Pediatric Emergency Medicine Educational Morsels

Enjoyable Pediatric Emergency Medicine Education

Why “Morsels?” Simply put, I like desserts more than I like jewelry (also known as pearls).

Additionally, the overall goal of continuing our education is to enhance our comfort with the vast topics that exist in the medical arena.  What is more comforting: solitary and expensive calcium carbonate rejected by a mollusk or delicious, sweet tidbits that were just delivered to you fresh and warm?  I agree: Morsels beat Pearls.

The goal of these Pediatric EM Morsels is to continue to encourage us all to enhance and refine our understanding of pediatric emergency medicine and to augment the care of pediatric patients.  The care of pediatric patients often brings up a myriad of diverse topics ranging from the common to the very unusual.  It is difficult to stay abreast of the appropriate management of some many diverse entities, particularly when they may be quite different from those of our adult patients.

I encourage you to explore the Morsels that already exist… and if you are interested, subscribe in order to receive the weekly Morsel directly.

Thank you for your interest and dedication.

Have a great day,

Sean M. Fox, MD, FACEP, FAAP

Professor of Emergency Medicine and Pediatrics

Department of Emergency Medicine

Carolinas Medical Center Charlotte, NC


The posting on this site is my own opinion and doesn’t represent Atrium Health’s positions, strategies or opinions.

91 Comments

  1. I am a 49 year old 4-K preschool teacher. This is my 26th year teaching. I had a little boy in my room that would have breathing fits (Jan and Feb). Docs couldn’t figure out what it was. Mom took him to the doctor 3 times, they said allergies. His brothers and sister had this too, with fevers. The little boy in my room never had a fever. Mom told me that to this day, they still have coughing fits but they’re not throwing up with them anymore.
    Then came the Rona scare and our school shut down.
    After 7 doctor visits, having stridor for 7 of the 8 weeks, Doxycycline, Augmentin, Biaxin and Levaquin, I’m not any better! I was virtually diagnosed at 6 weeks with mycoplasma pneumonia. Before that everyone thought it was either viral or a bacterial infection that needed Augmentin. That’s why the continued Macrolide antibiotics.
    My husband and one of our boys has this now. My husband is on Doxycycline and our son just finished a Zpack. I refuse to let them suffer as I have. I am trying to figure this out as I really don’t get anything from ER docs. Not being able to breathe in air is the scariest thing I’ve ever been through. After googling causes of severe stridor, it sounds like I have bacterial croup! If my son and I look up, our trachea signals and we go into a coughing fit. My son Hudson started symptoms 2 weeks ago. He has body aches, sore throat, and inflammation. The cough produces phlegm sometimes. Mostly dry. We have a plug of mucous in our trachea at all times. We clear our throats a gazillion times a day. We cannot clear our throats.
    After X-rays and CT of chest, docs are perplexed.
    On Wed, May 6, I finally had bloodwork for Macoplasma antibodies, phlegm and had to have another C19 test to get a RVP Panel. Panel came back clear. I’m still waiting on Macoplasma antibody test results.
    My WBC- is 12.15/CRP-.55/SED-26
    I am beyond inflamed under my breast! My skin is so tight.
    I have also completely stopped breathing 5 times with this. No air coming in or going out. I have to swallow 10 times, drink water then I barely get breath in for about 10 seconds. I have to keep water by me everywhere I go so that if I have an attack, I have it right there to help me breathe again. to help me breathe again! I wear depends because the coughing fits make me pee all over myself. I truly think that I continue to be misdiagnosed over and over. I think that I need a 3rd class cephalosporin. Please tell me that I’m Acute and that I (my son and husband) can fight this. Why don’t we have a better testing system to see if it’s bacterial, fungal or viral? With all of our technology we can test for the scary bacteria that are out there.
    Thank you for just listening. I’ve left instructions for my boys on what to do if another coughing fit causes me to faint.

  2. Hello,

    Was searching for a note on Faget’s sign, and by chance came across your write up. Nice and simple way of expressing the subject.

    Thanks much.

  3. I had the pleasure of hearing you at the NWAS conference in Turks and Caicos. I tell my residents to look at your take on many things regularly. If you have not done one yet, could you please give us a morsel about proper wound cleaning, and how damaging to tissue healing chlorhexidine, iodine, and H2O2 are? Thanks!

  4. Hello team,

    I’m a medical student in Vancouver, working with a team at BC Children’s hospital that developed the open HEARTSMAP online tool for Emergency Physicians and health care professionals to better triage child and youth mental health presentations in the Emergency department.

    We would like to discover the impact of social media to spread word about this tool, on its uptake rate (which we can monitor).

    I would like to discuss whether possible and if so, how we may create a very quick small post with a link on your website/Instagram/twitter feeds?

    I would be happy to discuss further.

    Thank you so much!

    • Thank you for your interest in the PedEMMorsels!!
      Please feel free to invite others to join in the fun!

      Also… feel free to send requests for topics… I’m always looking for ideas.
      Have a great day,
      sean

  5. Hello Sean,

    I’m a pediatrician in Barcelona (Spain), working in the ER in a big teaching hospital. I love the way you navegate through de most common pediatric complaints, I keep suggesting our residents to subscribe to your Morsels.
    I wonder if we could collaborate anyway (translating to spanish?).
    Congrats for the nice work!

    Andrés

    • Dr. Almario,
      THANK YOU SO MUCH for your kind words! I also appreciate your support of the site!

      I would love to discuss possible collaborative efforts (that is the essence of the #FOAMed and #FOAMped realms).
      Feel free to email me directly at pedemmorselsfox@gmail.com .

      Have a great day,
      sean

  6. Thank you for the good work.
    I light up each Saturday morning when I get these in my email.
    Succint and priceless.
    Thank you!
    Sincerely,
    Vivian Okoye, M.D

    • Thank you, Dr. Okoye, for your kind words!
      I am glad that the Morsels are having a positive impact on your Saturdays!
      🙂
      Please feel free to share them with anyone you think will enjoy them.
      Have a great day,
      sean

    • Kathryn,
      Thank you for your interest in the PedEMMorsels! I will be glad to add you to the weekly distribution list. Simply send an email to pedemmorselsfox@gmail.com listing your preferred email address. Feel free to invite others to join in the fun!
      Have a great day,
      sean

  7. great website and valueable information thanks for hardwork.
    kindly can you add me on subcription list.Thanks a million Sean

  8. Good evening, I am pediatrician who stumbled onto this wonderful website.
    Keep up the great work .
    I would love to receive the weekly morsels.

  9. How is this website not more visible?? How did I not find this on all those shifts I had in the ED??
    Really good. I am a Gen Ped and really appreciate the info. Helpful. Well researched and well presented.
    Love the crazy pictures too. will suscribe

    • Dr. Vivian,
      I’m glad you appreciate the site! It has been around for awhile, so there is plenty of content in there, but if you have any specific topics/questions you’d like addressed, let me know.
      Spread the word!
      Thank you,
      Sean

    • Thank you for your kind words and interest in the PedEM Morsels! Your email address has been added to the weekly distribution list. Have a great day, sean

    • Thank you for your interest in the PedEMMorsels! I have added your email address to the weekly distribution list! Feel free to invite others to join in the fun.
      Have a great day,
      sean

  10. These morsels continue to be very readable and informative. Just wanted to say thanks and keep them coming. It’s one of the few emails I read religiously and completely each week.

    Seth

    • Seth,
      I really appreciate your comment and I am very glad that you continue to find the Ped EM Morsels valuable.

      Please let me know if you ever have a clinical topic or question you would like the Morsels to attempt to address.

      Thank you,
      sean

  11. Dr. Fox,
    As a new Nurse Practitioner in an incredibly busy Pediatric Emergency Department, I spend time on days off studying and learning new things to help expand my knowledge base and improve my skills in order to provide excellent care. I inadvertently found your website and could not be happier!! I find your morsels to be super relevant, practical and easy-to-follow tidbits of invaluable information!
    I would be so appreciative if you would add me to your list for Weekly morsels…I promise, they will be ‘devoured’ as soon as they are delivered!!

    Thank you very much!!!

    • Thank you for your interest in the Ped EM Morsels!!
      I removed the automated subscription tool, as it lead to many more headaches with spammers. So now I do this manually.
      Please send me your preferred email address to pedemmorselsfox@gmail.com. I will put you on the distribution list then.
      Have a great day,
      Sean

    • Thank you for your interest in the Morsels!
      Your email has been added to the Friday distribution list!
      Feel free to request topics… I’m always looking for something interesting to talk about.
      Thank you,
      sean

    • Hello Dr. Bailitz! The subscription button has been removed due to issues with spammers… So now I manually add people who request to be added. Just send me your preferred email address.

  12. thanks for all the time and effort put into this. Its an amazing body of work. I am an adult academic physician in Canada and I see kids infrequently, so this is a great review. I know what i’m reviewing on the site will save a kid for sure.

    leg pain and meningococcemia?! who would have known unless I went through the site.

    I do personally think the social media market is too saturated with podcast type learning. what happens is that you listen for an hour and get 4 main points out of the podcast. Whereas, I can pound out 6 morsels in an hour and review 24 points, which I can actually utilize. Its far more effective. I will actually refer to a morsel on shift quickly before seeing a patient sometimes. Can’t really do that with a podcast. Sometimes old school is just better.

    Ram

  13. I pretty much read all the emergency medicine social media blogs. I think this one is the most useful and most practical by far.

    • Truly appreciate the feedback! Please let me know if there are any topics that you’d like covered. Please feel free to invite others to join in the Morsel fun!
      -sean

  14. i’ve struggled to find an emergency blog totally dedicated to peds, so got really excited and ive subscribed!

  15. I want morsels! Was looking for EMS blogs and found this great site instead. Needless to say that I have subscribed immediately! 🙂

  16. Hi Sean,

    I was delighted to stumble upon this website, and follow on twitter. I wondered if you had a morsel to the approach to a child’s rash! Not asking for much, I know, but the toddler/baby rash is probably the one thing that I struggle with – rashes in adults are complex enough – but if they look well, it’s more reassuring. With little ones, although I’m guessing the same philosophy follows, the concern is missing that one ‘viral’ looking rash that turns out to be something nasty.

    Any advice would be much appreciated

    Many thanks

    Kesh
    Twitter @KiefKhullar

    • Dr. Khullar,
      Thank you for the interest in the Morsels first of all! I appreciate the comment.

      As for rashes… I hope no Dermatologist is reading… I HATE RASHES! Adult and Pediatric!

      I have covered a few different rashes in the Morsels:
      Molluscum Contagiosum, ITP, Staph Scalded Skin, Perianal Strep, Intertrigo, and Meningococcemia to name the ones I can easily remember.

      The way I approach rashes is simple (because I am simple minded in general).
      1) Identify presence or lack of Petechiae, Purpura, Vesicles, Bullae, Target Lesions, or Desquamation. If any of these are present, it is time to think a little harder (ex, petechiae can be present for benign reasons like vigorous vomiting or coughing, but a single petechiae below the nipple line is concerning for meningococcemia).

      2) If the above are not present, then look for common childhood rashes. Molluscum, pityriasis rosea, 5ths Disease, etc.

      3) If neither #1 nor #2 are readily apparent and the child looks well… I admit defeat and tell the family that I am not sure what this particular rash is but I do not think it is life threatening.

      Certainly there are caveats to #3. Kawasaki Disease is a great example because the associated rash can be almost any type (generally not bullous though). So the “maculopapular” rash that is often seen with viral exanthems can easily be apart of the Kawasaki Disease presentation… but naturally, there are other findings that should alert the provider to that condition.

      I hope that that helps. I will look at covering some more typical rashes in the coming Morsels.

      Thank you for your question and comment!
      Have a great day,
      sean

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