Pediatric Emergency Playbook

"She won't walk", or "He just looks like he's limping". So many things can be going on -- how do we tackle this chief complaint? You’re dreading a big work-up.  You almost want to tell the kid – please, STOP LIMPING... STOP LIMPING! S – Septic Arthritis  The most urgent part of our differential diagnosis. The hip is the most common joint affected, followed by the knee.  Lab work can be helpful, as well as US of the hip to look for an effusion,  but sometimes, regardless of the results, the joint just has to be tapped to know for sure. T – Toddler’s fracture This is usually a torque injury when the wobbling toddler pivots quickly or trips and falls.  Toddler’s fractures happen in children 1 to 3 years of age, and occur in the distal 1/3 of the tibia.  Sometimes a cast is needed, but currently there is a new trend in foregoing casting in mild cases. O – Osteomyelitis Bacteremia – from any source – can seed into any bone.  It’s not very common, but it happens: approximately 2% of children who present to an ED wi