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Pain children emergency

Marjolijn E W Timmerman, Monika Trzpis, Paul M A Broens
Introduction: Many children with acute abdominal pain and suspicion of appendicitis are diagnosed with constipation. Nevertheless, it can be difficult to differentiate between acute constipation and acute appendicitis because of similar symptoms and lack of diagnostic criteria. Consequently, constipation is often missed despite repeated consultations at the emergency department. We hypothesise that the diagnostic process can be improved and adequate treatment accelerated by supporting faecal evacuation in children with acute abdominal pain...
2018: BMJ Paediatrics Open
Amy Gl Nuttall, Katie M Paton, Alison M Kemp
OBJECTIVE: To evaluate utility and equivalence of Glasgow Coma Scale (GCS) and the Alert, Voice, Pain, Unresponsive (AVPU) scale in children with head injury. DESIGN: Cross sectional study. SETTING: UK hospital admissions: September 2009-February 2010. PATIENTS: <15 years with head injury. INTERVENTIONS: GCS and/or AVPU at injury scene and in emergency departments (ED). MAIN OUTCOME: Measures used, the equivalence of AVPU to GCS, GCS at the scene predicting GCS in ED, CT results by age, hospital type...
November 28, 2018: BMJ Open
Preston O'Brien, Robert W Wong
BACKGROUND: Diphtheria, tetanus, pertussis, and inactivated poliovirus combined vaccine is widely used in young children as part of a series of immunizations before they start attending school. Case studies of demyelinating conditions following administration of diphtheria, tetanus, pertussis, and polio vaccine have been reported, but none so far resulting in optic neuritis. This report further contributes to the database of central nervous system demyelinating conditions affiliated with receipt of vaccines...
November 30, 2018: Journal of Medical Case Reports
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
Gabija Pancekauskaitė, Lina Jankauskaitė
Paediatric pain and its assessment and management are challenging for medical professionals, especially in an urgent care environment. Patients in a paediatric emergency room (PER) often undergo painful procedures which are an additional source of distress, anxiety, and pain. Paediatric procedural pain is often underestimated and neglected because of various myths, beliefs, and difficulties in its evaluation and treatment. However, it is very different from other origins of pain as it can be preventable. It is known that neonates and children can feel pain and that it has long-term effects that last through childhood into adulthood...
November 27, 2018: Medicina
C Longobardi, L E Prino, M A Fabris, M Settanni
BACKGROUND: Hospitals can cause anxiety, pain and fear in children perceiving medical procedures as intrusive and painful. Among the non-pharmacological strategies, distraction techniques have proved to be effective in the management of pain and distress. METHODS: The aim of the present study is to assess the effectiveness of soap bubbles as a distraction technique for the management of anxiety, fear and pain in children waiting for a medical examination at the pediatric emergency room...
November 22, 2018: Child: Care, Health and Development
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
Katherine A Lyseng-Williamson
Burosumab (Crysvita® ), a fully human IgG1 monoclonal antibody directed at fibroblast growth factor 23 (FGF23), is indicated for the treatment of X-linked hypophosphatemia (XLH), a condition associated with excessive FGF23 production. It directly addresses the excessive FGF23 activity in patients with XLH by binding to FGF23, and inhibiting its signaling. This leads to increased gastrointestinal phosphate absorption and renal phosphate reabsorption, thereby improving serum phosphate levels, and, ultimately, bone mineralization and the risk of bone disease...
2018: Drugs & Therapy Perspectives: for Rational Drug Selection and Use
Sylvia Kramer, Martin Krebs, Claudia Spies, Shahab Ghamari, Claudia Höhne, Karin Becke, Christoph Eich, Andreas Hoeft, Julius Wermelt, Richard K Ellerkmann
The upcoming and ongoing debate on neurotoxicity of anesthetics at a young age put a new spotlight on the emergence delirium of children (paedED). The European Society for Anesthesiology published a consensus guideline on prevention and therapy in 2017 which can be a useful guidance in daily clinical practice. Patient data management systems with their clear documentation concerning pain/therapy of pain and paedED will be valuable tools in order to assess the real incidence of paedED. Differentiating between pain/agitation and paedED migth not always be easy...
November 2018: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Silvina Neyro, Lorena Mirón, María N Orlando, Estefanía J Biondi, Ariel Cheistwer, Gonzalo Guiñazú, Lorena Ml Firenze Aldeghi, Emilio Martinez Iriart
Infectious Spondylodiscitis is a rare infection in children. It is more frequent in patients under 6 years of age. We report the case of an 8-year-old patient with lumbar pain for 2 months, without fever. Xrays, computed tomography and magnetic resonance imaging all three showed spondylodiscitis L4-L5. After a 10-day antibiotic treatment with clindamycin with regular response, a bone puncture was performed isolating Kingella kingae (Kk). Ostearticular infections caused by Kk have increased among infants and children...
December 1, 2018: Archivos Argentinos de Pediatría
Jeroen Hagendoorn, Carolijn L M A Nota, Inne H M Borel Rinkes, I Quintus Molenaar
BACKGROUND: Pancreatoduodenectomy (Whipple resection) in children is feasible though rarely indicated. In several pediatric malignancies of the pancreas, however, it may be the only curative strategy [1]. With the emergence of robotic pancreatoduodenectomy as at least a clinically equivalent alternative to open surgery [2], it remains to be determined whether the pediatric population may potentially benefit from this minimally invasive procedure. Here we present, for the first time, a video of setup and surgical technique of robotic pancreatoduodenectomy in a child...
December 2018: Surgical Oncology
Renato Tambucci, Paolo Quitadamo, Michela Ambrosi, Paola De Angelis, Giulia Angelino, Stefano Stagi, Albero Verrotti, Annamaria Staiano, Giovanni Farello
OBJECTIVE: Although emerging data indicate that obese/overweight children are more likely to develop functional gastrointestinal disorders (FGIDs) than normal-weight peers, contrasting results have been reported. The present observational, case-control study aimed at estimating the prevalence of FGIDs in obese/overweight children compared to normal-weight peers. METHODS: Consecutive obese and overweight children aged 4-18 years attending the obesity outpatient clinic were enrolled as study cases...
November 15, 2018: Journal of Pediatric Gastroenterology and Nutrition
Donald R Hopkins, Ernesto Ruiz-Tiben, Adam J Weiss, Sharon L Roy, James Zingeser, Sarah Anne J Guagliardo
Dracunculiasis (Guinea worm disease), caused by the parasite Dracunculus medinensis, is acquired by drinking water containing copepods (water fleas) infected with its larvae. The worm typically emerges through the skin on a lower limb approximately 1 year after infection, causing pain and disability (1). The worldwide eradication campaign began at CDC in 1980. In 1986, the World Health Assembly called for dracunculiasis elimination, and the global Guinea Worm Eradication Program (GWEP), led by the Carter Center in partnership with the World Health Organization (WHO), United Nations Children's Fund (UNICEF), CDC, and others, began assisting ministries of health in countries with dracunculiasis...
November 16, 2018: MMWR. Morbidity and Mortality Weekly Report
Zachary I Meyer, Paul Krucylak, Michelle Mo, Mark L Miller, Lindley B Wall
BACKGROUND: Opioids are a commonly utilized component of pain management following pediatric extremity fractures, yet an increasing number of adolescents and children are falling victim to their negative effects. The purpose of this study was to examine opioid use in the pediatric fracture population by determining and comparing the average hospital opioid dosage utilized in the operative pediatric elbow and femur fractures and determining and comparing the average dose prescribed following operative treatment of elbow and femur fractures...
November 13, 2018: Journal of Pediatric Orthopedics
Li-Na Zhang, Wei Guo, Ji-Hong Zhu, Yang Guo
Herein we report a case of acute liver failure (ALF) and hemophagocytic lymphohistiocytosis (HLH) induced by varicella infection, successfully rescued by a combination therapy of acyclovir, supportive care, and immunosuppression with dexamethasone and etoposide. A previously healthy 16-year-old boy presented with generalized rash, fever, severe abdominal pain, and abnormal liver function within 4 d. Chickenpox was suspected, and acyclovir and intravenous immunoglobulin were started on admission. However, the patient's condition deteriorated overnight with soaring transaminases, severe coagulopathy and encephalopathy...
November 6, 2018: World Journal of Clinical Cases
Chiara Tersigni, Alessandro Semeraro, Marcello Caremani, Elisabetta Venturini, Claudio de Filippi, Luisa Galli
We report the case of an adolescent Moroccan girl with abdominal pain and palpable mass in the upper right side of the abdomen. In the emergency department, an abdominal ultrasound showed hepatomegaly and eight active liver cysts, compatible with cystic echinococcosis. Serology for Echinococcus granulosus confirmed the diagnosis. Other sites of localization were excluded. Treatment involved albendazole combined with puncture, aspiration, injection, re-aspiration, performed only for the most medial cysts. Periodical follow-up with abdominal ultrasound and with abdominal magnetic resonance imaging showed a progressive involution of all cysts...
November 12, 2018: American Journal of Tropical Medicine and Hygiene
Keith M Porter, Anthony D Dayan, Sara Dickerson, Paul M Middleton
Methoxyflurane is an inhaled analgesic administered via a disposable inhaler which has been used in Australia for over 40 years for the management of pain associated with trauma and for medical procedures in children and adults. Now available in 16 countries worldwide, it is licensed in Europe for moderate to severe pain associated with trauma in conscious adults, although additional applications are being made to widen the range of approved indications. Considering these ongoing developments, we reviewed the available evidence on clinical usage and safety of inhaled analgesic methoxyflurane in trauma pain and in medical procedures in both adults and children...
2018: Open Access Emergency Medicine: OAEM
Henry W Ortega, Heidi Vander Velden, Walter Truong, Joseph L Arms
BACKGROUND: Inadequate treatment of painful conditions in children is a significant and complex problem. The objective of this study was to examine the effect of socioeconomic status on the provision of analgesic medicines at discharge in children treated emergently for a long-bone fracture. METHODS: A retrospective review of all patients during a 1-year period with a long-bone fracture treated in 2 urban pediatric emergency departments (EDs) was performed. RESULTS: Eight hundred seventy-three patients were identified who met our inclusion criteria...
November 5, 2018: Pediatric Emergency Care
David Gremse, Benjamin D Gold, Betsy Pilmer, Barbara Hunt, Bartosz Korczowski, Maria Claudia Perez
BACKGROUND: In gastroesophageal reflux disease (GERD), the frequency of heartburn symptoms and erosive esophagitis (EE) increases with age in children and adolescents. Proton pump inhibitor, dexlansoprazole, is approved for healing EE of all grades, maintenance of healed EE, relief of heartburn, and treatment of symptomatic non-erosive GERD in patients ≥ 12 years. AIM: To assess safety and efficacy of dexlansoprazole dual delayed-release capsule in healing of EE and maintenance of healed EE in adolescents...
November 2, 2018: Digestive Diseases and Sciences
Naeha Haridasa, Michael R DeBaun, Maureen Sanger, Tilicia L Mayo-Gamble
OBJECTIVE: The study objective was to identify the perceptions of children with sickle cell disease (SCD) in the school environment. METHODS: Semistructured interviews (N = 14) were conducted with pediatric patients ages 6 to 10 who attended Metro Nashville Public Schools. These participants were recruited through the Vanderbilt Sickle Cell Disease Clinic. Participants were asked about the perceived efficacy of their teachers to (1) understand SCD; (2) communicate with students regarding SCD; (3) handle an SCD-related pain episode in school; and (4) identify methods to compensate for school absenteeism associated with an SCD diagnosis...
November 1, 2018: Pediatric Blood & Cancer
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