In this episode, our hosts, Andy Little and Drew Kalnow are joined by our blog editor, Patricia Capone, and friend of the show, Yaron Ivan at the ACOEP 2022 Scientific Assembly to discuss pediatric patients in the ED.

Why are pediatric patients so scary to adult ED docs?

  • We don’t see as many pediatric patients
    • Pattern recognition becomes more difficult with lower frequency
    • There is a different set of differential diagnoses that we can’t forget to consider
  • When kids are sick, they crash fast
    • They don’t signpost their illnesses as clearly as adults because their bodies are so good at compensating
  • Pediatric patients usually present to the ED at the extremes
    • Either parents wait until their children are very sick to bring them in or they present so quickly after the onset of symptoms that the disease process may not have had time to develop yet
  • Early on in training, it can be challenging to know how to best interact with children depending on prior experience with children
  • Acceptable miss rate in pediatrics is virtually zero
  • Diagnostic testing feels more limited in children, as we try to avoid invasive procedures and excessive radiation
    • This makes us more anxious that we are going to miss something
  • Bad outcomes are often more emotional in pediatrics

Dr. Ivan’s Advice and Take-Home Points:

  • Good anticipatory guidance can go a long way
  • The sicker the child, the easier it is:
    • Stick to a general approach for sick children:
      • Full set of vitals
      • Establish IV
      • Give fluids
      • Check for easily reversible causes like hyponatremia and hypoglycemia
    • Keep an open mind to learning as much you can about pediatric patients
    • Don’t manage pediatric patients like adults
    • Obtain a thorough H&P to avoid unnecessary testing and to avoid missing things
    • Consider PEM fellowship!

About Our Guest:
Yaron Ivan, MD
Assistant Director for EM Pediatrics, AdventHealth EM Residency

For more from Dr. Ivan, check out his podcast, PEM Rules!

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