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Pediatric Emergency Care

Dante Allen Pappano, Rebecca Trout Fryxell, Ernest Bernard, Heather Radu
We present the rare case of a 12-year-old girl from Tennessee with domestically acquired aural myiasis.
August 14, 2018: Pediatric Emergency Care
Hannah Sneller, Carolina Vega, Lawrence Zemel, Henry P Chicaiza
Acute hemorrhagic edema of infancy is a rare leukocytoclastic vasculitis that affects infants and children aged 4 to 24 months. We report a case of a 5-month-old girl with purpuric lesions with associated hemorrhagic lacrimation and epistaxis.
August 14, 2018: Pediatric Emergency Care
Yusuke Okubo, Kotaro Nochioka, Marcia A Testa
OBJECTIVE: Anaphylaxis is a common, serious, systemic allergic reaction. In the United States, the change of annual hospitalization rates by anaphylaxis-trigger foods and risk factors associated with severity remain unclear. METHODS: Hospital discharge records of food-induced anaphylactic reactions of individuals younger than 20 years were obtained from Kids' Inpatient Database in 2006, 2009, and 2012 and were weighted to estimate the number of hospitalizations in the United States...
August 14, 2018: Pediatric Emergency Care
Seda Sirin Kose, Suna Asilsoy, Nevin Uzuner, Ozkan Karaman, Erdener Ozer, Ozden Anal
Pulmonary alveolar proteinosis (PAP) is a respiratory pathology characterized by the accumulation and increase of surfactant-derived material in the lungs. In clinical practice, PAP may present as the primary form, which includes autoimmune and hereditary PAP, or as the secondary form. Diffuse alveolar radiopacities on chest x-ray and the crazy-paving pattern on high-resolution computed tomography are important, although not specific findings for PAP. Bronchoalveolar lavage biopsy is a diagnostic method, and whole-lung lavage remains the criterion standard for the treatment of PAP...
August 14, 2018: Pediatric Emergency Care
Kathryn E Kasmire, Carolina Vega, Nicholas J Bennett, V Matt Laurich
OBJECTIVES: Diagnosis of sepsis in young infants can be challenging due to the nonspecific signs, which can include hypothermia. Whether the presence of hypothermia in young infants should prompt evaluation for serious infection is unclear. The objectives were to measure the prevalence of serious infection among infants ≤60 days of age with hypothermia in the emergency department (ED) and determine other clinical features of hypothermic infants who have serious infection. METHODS: This is a retrospective analysis of all infants ≤60 days seen in a children's hospital ED from April 2014 to February 2017...
August 14, 2018: Pediatric Emergency Care
Kristin J Roberts, Suzanne Tomasi, Jason W Stull, Lara B McKenzie, Henry A Spiller
INTRODUCTION: Ingestion of buprenorphine by young children is on the rise and can lead to life-threatening consequences and death. Exposure most often occurs when a child acquires the medication intended for adult use. However, buprenorphine is also prescribed by veterinarians and may be sent home, typically in non-child-resistant packaging, to be administered to the family pet. CASE: A previously healthy 2-year-old girl weighing 11.36 kg was found with a 1-mL syringe containing 0...
August 13, 2018: Pediatric Emergency Care
Thomas R McCarty, Thomas J Abramo, Robert T Maxson, Gregory Albert, Mallikarjuna R Rettiganti, Marie E Saylors, Jonathan W Orsborn, Amanda I Hollingsworth
OBJECTIVE: Hypothermia is an independent risk factor for mortality in adult trauma patients. Two small studies have shown similar results in pediatric trauma patients. Temperature is not included in any pediatric trauma assessment scores. This study sought to compare mortality and various descriptive outcomes between pediatric hypothermic and normothermic trauma patients. METHODS: Data were obtained from the National Trauma Database from 2009 to 2012. Patients meeting inclusion criteria were stratified by presence of isolated head injury, head injury with multiple trauma, and absence of head injury...
August 13, 2018: Pediatric Emergency Care
Lukasz Szarpak, Jerzy R Ladny, Marek Dabrowski, Michael Ladny, Jacek Smereka, Sanchit Ahuja, Kurt Ruetzler
BACKGROUND: Obtaining intravascular access can be challenging or even impossible in several clinical situations. As an alternative, medications and fluids can be administered via the intraosseous (IO) route, which is a well-tolerated and established alternative, especially in the emergency setting. METHODS: Seventy-five novice physicians participated in this randomized simulation study. After a single educational session and 6 months without any clinical application, participants were asked to identify the correct puncture site and obtain IO access using 3 widely used mechanical devices (BIG Pediatric, Arrow EZ-IO, NIO Pediatric) and a manual device (Jamshidi needle) on a pediatric manikin and turkey bone, respectively...
August 13, 2018: Pediatric Emergency Care
Elizabeth Mannino Avila, Erin Stucky Fisher, Kyung Rhee
OBJECTIVE: The objective of this study was to examine patient history as well as clinical and laboratory features associated with true bacteremia versus false bacteremia in previously healthy febrile children ages 0 to 36 months in the era of polyvalent conjugate pneumococcal immunization. METHODS: Using retrospective chart review, we examined history, physical examination, and laboratory characteristics associated with true and false bacteremia. We included subjects under 3 years old, with a positive blood culture obtained in the emergency department or clinic from July 2011 to July 2013, and fever defined as a temperature of greater than or equal to 100...
August 13, 2018: Pediatric Emergency Care
Matthew Kline, Lauren Crispino, Ambika Bhatnagar, Rajavee A Panchal, Marc Auerbach
OBJECTIVES: For children presenting in shock, American College of Critical Care Medicine guidelines recommend 3 boluses of intravenous fluids during initial resuscitation, but these are often not met. This study aims to compare a novel device LifeFlow, to established manual methods for rapid fluid delivery in a simulated environment. METHOD: This single-blinded randomized trial was conducted in a level 1 pediatric trauma center emergency department. Fifty-four participants were paired and randomized to one of the following methods: push/pull, pressure bag, or LifeFlow...
August 13, 2018: Pediatric Emergency Care
G Anthony Fidacaro, Christopher W Jones, Lisa A Drago
OBJECTIVE: There are nearly 1000 annual ambulance crashes within the United States involving pediatric patients. In 2012 National Highway Traffic Safety Administration/US Department of Transportation released Best-Practice Recommendations for the Safe Transportation of Children in Emergency Ground Ambulances. The aim of our study was to measure emergency medical services (EMS) providers' knowledge and opinions of how to safely transport pediatric patients. In addition, we aimed to gather information on barriers to safe pediatric transport...
August 13, 2018: Pediatric Emergency Care
Indira Valadê Carvalho, Vanessa Marcilio de Sousa, Marília Berlofa Visacri, Júlia Coelho França Quintanilha, Cinthia Madeira de Souza, Rosiane Fátima Lopes Ambrósio, Marcelo Conrado Dos Reis, Rachel Alvarenga de Queiroz, Priscila Gava Mazzola, Taís Freire Galvao, Patricia Moriel
OBJECTIVES: The objectives of this study were to analyze adverse drug events (ADEs) related to admissions to a pediatric emergency unit and to identify the associated risk factors. METHODS: This was a prospective study. Demographic data and details of medications were collected for each patient admitted. Case studies were performed by clinical pharmacists and the clinical team to discuss whether the admission was due to an ADE and to characterize the ADE. Multivariate logistic regression was used for statistical analysis...
August 13, 2018: Pediatric Emergency Care
Leman Akcan Yildiz, Ayse Gultekingil, Selman Kesici, Benan Bayrakci, Ozlem Teksam
OBJECTIVE: Carbon monoxide (CO) is a gas, which is produced by incomplete combustion of hydrocarbon-containing substances, and causes significant tissue and organ damage in the common event of CO poisoning. This study aims to evaluate the demographic, clinical, and laboratory characteristics of patients diagnosed with CO poisoning in the emergency department and to determine the factors associated with severe course in the acute phase of poisoning. METHODS: A total of 331 patients diagnosed with CO poisoning in Hacettepe University Children's Hospital, Pediatric Emergency Unit, between January 2004 and March 2014 were included in the study...
August 13, 2018: Pediatric Emergency Care
Emily A Eismann, Robert A Shapiro, Jonathan Thackeray, Kathi Makoroff, Colleen J Bressler, Grace J Kim, Lori Vavul-Roediger, Paul McPherson, Eugene Izsak, Sandra P Spencer
OBJECTIVES: The objectives of this study were to assess the ability of pediatric health care providers and social workers to recognize sentinel injuries in infants under 6 months of age and to determine what factors influence their decision to evaluate for physical abuse. METHODS: A statewide collaborative focused on sentinel injuries administered a survey to pediatric health care providers and social workers in the emergency department, urgent care, and primary care...
August 8, 2018: Pediatric Emergency Care
Chiara Ossella, Floriana DellʼOmo, Elena Zanetti, Isabella Ferdinanda Pestalozza, Pierluigi Galizia, Salvatore Tripodi
BACKGROUND: Belly dancer syndrome is a rare condition consisting of involuntary, repetitive, often rhythmic contractions of the diaphragm, causing undulating movements of the abdomen that recall those of a belly dancer. It is frequently associated with pain or discomfort in the upper abdomen or lower chest, but clinical symptoms are highly variable often resulting in late diagnosis. Very few pediatric cases have been reported, all of which were secondary to other conditions, and to our knowledge, no idiopathic cases of Belly Dancer Syndrome have been reported in children...
August 8, 2018: Pediatric Emergency Care
Becky Rozier, Erica Liebelt
Acute ingestions of spherical lead ammunition foreign bodies such as bullets and lead shot can cause acute blood lead level elevations and clinical symptoms necessitating emergency department evaluations and sometimes treatment. This article presents 3 cases of children ingesting lead ammunition, all receiving gastrointestinal (GI) decontamination and chelation therapy for significantly elevated blood lead level. Case-specific exposures and treatments for the lead ammunitions are presented. Radiographs documented lead pellet ingestion in all 3 cases...
August 8, 2018: Pediatric Emergency Care
Gabriele Lisi, Maria Teresa Illiceto, Erminia Francesca Romeo, Giuseppe Lauriti, Simona Faraci, Giuliano Lombardi, Luigi DallʼOglio, Pierluigi Lelli Chiesa
OBJECTIVES: Disk battery esophageal retention in children younger than 6 years represents an increasing endoscopic emergency, followed by a relevant risk of life-threatening late complications. Surgical removal after a failed endoscopic approach is rarely reported in the literature. We describe our experience in this scenario. METHODS: Two female asymptomatic patients aged 26 and 29 months presented within 4 hours after a witnessed ingestion of a 2-cm, 3-V lithium battery (CR2032) retained in the cervical esophagus...
July 25, 2018: Pediatric Emergency Care
Tharwat El Zahran, Mohammad El Warea, Rana Bachir, Eveline Hitti
OBJECTIVE: The aim of this study was to identify the most common diagnoses for pediatric emergency department (ED) visits at a tertiary care center in Lebanon. METHODS: A retrospective chart review of pediatric patients (aged ≤18 years) presenting to the American University of Beirut Medical Center ED during 2010-2011 was completed. The common diagnoses among 5 age groups (<1, 1-4, 5-9, 10-14, and 15-18 years) in 3 categories (all pediatric ED visits, treat and release, admitted visits) were assessed...
July 24, 2018: Pediatric Emergency Care
Chris Bird, Gemma Winzor, Katherine Lemon, Alasdair Moffat, Tina Newton, Jim Gray
OBJECTIVE: Sore throat is a common presentation to the children's emergency department (ED), and many patients are likely prescribed antibiotics unnecessarily. We aimed to reduce antibiotic prescribing for sore throat in our UK ED through use of an established scoring system combined with a rapid diagnostic test (RDT) to detect group A streptococcal (GAS) pharyngitis. METHODS: AB single-subject and diagnostic accuracy studies were used to measure both antibiotic prescribing rates over time and the performance of the McIsaac clinical score combined with RDT to screen for and treat GAS pharyngitis...
July 24, 2018: Pediatric Emergency Care
Kellie Quinn, Sabina Kriss, Jefferson Drapkin, Antonios Likourezos, Illya Pushkar, Jason Brady, Matthew Yasavolian, Salil S Chitnis, Sergey Motov, Christian Fromm
PURPOSE: This study aimed to compare analgesic efficacy of intranasal (IN) ketamine to IN fentanyl for moderate to severe pain in children in a pediatric emergency department. METHODS: A prospective, randomized, double-blinded, noninferiority study evaluating children aged 3 to 17 years in a pediatric emergency department with acute moderate to severe pain was conducted. Patients received either 1 mg/kg of IN ketamine or 1.5 μg/kg of IN fentanyl and were evaluated after 10, 20, 30, and 60 minutes...
July 24, 2018: Pediatric Emergency Care
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