CHKD Pediatric EM and EVMS EM Combined JC:

This month JC is pleased to welcome our EM colleagues from CHKD. As usual, we like to squeeze out many clinical pearls as possible from our colleagues, so we decided to tackle a few clinical topics. First, a recent RCT on the use of tranexamic acid in nosebleeds adds to a reasonably supportive body of evidence. I’m not sure I know of any EM clinicians who look upon managing epistaxis with great fervor. Nosebleeds though less common in children, are probable more difficult to manage when compression alone is insufficient. Does this additional evidence suggest that a bit of atomized TXA could be a game changer? Second, the potentially beneficial effects of probiotics in the scientific community dates back to the early 1900’s and has been advocated in some clinical settings as reported in the Cochrane Library and a AAP Clinical Report.We will report on a recent RCT in the NEJM on probiotics in pediatric gastroenteritis. Finally, the diagnosis and management of mild traumatic brain injury (mTBI) in children is not without challenges. Parents are often advised to restrict physical activity when mTBI is suspected. Dr. Ransford found an RCT in JAMA that considers earlier reintroduction of exercise in mTBI patients. I anticipate each of these topics will provide a springboard for an evening or great discussion. Hope to see you there! Charlie

We are really excited about having a new venue, the Pretlow Planetarium at ODU. Our host and Director of the Pretlow, Justin Mason will present a 30-minute overview of the current night sky and field any questions. I found a recent podcast he was interviewed in quite interesting.   

Akkan S. et al, Evaluating Effectiveness of Nasal Compression With Tranexamic Acid Compared With Simple Nasal Compression and Merocel Packing: A Randomized Controlled Trial. Ann Emerg Med. 2019 Jul;74(1):72-78 Appraisal

Schnadower D,et al,Lactobacillus Rhamnosus GG versus Placebo for Acute Gastroenteritis in Children. N Engl J Med. 2018 Nov 22;379(21):2002-2014. Appraisal

Leddy JJ. Early Subthreshold Aerobic Exercise for Sport-Related Concussion: A Randomized Clinical Trial. JAMA Pediatr.2019 Apr 1;173(4):319-325. Appraisal