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Clinical Presentation
Of 996 evaluations included in our ED study population, 109 (10.9%) had MSK infections. In a multivariate model, an adjusted odds ratio was significant for fever (3.9, 95% CI 2.4-6.4), refusal to bear...
Infection Site Culture
“Antibiotic exposure prior to culture-sample acquisition does not interfere with aerobic culture results from the site infection” - Gibbons, S. D., Barton, T., Greenberg, D. E., Jo, C. H., & Copley, L.
Myelomeningocele: Spinal Differences Coordinator
Notify Spinal Differences Nurse Coordinator of patient admission: Pager (816) 458-3443. If unavailable, call Rehab Nurse ext. 73390. These pathways do not establish a standard of care to be followed in...
Obtain CT or rMRI and Shunt Series
If possible, it is preferable to be consistent with imaging when evaluating for ventricular changes (such as if the patient had a prior CT, then obtain CT now or if patient had a prior rMRI...
Stratification Guidelines for Tumor Lysis Syndrome
For risk assessment in tumor lysis syndrome, see Figures 2 and 3 in the Pediatrics in Review (access is provided below): For Children's Mercy providers: Library Services For providers without Children's...
ACEs and Mental Health in Adolescents - Hot Topics - October 2022
A recent CDC study found that 73% of high school students experienced at least one ACE during the COVID-19 pandemic. As the number of ACEs increased, mental health worsened. Screening for depression in...
SSTI: Indication for Incision and Drainage
Indications for and methods of incision and drainage are outside the scope of this CPG. Please employ clinical judgment, utilizing ultrasound and/or surgical consultation as needed. These pathways do not...
SSTI: Discharge Education
Discharge education: Kids Health Cellulitis Kids Health Abscess Kids Health Impetigo These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is...
Supportive Care Measures
Encourage non-caffeinated and non-carbonated fluids. For girls, encourage wiping after each void from front to back. Decrease discomfort with voiding by urinating while sitting in a warm bath tub. Provide...
Chronic Rhinitis and Sinusitis
Allergic and irritant rhinitis are common comorbidities of asthma in pediatric and adult patients. Chronic rhinosinusitis is an independent risk factor for uncontrolled asthma and asthma exacerbations.
Gastroesophageal Reflux Disease (GERD)
Symptoms of GERD heartburn regurgitation Other suggestive syptoms dysphagia hypersalivation globus sensation odynophagia nausea Symptoms of GERD complicating asthma may include increased asthma...
11. Allergy Immunotherapy and Biologic Therapy
If there is a concern for refractory asthma or allergic asthma, the patient can be referred to subspecialty clinics, Allergy/Immunology or Pulmonary medicine, for the evaluation of advanced therapies.
Consider Additional Consults
Consider additional consults to: Either Allergy & Immunology OR Pulmonology. Social Work. Environmental Health. Indications for all 3 consults: > 4 ED/UCC/Inpatient episodes in the past 12 months...
Acute Chest Syndrome: Reference List
Chou, S. T., Alsawas, M., Fasano, R. M., Field, J. J., Hendrickson, J. E., Howard, J., Kameka, M., Kwiatkowski, J. L., Pirenne, F., Shi, P. A., Stowell, S. R., Thein, S. L., Westhoff, C. M., Wong, T. E., &...
Acute Chest Syndrome: Prepare for Exchange Transfusion
Prepare for exchange transfusion in the PICU if pt. presents with severe or rapidly progressing Acute Chest Syndrome or Hgb>10 gm/dL: Alert PICU and pheresis team Automated RBC exchange preferred Labs...
Acute Chest Syndrome: Definition
A patient with sickle cell disease who has a new infiltrate on CXR, in addition to at least one of the following: chest pain, fever, hypoxia or respiratory symptoms (shortness of breath, wheezing...
Assure Pregnancy Test is Negative
LexiComp (2016) places valproic acid in Category X for migraine prophylaxis and Category D for all other indications when assessing Pregnancy Risk Factors. For medications that are in either category X or...
Valproic Acid
In the pediatric patient diagnosed with refractory migraine, is valproic acid an effective treatment? Plain language summary from the office of evidence based practice Migraine in the ED Team...
Necrotizing Fasciitis
High likelihood of MSK infection with sepsis or necrotizing fasciitis: History, Exam. Lab work: (CBC with Differential, Blood Culture, ESR and CRP). Administer antibiotics: (vancomycin, clindamycin, and...
Myelomeningocele: Recommendation if Born at Outside Hospital for Pre-natal Repair
Recommend transfer to Children's Mercy for further evaluation, management and initial inpatient care coordination. Timing of transfer, if stable, can be arranged after 48 hours closer to maternal discharge...