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Pediatric Emergency Care

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https://www.readbyqxmd.com/read/29200143/the-predictors-for-positive-yield-abdominal-computed-tomography-in-pediatric-abdominal-trauma
#1
Abdulrahman M Alzahem, Soundappan S V Soundappan, Daniel T Cass
OBJECTIVES: Abdominal computed tomography (ACT) use in the initial evaluation of pediatric abdominal trauma is liberal in most instances. The aim of this study was to identify the predictors for a positive yield ACT scan in this population. METHODS: A prospective, cohort, single-center observational study was conducted at Children's Hospital at Westmead, New South Wales, from January 2008 to June 2015 on 240 pediatric abdominal trauma patients who had abdominal computed tomography...
December 1, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29200142/burnout-rates-in-pediatric-emergency-medicine-physicians
#2
Jasmine Patterson, Alison Gardner
OBJECTIVE: Burnout is a syndrome in which a reduced sense of personal accomplishment, depersonalization, and emotional exhaustion develop in response to prolonged stress. It is well known that physicians suffer high rates of burnout; emergency medicine physicians experience significantly increased rates of burnout, whereas physicians in other specialties, like pediatrics, may be spared. Pediatric emergency medicine physicians are on the frontline of care for the critically ill child, which could put them at high risk for burnout...
December 1, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29200141/effects-of-the-introduction-of-intranasal-fentanyl-on-reduction-of-pain-severity-score-in-children-an-interrupted-time-series-analysis
#3
Bill Lord, Paul A Jennings, Karen Smith
OBJECTIVES: Children are at risk of inadequate analgesia due to paramedics' inexperience in assessing children and challenges in administering analgesics when the patient is distressed and uncooperative. This study reports on the outcome of a change to practice guidelines that added intranasal fentanyl and intramuscular morphine within a large statewide ambulance service. METHODS: This retrospective study included patients younger than 15 years treated by paramedics between January 2008 and December 2011...
December 1, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29200140/evaluating-the-implementation-barriers-of-an-intranasal-fentanyl-pain-pathway-for-pediatric-long-bone-fractures
#4
Tamara Arnautovic, Kathryn Sommese, Paul C Mullan, Steven Barron Frazier, Turaj Vazifedan, Dana Erikson Ramirez
OBJECTIVES: This study aimed to assess physician comfort, knowledge, and implementation barriers regarding the use of intranasal fentanyl (INF) for pain management in patients with long-bone fractures in a pediatric emergency department (ED) with an INF pain pathway. METHODS: A retrospective chart review was conducted of patients, 3 to 21 years old, in our ED with an International Classification of Diseases-9th Revision code for a long-bone fracture from September 1, 2013, to August 31, 2015...
December 1, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29200139/hyperkalemia-and-acute-kidney-injury-in-an-adolescent-thinking-outside-the-box
#5
Adam Szadkowski, Allison J Pollock, Awni M Al-Subu
Addison disease is a rare endocrine disorder, which typically presents with nonspecific symptoms including weight loss, fatigue, and nausea in conjunction with hyponatremia and hyperkalemia. This case demonstrates key diagnostic clues in evaluation of an adolescent who presented with severe hyperkalemia and acute kidney injury that was resistant to insulin, glucose, and sodium polystyrene sulfonate and was found to have primary adrenal insufficiency.
December 1, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29200138/dispatcher-assisted-cardiopulmonary-resuscitation-program-and-outcomes-after-pediatric-out-of-hospital-cardiac-arrest
#6
Yu Jin Lee, Kyoung Jun Song, Sang Do Shin, Seung Chul Lee, Eui Jung Lee, Young Sun Ro, Ki Ok Ahn
OBJECTIVES: A dispatcher-assisted bystander cardiopulmonary resuscitation (DA-BCPR) is expected to influence the outcomes of pediatric out-of-hospital cardiac arrest (OHCA). Our objective was to measure the effect size of a DA-BCPR on survival outcomes according to location of the event. METHODS: All emergency medical service treated OHCA patients younger than 19 years in Korea from January 2012 through December 2013 were analyzed. Patients with OHCA witnessed by emergency medical service providers and those with missing outcome information were excluded...
December 1, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29210887/composition-and-associated-factors-of-radiological-examination-in-major-trauma-patients-a-prospective-observational-study
#7
Liu Shanshou, Zhao Wei, Wang Xianqi, Xie Jiangang, Zhu Chaojuan, Wang Qianmei, Yin Wen, Li Junjie
The care of major trauma patients continues to be a challenge for emergency physicians and trauma surgeons. We found that the total number of radiological examinations for major trauma patients in this study was high and mainly comprised radiography and computed tomography (CT), with CT being more commonly adopted. The number of CT scans was positively correlated with severity of injury and intensive care unit length of stay. Further study is warranted to optimize radiological examinations involving major trauma patients...
November 28, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29210890/allergic-colitis-with-pneumatosis-intestinalis-in-an-infant
#8
Helena Liu, Troy W S Turner
Inflammatory causes of bloody diarrhea during infancy include necrotizing enterocolitis and allergic colitis, often due to cow's milk protein. We report this case of cow's milk protein allergy, managed successfully with elimination of dietary antigen, to highlight the unusual finding of pneumatosis intestinalis on abdominal x-ray, a radiographic hallmark associated with necrotizing enterocolitis. Detailed patient's history, clinical presentation, and physical examinations are discussed for cow's milk protein allergy and necrotizing enterocolitis...
November 27, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29210889/does-specialty-training-and-practice-setting-affect-adherence-to-the-pediatric-emergency-care-applied-research-network-criteria-for-pediatric-head-trauma
#9
Maria Tama, Neel Andharia, Collin Bufano, Josh Greenstein, Boris Khodorkovsky
OBJECTIVE: The goal was to determine the effects of specialty training and practice settings on the adherence to the Pediatric Emergency Care Applied Research Network (PECARN) criteria. METHODS: A retrospective study was conducted on a 2-campus hospital. Chart documentation was used to determine adherence to PECARN criteria. Inclusion criteria were any traumatic head injury within 24 hours in patients younger than 18 years over a 1-year period. Specialty training was subdivided into 3 groups: pediatric emergency medicine, emergency medicine (EM), and general pediatrics...
November 27, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29210888/pneumonia-in-a-teenager-hiding-a-fire-eating-stunt
#10
Michele Ghezzi, Marta Odoni, Oriana Testagrossa, Daniela Messina, Jorge Daniel Ruocco, Camillo Lovati, Ahmad Kantar
Pneumonia in children due to hydrocarbon aspiration is usually the result of an uncommon accidental event. However, an acute and severe type of pneumonia induced by hydrocarbon aspiration is occasionally experienced by entertainers known as fire-eaters. Different approaches to treat fire-eater's pneumonia appear in the literature. Although there is no consensus regarding the management of this condition, the use of antibiotic therapy is well recognized and recommended by some, whereas others recommend only supportive treatment...
November 27, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29166296/emergency-intubations-in-a-high-volume-pediatric-emergency-department
#11
Jen Heng Pek, Gene Yong-Kwang Ong
INTRODUCTION: Resuscitation of critically ill children can be chaotic, and emergency airway management is often fraught with difficulties. This study aimed to characterize the Singaporean landscape of tracheal intubation in a pediatric emergency unit, placing emphasis on safety outcomes, procedural process of care, and provider training. METHODS: A retrospective review of all cases presented to the KK Women's and Children's Hospital from January 2009 to December 2013 with intubation carried out within the pediatric emergency unit was done...
November 21, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29189596/procedural-training-and-assessment-for-pediatric-emergency-medicine-physicians-within-the-united-states-and-canada-a-survey-study
#12
Rebekah A Burns, Neil G Uspal
OBJECTIVES: The aims of this study were to determine current practices in procedural training and skill assessment for attending physicians working in pediatric emergency departments within the United States and Canada and identify barriers to providing training and assessment. METHODS: This was a cross-sectional survey study. Members of the pediatric emergency medicine fellowship program directors and associate program directors Listserv were invited to participate in an anonymous survey about attending physician training and assessment practices for 9 specific procedures and barriers to training and assessment...
November 20, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29189595/fast-and-sensitive-automated-point-of-care-urine-dips
#13
Laurie Malia, Kaitlin Strumph, Sharon Smith, John Brancato, Stephanie T Johnson, Henry Chicaiza
OBJECTIVE: Point-of-care (POC) urine dipstick is a highly used test in the pediatric emergency department (PED) owing to its fast turn-around time and inexpensive cost. Past studies have shown hand-held urine dipsticks and automated urinalysis in children younger than 48 months to be sensitive predictors for urinary tract infection (UTI). It is hypothesized that POC dip testing is as accurate as laboratory urinalysis in the diagnosis of UTI. METHODS: A retrospective chart review was conducted on patients (aged birth through 18 years) presenting to a PED between January 2015 and December 2015...
November 20, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29189594/unusual-case-of-penile-ecchymosis
#14
Thomas Peterson, Emily Supenia, Andrew Hashikawa
Hirudin is a potent anticoagulant found in the salivary glands of several species of leeches. We report a case of direct hirudin exposure after suspected leech bite causing significant penile ecchymosis. Diagnosis was not apparent on initial evaluation but made after a thorough history was obtained and the leech was found in the lining of his swim trunks, which he left at home. Although this presentation mimics several other potentially serious conditions, treatment is largely observational with anticipated rapid improvement over the course of hours without intervention...
November 20, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29189593/association-of-insurance-with-use-of-emergency-medical-services-among-children
#15
Parul Dayal, Timothy K Ruttan, Jamie L Kissee, Ilana S Sigal, James P Marcin
OBJECTIVE: The use of emergency medical services (EMS) can be lifesaving for critically ill children and should be defined by the child's clinical need. Our objective was to determine whether nonclinical demographic factors and insurance status are associated with EMS use among children presenting to the emergency department (ED). METHODS: In this cross-sectional study using the National Hospital Ambulatory Medical Care Survey, we included children presenting to EDs from 2009 to 2014...
November 20, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29189592/early-reduction-of-pediatric-traumatic-posterior-hip-dislocation-is-much-more-important-than-the-treatment-procedure
#16
Serdar Yuksel, Cem Albay
Traumatic hip dislocations are very rare in the pediatric population, and they are real emergent cases that can occur with minimal trauma. If they are not diagnosed immediately and reduction is not performed as soon as possible, they may cause problems such as avascular necrosis and degenerative arthritis. Performing reduction within the first 6 hours is of vital importance.We aim to present the functional outcomes and radiographic results of 2 pediatric traumatic hip dislocation cases with 36 months of follow-up who were treated with abduction orthosis after the reduction...
November 20, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29189591/luc-s-abscess-and-temporomandibular-joint-septic-arthritis-two-rare-sequelae-of-acute-otitis-media
#17
Carmelle Tsai, Jennifer Deramo, Xiaofan Shen, Kathleen Vandiver, Vineeta Mittal
A 5-year-old previously healthy child presented with right-sided otalgia, right facial and temporal swelling, and right jaw pain in the setting of 6 days of low-grade fever. The child had no trauma, vomiting, or prior dental treatments. On physical examination, the patient had facial swelling, erythema, and tenderness over the right temporal region along with trismus, as well as pain on palpation of the right temporomandibular joint (TMJ). A computed tomography scan revealed otitis media, Luc's abscess, and TMJ septic arthritis requiring surgical drainage and intravenous antibiotics...
November 20, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29189590/management-of-pediatric-isolated-skull-fractures-a-decision-tree-and-cost-analysis-on-emergency-department-disposition-strategies
#18
Daniel C Williams, W Scott Russell, Annie L Andrews, Kit N Simpson, William T Basco, Ronald J Teufel
OBJECTIVE: Pediatric isolated skull fractures (ISFs) are common injuries that represent challenging disposition decisions for clinicians. The purpose of this study is to use a decision analysis to compare the clinical and cost-effectiveness of 3 emergency department (ED)-based disposition scenarios for a pediatric patient presenting with ISF. METHODS: We conducted a cost-effectiveness analysis comparing ED disposition scenarios that included current practice, increased at-home surveillance, and observation unit utilization...
November 20, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29189589/pediatric-emergency-research-canada-origins-and-evolution
#19
Liza Bialy, Amy Plint, Roger Zemek, David Johnson, Terry Klassen, Martin Osmond, Stephen Freedman
OBJECTIVE: The objective of the study was to describe the origins, growth, and progress of a national research network in pediatric emergency medicine. METHODS: The success of Pediatric Emergency Research Canada (PERC) is described in terms of advancing the pediatric emergency medicine agenda, grant funding, peer-reviewed publications, mentoring new investigators, and global collaborations. RESULTS: Since 1995, clinicians and investigators within PERC have grown the network to 15 active tertiary pediatric emergency medicine sites across Canada...
November 20, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29140931/hemispheric-cerebral-oximetry-monitoring-during-pediatric-seizure-activity-in-a-pediatric-emergency-department
#20
Thomas J Abramo, Shane McKinney, James Moore, Richard Jacobs, Gregory Albert, Mark Meredith, Nicholas Hobart Porter, Elizabeth Storm, Errin Willis, Cruz Velasco Gonzalez, Hailey Hargrave, Brad Schneider, Gergory Sharp
BACKGROUND: Sustained neuronal activity during seizures causes cellular perturbations, alterations in cerebral physiology, and potentially neurological injury, a neurological emergency. With variable clinical manifestations of seizures, frequent failure of seizure recognition by providers in pediatric and developmentally challenged patients can increase seizure complications. Neuroresuscitation should include rapid cerebral physiology assessment for increased seizure recognition and optimal neurological outcomes...
November 15, 2017: Pediatric Emergency Care
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