I struggled to find PEM resources for my CT3 year, despite the variety of excellent resources out there. I hope this website will help point you in the right direction. I'm not a PEM expert, but am following the guidance CEM have issued (in the form of a syllabus) to put together this page. This page is not endorsed by CEM, and any mistakes are mine.

Please comment with corrections, additions and further suggestions.

All the information here is collected from the internet, and it might be out of date or inaccurate, so please use your judgement and adhere to your hospital's protocols. If you do notice any errors or omissions please comment so we can put them right!

To navigate, decide whether you want to start with a PMP or a PAP. You can then select which PMP or PAP you want to look at. You will then be taken to the summary page for that PMP, with links expanded topic collections. If you know what topic you want to look at already, click on the link on the right hand side.

Sunday, 7 February 2016

Long Bone Fractures - in Children

Femoral fractures are uncommon, as considerable force is often required. There is often a history of a fall with the leg twisted awkwardly. In children fractures are more common at the physis, and we need to know about the "SALTER" classification. There is a bimodal distribution of femoral fractures - they are common in 2 - 4 year olds, and adolescents. We should always consider child abuse and non accidental injury, especially if the fracture presents in a patient before walking age.

Radiology of Note
The distal femoral epiphyses are normally present from birth to 18 -20 years
The patella ossifies between 3 - 6 years

Support the leg with the hip and knee slightly flexed
Analgesia (intra-nasal very likely to be helpful)
Orthopaedic referral

Most sources agree that splinting should be carried out as soon as possible, although practically this can be difficult.
< 3months:           Pavlick harness
>3 months/ 16kg:  Gallows traction
> 16kg:                Thomas splint (skin traction)

I have written a presentation that says all this with pretty pictures.

Emergency Care of Minor Trauma in Children. Ffion Davies et al. 
ABC of Emergency Radiology


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