Pediatric Emergency Playbook

Tim Horeczko, MD, MSCR, FACEP, FAAP•pemplaybook.org

You make tough calls when caring for acutely ill and injured children. Join us for strategy and support -- through clinical cases, research and reviews, and best-practice guidance in our ever-changing acute care landscape. Please visit our site at http://PEMplaybook.org/ for show notes and to get involved with the show -- see you there!

Last refreshed: July 2nd, 2025 at 2:46 PM ⓘ

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Episodes

Please STOP LIMPING!

" She won't walk ", or " He just looks like he's limping ". So many things can be going on -- how do we tackle this chief complaint? You’re dreading a big work-up. You almost want to tell the kid – please, STOP LIMPING... STOP LIMPING! S – Septic Arthritis The most urgent part of our differential diagnosis. The hip is the most common joint affected, followed by the knee. Lab work can be helpful , as well as US of the hip to look for an effusion, but sometimes, regardless of the results, the join...

Jul 01, 2016•33 min

Approach to Shock

Do we recognize shock early enough? How do we prioritize our interventions? How can we tell whether we’re making our patient better or worse ? World wide, shock is a leading cause of morbidity and mortality in children, mostly for failure to recognize or to treat adequately. So, what is shock? Simply put, shock is the inadequate delivery of oxygen to your tissues. That’s it. Our main focus is on improving our patient’s perfusion. Oxygen delivery to the tissues depends on cardiac output, hemoglob...

Jun 01, 2016•39 min

Altered Mental Status in Children

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...

May 01, 2016•37 min

Big Labs, Little People

It's a busy shift. Today no one seems to have a chief complaint. Someone sends a troponin on a child. Good, bad, or ugly, how are you going to interpret the result? And while we’re at it – what labs do I need to be careful with in children – sometimes the normal ranges of common labs can have our heads spinning! Read on to go from bread-and-butter pediatric blood work to answer the question – what’s up with troponin, lactate, d-dimer, and BNP in kids? A fundamental tenet of emergency medicine: W...

Apr 01, 2016•32 min

Multisystem Trauma in Children, Part Two: Massive Transfusion, Trauma Imaging, and Resuscitative Pearls

A 5-year-old boy was playing with his older brother in front of their home when he was struck by a car. He sustained a femur fracture, splenic laceration, and blunt head trauma – the so-called Waddell’s triad. On arrival, he was in compensated shock, with tachycardia. He decompensates and needs blood. How do we manage his hemodynamics and when do we perform massive transfusion? Pediatric Massive Transfusion 40 mL/kg of blood products given at any time within the first 24 hours. Adolescents and A...

Mar 01, 2016•38 min

Multisystem Trauma in Children, Part One: Airway, Chest Tubes, and Resuscitative Thoracotomy

Traumatized children need your full attention. Protocols work well for adults, but trauma in children requires that we exercise our clinical muscles just a bit more. Two main reasons: Children have specific injury patterns Their physiologic response to trauma is unique. Crash course in pediatric anatomy and physiology in trauma When you think of trauma in children, think of Charlie Brown . Large head, no neck, his chest and abdomen form an underdeveloped, amorphous shape. Alternatively, think of...

Feb 01, 2016•35 min

Vomiting in the Young Child: Nothing or Nightmare

In the young child, vomiting is the great imitator: Gastrointestinal, Neurologic, Metabolic, Respiratory, Renal, Infectious, Endocrine, Toxin-related, even Behavioral. To help us organize, below is a review of can't-miss diagnoses by age. The Neonate: Malrotation with Volvulus In children with malrotation, 50% present within the first month of life , with the majority occurring in the first week after birth. 90% of children with malrotation with volvulus will present by one year of age. This is ...

Jan 01, 2016•47 min

Electrical Injuries: Hertz So Bad

Victims of electrical injuries present either in extremis or as the seeming well patient with insidious, developing disease. A targeted history usually gets you the information you need. Four main things to find out: 1. Household or Industrial electricity? Household electricity uses alternating current , or AC . Voltages across the world range anywhere from 100 to 240 V. Here in North America, most outlets and appliances use 120 volts, which is the measure of electrical tension, or the potential...

Dec 01, 2015•36 min

Adventures in RSI

Pediatric airway management is a skill that integrates the three types of knowledge as described by the ancient Greeks: episteme , or theoretical knowledge, techne , or technical knowledge, and phronesis , or practical wisdom, also called prudence . Here we’ll invoke each type of knowledge and understanding as we go beyond the anatomical issues in pediatric airway management – to the advanced decision-making aspect of RSI and the what-to-do-when the rubber-hits-the road. Case 1: Sepsis Laura is ...

Nov 01, 2015•52 min

The Technologically Dependent Child in the ED

EMS is bringing you a child with a VP shunt, port-a-cath, trached on a vent, seizing, hypotensive, and now desaturating – ETA – 3 minutes. Are you ready? Medicine is evolving. As technology advances, we need to meet the challenge of taking care of our patients who have come to rely on this technology for their basic needs. Before we go further, remember to assess the parent and the child as a unit. The caregiver who is usually the parent, is a rich source of knowledge about the child’s particula...

Oct 01, 2015•36 min

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