PGY-2 Pearl #22: The Holy Trinity of Allergy-Immunology Things You Actually Need To Know (in peds)

There is no reason to use Benadryl in any patient who can tolerate enteral medications (PO/NG/GT); use second-generation antihistamines (Aerius, Reactine, Claritin, Rupall) instead! They have a much more favourable side effect profile and are non-drowsy. This is especially important for kids with possible anaphylactic reactions, so it doesn’t muddy the clinical picture (syncope vs …

Baby cuddler for hire?

Ah, another baby cuddling day! Today in the NICU my patient was very agitated, and every few minutes the nurses were scrambling to tend to their patients while also rotating by her cot to try to soothe her so her wailing didn’t completely unsettle all the other families in the unit. Unfortunately, she would only …

Another Airport Story…

On the way back from some interviews across the country, I was sitting opposite a little boy and his grandmother waiting for the same flight. He was probably about four or five, and was a cute little thing with blue eyes and curly light brown hair. The entire time he sat there making faces at …

This is why peds…

The toddler sister of my patient runs up to me and growls theatrically, then runs behind her mom. She repeats this several times until I notice her little pink shoelaces are untied. I point this out to her, so she stops mid-growl to let me tie her shoe. When I ask for the other foot, …

PGY-2 Pearl #21

When you have identified a patient requiring pharmacologic hypertension management (ie/meets criteria for stage II hypertension or critical hypertension per AAP 2017 pediatric hypertension guidelines, and/or symptomatic from hypertension), think about the underlying mechanism for hypertension in that patient. Then, think about the ABCD’s of hypertension: A: ACE inhibitors (for increased RAAS activation, decreased vascular …

Oh my heart…

Today I was booking it across the ward to try to make it to my journal club presentation on time and a little boy was standing outside his sister’s room. He looked up at me with the biggest, most imploring eyes I have ever seen, so I stopped in my tracks and crouched down to …

PGY-2 Pearl #19

If it looks like gastroenteritis, remember to ask about possible exposures to excess iron. Common examples include new baby siblings (i.e. prenatal vitamins hanging out at home) or family members/PMHx of anemia.  Iron poisoning can look like gastroenteritis and often appears to resolve initially. Rises in serum iron level can be delayed, and may not …

PGY-2 Pearl #18

Have an irritable infant (>3mo) with no localizing infectious signs/symptoms and no meningismus? Is the urinalysis negative? Before you get that LP, consider a lateral neck X-ray to rule out retropharyngeal abscess (RPA). These infants can present very similarly to meningitis (and may even have neck pain/stiffness given the location of the abscess), and they …

On Grief

As healthcare professionals, we have the unique privilege of meeting many people throughout our careers, often at extremely vulnerable times in their lives. Some of these times are vulnerable in happiness, but more often they are vulnerable in pain, suffering, and grief. Loss is something that every human experiences at some point in their lives. …

The real superheroes

Me, to my 5yo patient wearing a Superman T-shirt: So are you gonna go home and save the world? Patient: No. Me: Oh? So then the world is just gonna have to figure it out on their own? Patient: No... Me: So then... who's gonna save them? Patient: Daddy, 'cause he's the real superhero. Patient's …