally published online July 20, 2015; DOI: 10.1542/peds.2015-0156


Validation of a Prediction Tool for Abusive Head Trauma

Laura Elizabeth Cowley, MSc, MBPsS, BSc, Charlotte Bethan Morris, MBBCh, BSc, Sabine Ann Maguire, MRCPI, MRCPC, FRCPI, Daniel Mark Farewell, MMath, PhD, Alison Mary Kemp, MRCP, DCH, FRCPCH, FRCP

Pediatrics Volume 136, number 2, August 2015


Improving Situation Awareness to Reduce Unrecognized Clinical Deterioration and Serious Safety Events

Patrick W. Brady, Stephen Muething, Uma Kotagal, Marshall Ashby, Regan Gallagher, Dawn Hall, Marty Goodfriend, Christine White, Tracey M. Bracke, Victoria DeCastro, Maria Geiser, Jodi Simon, Karen M. Tucker, Jason Olivea, Patrick H. Conway and Derek S. Wheeler

Pediatrics 2013;131;e298; originally published online December 10, 2012; DOI: 10.1542/peds.2012-1364


Prevalence of and Risk Factors for Intracranial Abnormalities in Unprovoked Seizures

Peter S. Dayan, MD, MSc, Kathleen Lillis, MD, Jonathan Bennett, MD, Gregory Conners, MD, MPH, MBA, Pam Bailey, MD, James Callahan, MD, Cigdem Akman, MD, Neil Feldstein, MD, Joshua Kriger, MS, W. Allen Hauser, MD, Nathan Kuppermann, MD, MPH

Pediatrics Volume 136, number 2, August 2015

 Dr. Foster’s Question of the Week – #5

Dr. Foster

 A 3 y/o presents w/ a low grade fever, URI sx. and neck pain.   He was seen by the PCP, and his rapid flu and Strep. were neg.   His temp is 102, and his parents think his neck movement is decreased​.   His anterior cervical nodes are swol​len and sl. TTP.   There is not overlying erythema nor fluctuance.   Active and passive flexion and lateral rotation of his neck are normal.   He has pain w/ active or passive ​extension of his neck, and this makes you think his symptoms are due to:

A. discitis
B. GE reflux
C. meningitis
D. acute lymphadenitis
E. retropharyngeal infection 
F. none of the above
Discitis is usually in the lumbar or lower thoracic spine.   GE reflux may cause apparent neck pain and stiffness in infants, but the posture is opisthotonic, i.e. Sandifer’s syndrome.   Meningitis typically causes pain w/ flexion of the neck.   It would be difficult to say if this patient has lymphadenitis vs. lymphadenopathy w/o seeing him, but the former usually has significant TTP, and there is usually induration +/- fluctuance. 
His neck pain w/ active or passive extension raises the suspicion for a retropharyngeal infection, and this may be cellulitis, adenitis, phlegmon, or abscess.   The pain w/ extension is because of the infection in the prevertebral soft tissues of the neck.   So the correct answer is E.
Widening of the prevertebral ST may be seen on a ST lateral x-ray of the neck, but a CT w/ IV contrast is required to R/O a phlegmon or abscess.   (The x-ray must be done w/ the neck in slight extension, because flexion of the neck may cause pseudo-widening of the prevertebral ST.   Crying or expiration also causes pseudo-widening.   The lateral view may have to be repeated to determine if widening is real or pseudo.) 
Many patients w/ a retropharyngeal infection do not require surgery, and they can be treated w/ IV  antibiotics.​
FYI – Drs. McCormack and Nowell recently saw a similar patient w/ neck symptoms x 2 weeks, but no h/o fever.  (Kids don’t always “​read the book”.)   Her ST lat. x-ray showed widening of the prevertebral ST.   Her ESR and C-RP were increased.   Her CT showed a parapharyngeal abscess which did not require surgery.