Tuesday, May 28, 2019 • 13:00 - 14:30
Track 2 - Controversies in Pediatric Emergency Medicine
Track Chair: Dr. Shannon MacPhee & Dr. Kevin Chan
Room: Argyle Suite (A1-A3)

Controversies in Pediatric Musculoskeletal Injuries - Dr. Kathy Boutis and Dr. Arun Sayal

Description: There is an increasing body of evidence that supports a de-escalation of medical care for specific common and low-risk pediatric fractures. We will review the evidence and pitfalls of the evidence so that emergency physicians can make informed decisions for their pediatric patients who present with fractures.

Learning Objectives
At the end of this presentation, participants will be able to:

  1. Understand why some may benefit from a de-escalation of medical care.
  2. Apply minimal intervention strategies for low risk wrist and ankle fractures.
  3. Understand why low-risk ankle and wrist fractures can be considered appropriate for primary care follow up.


  1. Over-treating also carries harm for patients and the health care system
  2. Low-risk ankle and wrist fractures can be safely and effectively managed with removable devices
  3. Low-risk ankle and wrist fractures can be safely and effectively followed up with a primary care physician rather than an orthopedic surgeon’s office

Dr. Kathy Boutis completed her medical school at the University of Toronto and completed her residency in pediatrics and fellowship in pediatric emergency medicine at Boston Children’s hospital. She then joined the Department of Pediatrics at the Hospital for Sick Children as an emergency physician and Clinician Investigator.

Emergency Physician – North York General Hospital in Toronto. Runs the weekly Minor Fracture Clinic for over 13 years. Creator and Director of CASTED – a series of hands-on orthopedic CME courses.

Controversies in Pediatric DKA - Dr. Kevin Chan and Dr. Mona Jabbour

Description: We will be discussing why not changing to rapid blousing in DKA yet, until more evidence is acquired.

Learning Objectives
At the end of this presentation, participants will be able to:

  1. Debate the pros and cons of rapid fluid hydration in DKA.
  2. Learn new evidence that suggests rapid fluid bolus may not be harmful in DKA.
  3. Review the evidence supporting current therapeutic treatment.


  1. Rapid bolusing in DKA may be an acceptable alternative to traditional slow IV replacement therapy.
  2. There may be evidence that rapid bolusing may lead to better outcomes, but more data is required.
  3. Current treatment has been successful in reducing fluid resuscitation morbidity/mortality in the past.

Kevin Chan is chair of pediatrics at Memorial University and clinical chief of children’s health at Eastern Health. He is currently president of the emergency medicine section of the Canadian Paediatric Society, and the Canadian representative to the Advance Pediatric Life Support (APLS) committee.

Mona Jabbour is an Associate Professor in Pediatrics, Division of Emergency Medicine and Vice-Chair/Chief of Pediatrics at the Children’s Hospital of Eastern Ontario (CHEO) and University of Ottawa. She is cross-appointed to the Department of Emergency Medicine, Faculty of Medicine, as well as the Faculty of Education, at the University of Ottawa.

Controversies in the Use of High Flow by Nasal Cannula in Pediatric Patients - Dr. Andrew Lynk and Dr. Dan Hughes

Description: The safety and effectiveness of Pediatric High Flow Nasal Cannula therapy outside of PICU settings is still debated, although the practice is commonplace in ED and ward settings across the country, both in academic and regional centers. The authors will review and debate the merits and cautions around HFNC therapy outside of PICU settings.

Learning Objectives
At the end of this presentation, participants will be able to:

  1. Understand how HFNC is thought to assist children with respiratory distress.
  2. Understand the safety and effectiveness evidence for implementing HFNC outside of PICU settings.
  3. Understand the importance of using guidelines.


  1. HFNC decreases the work of breathing in distressed infants.
  2. HFNC masks the severity of the underlying condition, which may give a false sense of reassurance to the attending clinicians.
  3. The best evidence and experience to date centers around infants with bronchiolitis.

Dr. Andrew Lynk is Chair & Chief of Pediatrics at Dalhousie & The IWK Health Center. He is a past President of CPS, and practiced in Cape Breton for 26 years.

Dan Hughes is Head of the Respiratory Division at the IWK Health Centre Dept of Pediatrics and Director of the CF Clinic.