PEM-Cases

Case: A helmeted 13-yo-boy carrying a friend on his e-scooter ran into a pole and was pinned against the handle. He was brought in by his parents for chest pain from periphery to SMH. His CXR shows rib fractures and a tension hemopneumothorax. He is hypoxic and requires a decompression. What is the ideal location for needle decompression according to 2025 ATLS?

Discussion: 2025 ATLS recommends 2nd ICS at midclavicular line in peds and 4th/5th ICS anterior to midaxillary line in adults. Transition from peds to adult for placement site is considered based on chest wall thickness and patient size (around age 13). See latest EB article for a deeper dive.

Case: A 5 year-old boy presents with scaly plaques affecting both ears. They are itchy with crusty vesicular lesions. He is not responding to mupirocin. This happened last spring as well. 

Discussion: These lesions are Juvenile Spring Eruptions (JSE). They are caused by an immune response to UV radiation often in the spring, after the first significant sun exposure, more commonly in boys and young men who are more likely to have their ears exposed to sunlight. They can be treated with mineral-based SPF 30 sunscreens and nonsteroid anti-inflammatories i.e. protopic 0.1% oint BID until improved.