POPULARITY
2 episodes with Intussusception
2 episodes with Intussusception
2 episodes with Intussusception
2 episodes with Intussusception
2 episodes with Intussusception
2 episodes with Intussusception
2 episodes with Intussusception
2 episodes with Intussusception
2 episodes with Intussusception
In this new segment of PEM Rules Dr. Jay Fisher, who has been practicing PEM since 1992 is back to discuss intussusception and how can we all do a better job identifying those children among the sea of children with constipation.
An update from Capitals PA announcer Wes Johnson.
Morgan McLuckey, MD, discusses the AJR article by Mertiri et al. comparing outcomes between pediatric intussusception reductions performed on an emergent versus urgent basis. ARTICLE TITLE - Association of Time Since Diagnosis of Pediatric Ileocolic Intussusception With Success of Attempted Reduction: Analysis in 1065 Patients
SORRY FOR THE DELAY, I JUST NOTICED THIS EPISODE NEVER DROPPED. I'LL DO BETTER (well, try to, anyway) Dr Steve, Dr Scott discuss: trichinosis and bear meat anger and stress = bad intussusception imposter syndrome in nursing Kevin Kraft (from Mad Scientist Party Hour) and his unusual libation Plop plop fizz fizz my colon is going to explode PPI long term use Opioid induced constipation and more Please visit: simplyherbals.net/cbd-sinus-rinse (the best he's ever made. Seriously.) instagram.com/weirdmedicine (instagram by ahynesmedia.com!) x.com/weirdmedicine stuff.doctorsteve.com (it's back!) RIGHT NOW GET A NEW DISCOUNT ON THE ROADIE 3 ROBOTIC TUNER! roadie.doctorsteve.com (the greatest gift for a guitarist or bassist! The robotic tuner!) see it here: stuff.doctorsteve.com/#roadie Also don't forget: Cameo.com/weirdmedicine (Book your old pal right now because he's cheap! "FLUID!") Most importantly! CHECK US OUT ON PATREON! ALL NEW CONTENT! Robert Kelly, Mark Normand, Jim Norton, Gregg Hughes, Anthony Cumia, Joe DeRosa, Pete Davidson, Geno Bisconte, Cassie Black ("Safe Slut"). Stuff you will never hear on the main show ;-) Learn more about your ad choices. Visit podcastchoices.com/adchoices
In this episode, we review the high-yield topic of Intussusception from the Pediatrics section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets Linkedin: https://www.linkedin.com/company/medbullets
In this powerful episode, I speak with Helene Hill, the Co-founder and Owner of The Spoonie Society and Slug Lounger. A warrior in her own right, Helene shares her courageous journey through multiple chronic illnesses, including Endometriosis, Adenomyosis, PCOS, IBS, and GERD. In a deeply personal conversation, we explore Helene's resilience in facing numerous laparoscopies, procedures, and the emotional rollercoaster of freezing her eggs and having her left ovary and both fallopian tubes removed. Her journey took an unexpected turn earlier this year, with a rare medical event - Intussusception - leading to a harrowing experience of vomiting blood, immense pain, emergency surgeries, ICU stays, MET calls, and moments of feeling like she was going to die. Helene shares invaluable tips and advice for those navigating their chronic illness journey. This episode not only serves as a platform for awareness but also provides a comforting space for listeners to feel heard and understood. Tune in for an insightful and informative discussion that goes beyond the surface, amplifying the voices of those battling unseen battles, as Helene shares her story of resilience, hope, and healing.
In this episode, we review the high-yield topic of Intussusception from the Gastrointestinal section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbull --- Send in a voice message: https://podcasters.spotify.com/pod/show/medbulletsstep1/message
On this month's EM Quick HIts podcast: Anand Swaminathan on EVT for large vessel occlusion strokes, Sarah Reid on picking up intussusception, Andrew Petrosoniak on 5 Penetrating Trauma Tips, Peter Toth on using a slit lamp to manage skin foreign body hack, Nour Khatib and Jonathan Wallace on CT Radiation Risk and Matt Poyner on setting up an emergency fund... The post EM Quick Hits 49 Stroke Management Update, Intussusception, 5 Penetrating Trauma Tips, Skin Foreign Body Hack, CT Radiation Risk, Emergency Fund appeared first on Emergency Medicine Cases.
In this radiology lecture, we review the ultrasound appearance of ileocolic and small bowel-small bowel intussusception in children! Key teaching The post Ultrasound of Intussusception appeared first on Radiologist Headquarters.
Please join Drs. Brian Gray, Amanda Jensen and Manisha Bhatia from Indiana University as they discuss the nuances of 3 common pediatric general surgery scenarios. Journal Article links: Nguyen HN, Navarro OM, Bloom DA, Feinstein KA, Guillerman RP, Munden MM, et al. Ultrasound for Midgut Malrotation and Midgut Volvulus: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2022;218(6):931-9. https://pubmed.ncbi.nlm.nih.gov/35107311/ Plut D, Phillips GS, Johnston PR, Lee EY. Practical Imaging Strategies for Intussusception in Children. AJR Am J Roentgenol 2020;215(6):1449-63. https://pubmed.ncbi.nlm.nih.gov/33084362/ Markel TA, Scott MR, Stokes SM, Ladd AP. A randomized trial to assess advancement of enteral feedings following surgery for hypertrophic pyloric stenosis. J Pediatr Surg 2017;52(4):534-9. https://pubmed.ncbi.nlm.nih.gov/27829521/ St Peter SD, Holcomb GW, 3rd, Calkins CM, Murphy JP, Andrews WS, Sharp RJ, et al. Open versus laparoscopic pyloromyotomy for pyloric stenosis: a prospective, randomized trial. Ann Surg 2006;244(3):363-70. https://pubmed.ncbi.nlm.nih.gov/16926562/ Dalton BG, Gonzalez KW, Boda SR, Thomas PG, Sherman AK, St Peter SD. Optimizing fluid resuscitation in hypertrophic pyloric stenosis. J Pediatr Surg 2016;51(8):1279-82. https://pubmed.ncbi.nlm.nih.gov/26876090/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out other pediatric surgery episodes here: https://behindtheknife.org/podcast-category/pediatric/
This Episode has EVERYTHING!It's got:RIP Burt Bacharach!Settling graves!Happy Valentine's Day!Happy colon removal day!Dave's mouth noises!"For the Love of DILFs"!Tony Cannoli!Paul Hollywood!More of Dave's noises!Valentine's Day cockroaches!Paul's aggression!VHRS!Dave is on "Risk! True Tales Boldly Told" podcast!Thanks Taj Easton!Inert vs Inate!Paul loves to be Devil's Advocate!So much bitching!DNA test surprises!Incest is best!Bad mechanics!The unmitigated gall!McCrispy Crematoriums!Episode Links (In Order):Saint Valentine's Day Massacre!Intussusception!"For the Love of DILFs"!"For the Love of DILFs" Review!Name a Cockroach After Your Ex on Valentine's Day!Dave's "Risk! True Tales Boldly Told" Episode!Taj Easton's Website!Woman's DNA Test Surprise!Rachel Dratch as Qrplt*xk!Man Sees Own Car Driven to McDonald's by Mechanic!McDonald's to Take Down "McCrispy" Sign Near Crematorium!Music Credit!Opening music graciously supplied by: https://audionautix.com/ Visit Our Patreon! Email Us Here: Disturbinglypragmatic@gmail.comWhere To Find Us!: Disturbingly Pragmatic Link Tree!
This Episode has EVERYTHING!It's got:Paul thinks "The Wreck of the Edmund Fitzgerald" might be racist!Paul isn't really a Canadian, apparently!River Dancing!Yes, Paul...Gordon Lightfoot is still alive!Canadian accents!Paul STILL hates "Human Centipede"!Cats cost a LOT of money!Paul's whiplash!"Alo Glo" is from "Cabinet of Curiosities"!Lilly's joints, and Leonard's coughs!Clean the cat litter, folks!Doug's in a MOVIE!! "Bridge of the Doomed"!Cheeto McOrangeDust!Triggering Trump!Masturbatorium sanctuary!Dave's continued gastrointestinal issues explored!Dave had Intussusception in 1986!Silent screaming!Dick measuring contests!Zip! No FWUMP!Shitsplosions!Panning for gold!SATs fly out of UPS window!Dave annoys Paul again!Drink yer juice, Shelby!Hello to Andreas!Married beauty queens!Bad airline passengers!John Woo movies!Episode Links (In Order):Log Driver's Waltz!"Wreck of the Edmund Fitzgerald"!Stompin' Tom Connors!Paul Hates Human Centipedes Episode!Alo Glo Commercial!Doug Maulden-Locke's IMDB Page!"Bridge of the Doomed" IMDB Page!"Bridge of the Doomed" Google!Sugar Free Hairbo Gummy Bear Review!Intussusception!SATs Fly out of UPS Window!Miss Argentina and Miss Puerto Rico are Married!Pilot Threatens to Turn Around if Passengers didn't stop Air Dropping Nudes!MUSIC CREDIT!Opening Music Graciously Supplied By: https://audionautix.com/ Visit Our Patreon! Email Us Here: Disturbinglypragmatic@gmail.comWhere To Find Us!: Disturbingly Pragmatic Link Tree!
Dragon Bytes Basics - This subseries is aimed at teaching some basic paediatric concepts to healthcare students. Each week medical students from Wales will be joined by a paediatric doctor to discuss common paediatric conditions. These episodes are just introductions and aren't meant to replace standard revision – remember there will be some regional variations in practice and practice will change as new evidence comes to light. However, this is paediatrics made easy to help listeners get their heads around some thing new. In this episode of Dragon Bytes Basics, Emily Jenkinson (Swansea University Medical Student) speaks to Ms Carmen Francis (Surgical Trainee, Wales Deanery) about intussusception.
Intussusception and Other GI Accidents Dr. Marty Greer, DVM is back with host Laura Reeves to discuss Intussusception and other GI related accidents that may affect our dogs. “Intussusception is when the intestinal tract invaginates, or folds up on itself, so accordions on itself,” Greer said. “So, a piece of the intestine slips into another piece of the intestine, all aligned. And unfortunately, what happens when that occurs, is the blood flow is compromised to that part of the intestines and very quickly the dog gets into trouble. “(They have) vomiting, diarrhea, they look really sick, really fast. So, it doesn't look like your garden variety, ‘I ate grass and vomited' or, you know, those kinds of things. It ranks up there in severity with parvovirus (and bloat). There's a lot of different GI things, intestinal and stomach things that happen as intestinal accidents. “So, it's one of those intestinal accidents that happen. If intussusception happens, they're almost always young puppies. They're almost always associated with a heavy parasite load. “Any parasite, usually roundworms, but any parasite, anything that can make the gut hyper motile. So, increase the motility of the activity of the gut to the point that it gets really angry and it just sucks in. It's sort of like if you take off your sock and you kind of pull it wrong side out for part of it. That's kind of how it looks. It has this double loop of intestines, so it's usually because of hypermotility, although it can happen also with linear foreign bodies. “A linear foreign body is something long and skinny that gets swallowed that shouldn't be swallowed. It's a non-food item, so it's pantyhose, it's string, it's yarn, it's balloon strings. Those long strands that come off of the rug. Those throw rugs, rope toys when they pull bits off the rope toy. So those are the things that tend to cause foreign body intestinal intussusception. “Most of the time those dogs and cats end up in surgery because of the risk of intussusception or sawing effect of the long string foreign body kind of thing that just cuts through the intestinal wall. It can be pretty ugly. “But intussusception is unique unto itself because it may or may not be related to a foreign body. It may look like parvo, 'cause, it's a young dog, comes in acute abdomen, vomiting, anemic, sick. The real interesting thing is either you can feel it or there's sort of a characteristic. look of how intussusception looks on ultrasound. “So, if you have the suspicion of this, a good diagnostic tool is ultrasound. It's much more effective than X-ray in making the diagnosis, but feeling it is oftentimes what we can do. I've seen this in puppies as young as six or seven weeks old, and those puppies are relatively easy to feel because they're not very big and there's not a lot of body fat.”
In this podcast, Gal Kelmer discusses small intestinal intussusception in horses.
Intussusception is a big deal and an area where POCUS can potentially make a difference. The literature has been promising, but there hasn't been any definitive studies...until now? The GEL Jr hosts dive into this impressive prospective, multicenter, non-inferiority study and (much like an air enema) they try to get to the bottom of this question to reduce our impacted uncertainty. https://www.ultrasoundgel.org/123 https://pubmed.ncbi.nlm.nih.gov/34226072/
Beyond the Pearls: Cases for Med School, Residency and Beyond (An InsideTheBoards Podcast)
Today's Episode Dr. Hosseini reviews the case of an 18 month old male who presents with vomiting and altered mental status. Today's Host Dr. Parastou Khalessi Hosseini is a current second year pediatric resident at LAC-USC who will be pursuing a career in pediatric gastroenterology. About Dr. Raj Dr Raj is a quadruple board certified physician and associate professor at the University of Southern California. He was a co-host on the TNT series Chasing the Cure with Ann Curry, a regular on the TV Show The Doctors for the past 7 seasons and has a weekly medical segment on ABC news Los Angeles. More from Dr. Raj www.BeyondThePearls.net The Dr. Raj Podcast Dr. Raj on Twitter Dr. Raj on Instagram Want more board review content? Crush Step 1 Step 2 Secrets Physiology by Physeo Step 1 Success Stories The InsideTheBoards Study Smarter Podcast The InsideTheBoards Podcast Study on the go for free! Download the Audio QBank by InsideTheBoards for free on iOS or Android. If you want to upgrade, you can save money on a premium subscription by customizing your plan until your test date on our website! Produced by Ars Longa Media To learn more about us and this podcast, visit arslonga.media. You can leave feedback or suggestions at arslonga.media/contact or by emailing info@arslonga.media. Produced by: Christopher Breitigan Executive Producer: Patrick C. Beeman, MD Legal Stuff InsideTheBoards is not affiliated with the NBME, USMLE, COMLEX, or any professional licensing body. InsideTheBoards and its partners fully adhere to the policies on irregular conduct outlined by the aforementioned credentialing bodies. The information presented in this podcast is intended for educational purposes only and should not be construed as professional or medical advice. Learn more about your ad choices. Visit megaphone.fm/adchoices
Dr. Jose Campos is back, this time helping us review some of the latest literature on the diagnosis and management of intussusception in children. In this podcast, we're reviewing a typical case with Dr. Todd Ponsky and incorporating literature from the last few years. Hosts: Rod Gerardo and Ellen Encisco Tsou, Po-Yang, et al. "Accuracy of point-of-care ultrasound and radiology-performed ultrasound for intussusception: a systematic review and meta-analysis." The American Journal of Emergency Medicine 37.9 (2019): 1760-1769. Accuracy of point-of-care ultrasound and radiology-performed ultrasound for intussusception: A systematic review and meta-analysis Liu, Shu Ting, et al. "Ultrasound-guided hydrostatic reduction versus fluoroscopy-guided air reduction for pediatric intussusception: a multi-center, prospective, cohort study." World Journal of Emergency Surgery 16.1 (2021): 1-7. Ultrasound-guided hydrostatic reduction versus fluoroscopy-guided air reduction for pediatric intussusception: a multi-center, prospective, cohort study - World Journal of Emergency Surgery Patel, Dhruv M., et al. "Radiographic findings predictive of irreducibility and surgical resection in ileocolic intussusception." Pediatric Radiology 50.9 (2020): 1249-1254. Radiographic findings predictive of irreducibility and surgical resection in ileocolic intussusception Gondek, Andrea Soria, et al. "Ileocolic intussusception: Predicting the probability of success of ultrasound guided saline enema from clinical and sonographic data." Journal of Pediatric Surgery 53.4 (2018): 599-604. https://doi.org/10.1016/j.jpedsurg.2017.10.050 Feldman, Oren, et al. "Success rate of pneumatic reduction of intussusception with and without sedation." Pediatric Anesthesia 27.2 (2017): 190-195. https://doi.org/10.1111/pan.13045 van de Bunt, Jascha A., et al. "Effects of esketamine sedation compared to morphine analgesia on hydrostatic reduction of intussusception: A case‐cohort comparison study." Pediatric Anesthesia 27.11 (2017): 1091-1097. https://doi.org/10.1111/pan.13226 Litz, Cristen N., et al. "Outpatient management of intussusception: a systematic review and meta-analysis." Journal of pediatric surgery 54.7 (2019): 1316-1323. https://doi.org/10.1016/j.jpedsurg.2018.09.019 Vo, Andrea, et al. "Management of intussusception in the pediatric emergency department: risk factors for recurrence." Pediatric Emergency Care 36.4 (2020): e185-e188. Pediatric Emergency Care Ferrantella, Anthony, et al. "Incidence of recurrent intussusception in young children: A nationwide readmissions analysis." Journal of pediatric surgery 55.6 (2020): 1023-1025. https://doi.org/10.1016/j.jpedsurg.2020.02.034
Any list of “Top 10 Emergency Department diagnoses in children you can't miss” should include intussusception. This episode reviews the diagnosis and management in practical manner that should help you on your next shift. It also features the talents of Kriti Gupta, MD, a Pediatric Emergency Medicine fellow from NewYork Presbyterian Brooklyn Methodist Hospital who […]
Good morning and welcome to your Tuesday dose of Your Daily Meds.Bonus Review: What are some of the actions of gastric acid?Answer: A few main ones - Activation of pepsinogens to produce pepsinsAssists protein digestion (pepsins require low pH for activity)Kills ingested bacteria - helps prevent infectionInhibited gastrin secretion from antral G-cells (negative feedback loop)Increases secretion of bile and pancreatic juicesFacilitates iron absorption in duodenumPaeds:A 4-year-old boy complains to his mother of acutely painful defaecation. The mother reports that there is spotting of blood on the toilet paper. Whish of the following is the most likely diagnosis?Meckel diverticulumIntussusceptionAnal fissureHenoch-Schönlein purpuraAppendicitisHave a think.More scroll for more chat.A Query:Which of the following biochemical abnormalities is most likely in Cushing’s syndrome due to ectopic ACTH secretion?Elevated ACTH, elevated cortisol, reduced serum potassiumElevated ACTH, elevated cortisol, elevated serum potassiumElevated ACTH, reduced cortisol, reduced serum potassiumReduced ACTH, markedly elevated cortisol, reduced serum potassiumMarkedly elevated ACTH, reduced serum cortisol, reduced serum potassium(Where ACTH = adrenocorticotrophic hormone)Have a think.More scroll for more chat.Spots and Pain:Anal fissure is the most common cause of painful rectal bleeding in this age group. It is often due to passage of a hard constipated stool. Intussusception can occur acutely, it is more likely to be reported as colicky pain and the stool classically has the appearance of red currant jelly. Meckel diverticula, when acute, are associated with central abdominal pain and can cause sufficient blood loss and result in haemodynamic instability, as opposed to spotting on the toilet paper. Henoch-Schönlein purpura is also associated with intussusception and bloody stools (as opposed to spotting) and often presents with abdominal pain, vasculitic rash and joint pain and swelling. Appendicitis classically presents as a central abdominal pain that localises to the right iliac fossa. It is associated with fever, nausea and vomiting and diarrhoea but is less likely to cause spotting.Cushingoid:Key to answering this question is understanding that Cushing’s syndrome is caused by excess activation of glucocorticoid receptors.Most commonly, Cushing’s syndrome is iatrogenic due to exogenous administration of glucocorticoids.Endogenous forms of Cushing’s syndrome are due to over-production of cortisol by the adrenal glands as a result of adrenal tumour, excess adrenocorticotrophic hormone (ACTH) secretion by a pituitary tumour (Cushing’s disease), or ectopic ACTH production by some other tumour. In ACTH-secreting tumours, there is likely to be impaired negative feedback sensitivity to cortisol, unlike in ACTH-secreting pituitary tumours, which retain this sensitivity.So patients would most likely exhibit elevated ACTH, elevated cortisol, reduced serum potassium.This inappropriately elevated ACTH is associated with pigmentation changes, as it binds to melanocortin-1 receptors in skin melanocytes. The elevated cortisol can overcome the kidney’s capacity to inactivate cortisol, resulting in Hypokalaemic alkalosis, contributing to the myopathy and hyperglycaemia typical of Cushing’s syndrome.Cast your mind back to awful feedback loops like this one:Bonus: What is bile?Answer in tomorrow’s dose.Closing:Thank you for taking your Meds and we will see you tomorrow for your MANE dose. As always, please contact us with any questions, concerns, tips or suggestions. Have a great day!Luke.Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks. Just credit us where credit is due. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit yourdailymeds.substack.com
Dr. Colton Lee (PGY3) returns to discuss advice on how to best prep for the ABSITE when there's two months left to go. Case discussion of adult intussusception starts at 13:23 Get your tickets for the ABSITE Smackdown! Review conference here: https://www.airmeet.com/e/86e0fa10-270a-11ec-a681-9d3d1198aac4
The Center for Medical Education's new course title EMCert Module Mastery has been designed to guarantee participants a passing grade on the new MyEMCert exams from ABEM. This episode comes from the Neurology Module and discusses Pediatric AMS.Differential Diagnosis: Epilepsy (active seizures or post‐ictal state), CNS infection: meningitis, encephalitis, Intussusception, midgut malrotation, Nonaccidental trauma, BRUE, Inborn errors of metabolism, Endocrine (new onset DKA), Electrolyte disturbance, Obstructed VP shunt, Toxicologic causes.To learn more, visit https://ccme.org/emcertmodule
In this episode, we review the high-yield topic of Intussusception from the Pediatrics section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets
It's the JournalFeed Podcast for the week of August 2-6, 2021. We cover GRACE-1, communicating stats better, managing seizures after initial control, POCUS for intussusception, and reading STEMI on ECG with a paced rhythm.
GERD, cleft lips & palate, Hirschsprung's disease, Intussusception, Appendicitis, Meckel Diverticulitis
Want to experience the greatest in board studying? Check out our interactive question bank podcast- the FIRST of its kind here: https://emrapidbombs.supercast.tech If this were a spelling bee we would definitely flunk this word. So let's focus instead on how to not flunk and miss the diagnosis. let's talk all you need to know about this classic pediatric disease.
David Kiely asks Shalinder Singh about intussusception, a common and serious cause of abdominal pain in children aged 3 months to 3 years. This podcast covers all you need to know about the incidence, history and examination of intussusception. Part 2 covers investigation and treatment. Accompanying notes can be downloaded from here https://drive.google.com/file/d/1BTNoeYe-csn0X2mTsb3rGJ38o5KKyQdy/view?usp=sharing
All you need to know about investigation and treatment of this common and serious condition. Indications for pneumatic or hydrostatic reduction, plus operative intervention and complications are all covered. There are fantastic, beautifully handwritten notes to accompany both podcasts that you can download here: https://drive.google.com/file/d/1BTNoeYe-csn0X2mTsb3rGJ38o5KKyQdy/view?usp=sharing Shalinder Singh is a consultant in Paediatric Surgery in Nottingham, UK, and David Kiely is a trainee in Paediatric Surgery in the East Midlands of the UK
This episode covers intussusception and volvulus!
Dr. Martin Zielinski from the Mayo Clinic, Rochester, MN, joins us on Rounds to discuss best practices in the management of bowel obstruction. In this episode, we review common etiologies for bowel obstruction, discuss the role of imaging, as well as the significance of clinical and radiographic findings on the likelihood of operative intervention. Dr. Zielinski also shares with us the Gastrografin swallow protocol that has been successfully developed and implemented at the Mayo Clinic in the management of patients with small bowel obstruction.
Intussusception is the telescoping of a proximal segment of bowel into the more distal bowel lumen. It is the most common cause of intestinal obstruction in kids aged 5 months to 3 years, and is the most common abdominal emergency in children under 2 years of age. Intussusception can present in a nonspecific manner, so it is vital for clinicians to consider it as a possibility for many types of presentations. In this episode, we discuss the various ways in which intussusception can present, and the approach to management. You don’t want to miss: A case Epidemiology Pathophysiology Important differentials to consider Management Complications and prognosis Links and resources: Follow us on Instagram: https://www.instagram.com/yourekiddingright.pod/ and Facebook: https://www.facebook.com/yourekiddingrightpod-107273607638323/ Our email is yourekiddingrightpod@gmail.com Make sure you hit SUBSCRIBE/FOLLOW so you don’t miss out on any pearls of wisdom and RATE if you can to help other people find us! (This isn’t individual medical advice, please use your own clinical judgement and local guidelines when caring for your patients)
It’s the JournalFeed Podcast for the week of Oct 19-23, 2020. We cover hands-on defibrillation, new info on fluoroquinolones and aortic dissection risk, diagnosing intussusception, EMS benzodiazepine use for status epilepticus, and how to spot elder abuse.
This free iTunes segment is just one tiny snippet of the fully-loaded 3-hour monthly Peds RAP show. Earn CME on your commute while getting the latest practice-changing peds information: journal article breakdowns, evidence-based topic reviews, critical guideline updates, conversations with experts, and so much more. Sign up for the full show at hippoed.com/PEDSRAPPOD. Sol Behar, MD, and Jason Woods, MD discuss the evaluation and management of bilious emesis in a neonate. Bilious emesis in an infant should be treated as an emergency because this is often a symptom of obstruction due to intestinal atresia or midgut volvulus. Causes of intestinal obstruction that present during the neonatal period include: Malrotation with or without volvulus Intestinal atresia Hirschsprung disease Intussusception (rare in the neonatal period) Necrotizing enterocolitis Malrotation with volvulus. In this condition, the cecum is abnormally positioned in the right upper quadrant and this abnormal positioning predisposes the intestine to twist on its mesentery resulting in volvulus. This causes acute small bowel obstruction and ischemia. An upper GI, the gold standard for diagnosing or evaluating malrotation, classically shows a duodenum with a "corkscrew" appearance. Intestinal atresia. This is a term used to describe a complete blockage or obstruction anywhere in the intestine. Approximately 30% of infants with duodenal atresia have a chromosomal anomaly, most typically Down syndrome. The "double bubble" sign is caused by dilation of the stomach and proximal duodenum and strongly suggests duodenal atresia Hirschsprung disease. This is a disorder of the motor innervation of the distal intestine that leads to a functional obstruction. In Hirschsprung, the nerves that allow the relaxation of the smooth muscle within the intestine wall are missing, so the area that is affected is constricted. A contrast enema can support the diagnosis of Hirschsprung disease. It will often show the presence of a “transition zone” which represents the change from the normal caliber rectum to the dilated colon proximal to the aganglionic region. For younger kids who have not had time to develop the “transition zone”, the rectosigmoid index, the ratio between the diameter of the rectum and the sigmoid colon, is typically >1 in normal children Necrotizing enterocolitis. This is a condition characterized by bowel necrosis with associated severe inflammation, bacterial invasion, and dissection of gas into the bowel wall. Pneumatosis intestinalis, a hallmark of NEC, appears as bubbles of gas in the bowel wall. Meconium ileus is caused by the obstruction of the small intestines with inspissated meconium. Approximately 10% of patients with CF present with meconium ileus.
In this episode, host Beckie Mossor, RVT, talks to Christian Latimer, DVM, CCRP, DACVS-SA, about his recent Clinician’s Brief article, “Intussusception Reduction.” Though rare, Dr. Latimer reviews those patients who are at greatest risk for developing intussusceptions, as well as how to diagnose them. He goes into great detail about treatment options and whether what we do has an impact on recurrence. Dr. Latimer also makes sure we all keep our terms straight: intussuscipiens vs intussusceptum.Resources:https://www.cliniciansbrief.com/article/intussusception-reductionContact us:Podcast@briefmedia.comWhere to find us:Cliniciansbrief.com/podcastsFacebook.com/clinciansbriefTwitter: @cliniciansbriefInstagram: @clinicians.briefThe Team:Beckie Mossor, RVT - HostAlexis Ussery - Producer & Digital Content CoordinatorRandall Stupka - Podcast Production & Sound EditingMichelle Munkres - Senior Director of Content
Sol Behar, MD and Jason Woods, MD get together to discuss the evaluation and management of bilious emesis in a neonate. Bilious emesis in an infant should be treated as an emergency because this is often a symptom of obstruction due to intestinal atresia or midgut volvulus. Causes of intestinal obstruction that present during the neonatal period include: Malrotation with or without volvulus Intestinal atresia Hirschsprung disease Intussusception (rare in the neonatal period) Necrotizing enterocolitis To view all the rest of the incredible show notes and see all the references Click Here
This episode covers intussusception.Written notes can be found at https://zerotofinals.com/paediatrics/gastro/intussusception/ or in the gastroenterology section in the Zero to Finals paediatrics.The audio in the episode was expertly edited by Harry Watchman.
This episode is one packed full of different topics! You will get to learn more about appendicitis, intussusception, how heavy backpacks can cause damage, Halloween safety, lice, scabies, AND bed bugs. Doctors Tara Sarin and Rachel Zincone discuss all of these topics to keep us informed during the spooky season! Tune in! Topic Times! Health News 1:24 Appendicitis and Intussusception 3:09 Halloween Safety 9:38 Lice, Scabies, & Bed bugs 18:19 Trivia 18:40 This episode was recorded in October of 2015.
Dr. Kevin is back four our 55th podcast and he brought a surprise tiny guest. He will be talking about Intussusception. This is a life-threatening condition which mostly affects children below the age of three. It occurs when one part of the intestine slides into the adjacent part of the intestine. This causes bowel ischemia, […] The post Podcast 55: Intussuception with Dr. Kevin appeared first on Primary Medicine Podcast.
Intussusception is the commonest cause of infant bowel obstruction. Join us in discovering more with Dr Carapinha.
Core questions: List 8 causes of neonatal jaundice and indicate whether they are conjugated or unconjugated List indications for work-up of a jaundiced infant What are RFs for hyperbilirubinemia? (8) What is the differential diagnosis for vomiting in a child? Describe the typical presentation of each of the following: Hypertrophic pyloric stenosis Malrotation with midgut volvulus NEC GERD Intussusception Hirschsprung's Disease Meckel’s Diverticulum HSP List Xray findings for each of the following: Malrotation with midgut volvulus (2) NEC (4) Intussusception (5) Hirschsprung's Disease (2) Describe the conservative management of a patient with GERD. What is the preferred diagnostic test for diagnosis for intussusception? List causes of lead points in pts with intussusception. Describe each of the following signs on physical exam: Sandifer’s syndrome Red-currant Jelly Stools Dance’s Sign Rovsing’s sign Psoas Sign Obturator Sign Describe the “Rule of 2” for Meckel’s Diverticulum What are 3 common locations of lodging in the esophagus List 3 indications for FB removal from stomach. Describe the management of button battery FBs What is HSP? How does it typically present? List three complications of HSP. Why is appendicitis different in very young children? List 10 causes of pancreatitis in children List 10 causes of biliary tract disease in children List conditions associated with the development of gallstones in children. Wisecracks. What are the risk factors for necrotizing enterocolitis? Describe the proposed pathophysiology of necrotizing enterocolitis? List five pathologic causes of constipation in a child. What is the most concerning complication of hirschsprung’s disease? How does it occur? What is gallbladder hydrops? What conditions is it associated with?
Core questions: List 8 causes of neonatal jaundice and indicate whether they are conjugated or unconjugated List indications for work-up of a jaundiced infant What are RFs for hyperbilirubinemia? (8) What is the differential diagnosis for vomiting in a child? Describe the typical presentation of each of the following: Hypertrophic pyloric stenosis Malrotation with midgut volvulus NEC GERD Intussusception Hirschsprung's Disease Meckel’s Diverticulum HSP List Xray findings for each of the following: Malrotation with midgut volvulus (2) NEC (4) Intussusception (5) Hirschsprung's Disease (2) Describe the conservative management of a patient with GERD. What is the preferred diagnostic test for diagnosis for intussusception? List causes of lead points in pts with intussusception. Describe each of the following signs on physical exam: Sandifer’s syndrome Red-currant Jelly Stools Dance’s Sign Rovsing’s sign Psoas Sign Obturator Sign Describe the “Rule of 2” for Meckel’s Diverticulum What are 3 common locations of lodging in the esophagus List 3 indications for FB removal from stomach. Describe the management of button battery FBs What is HSP? How does it typically present? List three complications of HSP. Why is appendicitis different in very young children? List 10 causes of pancreatitis in children List 10 causes of biliary tract disease in children List conditions associated with the development of gallstones in children. Wisecracks. What are the risk factors for necrotizing enterocolitis? Describe the proposed pathophysiology of necrotizing enterocolitis? List five pathologic causes of constipation in a child. What is the most concerning complication of hirschsprung’s disease? How does it occur? What is gallbladder hydrops? What conditions is it associated with?
In this Audio Summary Foteini discusses whether enteroplication reduces the probability of recurrence of intussusception in dogs. Read the full Knowledge Summary here. Audio Summaries are a free resource that enables vets and vet nurses to access and digest relevant and up-to-date evidence quicker and easier! A time-saving way to make better and faster evidence-based decisions.
Podcast summary of articles from the December 2017 edition of Journal of Emergency Medicine from the American Academy of Emergency Medicine. Topics include hyperglycemia, blunt trauma, intussusception, ectopic pregnancy, suicide, and board review on myasthenia gravis. Guest speaker is Dr. Ayesha Khatoon from the Metrohealth Emergency Medicine Residency.
This week on Sickboy the three amigos are finally (damn daniel) back at it again! This time around It’s story time with Jeremie who luckily didn’t die during his recent hospital woes. God bless him as he is so gosh darn humble about the whole horrifying ordeal. We dive deep deep deep into his colon that no longer exists. “Intussusception The Sequel” has it all. Deep butt hole fingering, hardcore opioids, run down terrifying hospitals. a violent vomit sesh, tubes in holes… like, all the holes, strap on dildos and of course a good ol’ laugh or two!
This week on Sickboy the three amigos are finally (damn daniel) back at it again! This time around It’s story time with Jeremie who luckily didn’t die during his recent hospital woes. God bless him as he is so gosh darn humble about the whole horrifying ordeal. We dive deep deep deep into his colon that no longer exists. “Intussusception The Sequel” has it all. Deep butt hole fingering, hardcore opioids, run down terrifying hospitals. a violent vomit sesh, tubes in holes… like, all the holes, strap on dildos and of course a good ol’ laugh or two!
This week on Sickboy the three amigos are finally (damn daniel) back at it again! This time around It’s story time with Jeremie who luckily didn’t die during his recent hospital woes. God bless him as he is so gosh darn humble about the whole horrifying ordeal. We dive deep deep deep into his colon that no longer exists. “Intussusception The Sequel” has it all. Deep butt hole fingering, hardcore opioids, run down terrifying hospitals. a violent vomit sesh, tubes in holes… like, all the holes, strap on dildos and of course a good ol’ laugh or two! Get exclusive content on Patreon: http://www.patreon.com/sickboy Subscribe on Apple Podcasts: https://itunes.apple.com/ca/podcast/sickboy/id1034035933?mt=2# Visit http://www.hellofresh.ca/sickboy and enter promo code SICKBOY to get 50% your first Hello Fresh box Visit http://www.freshbooks.com/sickboy and enter Sickboy in the ‘How did you hear about us’ section to get your free one month trial of this amazing cloud accounting software
Abdominal pain is common; so are strongly held myths and legends about what is concerning, and what is not. One of our largest responsibilities in the Emergency Department is sorting out benign from surgical or medical causes of abdominal pain. Morbidity and mortality varies by age and condition. Abdominal Surgical Emergencies in Children: A Relative Timeline General Advice Neonate (birth to one month) Necrotizing Enterocolitis Pneumatosis Intestinalis. Essentials: Typically presents in 1st week of life (case reports to 6 months in chronically ill children) Extend suspicion longer in NICU graduates Up to 10% of all cases of necrotizing enterocolitis are in full-term children Pathophysiology is unknown, but likely a translocation of bacteria Diagnosis: Feeding intolerance, abdominal distention Abdominal XR: pneumatosis intestinalis Management: IV access, NG tube, broad-spectrum antibiotics, surgery consult, ICU admission Intestinal Malrotation with Volvulus Essentials: Corkscrew Sign in Malrotation with Volvulus Bilious vomiting (80-100%) in the 1st month; especially in the 1st week May look well initially, then rapidly present in shock Ladd’s bands: abnormally high tethering of cecum to abdominal wall; peristalsis, volvulus, ischemia Diagnosis: History of bilious emesis is sufficient to involve surgeons Upper GI series: corkscrew appearance US (if ordered) may show abnormal orientation of and/or flow to superior mesenteric artery and vein Management: Stat surgical consult IV access, resuscitation, NG tube to decompress (bowel wall perfusion at risk, distention worsens) Hirschprung Disease Essentials: Problem in migration of neural crest cells Aganglionic colon (80% rectosigmoid; 15-20% proximal to sigmoid; 5% total colonic aganglionosis) colon (known as short-segment disease) Poor to no peristalsis: constipation, perforation, and/or sepsis Diagnosis: May be diagnosed early as “failure to pass meconium in 1st 48 hours” In ED, presents as either bowel obstruction or enterocolitis Contrast enema Beware of the toxic megacolon (vomiting, distention, sepsis) Management: Resuscitation, antibiotics, NG tube decompression, surgical consultation; stable patients may need rectal biopsy for confirmation Staged surgery (abdominoperineal pull-through with diverting colostomy, subsequent anastomosis) versus one-stage repair. Infant and Toddler (1 month to 2 years) Pyloric Stenosis Essentials: Hypertrophy of pyloric sphincter; genetic, environmental, exposure factorsString Sign in Pyloric Stenosis. Diagnosis: Hungry, hungry, not-so-hippos; they want to eat all of the time, but cannot keep things down Poor weight gain (less than 20-30 g/day) US: “π–loric stenosis” (3.14); pylorus dimensions > 3 mm x 14 mm UGI: “string sign” Management: Trial of medical treatment with oral atropine via NGT (muscarinic effects decrease pyloric tone) Ramstedt pyloromyotomy (definitive) Intussusception Essentials: Majority (90%) ileocolic; no pathological lead point Small minority (4%) ileoileocolic due to lead point: Meckel’s diverticulum, polyp, Peyer’s patches, Henoch-Schönlein purpura (intestinal hematoma) Diagnosis: Target Sign (Donut Sign). Ultrasound sensitivity and specificity near 100% in experienced hands Abdominal XR may show non-specific signs; used mainly to screen for perforation before reduction Management: Hydrostatic enema: contrast (barium or water-soluble contrast with fluoroscopy) or saline (with ultrasound) Air-contrast enema: air or carbon dioxide (with either fluoroscopy or ultrasound); higher risk for perforation than hydrostatic (1% risk), but generally safer than perforation from contrast Consider involving surgical service early (precaution before reduction) Traditional disposition is admission; controversial: home discharge from ED Young Child and Older (2 years and up) Appendicitis Essentials: Appendicitis occurs in all ages, but rarer in infants. Infants do not have fecalith; rather they have some other anatomic or congenital condition. More common in school-aged children (5-12 years) and adolescents Younger children present atypically, more likely to have perforated when diagnosed. Diagnosis: Non-specific signs and symptoms Often have abdominal pain first; vomiting comes later Location/orientation of appendix varies Appendicitis scores vary in their performance Respect fever and abdominal pain Management: Traditional: surgical On the horizon: identification of low-risk children who may benefit from trial of antibiotics If perforated, interval appendectomy (IV antibiotics via PICC for 4-6 weeks, then surgery) Obstruction SBO. Incarcerated Inguinal Hernia. Essentials: Same pathophysiology and epidemiology as adults: “ABC” – adhesions, “bulges” (hernias), and cancer. Diagnosis: Obstruction is a sign of another condition. Look for cause of obstruction: surgical versus medical Abdominal XR in low pre-test probability CT abdomen/pelvis for moderate-to-high risk; confirmation and/or surgical planning Management: Treat underlying cause NG tube to low intermittent wall suction Admission, fluid management, serial examinations Take these pearls home: Consider surgical pathology early in encounter Resuscitate while you investigate Have a low threshold for imaging and/or consultation, especially in preverbal children Selected References Necrotizing Enterocolitis Neu J, Walker A. Necrotizing Enterocolitis. N Eng J Med. 2011; 364(3):255-264. Niño DF et al. Necrotizing enterocolitis: new insights into pathogenesis and mechanisms. Nature. 2016; 13:590-600. Walsh MC et al. Necrotizing Enterocolitis: A Practitioner’s Perspective. Pediatr Rev. 1988; 9(7):219-226. Malrotation with Midgut Volvulus Applegate KE. Intestinal Malrotation in Children: A Problem-Solving Approach to the Upper Gastrointestinal Series. Radiographics. 2006; 26:1485-1500. Kapfer SA, Rappold JF. Intestinal Malrotation – Not Just the Pediatric Surgeon’s Problem. J Am Coll Surg. 2004; 199(4):628-635. Lee HC et al. Intestinal Malrotation and Catastrophic Volvulus in Infancy. J Emerg Med. 2012; 43(1):49-51. Martin V, Shaw-Smith C. Review of genetic factors in intestinal malrotation. Pediatr Surg Int. 2010; 26:769-781. Nehra D, Goldstein AM. Intestinal malrotation: Varied clinical presentation from infancy through adulthood. Surgery. 2010; 149(3):386-391. Hirschprung Disease Amiel J, Sproat-Emison E, Garcia-Barcelo M, et al. Hirschsprung disease, associated syndromes and genetics: a review. J Med Genet 2008; 45:1. Arshad A, Powell C, Tighe MP. Hirschsprung's disease. BMJ 2012; 345:e5521. Aworanti OM, McDowell DT, Martin IM, Quinn F. Does Functional Outcome Improve with Time Postsurgery for Hirschsprung Disease? Eur J Pediatr Surg 2016; 26:192. Clark DA. Times of first void and first stool in 500 newborns. Pediatrics 1977; 60:457. Dasgupta R, Langer JC. Evaluation and management of persistent problems after surgery for Hirschsprung disease in a child. J Pediatr Gastroenterol Nutr 2008; 46:13. De Lorijn F, Reitsma JB, Voskuijl WP, et al. Diagnosis of Hirschsprung's disease: a prospective, comparative accuracy study of common tests. J Pediatr 2005; 146:787. Doig CM. Hirschsprung's disease and mimicking conditions. Dig Dis 1994; 12:106. Khan AR, Vujanic GM, Huddart S. The constipated child: how likely is Hirschsprung's disease? Pediatr Surg Int 2003; 19:439. Singh SJ, Croaker GD, Manglick P, et al. Hirschsprung's disease: the Australian Paediatric Surveillance Unit's experience. Pediatr Surg Int 2003; 19:247. Suita S, Taguchi T, Ieiri S, Nakatsuji T. Hirschsprung's disease in Japan: analysis of 3852 patients based on a nationwide survey in 30 years. J Pediatr Surg 2005; 40:197. Sulkowski JP, Cooper JN, Congeni A, et al. Single-stage versus multi-stage pull-through for Hirschsprung's disease: practice trends and outcomes in infants. J Pediatr Surg 2014; 49:1619. Pyloric Stenosis Aspelund G, Langer JC. Current management of hypertrophic pyloric stenosis. Semin Pedaitr Surg. 2007; 16:27-33. Dias SC et al. Hypertrophic pyloric stenosis: tips and tricks for ultrasound diagnosis. Insights Imaging. 2012; 3:247-250. Kawahara H et al. Medical treatment of infantile hypertrophic pyloric stenosis: should we always slice the olive? J Pediatr Surg. 2005; 40:1848-1851. Mack HC. Adult Hypertrophic Pyloric Stenosis. Arch Inter Med. 1959; 104:78-83. Meissner PE et al. Conservative treatment of infantile hypertrophic pyloric stenosis with intravenous atropine sulfate does not replace pyloromyotomy. Pediatr Surg Int. 2006; 22:1021-1024. Mercer AE, Phillips R. Can a conservative approach to the treatment of hypertrophic pyloric stenosis with atropine be considered a real alternative to pyloromyotomy? Arch Dis Child. 2013; 95(6): 474-477. Pandya S, Heiss K, Pyloric Stenosis in Pediatric Surgery.Surg Clin N Am. 2012; 92:527-39. Peters B et al. Advances in infantile hypertrophic pyloric stenosis. Expert Rev Gastroenterol Hepatol. 2014; 8(5):533-541. Intussusception Apelt N et al. Laparoscopic treatment of intussusception in children: A systematic review. J Pediatr Surg. 2013; 48:1789-1793. Applegate KE. Intussusception in Children: Imaging Choices. Semin Roentgenol. 2008; 15-21. Bartocci M et al. Intussusception in childhood: role of sonography on diagnosis and treatment. J Ultrasound. 2015; 18 Gilmore AW et al. Management of childhood intussusception after reductiion by enema. Am J Emerg Med. 2011; 29:1136-1140.:205-211. Chien M et al. Management of the child after enema-reduced intussusception: hospital or home? J Emerg Med. 2013; 44(1):53-57. Cochran AA et al. Intussusception in traditional pediatric, nontraditional pediatric, and adult patients. Am J Emerg Med. 2011; 523-527. Loukas M et al. Intussusception: An Anatomical Perspective With Review of the Literature. Clin Anatomy. 2011; 24: 552-561. Mendez D et al. The diagnostic accuracy of an abdominal radiograph with signs and symptoms of intussusception. Am J Emerg Med. 2012; 30:426-431. Whitehouse et al. Is it safe to discharge intussusception patients after successful hydrostatic reduction? J Pediatr Surg. 2010; 45:1182-1186. Appendicitis Amin P, Chang D. Management of Complicated Appendicitis in the Pediatrc Population: When Surgery Doesn’t Cut it. Semin Intervent Radiol. 2012; 29:231-236 Blakely ML et al. Early vs Interval Appendectomy for Children With Perforated Appendicitis. Arch Surg. 2011; 146(6):660-665. Bundy DG et al. Does This Child Have Appendicitis? JAMA. 2007; 298(4):438-451. Cohen B et al. The non-diagnostic ultrasound in appendicitis: is a non-visualized appendix the same as a negative study? J Pediatr Surg. 2015 Jun;50(6):923-7 Herliczek TW et al. Utility of MRI After Inconclusive Ultrasound in Pediatric Patients with Suspected Appendicitis. AJT. 2013; 200:969-973. Janitz et al. Ultrasound Evaluation for Appendicitis. J Am Osteopath Coll Radiol. 2016; 5(1):5-12. Kanona H et al. Stump Appendicitis: A Review. Int J Surg. 2012; 10:4255-428. Kao LS et al. Antibiotics vs Appendectomy for Uncomplicated Acute Appendicitis. Evid Based Rev Surg. 2013;216(3):501-505. Petroianu A. Diagnosis of acute appendicitis. Int J Surg. 2012; 10:115-119. Mazeh H et al. Tip appendicitis: clinical implications and management. Amer J Surg. 2009; 197:211-215. Puig S et al. Imaging of Appendicitis in Children and Adolescents. Semin Roentgenol. 2008; 22-28. Schizas AMP, Williams AB. Management of complex appendicitis. Surgery. 2010; 28(11):544-548. Shogilev DJ et al. Diagnosing Appendicitis: Evidence-Based Review. West J Emerg Med. 2014; 15(4):859-871. Wray CJ et al. Acute Appendicitis: Controversies in Diagnosis and Management. Current Problems in Surgery. 2013; 50:54-86 Intestinal Obstruction Babl FE et al. Does nebulized lidocaine reduce the pain and distress of nasogastric tube insertion in young children? A randomized, double-blind, placebo-controlled trial. Pediatrics. 2009 Jun;123(6):1548-55 Chinn WM, Zavala DC, Ambre J. Plasma levels of lidocaine following nebulized aerosol administration. Chest 1977;71(3):346-8. Cullen L et al. Nebulized lidocaine decreases the discomfort of nasogastric tube insertion: a randomized, double-blind trial. Ann Emerg Med. 2004 Aug;44(2):131-7. Gangopadhyay AN, Wardhan H. Intestinal obstruction in children in India. Pediatr Surg Int. 1989; 4:84-87. Hajivassiliou CA. Intestinal Obstruction in Neonatal/Pediatric Surgery. Semin Pediatr Surg. 2003; 12(4):241-253. Hazra NK et al. Acute Intestinal Obstruction in children: Experience in a Tertiary Care Hospital. Am J Pub Health Res. 2015; 3(5):53-56. Kuo YW et al. Reducing the pain of nasogastric tube intubation with nebulized and atomized lidocaine: a systematic review and meta-analysis. J Pain Symptom Manage. 2010 Oct;40(4):613-20. . Pediatric Surgery Irish MS et al. The Approach to Common Abdominal Diagnoses in Infants and Children. Pedaitr Clin N Am. 1998; 45(4):729-770. Louie JP. Essential Diagnosis of Abdominal Emergencies in the First Year of Life. Emerg Med Clin N Am. 2007; 25:1009-1040. McCullough M, Sharieff GQ. Abdominal surgical emergencies in infants and young children. Emerg Med Clin N Am. 2003; 21:909-935. Pepper VK et al. Diagnosis and Management of Pediatric Appendicitis, Intussusception, and Meckel Diverticulum. Surg Clin N Am. 2012 This post and podcast are dedicated to Mr Ross Fisher for his passion and spirit of collaboration in all things #FOAMed. Thank you, sir!
In this episode with the help of Dr. Bryan Dicken, Pediatric General Surgeon, 4th year medical student Alessia Gallipoli discusses intussusception, an important cause of bowel obstruction in young children. After listening to this episode, learners should be able to: Define intussusception Be able to recognize the signs and symptoms in a patient you think might have intussusception Identify some key features to help differentiate intussusception from other causes of bowel obstruction Be familiar with the diagnostic and treatment options
This episode will discuss an approach for a child in whom you suspect idiopathic intussusception. Listeners will learn how to recognize the presenting signs and symptoms of idiopathic intussusception, develop an organized approach to a child with suspected intussusception including differential diagnosis, physical exam and investigations and review the treatment and prognosis of intussusception. This podcast was developed by Kieran Purich a medical student at the University of Alberta, with the help of Dr. Ioana Bratu, a pediatric surgeon and Associate Professor at the University of Alberta. Related Content: Podcast: Acute Abdominal Pain Podcast: Approach to Pediatric Abdominal X-rays Case: Abdominal pain in a 4 month old female
There were some incredible lectures at Castlefest last year……as there always are, and our goal is to get it out to you as much as possible! So, here you go: The one, the only, Bret Nelson incredibly decked out in Seersucker laying down some mad Pediatric ultrasound knowledge. Follow us: @ultrasoundpod Learn with us: www.ultrasoundleadershipacademy.com Register: Cabofest Ultrasound Course, Castlefest 2017, yellowstoneultrasound.com FREE Introduction to Bedside Ultrasound eBook: Volume 1 Volume 2 One Minute Ultrasound Smartphone App for iOS One Minute Ultrasound Smartphone App for Android
How do you approach the child who may be altered? Altered mental status in children can be subtle. Look for age-specific behaviors that range from irritability to anger to sleepiness to decreased interaction. In the altered child, anchoring bias is your biggest enemy. Keep your mind open to the possibilities, and be ready to change it, when new information becomes available. For altered adults, use AEIOU TIPS (Alcohol-Epilepsy-Insulin-Overdose-Uremia-Trauma-Infection-Psychosis-Stroke). Try this for altered children: remember that they need their VITAMINS! V – Vascular (e.g. arteriovenous malformation, systemic vasculitis) I – Infection (e.g. meningoencephalitis, overwhelming alternate source of sepsis) T – Toxins (e.g. environmental, medications, contaminated breast milk) A – Accident/abuse (e.g. non-accidental trauma, sequelae of previous trauma) M – Metabolic (e.g. hypoglycemia, DKA, thyroid disorders) I – Intussusception (e.g. the somnolent variant of intussusception, with lethargy) N – Neoplasm (e.g. sludge phenomenon, secondary sepsis, hypoglycemia from supply-demand mismatch) S – Seizure (e.g. seizure and its variable presentation, especially subclinical status epilepticus) Case One: Sleepy Toddler 16-month-old who chewed on his grandmother's clonidine patch Clonidine is an alpha-2 agonist with many therapeutic indications including hypertension, alcohol withdrawal, smoking cessation, perimenopausal symptoms. In children specifically, clonidine is prescribed for attention deficit hyperactivity disorder, spasticity due to cerebral palsy and other neurologic disorders, and Tourette’s syndrome. The classic clonidine toxidrome is altered mental status, miosis, hypotension, bradycardia, and bradypnea. Clonidine is on the infamous list of “one pill can kill”. Treatment is primarily supportive, with careful serial examinations of the airway, and strict hemodynamic monitoring. Naloxone can partially counteract the endogenous opioids that are released with clonidine's pharmacodynamics. Start with the usual naloxone dose of 0.01 mg/kg, up to the typical adult starting dose is 0.4 mg. In clonidine overdose, however, you may need to increase the naloxone dose (incomplete and variable activity) up to 0.1 mg/kg. Titrate to hemodynamic stability and spontaneous respirations, not full reversal of all CNS effects. Case Two: In Bed All Day A 7-year-old with fever, vomiting, body aches, sick contacts. Altered on exam. Should you get a CT before LP? If you were going to perform CT regardless, then do it. Adult guidelines: age over 60, immunocompromised state, history of central nervous system disease, seizure within one week before presentation, abnormal level of consciousness, an inability to answer two consecutive questions correctly or to follow two consecutive commands, gaze palsy, abnormal visual fields, facial palsy, arm drift, leg drift, and abnormal language. Children: if altered, and your differential diagnosis is broad (especially if you may suspect tumor, bleed, obvious abscess). Influenza is often overlooked as a potential cause of altered mental status. Many authors report a broad array of neurological manifestations associated with influenza, such as altered mental status, seizures, cranial nerve abnormalities, hallucinations, abnormal behavior, and persistent irritability. All of this is due to a hypercytokinemic state, not a primary CNS infection. Case Three: Terrible Teenager 14-year-old brought in for "not listening" and "acting crazy"; non-complaint on medications for systemic lupus erythematosus (SLE). SLE is rare in children under 5. When school-age children present with SLE, they typically have more systemic signs and symptoms. Teenagers present like adults. All young people have a larger disease burden with lupus, since they have many more years to develop complications. Lupus cerebritis: high-dose corticosteroids, and possibly IV immunoglobulin. Many will need therapeutic plasma exchange (TPE), a type of plasmapheresis. Summary In altered mental status, keep your differential diagnosis open Pursue multiple possibilities until you are able to discard them Be ready to change your mind completely with new information Make sure your altered child gets his VITAMINS (Vascular, Infectious, Toxins, Accident/Abuse, Metabolic, Intussusception, Neoplasm, Stroke) References Beckman HB, Frankel RM. The effect of physician behavior on the collection of data. Ann Intern Med 1984; 101:692. Fujita K, Nagase H, Nakagawa T et al. Non-convulsive seizures in children with infection-related altered mental status. Pediatrics International. 2015; 57(4):659–664. Gallagher J, Luck RP, Del Vecchio M. Altered mental status – a state of confusion. Paediatr Child Health. 2010 May-Jun; 15(5): 263–265. Hasbun R, Abrahams J, Jekel J, Quagliarello VJ. Computed tomography of the head before lumbar puncture in adults with suspected meningitis. N Engl J Med. 2001; 345(24):1727-33. Oliver WJ, Shope TC, Kuhns LR. Fatal Lumbar Puncture: Fact Versus Fiction—An Approach to a Clinical Dilemma. Pediatrics. 2003; 112(3) Schwartz J et al. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice—Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Sixth Special Issue. Journal of Clinical Apheresis. 2013; 28:145–284. Zorc JJ. A lethargic infant: Ingestion or deception? Pediatr Ann 2000; 29: 104–107 This post and podcast are dedicated to Teresa Chan, HBSc, BEd, MD, MS, FRCPC for her boundless passion for and support of #FOAMed, for her innovation in education, and for her dedication to making you and me better clinicians and educators. Thank you, T-Chan. Altered Mental Status Powered by #FOAMed -- Tim Horeczko, MD, MSCR, FACEP, FAAP
A brief review of pediatric intussusception and its presentation in the ER.
PhysicianAssistantBoards.com - Today were going to speak on intussusception. Key points: triad of abdominal pain, vomiting, and currant jelly stool. Bilious vomiting is a surgical condition until proven otherwise. Ultrasound is the first test which should be ordered. Contrast enema is diagnositic and therapeutic.
This week we review Dr. Natalie May's brilliant post on the St. Emlyn's blog, "When Sick Means Sick: Emesemantics and Vomiting in Kids" in which she dissects emesis descriptors such as bilious, projectile, and coffee-ground. Then, we delve into core content on Neonatal Jaundice and Intussusception. Key Texts: Tintinalli (7e) Chapters 111, 124 ; Rosen's (8e) Chapter 172 As always, visit foamcast.org for show notes and the generously donated Rosh Review questions. Thanks y'all! -Jeremy Faust and Lauren Westafer
Interview with Irene M. Shui, ScD, author of Risk of Intussusception Following Administration of a Pentavalent Rotavirus Vaccine in US Infants
04/18/2011 | CT of Small Bowel Intussusception
This episode covers an approach to children with acute abdominal pain. The podcast covers an approach to history, an approach to physical examination, discusses investigations and lists indications for a surgical consult. This episode was written by Peter MacPherson and Dr. Melanie Lewis. Peter is a medical student at the University of Alberta. Dr. Lewis is a general pediatrician and an Associate Professor of Pediatrics at the University of Alberta and Stollery Children's Hospital. She is also the Clerkship Director. Related Content: Case: Acute Abdominal Pain in a 14 year old female Case: Abdominal Pain in a 4 month old female Case: Abdominal Pain in a 8 year old Podcast: Urologic Emergencies Podcast: Approach to Intussusception
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