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Hot Seat #243: Rash Decisions

Case by Maria Elena Arrate MD, CNH PEM Fellow A 15-year-old female presents to the ED for fever and umbilical drainage. Seen 9 days ago for drainage from the belly button that had been ongoing for 6 weeks, and intermittent fevers. Had been on a 10-day course of Cefalexin for soft tissue infection around belly […]

Push-Pull Fluid Bolus in Pediatrics 

✅ Indications for Push-Pull Bolus:  Typical Fluid Dose:  Push-Pull Technique Using a 3-Way Stopcock  Equipment Needed:  ✅ Steps to Set Up:  ✅ Pro Tips:  Keep the IV site visible—stop immediately if infiltration is suspected.  Use the largest-bore IV possible for effective flow rates.  Limit disconnections to maintain sterility and prevent air embolism.  Monitor for signs […]

Nasogastric Tube Placement Guide

✅ Preparation:  ✅ Insertion Procedure:  ✅ Secure the Tube:  ✅ Confirm Placement (Critical Safety Step):  ⚠ Safety Tips:  ✅ Example: NG Tube Placement Video – OPENPediatrics 

Gastrostomy Replacement Guide

Steps to Replace: *Lidocaine jelly can be used to decrease the pain of insertion but there is no literature about the safety or efficacy of its use for this purpose.*  ** If a G-tube has been out for several hours, its stoma may have already started to close.  If this occurs, a smaller G-tube can […]

Tracheostomy Replacement Guide

Steps to Replace: ** If unable to obtain a tracheostomy of appropriate size, can use 6.0 endotracheal tube cut down to 12 cm; insert no more than 1 cm past the cuff**   VISUALIZE with Videos!  CHANGING A TRACHEOSTOMY – OPENPediatrics  TRACHEOSTOMY TROUBLE SHOOTING – OPENPediatrics