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Patient's Pain

Is the patient's pain assessed to be >3? Assess the patient's comfort level using an age and developmentally appropriate pain scale. Children's Mercy Kansas City uses the following pain...

Case Definition for Multisystem Inflammatory Syndrome in Children (MIS-C)

If you are concerned you may have a patient with MIS-C, please consult ID.  An individual aged <21 years presenting with feveri, laboratory evidence of inflammationii, and evidence of clinically severe...

Low Dose Systemic Thrombolysis

tPA 0.03-0.06 mg/kg/hr x 24 hours (max hourly dose 2 mg/hr) If on heparin: decrease heparin dose to 5-10 units/kg/hr. If on direct thrombin inhibitor (DTI) decrease rate by 50%. Heparin and/or DTI lab...

Bruising

Children’s Mercy obtained permission to use this picture for educational purposes. These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is...

Empiric STI Treatment:

While tests are pending, empiric treatment for Chlamydia and Gonorrhea should be provided for those at increased risk (e.g., women <25 years, new sex partner, known STI exposure), if follow-up cannot be...

October

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Mary Ann Queen, MD | Children's Mercy Research Institute

Mary Ann Queen, MD, is the Interim Chair of the Department of Pediatrics at Children’s Mercy and at the University of Kansas Medical Center. At the University of Missouri – Kansas City School of Medicine...

Drs. Laura Plencner and Molly Krager Receive Funding to Broaden Food Security Initiatives, Including Healthcare-Based Food Pantry System at Children’s Mercy

Laura Plencner, MD, Pediatrics and Hospital Medicine, and Molly Krager, MD, Pediatrics and Hospital Medicine, and co-chairs of the Children’s Mercy Kansas City Hunger Free Hospital Council received a...

Oral Cephalosporins - Wise Use of Antibiotics - October 2022

Oral broad-spectrum cephalosporins, such as cefdinir, are some of the most inappropriately prescribed antibiotic classes in pediatrics. They should not be used routinely to escalate therapy for patients...

SSTI: Cellulitis or Erysipelas (Images)

For Children's Mercy providers: https://www-visualdx-com.ezproxy.cmh.edu/visualdx/diagnosis/cellulitis?moduleId=103&diagnosisId=51263&lang=en_US#view=text&gid=1&pid=2...

SSTI: Antibiotic Dosing

Abscess: PO: Clindamycin 10 mg/kg/dose PO TID (max 450 mg/dose). Alternative therapy: TMP-SMX 4-6 mg/kg/dose (trimethoprim component) PO BID (max 160 mg TMP/dose). IV: Clindamycin. Cellulitis or Erysipelas...

6. Asthma Outpatient Management

Initial visit tables/ Follow-up tables/ Step therapy tables Initial visit Tables/ Follow up Tables/ Step Therapy tables are included. These tables are used to highlight the similarities and differences...

Severity of Asthma Exacerbation

    Mild Moderate Severe Respiratory Rate  2-3 yrs: <34/min  4-5 yrs: <30/min 6-12 yrs: <26/min >12 yrs: <23/min 2-3 yrs: 35-39/min 4-5 yrs: 31-35/min 6-12 yrs: 27-30/min...

Antihypertensive(s) and/or Lifestyle Modifications

Severe BP elevation means a BP consistently ≥ 99th percentile. Consult Nephrology if ≥ 2 doeses in 24 hours required to normalize BP.

Initiation and Maintenance

Initiation of enoxaparin therapy: Obtain blood for baseline CBC, PT, PTT. Calculate enoxaparin dose (mg) based on age, weight and indication. See Table 1. Table 1 - Initial Dosing of Enoxaparin...

Continuation Of Therapy - Day 5 Forward

Target INR for patient who have completed Day 1 - 4 of the initiation protocol: 2.5 - 3.5 for patients with mechanical /prosthetic valves or recurrent thrombotic events 2 - 3 for ...

Constipation: RED FLAGS for Underlying Disease Causing Constipation

RED FLAGS to consider: Meconium not passed in first 48 hours as a newborn. Family history of Hirschsprung disease. Blood in the stools with fever. Failure to thrive (chronically low weight for height).

Dihydroergotamine (DHE)

In the pediatric patient diagnosed with a refractory migraine, what is the efficacy of DHE IV to decrease migraine pain in the Emergency Department? Plain language summary from the office of evidence based...

Triptan

DHE cannot be given if the patient has received triptans with the previous 24 hours (Lexi-Comp, 2016). These pathways do not establish a standard of care to be followed in every case. It is recognized that...

Migraine Therapy in the ED

Guideline inclusion criteria:  Children up to 18 years of age. Physical exam normal. History consistent with primary headache. Guideline exclusion criteria: Abnormal physical exam normal. History...