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Pediatric Emergency Care

Carissa van den Berk-Clark, Rachel Hughes, Sally Haywood, Bart Andrews, Peggy Gordin
RATIONALE: There is no universal system to facilitate communication between emergency rooms (ERs) and pediatric mental health providers, which leads to long wait times. This project tested the concept that a group texting application (GroupMe) could improve communication between providers and could reduce wait times by allowing frontline workers to contact multiple providers simultaneously. METHODS: We compared total wait times or overall length of service of 906 ER encounters before and 921 encounters after the GroupMe texting application was implemented...
June 14, 2018: Pediatric Emergency Care
Yusuke Okubo, Nobuaki Michihata, Naho Morisaki, Koichi Yoshida, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga
BACKGROUND: The benefits of glucocorticoid treatment and recent trends of adjunctive treatments during episodes of anaphylaxis remain unclear. OBJECTIVES: The aims of this study were to investigate the recent practice patterns and compare the effects of glucocorticoid for children hospitalized with anaphylaxis. METHODS: Using the Japanese Diagnosis Procedure Combination inpatient database, we compared the length of hospital stay, risk of 10-day readmission, and total hospitalization cost between the steroid and nonsteroid groups...
June 14, 2018: Pediatric Emergency Care
Julia K Shinnick, Shabnam Jain, Adina L Alazraki, Megan M Durham
Gastrointestinal duplication cysts are rare congenital malformations, with esophageal and gastric duplication cysts being among the rarest. We report an 8-week-old female who presented to the emergency department with failure to thrive and was subsequently found to have multiple gastric and esophageal duplication cysts that had ruptured intrathoracically and intra-abdominally. We describe the diagnosis and management of this patient who underwent successful resection of 4 gastrointestinal duplication cysts...
June 14, 2018: Pediatric Emergency Care
Blake C Gruenberg, David Mortel, Amanda Bogie
Pediatric penile pain is an uncommon complaint and is associated with a wide differential diagnosis including infectious, inflammatory, traumatic, and idiopathic conditions. Penile fractures, anatomically known as rupture of the corpus cavernosum, are almost exclusively reported in sexually mature patients and usually involve forceful manipulation during sexual activity. Rupture of the corpus cavernosum is a true urologic emergency. Failure to recognize and treat rupture of the corpus cavernosum has been associated with residual penile angulation, persistent hematoma, abscess, erectile dysfunction, and fibrosis...
June 14, 2018: Pediatric Emergency Care
Geoffrey S Kelly, Mariju F Baluyot, Jennifer F Anders
Congenital agenesis of the lower vagina is a rare disorder characterized by separation between the unaffected proximal vagina and the distal vagina by a band of fibrous tissue. The typical presentation is an early adolescent female with chronic, cyclic abdominal pain and primary amenorrhea. In this case report, we describe an adolescent who presented to the pediatric emergency department on 2 occasions with a chief complaint of lower abdominal pain.
June 14, 2018: Pediatric Emergency Care
Asuman Gürkan, Melahat Melek Oğuz, Esin Boduroğlu Cengiz, Saliha Şenel
Colchicine is an anti-inflammatory drug that has a narrow therapeutic index. Poisoning typically shows 3 phases with systemic symptoms. Gastrointestinal symptoms dominate in the first phase. Dermatologic manifestations usually appear, with skin eruptions in the second phase where multiorgan failure occurs and alopecia in the third phase where organ derangements resolve. Alopecia is a cardinal feature of the third phase, but there is no specifically defined eruption for toxication. Here, we report a case of colchicine intoxication in a 16-year-old girl with maculopapular/purpuric rash and alopecia...
June 14, 2018: Pediatric Emergency Care
Kari Schneider, Hai Nguyen-Tran, Bradley J Segura, Raymond G Areaux, Dan Nerheim, Jeffrey P Louie
The purpose of this study is to describe pediatric ocular injuries presenting to a level-III pediatric trauma center and emergency department. METHODS: We performed a retrospective study and identified children from January 1, 2011, to January 1, 2016. Charts were reviewed for any subject, age from newborn to younger than 18 years, based on International Classification of Diseases, ninth and tenth revision, codes for any ocular injury. Data abstraction included age, sex, means of arrival, eye involved, mechanism of injury, type of ocular injury, imaging studies obtained, procedures performed, location of definitive repair (in the operating room or emergency department), and subspecialty services involved...
June 14, 2018: Pediatric Emergency Care
Diana T Fleisher, Rachel J Katz-Sidlow, James A Meltzer
OBJECTIVE: The management of injured children is a required element of pediatric emergency medicine (PEM) fellowship training. Given the relatively infrequent exposure of trainees to major trauma, it is important to understand how programs train fellows and assess their competency in pediatric trauma. METHODS: An online survey was sent to 84 PEM fellowship program directors (PDs). Program directors were asked to describe their program's characteristics, the degree of fellow independence, educational techniques used to train fellows in trauma, and their expectation of fellows' competency in 14 core trauma-related skills upon graduation...
June 14, 2018: Pediatric Emergency Care
Taichi Itoh, Jannet Lee-Jayaram, Rui Fang, Travis Hong, Benjamin Berg
OBJECTIVES: Just-in-time training (JITT) is a method of simulation-based training where the training occurs within the clinical environment in a concise manner. Just-in-time training has shown effects at the learner, patient, and system-wide levels. We evaluated a JITT curriculum for the procedures of intraosseous (IO) needle placement and defibrillator use in a pediatric emergency department (ED) by comparing the trainees' comfort level in performing those procedures independently (Kirkpatrick level 2a) and trainees' knowledge of the procedures/equipment (Kirkpatrick level 2b) before and after the JITT...
June 14, 2018: Pediatric Emergency Care
Dimitri Poddighe, Ilaria Brambilla, Amelia Licari, Gian Luigi Marseglia
BACKGROUND: Acute pain is one of the major complaints reported in pediatric emergency departments and general wards. Recently, both the US Food and Drug Administration and European Medicine Agency emitted some warnings regarding the use of opioids, including codeine, in children. OBJECTIVE: The aims of this study were summarizing the main pharmacological aspects of ibuprofen, discussing the current evidence about the use of ibuprofen in different and specific clinical settings, and providing a comparison with acetaminophen and/or codeine, according to available studies...
June 14, 2018: Pediatric Emergency Care
Helena A Jenkinson, Ashley D Lundgren, Moise L Levy, Lucia Z Diaz
Epidermolysis bullosa (EB) refers to a heterogeneous group of genetic disorders characterized by epithelial fragility. We provide guidelines for management of pediatric patients with EB in the emergency department based on a review of literature, as well as insights from our own experiences caring for patients with EB. The purpose of the guidelines proposed is prevention of avoidable iatrogenic trauma to the skin and mucosa of patients with EB who are presenting to the emergency department for a variety of reasons...
June 14, 2018: Pediatric Emergency Care
Brunhild M Halm, Tina A Leone, Lindsey T Chaudoin, Kenneth W McKinley, Carrie Ruzal-Shapiro, Adrian A Franke, Daniel S Tsze
OBJECTIVES: The identification of hydrocephalus in infants by pediatric emergency medicine (PEM) physicians using cranial point-of-care ultrasound (POCUS) has not been evaluated. We aimed to conduct a pilot/proof-of-concept study to evaluate whether PEM physicians can identify hydrocephalus (anterior horn width >5 mm) in 15 infants (mean 69 ± 42 days old) from the neonatal intensive care unit using POCUS. Our exploratory aims were to determine the test characteristics of cranial POCUS performed by PEM physicians for diagnosing hydrocephalus and the interrater reliability between measurements made by the PEM physicians and the radiologist...
June 5, 2018: Pediatric Emergency Care
Chi-Yung Cheng, Hsiu-Yung Pan, Chao-Jui Li, Yi-Chuan Chen, Chien-Chih Chen, Yi-Syun Huang, Fu-Jen Cheng
OBJECTIVES: Traumatic brain injury is the leading cause of death and disability in children worldwide. The objective of this study was to determine the association between physician risk tolerance and head computed tomography (CT) use in patients with minor head injury (MHI) in the emergency department (ED). METHODS: We retrospectively analyzed pediatric patients (<17 years old) with MHI in the ED and then administered 2 questionnaires (a risk-taking subscale [RTS] of the Jackson Personality Inventory and a malpractice fear scale [MFS]) to attending physicians who had evaluated these patients and made decisions regarding head CT use...
May 25, 2018: Pediatric Emergency Care
Katie A Donnelly, Kristen Breslin, Karen J OʼConnell
OBJECTIVES: Nonoperative management of hemodynamically stable liver lacerations in pediatric trauma patients is a safe and effective management strategy for pediatric patients; approximately 90% will be successfully managed nonoperatively. No study has specifically identified risk criteria for the need for intervention versus observation alone. Our objective for this study was to determine risk factors from the physical examination, computed tomography scan, and laboratory results associated with intervention for liver laceration...
May 25, 2018: Pediatric Emergency Care
Eunjee Lee, Min-Kyung Yeo, Sun Kyoung You, Yeo Koon Kim, Seung Ryu, Jiwon M Lee
A child with acute abdomen with gross hematuria occasionally visits the emergency department (ED). Usually, such a condition is subject to differential diagnosis for stones, injuries, or sometimes malignancies in the urinary tract. Here we introduce an unusual case of a 9-year-old girl who presented to ED with acute lower abdominal pain and gross hematuria. She had no medical history. An urgent computed tomographic image revealed a renal vein thrombosis. Laboratory tests for autoimmune diseases and coagulaopathies were performed, and the results were within normal ranges...
May 23, 2018: Pediatric Emergency Care
Brad Sobolewski, Regina G Taylor, Gary L Geis, Benjamin T Kerrey
OBJECTIVES: The rapid cardiopulmonary assessment (RCPA) is an essential first step in effective resuscitation of critically ill children. Pediatric residents may not be achieving competency with resuscitative skills, including RCPA. Our objective was to determine how often pediatric residents complete the RCPA for actual patients. METHODS: This was an observational, cross-sectional study of senior residents (≥postgraduate year 2) performing the RCPA in the resuscitation area of a high-volume pediatric emergency department (PED), where pediatric residents are expected to perform the bedside examination and assessment for all medical (nontrauma) patients...
May 23, 2018: Pediatric Emergency Care
Naama Pines, Reuven Tsabari, Eitan Kerem, Joel Reiter
Herpes simplex virus (HSV) is rarely the cause of pneumonia in immunocompetent patients. We describe a previously healthy child, with no evidence of an immunodeficiency, who presented to the emergency department with severe pneumonia, wheezing, and pleural effusions with a history of orolabial HSV infection. On admission, he was started on antibiotics and systemic corticosteroids but continued to deteriorate. Oral lesions, blood, and pleural fluid tested positive for HSV, and improvement was achieved only after the addition of acyclovir and discontinuation of steroids...
May 23, 2018: Pediatric Emergency Care
Daniel S Tsze, Maria Ieni, Pamela L Flores-Sanchez, Sripriya T Shen, Joan S Bregstein, Nicole C OʼConnell, Peter S Dayan
OBJECTIVES: The aims of this study were to quantify the pain and distress associated with the administration of intranasal (IN) midazolam in young children using 4 observational measures and to evaluate the degree of validity of these measures. METHODS: We conducted a prospective observational pilot study. Children aged 1 to 7 years requiring IN midazolam were enrolled. Children were videotaped, and scores were assigned to baseline and administration phases using the Observational Scale of Behavioral Distress-Revised (OSBD-R), Children's Hospital of Eastern Ontario Pain Scale (CHEOPS), and the Faces-Legs-Activity-Cry-Consolability (FLACC) scale...
May 23, 2018: Pediatric Emergency Care
Hnin Khine, Sarah B Wren, Ohad Rotenberg, David L Goldman
Fitz-Hugh-Curtis syndrome is an extrapelvic manifestation of sexually transmitted infections. Partly because of the lack of specific clinical and laboratory features, this diagnosis is often missed or delayed. We describe a series of cases of patients with Fitz-Hugh-Curtis syndrome, where the diagnosis was initially not recognized and patients underwent extensive evaluations for their symptoms. Based on our experience, we also describe shared historical and physical features that may be useful in enhancing the recognition of patients with this disease...
May 23, 2018: Pediatric Emergency Care
Stefan Bohr, Toghrul Mammadli
OBJECTIVES: The objective of this study was to assess proper indications a nonsurgical treatment regime for pediatric fractures of the proximal phalanx based on principles of early functional treatment. METHODS: A case series (evidence level 4) of 30 pediatric patients with fractures of the proximal phalanx were treated nonsurgically using protective dynamic splinting techniques and fiberglass casting material. Assessments were performed clinically and by x-ray within 4 to 8 weeks of commencement of treatment...
May 23, 2018: Pediatric Emergency Care
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