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With the help of two of Canada's Pediatric Emergency Medicine seizure experts handpicked by TREKK, Dr. Lawrence Richer and Dr. Angelo Mikrogianakis, we'll give you all the tools you need to approach the child who presents to the ED with a seizure with the utmost confidence.

Video instructing how to diagnose otitis media with otoscopy and cerum removal.

For a list of references that were used in the creation of this resource, see Evidence Repository: Pain Treatment (2022)

For a list of references that were used in the creation of this resource, see Evidence Repository: Gastroenteritis (2022).

Evidence repositories are collections of best available resources and evidence (clinical guidelines, peer reviewed literature, systematic reviews, etc.), collated by our knowledge synthesis team and content advisors.

This evidence repository is not intended to be an exhaustive list of resources for a topic, but rather a curated list of current, evidence-based resources, based on expert consensus of relevance and usability for a general emergency department setting. We search databases (Cochrane Library, PubMed, TRIP Database) and web search engines (Google, Google Scholar) to locate evidence. Additionally, hospital websites are browsed for guidance documents, such as clinical practice guidelines (CPG) for healthcare professionals.

Every effort is made to identify resources that are open access (i.e. publicly available, free of charge, not requiring a subscription).

More information about the creation of our evidence repositories can be found at https://pubmed.ncbi.nlm.nih.gov/28537762 

Evidence repositories are collections of best available resources and evidence (clinical guidelines, peer reviewed literature, systematic reviews, etc.), collated by our knowledge synthesis team and content advisors.

This evidence repository is not intended to be an exhaustive list of resources for a topic, but rather a curated list of current, evidence-based resources, based on expert consensus of relevance and usability for a general emergency department setting. We search databases (Cochrane Library, PubMed, TRIP Database) and web search engines (Google, Google Scholar) to locate evidence. Additionally, hospital websites are browsed for guidance documents, such as clinical practice guidelines (CPG) for healthcare professionals.

Every effort is made to identify resources that are open access (i.e. publicly available, free of charge, not requiring a subscription).

More information about the creation of our evidence repositories can be found at https://pubmed.ncbi.nlm.nih.gov/28537762 

For a list of references that will inform the development of this resource, see Evidence Repository: Sickle Cell Disease (2022).

For a list of references that were used in the creation of this resource, see Evidence Repository: Procedural Sedation (2022)

For a list of references that informed this Bottom Line Recommendation, see the Evidence Repository: Urinary Tract Infection (2022). 

For a list of references that informed this Bottom Line Recommendation, see the Evidence Repository: Anaphylaxis (2023).

Evidence repositories are collections of best available resources and evidence (clinical guidelines, peer reviewed literature, systematic reviews, etc.), collated by our knowledge synthesis team and content advisors.

This evidence repository is not intended to be an exhaustive list of resources for a topic, but rather a curated list of current, evidence-based resources, based on expert consensus of relevance and usability for a general emergency department setting. We search databases (Cochrane Library, PubMed, TRIP Database) and web search engines (Google, Google Scholar) to locate evidence. Additionally, hospital websites are browsed for guidance documents, such as clinical practice guidelines (CPG) for healthcare professionals.

Every effort is made to identify resources that are open access (i.e. publicly available, free of charge, not requiring a subscription).

More information about the creation of our evidence repositories can be found at https://pubmed.ncbi.nlm.nih.gov/28537762 

This clinical practice guideline is based on a systematic review of published studies on the treatment of supracondylar fractures of the humerus in children. In addition to providing practice recommendations, this guideline highlights gaps in the literature and areas that require future research.

This evidence-based guideline provides recommendations for the evaluation and treatment of children withfunctionalconstipation to standardize and improve their quality of care. In addition, 2 algorithms were developed, one for the infants under 6 months of age and the other for older infants and children.

Provides evidence-based recommendations on the treatment of nervous system Lyme disease and post-Lyme syndrome. Three questions were addressed: 1) Which antimicrobial agents are effective? 2) Are different regimens preferred for different manifestations of nervous system Lyme disease? 3) What duration of therapy is needed?

To analyze efficacy, tolerability and safety data for anticonvulsant treatment of children and adults with convulsive status epilepticus and use this analysis to develop an evidence-based treatment algorithm.

The objective of this guideline is to recommend evidence-based practices for timely prehospital pediatric seizure cessation while avoiding respiratory depression and seizure recurrence.

Our objective was to develop a clinical practice guideline, based on systematic reviews of the literature, as interpreted by experts, to assist clinicians in managing procedure-related pain and distress among children undergoing vaccine injections.

Objective: Shock is a major preventable cause of morbidity and mortality in children referred to emergency care. The recently updated American College of Critical Care Medicine guidelines for the management of newborns and children with septic shock emphasize the role of emergency care in improving survival and functional outcomes. Implementation of these guidelines of stepwise use of fluids, antibiotics, and, if necessary, inotropes within the first hour of admission to the emergency department can reduce mortality and neurological morbidity risks 2-fold. Published: 2010.

To produce a treatment algorithm for the ICU management of infants, children, and adolescents with severe traumatic brain injury.

Aim: To facilitate the uptake of evidence and to reduce the evidence practice gap for management of newborn pain through the development of a clinical practice guideline.

This an an AAOS clinical guideline for pediatric distal radial fractures.

This summary examines the relationship between glucagon and the rate of radiological reduction for acute intestinal intussusception.

This summary investigates the diagnostic use of bedside ultrasound for paediatric intussusception in the emergency department.

This summary uses case examples to review the current evidence for the management of children with clinically suspected intussusception.

To assess whether benefits of noninvasive topical anaesthetic application occur at the expense of decreased analgesic efficacy. To compare the efficacy of various singlecomponent or multicomponent topical anaesthetic agents for repair of dermal laceration

Objective: To determine the efficacy of adjuvant dexamethasone therapy in paediatric bacterial meningitis.

This summary investigates the role of plain abdominal radiograph in the diagnosis of intussusception

Expert commentary on the Cochrane Review on nebulized epinephrine for reducing symptoms in children with severe croup. 

The purpose of this document is to describe the effectiveness of four treatment options, based on a 2012 Overview of Reviews.

Objective: To review the evidence comparing efectiveness of topical antibiotics with oral antibiotics, placebo, or no treatment in children with AOM presenting with ear discharge caused by spontaneous perforation of the eardrum.

This review covers the description, etiology, diagnosis and management of irritable bowel syndrome in children.

The objective of this systematic review was to investigate and summarise the quantity and quality of the current evidence for the effect of laxatives and dietary measures on functional childhood constipation.

This issue reviews the etiology and pathophysiology of child-specific fractures, as well as common injuries of the upper and lower extremities.

The purpose of this paper is to summarize and highlight the major findings from the systematic review that developed a clinical practice guideline from the American Academy of Orthopaedic Surgeons regarding treatment for type III supracondylar fractures.

A meta-analysis was performed to summarise available evidence and to give an overall risk of developing intussusception from case-control and cohort studies for all rotavirus vaccines that have been manufactured up to date.

The American Pediatric Surgical Association (APSA) guidelines for the treatment of isolated solid organ injury (SOI) in children were published in 2000 and have been widely adopted. The aim of this systematic review by the APSA Outcomes and Evidence Based Practice Committee was to evaluate the published evidence regarding treatment of solid organ injuries in children.

OBJECTIVES: To determine the effectiveness and safety of traditional Chinese medicine in people with epilepsy.

OBJECTIVES: To assess the benefits and harms of Huangqi and Huangqi type formulations in treating nephrotic syndrome in any age group, either as sole agents or in addition to other drug therapies.

OBJECTIVES: To assess the effects of Chinese herbal mixtures in the treatment of atopic eczema.

This review describes current evidence on the evaluation of febrile seizures in the acute setting, the need for further outpatient assessment, and predictors regarding long-term outcomes of these patients

Objective: To review the evidence regarding the utility of obtaining head CT prior to lumbar puncture in adults with suspected bacterial meningitis.

OBJECTIVES: To compare polymer-based ORS with glucose-based ORS for treating acute watery diarrhoea.

OBJECTIVES: The objective of this review was to assess the effects of rice-based oral rehydration salts solution compared with glucose-based oral rehydration salts solution on reduction of stool output and duration of diarrhoea in patients with acute watery diarrhoea.

Review to assess the effects of trauma algorithms that include ultrasound examinations in patients with suspected blunt abdominal trauma.

Objective: Given the emphasis on screening for suicidal ideation in the general hospital and ED, it is important for Emergency Physicians to be able to understand and perform suicide risk assessment.

Objective: To determine the level of evidence available in the literature in view of recent increased usage of Acticoat dressings in burns.

Objective: to evaluate the evidence for these instruments including assessment of risk of bias and diagnostic accuracy for suicide and suicide attempt.

Primary outcome of this study was the difference in active range of motion between a conventional forearm-based ulnar gutter or hand-based thermoplastic splint.

Objective: The 2002 American College of Critical Care Medicine (ACCM) guidelines for the resuscitation of pediatric septic shock suggest that 20 mL/kg of bolus intravenous fluid be given within 5 minutes. Of 3 commonly used, inexpensive methods of fluid delivery, we hypothesized that only use of a manual push-pull system will permit guideline adherence. Published: 2007.

The aim of this study was to describe the outcome differences between board-certified orthopedists and pediatric emergency medicine (PEM) physicians conducting forearm fracture reductions.

To determine if the Predicting Persistent Post-concussive Problems in Pediatrics (5P) clinical risk score, an emergency department (ED)derived and validated tool, is associated with developing PPCS when obtained in a primary care sports concussion setting.

Objective: Our objective was to determine the diagnostic accuracy of POCUS by novice sonographer pediatric emergency medicine physicians (PEM-Ps) who received focused US training for diagnosing INT.

Objectives: The primary objective was to evaluate the accuracy of PEM POCUS in identifying ileocolic intussusception. The secondary objective was to identify factors associated with air enema failure.

Objectives: To determine incidence, outcomes, and risk factors for pediatric cerebral edema with diabetic ketoacidosis (CEDKA) in Canada.

Objective: Our objective was to compare the effectiveness of prednisolone 2 mg/kg for 3 days, a treatment regimen already commonly prescribed by pediatricians in our community; with one dose of dexamethasone 0.6 mg/kg, a treatment regimen known to be effective in the ED setting, for children with mild or moderate croup diagnosed at an office visit.

Objective: The objective of this study was to describe the epidemiology of croup presentations to EDs made by infants (

Objective: This study sought to determine whether silver sodium carboxymethyl cellulose dressing is a superior treatment to nanocrystalline silver-coated polyethylene dressing in pediatric patients with partial thickness burns.

Objective: We have developed a primary care-based multifaceted educational intervention to optimise pain management in children with AOM, and we trial its clinical and cost effectiveness.

Objectives: The majority of pediatric patients with diabetic ketoacidosis (DKA) present to community emergency departments (CEDs) that are less prepared to care for acutely ill children owing to low pediatric volume and limited pediatric resources and guidelines. This has impacted the quality of care provided to pediatric patients in CEDs. We hypothesized that a simulation-based collaborative program would improve the quality of the care provided to simulated pediatric DKA patients presenting to CEDs.

Objective: evaluated the use of a mental health (MH) screening tool in a hospital-based centralized MH referral telephonic intake process.

The purpose of our study was to document the results of emergency department (ED) observation and discharge protocol after successful reduction of ileocolic intussusception.

Fever in childhood is a common acute presentation requiring clinical triage to identify the few children who have serious underlying infection. Clinical practice guidelines (CPGs) have been developed to assist clinicians with this task. This study aimed to assess the proportion of care provided in accordance with CPG recommendations for the management of fever in Australian children.

Episodes of childhood convulsive status epilepticus (CSE) commonly start in the community. Treatment of CSE aims to minimise the length of seizures, treat the causes, and reduce adverse outcomes; however, there is a paucity of data on the treatment of childhood CSE. We report the findings from a systematic, population-based study on the treatment of community-onset childhood CSE.

Removable splints when compared with circumferential casts in randomized trials have been shown to be a safe and cost-effective method of managing many common minor distal radius and fibular fractures. This study estimated the extent to which this evidence is being implemented in clinical practice, and determined the perceived barriers to the adoption of this evidence.

Objectives: To determine the proportion of emergency physicians who prescribe removable devices for distal radius buckle fractures and/or nondisplaced distal fibular Salter-Harris I fractures. The investigators also examined follow-up referral patterns for these injuries.

Objective: We report epidemiological and clinical investigations on ten pediatric SARS-CoV-2 infection cases confirmed by real-time reverse transcription PCR assay of SARS-CoV-2 RNA.

Objective: To use evidence-based methodology to characterize the 5 concussion subtypes and 2 associated conditions and report their prevalence in acute concussion patients as compared to baseline or controls within 3 d of injury.

Current childhood injury prevention guidance is anchored by a child's age. For example, children are considered at high risk for falls at ages 4 years and less, and guidance for prevention focuses on these ages. However, these guidelines may not be adequate for children with autism spectrum disorders (ASD). Analyses suggest that unintentional home injury prevention for children with ASD may require prevention guidance extended through older ages.

We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of adult and pediatric patients with a seizure and to compare these recommendations against the current protocol used by the 33 emergency medical services (EMS) agencies in California.

To review evidence on the assessment of the child with status epilepticus (SE).

Objective: This review article aims to provide a summary of several strategies, which are supported by definitive and systematically reviewed evidence, that can be implemented alone or in combination to reduce procedural pain and anxiety for children in t

Episode 50:In this episode, a continuation of our discussion on Fever from with Ottawa PEM experts, Sarah Reid and Gina Neto, we discuss the pearls and pitfalls in the recognition and management of pediatric sepsis and septic shock. We review the subtle clinical findings that will help you pick up septic shock before its too late as well as key maneuvers and algorithms to stabilize these patients. We cover tips for using IO in children, induction agents of choice, timing of intubation, ionotropes of choice, the indications for steroids in septic shock, and much more.Posted online: August 2014. 

Episode 48:In this episode, with the help of Dr. Sarah Reid and Dr. Gina Neto from the Childrens Hospital of Eastern Ontario, we will elucidate how to deal with fever phobia, when a rectal temp is necessary, how to pick out the kids with fever that we need to worry about, how to work up kids with fever depending on their age, risk factors and clinical picture, who needs a urinalysis, who needs a CXR, who needs blood cultures and who needs an LP, and much more. Posted online: August 2014. 

Episode 35:Dr. Sanjay Mehta & Dr. Jonathan Pirie, two experienced Pediatric EM docs from The Hospital for Sick Children in Toronto discuss their approach to a variety of common, occult, challenging and easy to miss pediatric orthopedics diagnoses including: differentiating Septic Arthritis from Transient Synovitis of the hip, Toddlers Fracture, Tillaux Fracture, Suprachondylar Fracture, ACL tear, tibial spine & Segond fractures. They also debate the value of the Ottawa Knee Rules in kids, non-accidental trauma, pediatric orthopedic pain management, the evidence for the best management of Buckle, Greenstick, Salter 1 and 2 distal radius fractures and lateral malleolus fractures. Published online: August 2013. 

Episode 19 Part 1:In Part 1 of this Episode on Pediatric Abdominal Pain, Dr. Anna Jarvis & Dr. Stephen Freedman discuss the nuances of the history, physical and work up of Pediatric Abdominal Pain & Appendicitis and key pearls on how to distinguish serious surgical causes from the very common diagnosis of gastroenteritis. An in-depth discussion on the pearls of the history, physical exam, lab tests, imaging including serial ultrasounds vs CT abdomen, clinical decision rules such as the Alvarado Score, best analgesics and antibiotics in pediatric appendicitis follows. Published online: December 2011.  

Episode 67: Pain is the most common reason for seeking health care. It accounts for 80% of ED visits. The WHO has declared that “optimal pain treatment is a human right”. As has been shown in multiple ED-based Pediatric pain management studies, Pediatric pain is all too often under-estimated and under-treated. Why does this matter? Under-estimating and under-treating pediatric pain may have not only short term detrimental effects but life-long detrimental effects as well; not to mention, screaming miserable children disturbing other patients in your ED and complaints to the hospital from parents. Whether it’s venipuncture, laceration repair, belly pain or reduction of a fracture we need to have the skills and knowledge to optimize efficient and effective pain management in all the kids we see in the ED. What are the indications for intranasal fentanyl? intranasal ketamine? Why should codeine be contra-indicated in children? How do triage-initaited pain protocols improve pediatric pain management? Which are most effective skin analgesics for venipuncture? To help you make these important pediatric pain management decisions, in this podcast we have one of the most prominent North American researchers and experts in Emergency Pediatric pain management, Dr. Samina Ali and not only the chief of McMaster Children’s ED but also the head of the division of Pediatric EM at McMaster University, Dr. Anthony Crocco.

Episode 76: Join Dr. Amy Drendel, a world leader in pediatric pain management and procedural sedation research, as she discusses how best to manage pain and anxiety in

Best Case Ever #48: In anticipation of EM Cases’ upcoming episode, Congenital Heart Disease Emergencies, Dr. Gary Joubert discusses his Best Case Ever of a four month old infant who presents with intermittent cyanosis. The Cyanotic Infant can present a significant challenge to the EM provider as the differential is wide, ranging from benign causes such as GERD to life threatening heart disease that may present atypically in a well-appearing child. Dr. Joubert provides some simple clinical pearls to help ED providers along the way. Published online: July 2016. 

Episode 84: You might be surprised to learn that the prevalence of critical cardiac disease in infants is almost as high as the prevalence of infant sepsis. Critical congenital heart defects are often missed in the ED. For a variety of reasons, there are currently more children with congenital heart disease presenting to the ED than ever before and these numbers will continue to grow in the future. With the goal of learning a practical approach to congenital heart disease emergencies using the child’s age, colour and few simple tests, Dr. Strobel and Dr. Joubert will discuss some key actions, pearls and pitfalls so that the next time you’re faced with that crashing baby in the resuscitation room, you’ll know exactly what to do. This podcast topic was chosen based on a Canada-wide needs assessment by TREKK – translating emergency knowledge for kids. 

Published online: August 2016. 

Management of the pediatric trauma patient is challenging regardless of where you work. In this EM Cases episode, two leading pediatric trauma experts, Dr. Sue Beno from Hospital for Sick Children in Toronto and Dr. Faud Alnaji from Children’s Hospital of Eastern Ontario in Ottawa answer such questions as: what are the most important physiologic and anatomic differences between children and adults that are key to managing the trauma patient? How much fluid should be given prior to blood products? What is the role of POCUS in abdominal trauma? Which patients require abdominal CT?

Learning Objectives

1. To develop a simple approach to CHD using age, colour and bedside tests
2. To understand how the hyperoxia test and 4 limb BP narrow the differential diagnosis

Learning Objectives

1. Investigations for congenital heart disease emergencies
2. Management of congenital heart disease emergencies

Episode 108: In this EM Cases main episode podcast on Pediatric Physical Abuse Recognition and Management Dr. Carmen Coombs and Dr. Alyson Holland discuss the 6 B’s of child abuse, the TEN-4 FACE decision rule, the Pittsburgh Infant Brain Injury Score, disclosure tips, screening tests, reporting responsibilities and more.

Published online: March 2018

Episode 124: Burn and inhalation injury patients present to the ED more often than one might think, with a staggering half a million annual visits in the USA alone. It turns out that for all burn patients—from minor to severe—there is a lot of room for improvement in ED management, counselling and disposition. Things like inaccurate estimation of burn size, unnecessary endotracheal intubation, over- and under-estimation of fluid resuscitation volumes, inadequate analgesia and inappropriate wound dressings are just some of the issues where a small change to ED practice patterns could have a huge impact on patient care. In this EM Cases main episode podcast we have the director of the Burn Unit at Hospital for Sick Children, Dr. Joel Fish and EM educator Dr. Maria Ivankovic discuss dozens of pearls and pitfalls in the management of both pediatric and adult burn and inhalation injuries management with a special appearance by airway master George Kovacs to talk about awake intubation in the burn and inhalation injuries patient. Published online: May 2019

This video describes the signs of acute anxiety in children and demonstrates approaches to interacting with children that minimize anxiety and maximize cooperation. Published: April 2016.

This study aims to update CanChild's 2015 RTA and RTS protocols, on the basis of empirical data and feedback collected from our recently completed prospective cohort study, focusing on concussed children and their caregivers; systematic review of evidence published since 2015; and consultation with concussion management experts.