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Pediatric Emergency Care

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https://www.readbyqxmd.com/read/28816891/computed-tomography-use-plateaus-among-children-with-emergency-visits-for-abdominal-pain
#1
Jahan Fahimi, Aaron E Kornblith, Hemal Kanzaria, Andrew Herring, Ralph C Wang
OBJECTIVES: Abdominal pain is a common pediatric complaint to emergency departments (EDs), and clinicians often rely on imaging for diagnosis. Studies have demonstrated an increase in computed tomography (CT) in this population. Following emphasis on radiation reduction by researchers and organizations, this study evaluates recent national trends in CT use among pediatric patients presenting to EDs with abdominal pain. METHODS: This is a cross-sectional analysis of ED patients 18 years or younger with chief complaint of abdominal pain in the National Hospital Ambulatory Medical Care Survey from 2008 to 2011...
August 14, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28816890/improving-timeliness-of-%C3%AE-agonist-and-corticosteroid-administration-in-patients-with-acute-wheezing
#2
Mandisa McIver, William Stoudemire, Cherrelle Smith-Ramsey, Mousumee Panigrahi, Christine Walsh-Kelly
OBJECTIVE: Timely delivery of β-agonists and steroids to patients with acute recurrent wheezing is a key component of the National Heart, Lung, and Blood Institute recommended emergency department (ED) asthma care. We conducted an ED improvement initiative to standardize asthma care and improve time to treatments. METHODS: Our multidisciplinary team identified key contributing factors to timeliness, developed key driver diagrams, implemented and refined a management pathway, designed and executed rapid cycle improvements, and implemented interventions...
August 14, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28796652/acyanotic-hypoxia-in-a-febrile-child
#3
Fiona Murphy, Julian Blackham, John Moppett, Mark Lyttle
Glucose-6-phosphate dehydrogenase deficiency affects approximately 400 million people worldwide and is an X-linked disorder most commonly found in individuals of African, Asian, Mediterranean, and Middle Eastern descent. It can present with acute hemolysis in response to certain drugs, infections, or fava beans, and affected individuals may not be aware that they have glucose-6-phosphate dehydrogenase deficiency. This case illustrates the importance of those working in the acute and urgent care sector having an awareness of the condition and the value of a full set of vital signs in an unwell child...
August 7, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28796651/ultrasound-assisted-reduction-of-displaced-and-shortened-fractures-by-pediatric-emergency-physicians
#4
Eric Scheier, Uri Balla
Pediatric emergency physicians at Kaplan Medical Center regularly reduce forearm fractures under point-of-care ultrasound guidance in the pediatric emergency department. We present 3 children who arrived at our department with shortened, angulated forearm fractures within the span of a single week. We report on the successful reduction of these fractures under point-of-care ultrasound and on the maintenance of anatomic alignment at follow-up 1 week postreduction.
August 7, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28767532/cardiac-arrest-secondary-to-lightning-strike-case-report-and-review-of-the-literature
#5
Elena L Rotariu, Mioara D Manole
Lightning strike injuries, although less common than electrical injuries, have a higher morbidity rate because of critical alterations of the circulatory system, respiratory system, and central nervous system. Most lightning-related deaths occur immediately after injury because of arrhythmia or respiratory failure. We describe the case of a pediatric patient who experienced cardiorespiratory arrest secondary to a lightning strike, where the Advanced Cardiac Life Support and Basic Life Support chain of survival was well executed, leading to return of spontaneous circulation and intact neurological survival...
August 1, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28763407/point-of-care-ultrasound-diagnosis-of-multiple-mandibular-fractures-in-an-adolescent-presenting-to-the-pediatric-emergency-department
#6
Nathan Zapolsky, Ivan Joseph Zapolsky, Czer Anthoney Lim
We present a case of an adolescent patient with multiple mandibular fractures diagnosed by point-of-care ultrasound in the pediatric emergency department. Sonographic findings consistent with fracture were identified in our patient, and early consultation expedited interdepartmental coordination and disposition. The role of ultrasound in identifying various traumatic orthopedic and maxillofacial injuries is discussed.
August 1, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28763406/massive-pericardial-effusion-and-tamponade-can-be-a-first-sign-of-familial-mediterranean-fever
#7
Tamer Yoldaş, Şeyma Kayali, İlker Ertuğrul, Vehbi Doğan, Utku Arman Örün, Selmin Karademir
Cardiac involvement is a rare initial presentation of familial Mediterranean fever (FMF). We described 2 children with massive pericardial effusion and cardiac tamponade, who were later diagnosed as having FMF based on clinical and laboratory findings. Therefore, in children presenting with massive pericardial effusion, FMF should be considered as one of the differential diagnoses. In addition, massive pericardial effusion is a serious clinical condition that requires emergency therapeutic approach including pericardiocenthesis...
August 1, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28763405/suspected-pediatric-influenza-risk-stratification-algorithm-a-clinical-decision-tool
#8
Patrick D Evers, Michelle Starr, Michael J McNeil, Laura OʼNeill, Andrea Posa, Timothy Savage, Russell Migita
BACKGROUND AND OBJECTIVES: Influenza causes significant annual burden among children. Current guidelines recommend empiric treatment for a broadly defined group of children at high risk for influenza complications, resulting in overtreatment or costly viral testing. This study creates an algorithm for clinicians to risk stratify children with influenza-like illness (ILI) according to likelihood of influenza infection. METHODS: A retrospective analysis was performed on 818 children seen in the emergency department from November 2012 to April 2013 for ILI...
August 1, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28742637/is-intussusception-a-middle-of-the-night-emergency
#9
Brooke S Lampl, Jonathan Glaab, Rama S Ayyala, Rania Kanchi, Carrie B Ruzal-Shapiro
OBJECTIVES: Intussusception is the most common abdominal emergency in pediatric patients aged 6 months to 3 years. There is often a delay in diagnosis, as the presentation can be confused for viral gastroenteritis. Given this scenario, we questioned the practice of performing emergency reductions in children during the night when minimal support staff are available. Pneumatic reduction is not a benign procedure, with the most significant risk being bowel perforation. We performed this analysis to determine whether it would be safe to delay reduction in these patients until normal working hours when more support staff are available...
July 24, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28742636/the-influence-of-chloride-for-the-interpretation-of-plasma-bicarbonate-during-the-treatment-of-diabetic-ketoacidosis
#10
Juan Pablo Ferreira, Magali Hamui, Milagros Torrents, Romina Carrano, Mabel Ferraro, Ismael Toledo
INTRODUCTION: Hyperchloremic metabolic acidosis can occur in diabetic ketoacidosis (DKA) and may affect the acid-base interpretation during treatment. OBJECTIVES: This study aims to describe the prevalence of hyperchloremia during the treatment of DKA and its effect on the interpretation of bicarbonate value. METHODS: A cross-sectional study, including all cases of DKA in patients aged 1 to 18 years old admitted from 2010 to 2015, was performed...
July 24, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28719485/does-the-application-of-heat-gel-pack-after-eutectic-mixture-of-local-anesthetic-cream-improve-venipuncture-or-intravenous-cannulation-success-rate-in-children-a-randomized-control-trial
#11
Silvana Schreiber, Giorgio Cozzi, Giuseppa Patti, Andrea Taddio, Marcella Montico, Chiara Pierobon, Egidio Barbi
OBJECTIVE: Needle-related procedures are the most common sources of pain for children in the hospital setting. The most used topical anesthetic, eutectic mixture of local anesthetic (EMLA) cream, may cause transient vasoconstriction. It has been postulated that this vasoconstriction may decrease vein visualization. The application of heat gel pack after removal of EMLA cream in the site of venipuncture counteracts the vasoconstriction, improving vein visualization. We assessed using a prospective randomized controlled trial whether the application of heat gel pack increases the needle procedure success rate...
July 17, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28719484/amitraz-a-perpetual-silent-menace-among-children-in-developing-countries-a-case-report
#12
Sowmya Shashidhara, Suneel C Mundkur, Shrikiran A Hebbar, Ashwini Kumar, Vaisakh Sambasivan
Amitraz is an acaricide and insecticide used to treat ticks, which infest domestic animals in developing countries. Because of its widespread use, it is one of the common poisons unintentionally consumed by infants and children when left unsupervised. A 3-year-old boy was brought with unintentional consumption of Amitraz. On examination, he was found to be progressively drowsy, with an irregular pulse, bradycardia, and hypotension. He was treated with atropine, intravenous fluids, and dopamine infusion; hemodynamic stability was achieved within 36 hours after ingestion...
July 17, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28719483/difficult-intubation-and-ventilation-in-an-infant-with-retropharyngeal-abscess-with-mediastinal-extension
#13
Michael A Bruno, Tomas Drabek, Mioara D Manole
A previously healthy 7-month-old male infant presented for evaluation of fever, deceased oral intake, and intermittent noisy breathing. Physical examination revealed neck tenderness. Soft tissue neck radiographs and computed tomography (CT) scan supported a diagnosis of retropharyngeal swelling with extension to the superior mediastinum. Surgical exploration was planned, and endotracheal intubation was performed in the operating room. Significant cardiorespiratory derangements developed immediately after the tracheal tube was inserted, including hypotension, hypoxia, and bradycardia with signs of cardiac ischemia...
July 17, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28719482/teaching-incision-and-drainage-perceived-educational-value-of-abscess-models
#14
Cynthia M Adams, Lise E Nigrovic, Gavin Hayes, Peter H Weinstock, Joshua Nagler
OBJECTIVES: Incision and drainage (I&D) of skin abscesses is an important procedural skill for pediatric emergency medicine providers. Practical skills training using simulation provides an opportunity to learn and gain confidence with this invasive procedure. Our objective was to assess the perceived educational value of 2 versions of an abscess model as part of an educational workshop for teaching I&D. METHODS: A combined didactic and practical skills workshop was developed for use at 2 national conferences...
July 17, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28719481/opioid-prescribing-practices-in-pediatric-acute-care-settings
#15
Michelle DePhillips, Jennifer Watts, Jennifer Lowry, M Denise Dowd
OBJECTIVES: Deaths due to prescription opioid overdoses are at record-high levels. Limiting the amount of opioid prescribed has been suggested as a prevention strategy. The purpose of this study was to describe the opioid prescribing practices in the emergency departments and urgent care sites of a Midwestern tertiary care children's hospital system. METHODS: This retrospective medical record review examined the visits from the 2 pediatric emergency departments and 2 pediatric urgent care sites in the system from June 1, 2012, to May 31, 2013, during which an outpatient opioid prescription was written...
July 17, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28719480/a-rare-pediatric-case-of-posttraumatic-pseudoaneurysm-case-report-and-literature-review
#16
Ada Gu, April J Kam
Posttraumatic pseudoaneurysms are extremely rare in pediatric populations. In many cases, pseudoaneurysms may be confused with abscesses, epidermoid cysts, arteriovenous fistula, foreign objects, and ganglion cysts, as well as tumors. They are associated with distinguishing findings of "pulsatile mass, a palpable thrill, and an audible to-and-fro murmur" (1), which can be confirmed by various imaging techniques. In this report, we describe the case of a 4-year-old boy who presented to the pediatric emergency department 3 weeks after falling and subsequently getting cut by glass...
July 17, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28719479/a-simulation-based-quality-improvement-initiative-improves-pediatric-readiness-in-community-hospitals
#17
Travis Whitfill, Marcie Gawel, Marc Auerbach
BACKGROUND: The National Pediatric Readiness Project Pediatric Readiness Survey (PRS) measured pediatric readiness in 4149 US emergency departments (EDs) and noted an average score of 69 on a 100-point scale. This readiness score consists of 6 domains: coordination of pediatric patient care (19/100), physician/nurse staffing and training (10/100), quality improvement activities (7/100), patient safety initiatives (14/100), policies and procedures (17/100), and availability of pediatric equipment (33/100)...
July 17, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28719478/a-review-of-nonfatal-drowning-in-the-pediatric-age-group-a-10-year-experience-at-a-university-hospital-in-saudi-arabia
#18
Faisal O Al-Qurashi, Abdullah A Yousef, Abdullah Aljoudi, Saleh M Alzahrani, Nasser Y Al-Jawder, Abdulrahman K Al-Ahmar, Mosab S Al-Majed, Hussam M Abouollo
OBJECTIVE: The aim of this study was to evaluate the nonfatal drowning experience, risk factors, intrahospital assessment and postincidental outcomes for children admitted to King Fahd Hospital of the University, AlKhobar, Saudi Arabia, over a 10-year period. METHODS: Children up to the age of 14 years who were admitted with the diagnosis of nonfatal drowning from July 2005 to June 2015 were included. Data regarding demographics, timing, season and location of drowning, presence of an assigned lifeguard, duration of submersion and transport to hospital, cardiopulmonary resuscitation, initial Glasgow Coma Scale, temperature, pH, blood sugar level, total hospital stay, and discharge status were extrapolated, and their effects on the patient's outcome analyzed...
July 17, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28697164/the-use-safety-and-efficacy-of-olanzapine-in-a-level-i-pediatric-trauma-center-emergency-department-over-a-10-year-period
#19
Jon B Cole, Lauren R Klein, Ashley M Strobel, Stephane R Blanchard, Rebecca Nahum, Marc L Martel
OBJECTIVES: Olanzapine is a second-generation antipsychotic increasingly used in emergency medicine for many indications. Literature on its use in children is sparse. Our objectives were to describe the use, safety, and efficacy of olanzapine in pediatric emergency patients. METHODS: A structured chart review was performed of patients 18 years old or younger receiving olanzapine from 2007 to 2016 in the emergency department of a pediatric level I trauma center. RESULTS: A total of 285 children received olanzapine...
July 11, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28697162/pediatric-orbeez-ingestions-reported-to-texas-poison-centers
#20
Mathias B Forrester
OBJECTIVES: There is concern that ingestion of superabsorbent polymer toys, which can absorb large amounts of fluid and increase greatly in volume, may pose a risk if swallowed by children.The intent of this study was to characterize pediatric Orbeez ingestions reported to a statewide poison center system. METHODS: Cases were Orbeez ingestions among patients 19 years or younger reported to Texas poison centers during January 2011 to June 2016. The distribution by various demographic and clinical factors was determined...
July 11, 2017: Pediatric Emergency Care
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