EM Quick Hits 52 Infant Vomiting, Orbital Cellulitis, Prehospital TXA in Trauma, Prevention and Treatment of Delirium, Procedural Skills Decay, Altitude Sickness

Topics in this EM Quick Hits podcast Sarah Reid on an approach to infant vomiting (1:08) Brit Long on orbital cellulitis essentials (10:45) Justin Morgenstern on update on TXA for polytrauma - the PATCH trial (18:04) Christina Shenvi on prevention and treatment of delirium (24:26) Jason Hine on procedural skills decay (36:58) Aaron Billin on altitude sickness (43:37) Podcast production, editing and sound design by Anton Helman Podcast content, written summary & blog post by Fadi Bahodi, Sarah Reid, Brit Long, Jason Hines, edited by Anton Helman Cite this podcast as: Helman, A. Reid, S. Long, B. Morgenstern, J. Shenvi, C. Hine, J. Billin, A. EM Quick Hits 52 - Infant Vomiting, Orbital Cellulitis, Prehospital TXA in Trauma, Prevention and Treatment of Delirium, Procedural Skills Decay, Altitude Sickness. Emergency Medicine Cases. October, 2023. https://emergencymedicinecases.com/em-quick-hits-october-2023/. Accessed September 17, 2024. Approach to infant vomiting Infant vomiting DDx * Structural/Surgical: pyloric stenosis, malrotation with volvulus, intussusception, incarcerated hernia, ovarian/testicular torsion, bowel stenosis/atresia, Hirschprung’s disease * Infectious: UTI, otitis media, pharyngitis, pneumonia, CNS (see below), gastroenteritis, URTI, pertussis * GI: GER/GERD, overfeeding, Cow’s Milk Protein Allergy (CMPA), Food Protein-Induced Enterocolitis Syndrome (FPIES) * CNS: mass, bleed, hydrocephalus, meningitis, encephalitis, brain abscess, congenital lesion, trauma, child maltreatment * Metabolic/Endocrine: inborn error of metabolism, adrenal insufficiency, DKA (very rare in infants) 3 key structural diagnoses in infant vomiting: General approach to infant vomiting * Is the baby sick or not? * Is there fever or not? Septic workup or not? * Characteristics and pattern of vomiting. * Is this bilious/yellow/green/bloody? * Is there a progression of vomiting (intermittent or every feed). Pyloric stenosis is classic for vomiting with every feed. * Assess for behaviour sometimes linked with intussusception. * Crying episodes, hard to console, seem in pain, drawing up their knees. Interspersed with periods of being quite well or the baby being pale lethargic. Can be (intussusception, severe illness, CNS process) Physical exam pearls for infant vomiting A head to toe exam is essential, including: * Assess fontanelles for dehydration vs raised ICP * Look in the diaper for an inguinal hernia, undescended testes, testicular torsion The child with vomiting who is otherwise well The normal baby with normal vitals, no blood or bile in their vomiting, vomiting intermittently, tolerating feeds in between and maintaining their hydration with an otherwise normal physical is usually an early viral illness versus GERD. Checklist for safe discharge in infant vomiting * Normal vitals * No bile/blood * Intermittent/few episodes of vomiting, tolerating feeds/oral rehydration in between. * Well hydrated, able to maintain hydration. * Normal full exam Discharge instructions and disposition for infant vomiting PCP follow-up in a few days, return to ED if persistent vomiting over a few feeds,