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Pediatric Emergency Care

Lucia Liao, Lilia Reyes
OBJECTIVES: The aim of this study was to determine if a racial disparity exists in the administration of an analgesic, time to receiving analgesic, and type of analgesic administered to children with long-bone fractures. Prior studies have reported the existence of racial disparity but were mostly in adult and urban populations. METHODS: This is a retrospective chart review of 727 pediatric patients (aged 2-17 years) with International Classification of Diseases, Ninth Revision (or 10th revision) codes for long-one fractures in an emergency department that cares for a suburban and rural population between January 2013 and January 2016...
November 26, 2018: Pediatric Emergency Care
Naomi Dreisinger, Jeffrey Nahn
The ability of the patient or the parent, in pediatrics, to read, understand, and act upon health information is termed health literacy. Health literacy has been shown to be of primary importance when determining a patient's ability to achieve optimal health. As physicians, we often fail to recognize the enormous obstacles facing our patients. In the pediatric emergency department (PED), communication is complicated. Physicians must be able to effectively relay information to the patient's caregiver while still not forgetting to provide developmentally appropriate instructions to the child...
November 26, 2018: Pediatric Emergency Care
Jessica K Creedon, Sigella Vargas, Lisa A Asaro, David Wypij, Raina Paul, Elliot Melendez
OBJECTIVES: Antibiotic administration within 1 hour of hypotension has been shown to reduce mortality. It is unknown whether antibiotics before hypotension in children who eventually meet criteria for septic shock improves outcomes. This study assesses whether antibiotic timing from the time of meeting criteria for sepsis in children with septic shock impacts morbidity and mortality. METHODS: This is a retrospective study of children 18 years or younger presenting to a tertiary free-standing children's hospital emergency department with sepsis that subsequently progressed to septic shock and were admitted to an intensive care unit from 2008 to 2012...
November 26, 2018: Pediatric Emergency Care
Adam A Vukovic, Meifawn D Poole, Erin F Hoehn, Alicia K Caldwell, Amanda C Schondelmeyer
We describe 2 cases of child maltreatment who presented as common pediatric conditions: preseptal cellulitis and gastroenteritis. The first case is an 8-year-old girl who presented with progressive right eye pain, swelling, and discharge. She was initially treated for preseptal cellulitis, but eye cultures ultimately grew Neisseria gonorrhoeae. Further investigation revealed sexual abuse by a male family member. The second case is a 2-year-old previously healthy girl who presented with 6 hours of emesis, lethargy, and abdominal pain...
November 26, 2018: Pediatric Emergency Care
Michael Ely, Elizabeth A Edgerton, Russell Telford, Kent Page, Craig Hemingway, Donald Vernon, Lenora M Olson
OBJECTIVES: Pediatric patients represent a small proportion of emergency medical services (EMS) calls, challenging providers in maintaining skills in treating children. Having structural capacity to appropriately diagnose and treat pediatric patients is critical. Our study measured the availability of off-line and on-line medical direction and recommended pediatric equipment at EMS agencies. METHODS: A Web-based survey was sent to EMS agencies in 2010 and 2013, and results were analyzed to determine availability of medical direction and equipment...
November 26, 2018: Pediatric Emergency Care
Syed Amir Ahmad, Tariq A Al Thobiti, Manal El Toum, Fahad Al Harbi
Ketogenic diets used for treating various neurological disorders can have potentially serious adverse effects. Among these is scurvy, a rarely reported, yet potentially fatal adverse effect of the ketogenic diet caused by vitamin C deficiency. We report a case of a 5-year-old patient with autism, who presented with scurvy secondary to the dietary restrictions of a ketogenic diet. Our review of the literature showed a single previously reported case of vitamin C deficiency in a patient on ketogenic diet. We have also reviewed the clinical indications and adverse effects of ketogenic diets with special reference to scurvy...
November 19, 2018: Pediatric Emergency Care
Elena Boccuzzi, Valentina A Ferro, Bianca Cinicola, Paolo M Schingo, Luisa Strocchio, Umberto Raucci
Leukemia is the most common childhood malignancy, and it is often characterized by pallor, fatigue, cytopenia, and organomegaly; sometimes musculoskeletal symptoms, mainly characterized by diffuse bone pain in the lower extremities, are the onset clinical characteristics of the disease. In these cases, the disease may initially be misdiagnosed as reactive arthritis, osteomyelitis, or juvenile idiopathic arthritis delaying appropriate diagnosis and management. Even if leukopenia, thrombocytopenia, and a history of nighttime pain are reported to be the most important predictive factors for a pediatric leukemia, blood examinations can sometimes be subtle or within normal limits, and this represents a further diagnostic difficulty...
November 19, 2018: Pediatric Emergency Care
Naoya Shatani, Sara Alshaibani, James Potts, Bruce Phillips, Heather Bray
OBJECTIVES: Radiographic survey of the entire aerodigestive tract (nares to anus) is common practice in children presenting to the emergency department following coin ingestion. The purpose of our study was to determine the optimal protocol for radiographic survey post-coin ingestion. We hypothesized that for children presenting with a clear history of coin ingestion a frontal chest radiograph including the entire esophagus is adequate to guide treatment. METHODS: We reviewed the clinical history and radiographic surveys of 134 patients presenting with suspected or witnessed coin ingestion to the emergency department of a tertiary care pediatric hospital between January 2012 and June 2016...
November 19, 2018: Pediatric Emergency Care
Michael Levine, Anthony Pizon, Michael Beuhler, F Lee Cantrell, Frank LoVecchio, Meghan Spyres, Aaron B Skolnik, Daniel E Brooks
BACKGROUND: Historically, anticoagulants and antiplatelet agents included warfarin and aspirin, respectively. In recent years, numerous novel anticoagulants (eg, direct thrombin inhibitors and factor Xa inhibitors) as well as the adenosine diphosphate receptor antagonists have increased significantly. Little information on the bleeding risk after exploratory ingestion of these agents is available. The primary purpose of this study is to evaluate the bleeding risk of these agents after an exploratory ingestion in children 6 years or younger...
November 19, 2018: Pediatric Emergency Care
Katherine M Steffen, Corina Noje, Philomena M Costabile, Eric Henderson, Elizabeth A Hunt, Bruce L Klein, Kristen Nelson McMillan
OBJECTIVES: We developed a Pediatric Transport Triage Tool (PT3) to objectively guide selection of team composition and transport mode, thereby standardizing transport planning. Previously, modified Pediatric Early Warning Score for transport has been used to assess illness severity but not to guide transport decision making. METHODS: The PT3 was created for pediatric transport by combining objective evaluations of neurologic, cardiovascular, and respiratory systems with a systems-based medical condition list to identify diagnoses requiring expedited transport and/or advanced team composition not captured by neurologic, cardiovascular, and respiratory systems alone...
November 19, 2018: Pediatric Emergency Care
Jennifer R Marin, Rachel P Berger
No abstract text is available yet for this article.
November 12, 2018: Pediatric Emergency Care
Kelsey A Miller, Matthew A Eisenberg, Edir S Abid, Joshua Nagler
First-pass success rates during intubation of infants in the emergency department have been shown to be low. Video laryngoscopy is being increasingly used during advanced airway management in the emergency department, but available data have not supported improved outcomes with use in pediatrics. The newly available Macintosh size 0 (curved) blade for the C-MAC video laryngoscope offers a narrower blade for use in infants. We describe the use of the new C-MAC Macintosh 0 blade for intubation of 2 infants with apnea secondary to respiratory syncytial virus bronchiolitis...
November 12, 2018: Pediatric Emergency Care
Michelle C Perry, Susan K Yaeger, Katie Noorbakhsh, Andrea T Cruz, Robert W Hickey
OBJECTIVES: Serious bacterial infections (SBIs) in young infants can present with fever or hypothermia. There are substantial data on fever as a presentation for SBI that help to inform the clinical approach. In contrast, data on hypothermia are lacking, thus leaving clinicians without guidance. We aimed to describe the workup and findings, specifically the occurrence, of SBIs in infants younger than 60 days of life with hypothermia. METHODS: We reviewed the medical records of infants younger than 60 days of life with rectal temperature of less than 36...
November 12, 2018: Pediatric Emergency Care
Kristy Williamson, Joshua M Sherman, Joanna Stein Fishbein, Joshua Rocker
OBJECTIVES: Oftentimes while pursing the diagnosis of appendicitis, an ultrasound cannot visualize the appendix, and physicians must utilize other resources for evaluation. The primary objective of this study was to determine if there was a lower rate of appendicitis when the appendix was not visualized on ultrasound. Furthermore, we assessed the importance of specific clinical predictors in this population. METHODS: We conducted a retrospective chart review of all children who presented to our pediatric emergency department from 2011 to 2013 and had an abdominal ultrasound...
November 12, 2018: Pediatric Emergency Care
Mohsen Saidinejad, Audrey Paul, Marianne Gausche-Hill, Dale Woolridge, Alan Heins, William Russell Scott, Phillip Friesen, David Rayburn, Gregory Conners, Emory Petrack, Timothy Horeczko, Michael Stoner, Elizabeth Edgerton, Madeline Joseph
This article provides recommendations for pediatric readiness, scope of services, competencies, staffing, emergency preparedness, and transfer of care coordination for urgent care centers (UCCs) and retail clinics that provide pediatric care. It also provides general recommendations for the use of telemedicine in these establishments.With continuing increases in wait times and overcrowding in the nation's emergency departments and the mounting challenges in obtaining timely access to primary care providers, a new trend is gaining momentum for the treatment of minor illness and injuries in the form of UCCs and retail clinics...
November 12, 2018: Pediatric Emergency Care
Lisa Schwartz, Rebecca Bishop, Jacqueline Le, Eugene Hu, Tommy Kim
Rhabdomyolysis is a syndrome caused by injury to skeletal muscle and subsequent release of intracellular components into the systemic circulation. We report a case of rhabdomyolysis causing acute paralysis from underlying and unrecognized hypothyroidism in an 11-year-old girl. To date, publications of rhabdomyolysis secondary to hypothyroidism have been limited, especially in the pediatric population. Early intervention with intravenous fluids and levothyroxine led to resolution of our patient's symptoms and is overall important in preventing the serious sequela of rhabdomyolysis including renal failure, cardiac dysrhythmias, compartment syndrome, and disseminated intravascular coagulation...
November 12, 2018: Pediatric Emergency Care
Dana M Kaplan, Jessica L Moore, Priyadarshini Hirway, Christine E Barron, Amy P Goldberg
OBJECTIVE: Close medical follow-up after pediatric acute sexual assault is recommended and may mitigate adverse consequences and decrease long-term comorbidities. The objectives are to (1) examine adherence to a comprehensive outpatient medical follow-up protocol after evaluation in the emergency department in a pediatric population and (2) identify characteristics associated with patient adherence to inform the utilization of a medical follow-up protocol after pediatric acute sexual assault...
November 12, 2018: Pediatric Emergency Care
Fran Balamuth, Andrea T Cruz, Stephen B Freedman, Paul T Ishimine, Aris Garro, Sarah Curtis, Kendra L Grether-Jones, Aaron S Miller, Neil G Uspal, Suzanne M Schmidt, Samir S Shah, Lise E Nigrovic
In our cohort of 20,947 infants aged 60 days or younger, cerebrospinal fluid Gram stain had a sensitivity of 34.3% (95% confidence interval, 28.1%-41.1%) and a positive predictive value of 61.4% (95% confidence interval, 52.2%-69.8%) for positive cerebrospinal fluid culture, suggesting that Gram stain alone may lead to both underdiagnosis and overdiagnosis of bacterial meningitis.
November 12, 2018: Pediatric Emergency Care
Amy W Bryl, Bema Bonsu, Ariana L Johnson, Kathleen B J Pommert, Kathryn A Hollenbach, John T Kanegaye
OBJECTIVES: Child life interventions reduce the anxiety of medical procedures but are not always available in emergency departments. In this study, we determined the effect of parent-directed tablet computer use without child life direction on patient anxiety and on parent and suturing clinician experience during pediatric facial laceration repair. METHODS: In a children's hospital emergency department, we enrolled children 2 to 12 years of age undergoing unsedated facial laceration repairs and randomized them to parent-directed tablet computer distraction or standard supportive care...
November 12, 2018: Pediatric Emergency Care
Wei Hao Lee, Zubin Grover, Meredith Borland, Kunal Thacker
OBJECTIVE: Esophageal foreign body impaction (EFBI) is a common presentation in pediatric emergency medicine. Interventions (medical or endoscopic) are often required because of the severity of symptoms and risk of complications. Use of medical disimpaction (MD) such as glucagon injections and effervescent agents (eg, carbonated beverages) has been well described in adults; however, there are limited data in the pediatric literature. Eosinophilic esophagitis (EoE) is a relatively "new" clinicopathological entity that may present with EFBI mostly due to food with histological findings of EoE...
November 5, 2018: Pediatric Emergency Care
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