ACEP Frontline - Emergency Medicine Peds EM Chest Pain, Fevers, Sedation and Readiness Round-up with Dr. Marianne Gausche-Hill
Apr 1, 2026
Dr. Marianne Gausche-Hill, a pediatric emergency medicine leader and ACEP Pediatrics contributor. She walks through pediatric chest pain evaluation and when EKGs or imaging matter. Practical tips for pain and procedural comfort, stepwise pharmacologic pain control. Fever approaches for underimmunized kids, Kawasaki cues, febrile neutropenia strategies. Rapid seizure control and pediatric readiness initiatives.
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Targeted History Identifies Rare Cardiac Chest Pain
- Cardiac causes of pediatric chest pain are rare, so targeted history and exam rule most out quickly.
- Ask about congenital heart disease, Kawasaki disease, medications, and family sudden deaths to identify the small high-risk group.
Always ECG And Low Threshold Chest X-Ray
- Always get an ECG for pediatric chest pain to 'take that thing off the table.'
- Use a low threshold for chest X-ray when exam or history doesn't fully explain pain because it can reveal diagnoses like pneumomediastinum.
Missed Family Clot History Led To Delayed PE Diagnosis
- A 19-year-old with pleuritic chest pain had a missed family history of clotting leading to a delayed PE diagnosis.
- Marianne's nephew's father had protein S deficiency and was on apixaban, which wasn't elicited initially.