Traditional Approach:
Adolescent with mallet finger and Kirschner wire fixation. Nellans et al. Pediatric Hand Injuires. Hand Clin. 2013 November ; 29(4): 569–578
Lee SA et al. Ultrasonography of the finger. Ultrasonography 2016; 35(2): 110-123.
A, B: Relatively normal appearance; C: in flexion, rotational abnormality evident. Liao CY et al. Pediatric Hand and Wrist Fractures. Clin Plastic Surg 46 (2019) 425–436
Mims L et al. Extra-Octave Fracture in a 14-Year-Old Basketball Player. Journal of Pediatrics. 2017; 186: P206-206
Kiely AL et al. The optimal management of Seymour fractures in children and adolescents: a systematic review protocol. Systematic Reviews. 2020; 9 (150).
Liao CY et al. Pediatric Hand and Wrist Fractures. Clin Plastic Surg 46 (2019) 425–436
Lin JS et al. Treatment of Acute Seymour Fractures. J Pediatr Orthop. 2009; 39(1):e23-e27.
Mims L et al. Extra-Octave Fracture in a 14-Year-Old Basketball Player. Journal of Pediatrics. 2017; 186: P206-206
Mohseni M et al. Ulnar Collateral Ligament Injury. Stat Pearls. 2020
Nellans et al. Pediatric Hand Injuires. Hand Clin. 2013 November ; 29(4): 569–578
Pattni A et al. Volar Plate Avulsion Injury. Eplasty. 2016; 16: ic22.
Stevenson J et al. The use of prophylactic flucloxacillin in treatment of open fractures of the distal phalanx within an accident and emergency department: a double-blind randomized placebo-controlled trial. The Journal of Hand Surgery: British & European. 2003; 28(5): 388-394
Yeh PC et al. Pediatric Hand Fractures. Techniques in Orthopaedics. 2009
Temperature (core) | Presentation | Management | |
Miliaria Crystallina | Normal | Salt-colored tiny papules, easily burst; not pruritic | Modify environment; light clothing; hydration |
Miliaria Rubra | Normal | Discrimiate, red papules, not assocaited with follicles; pruritic | Above plus cool compresses; calamine lotion; symptomatic tx for pruritis |
Miliaria Profunda | Normal | Confluent flesh-colored, “lumpy-bumpy”; burning | Same as rubra |
Miliaria Pustulosa | Normal | May resemble rubra and/or crustallina, but pustular; h/o previous dermatitis | Same as above, but may may need antibiotic if no improvement over time |
Heat edema | Normal | Swelling of feet, ankles, and/or lower legs | Modify environment; elevate legs |
Heat syncope | Normal | Dizziness, orthostatic hypotension, and syncope after exertion with rapid return to normal mental status when supine | Modify environment; rehydration; monitoring |
Heat cramps | May be elevated to 40°C (104°F) | Exercise-induced cramping in large muscle groups, especially legs | Hydration; consider labs (Cr, total CK); may counsel to stretch muscles passively, gently |
Heat tetany | May be elevated to 40°C (104°F) | Hyperventilation with paresthesia, carpopedal spasm | Modify environment; hydration; may place non-rebreather mask on low (or off) for rebreathing CO2 |
Heat exhaustion | Elevated up to 40°C (104°F) | Normal mental status, fatigue, that rapidly improves with treatment; tachycardia; GI symptoms; electrolyte abnormalities | Cool environment; hydration; consider labs with severe symptoms, or if not improved |
Heat Stroke | >40 to 40.5°C (104 to 105°F) | Altered mental status; tachypneic; tachycardic with hypotension; electrolyte abnormalities; GI symptoms; often with renal failure, rhabdomyloysis, renal failure; possibly with cardiogenic shock or ARDS or DIC | Rapid cooling with all modalities available (radiation, conduction, convection, evaporation); IV rehydration; labs; monitoring; ICU admission |
Selected References
Bergeron MF, Devore C, et al. Council on Sports Medicine and Fitness and Council on School Health, Policy statement—Climatic heat stress and exercising children and adolescents. Pediatrics 2011; 128:e741.
Casa DJ et al. The Inter-Association Task Force for Preventing Sudden Death in Secondary School Athletics Programs: Best-Practices Recommendations. J Athl Train. 2013 Jul-Aug; 48(4): 546–553.
DeFranco MJ et al. Environmental issues for team physicians. Am J Sports Med. 2008 Nov;36(11):2226-37.
Ishimine P. Hyperthermia. In: Pediatric Emergency Medicine, Baren JM, Rothrock SG, Brennan JA, Brown L (Eds), Saunders Elsevier, Philadelphia 2008. p.992.
Jardine DS. Heat illness and heat stroke. Pediatr Rev 2007; 28:249.
Ask yourself -- again -- why is this not... appendicitis-torsion-intussusception-etc.
Admit sick children, but most go home, so...
Selected References
Khan WA et al. Central Nervous System Manifestations of Childhood Shigellosis: Prevalence, Risk Factors, and Outcome. Pediatrics. 1999 Feb;103(2):E18
Lee JY et al. Diagnostic yield of stool culture and predictive factors for positive culture in patients with diarrheal illness. Medicine (Baltimore). 2017 Jul; 96(30): e7641.
Nelson JD et al. Treatment of Salmonella gastroenteritis with ampicillin, amoxicillin, or placebo. Pediatrics 1980; 65:1125.
Amount needed in addition to maintenance fluids:
Add 1/2 of X to maintenance over the 1st 8 hours
Add the other 1/2 of X to maintenance over the next 16 hours
Selected References
Mahar PD et al. Clinical differences between major burns patients deemed survivable and non-survivable on admisssion. Injury. 2015; 46:870-873.
Mathis E et al. Pediatric Thermal Burns and Treatment: A Review of Progress and Future Prospects. Medicines. 2017; 4:91.
Osuka A et al. Glycocalyx shedding is anhanced by age and correlates with increased fluid requirement in patients with major burns. Shock. 2017; 50(1):60-65.
Sebastian R et al. Percutaneous pigtail catheter in the treatment of pneumothorax in major burns: The best alternative? Burns. 2015; e24-227
Sherren PB et al. Lethal triad in severe burns. Burns. 2014; 1492-1496.
Strobel AM et al. Emergency Care of Pediatric Burns. Emerg Med Clin N AM. 2018; 441-458.