A 3 year-old male presents to the pediatric emergency department with leg pain. Prior to arrival, the patient had been at daycare and was found crying, reporting pain to his right leg. The daycare staff denied any specific trauma and noted that he had been playing happily throughout the morning. His parents were understandably concerned and dad reported that this had been his fourth visit to the emergency department for fractures since he started walking at 12 months of age…
Read MoreWe use ultrasound for a multitude of procedures in the emergency department, including central and peripheral venous access, abscess drainage, and joint aspiration. Less common, but just as useful, is the use of ultrasound to help identify landmarks when performing a lumbar puncture (LP). While the traditional method of LP is based on palpating anatomical landmarks, this is becoming increasingly difficult as the patient population becomes more obese. It may also be difficult in patients who have abnormal spinal anatomy or in those who have had previous spinal surgery. When palpating anatomy is difficult, ultrasound can be a useful tool to help identify appropriate landmarks and increase your LP success rate…
Read MoreIf your hospital system is like mine, it has a dedicated pediatric emergency department. A place connected to a larger children’s hospital, where all of the providers, including nurses are certified in pediatrics. They also offer a whole host of other pediatric support, like child life specialists, without whom I would not be able to suture a laceration or obtain cerebrospinal fluids samples. All of the people have one goal, the safety and well-being of the child. This system, as you might expect, fosters a unique culture of medicine; a culture which I assert is heavily steeped in paternalism…
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