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Pain children emergency

Parminder Singh
Vitamin D is essential for the maintenance of calcium and phosphorus homeostasis, skeletal growth and various other metabolic processes. The prevalence of vitamin D deficiency in India is 50-90% in various studies. Factors such as low sunlight exposure, age-related decrease in cutaneous synthesis, and low dietary intake of vitamin D contribute to the high prevalence of vitamin D inadequacy which has emerged as a highly pervasive condition. Bone diseases such as rickets in children, osteomalacia and osteoporosis in adults are related with vitamin D insufficiency...
January 2018: Journal of the Association of Physicians of India
Maisam Abu-El-Haija, Mark E Lowe
Pediatric pancreatitis is an emerging field with an increasing incidence of disease. Management of pediatric pancreatitis is understudied and, therefore, extrapolated from adult studies (although the etiologies are different). There is evidence that feeding is safe in mild acute pancreatitis in children without increased pain or length of stay. Studies are needed to predict course of the disease, disease severity, and risk of chronic pancreatitis in children.
December 2018: Gastroenterology Clinics of North America
Marie R Waterhouse, Phung K Pham, Todd P Chang
OBJECTIVES: Adolescent female patients who are not sexually active and who present to a pediatric emergency department with abdominal pain require a full bladder prior to transabdominal ultrasound. Procedures to fill the bladder are largely institution or provider dependent. We examined adolescent females' attitudes and opinions toward 2 common methods of bladder filling, intravenous fluid administration and transurethral Foley catheter placement, by means of a Q-sort study. METHODS: Two convenience samples of adolescent female patients in the pediatric emergency department at an academic children's hospital participated in the study...
October 17, 2018: Pediatric Emergency Care
Antonino Granata, Caterina Gandolfo, Carlo Acierno, Marcello Piazza, Gaetano Burgio, Mario Traina
BACKGROUND: While coins are still the most common foreign bodies swallowed by children, ingestion of batteries has become more frequent among children due to the increasing access to electronic toys and devices. Coin battery ingestion is potentially life threatening for children. Aortoesophageal fistula is the most common cause of death in children who have swallowed coin batteries, and there have not been any reported survivors. CASE PRESENTATION: A 3-year-old Caucasian girl presented to the emergency room of a community hospital complaining of abdominal pain...
October 18, 2018: Journal of Medical Case Reports
Stefan J Friedrichsdorf, Donna Eull, Christian Weidner, Andrea Postier
Introduction: Pain remains common, underrecognized, and undertreated in children's hospitals and pediatric clinics. Over 200,000 patients experience needle pain annually in our institution, caused by blood draws, intravenous access, vaccinations, and injections on all inpatient units, emergency departments, outpatient laboratories, and ambulatory clinics. Objectives: We implemented a hospital-based, system-wide initiative called the "Children's Comfort Promise," and created a new standard of care for needle procedures that required staff to consistently offer 4 strategies: (1) topical anesthetics, (2) sucrose or breastfeeding for infants 0 to 12 months, (3) comfort positioning (including swaddling, skin-to-skin, or facilitated tucking for infants; sitting upright for children), and (4) age-appropriate distraction...
September 2018: Pain Reports (Baltimore, Md.)
Kassi Shave, Samina Ali, Shannon D Scott, Lisa Hartling
BACKGROUND: Children experience multiple painful procedures when being cared for in emergency departments (EDs). Unfortunately, evidence-based interventions to manage such pain and distress are under-utilized across EDs. Caregivers are uniquely positioned and invested to advocate for the adaptation of such evidence into practice. Our objective was to gather information from caregivers of children experiencing procedural pain in the ED to inform the development of a novel, caregiver-focused knowledge translation (KT) tool...
October 13, 2018: BMC Pediatrics
Nobuhito Nakamura, Takahiro Mihara, Toshiyuki Hijikata, Takahisa Goto, Koui Ka
BACKGROUND: Emergence agitation (EA) is a frequent phenomenon in children recovering from general anaesthesia and increases the risk of self-injury. Previously, our group reported that stimulating the heart 7 (HT7) acupuncture point bilaterally using two neuromuscular transmission monitoring devices (NTMs) decreased the incidence of EA. However, bilateral stimulation is a barrier to clinical use because two NTMs are needed for one patient. OBJECTIVE: The objective of this study was to examine the efficacy of unilateral electrical stimulation of HT7 using an NTM to prevent EA in children...
2018: PloS One
Dmitry Tumin, Rebecca Miller, Mohammed Hakim, Shabana Z Shafy, David Drees, Sharon Wrona, Timothy P Smith, Joseph D Tobias, Tarun Bhalla
OBJECTIVES: To retrospectively characterize the rate of referrals to an outpatient chronic pain clinic among adolescents with chronic pain, and to identify factors associated with referral. METHODS: Adolescents 13-18 years of age seen in 2010-2015 at outpatient clinics associated with Nationwide Children's Hospital (NCH) and diagnosed with chronic pain were included if they lived near NCH and had not been previously referred to the NCH outpatient chronic pain clinic...
October 9, 2018: Clinical Journal of Pain
Yusheng Yao, Chao Yu, Xiaolan Zhang, Yanhua Guo, Xiaochun Zheng
BACKGROUND: Dexmedetomidine can prolong the duration of action of a local anesthetic agent, but the route of administration that is the most beneficial remains unclear. The purpose of this study was to compare the clinical effectiveness of caudal or intravenous dexmedetomidine administration on postoperative analgesia in children undergoing inguinal hernia repair given caudal levobupivacaine. METHODS: This was a prospective, randomized, double-blinded, placebo-controlled trial...
October 2018: Paediatric Anaesthesia
Sally E Jensen, Zabin S Patel, Robert Listernick, Joel Charrow, Jin-Shei Lai
This secondary data analysis qualitatively identified salient concerns reported by individuals with Neurofibromatosis Type 1 (NF1)-associated plexiform neurofibromas (pNFs) at different stages of development. Past literature has focused on overall symptomatology, but has not examined nuances in how these symptoms are experienced across developmental phases. Therefore, we aimed to identify commonalities and differences in symptom experiences across age groups to better assist individuals to adjust to symptoms across the lifespan...
October 8, 2018: Journal of Clinical Psychology in Medical Settings
T Pavelka, M Salášek
Anterior penetrating sacral injuries in children are extremely rare. These injuries are coupled with both a high energy mechanism (combat injury, motor vehicle accidents) and with foreign body impalement. The treatment is individual, laparotomy with penetrating wound exploration is indicated, osteosynthesis is performed in case of grossly displaced fractures, in an unstable injury to the posterior pelvic ring, and urgently in case of a neurological injury. The case report describes a 14-year-old girl with a left-sided anterior penetrating sacral injury at the level of S2/S3, who was injured during a bicycle accident (impalement on handlebars)...
2018: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
Niki Oikonomopoulou, Concepción Míguez-Navarro, Arístides Rivas-García, Mercedes García Gamiz, Rosario López-López, Paloma Oliver-Sáez, Bibiana Riaño-Méndez, Tamara Farfan-Orte, Zulema Lobato-Salinas, Júlia Rúbies-Olives, Priscila Llena-Isla, Encarnación María Lancho-Monreal
BACKGROUND: Acute appendicitis (AA) is one of the most frequent surgical pathologies in pediatrics. OBJECTIVES: To investigate the utility of proadrenomedullin (pro-ADM) for the diagnosis of AA. METHODS: Prospective, analytical, observational, and multicenter study conducted in 6 pediatric emergency departments. Children up to 18 years of age with suspected AA were included. Clinical, epidemiological, and analytical data were collected. RESULTS: We studied 285 children with an average age of 9...
September 26, 2018: American Journal of Emergency Medicine
Shinichi Fukuhara, Yoshimichi Yamaguchi
Ultrasonography can be useful in the evaluation of children with abdominal complaints and may be the initial imaging modality in patients presenting with a newly recognized abdominal mass. Hepatoblastoma is an uncommon cause of acute abdominal pain in children and can rarely metastasize to the heart through vascular invasion. We report a case in which a 4-year-old girl who presented to the emergency department with abdominal pain promptly underwent point-of-care ultrasound and was subsequently diagnosed with intracardiac invasion of an abdominal tumor...
October 2018: Pediatric Emergency Care
Christina Conrad, Parita Soni, Vasanth Coorg, Benjamin Thompson, Jared Muenzer, Zebulon Timmons, Blake Bulloch
PURPOSE: Undertreatment of pain by caregivers before presentation to the pediatric emergency department (ED) has been well documented. What has yet to be elucidated are the reasons why caregivers fail to adequately treat pain before arrival in the ED and whether there are differences based on ethnic background or age of the child. The objectives of this study were to determine the barriers to giving pain medication for injuries before ED arrival and to determine if there are any ethnic- or age-related variations to giving pain relief at home...
October 2, 2018: Pediatric Emergency Care
Li-Qin Li, Cong Wang, Hong-Yu Xu, Hong-Liu Lu, Hou-Zhong Zhang
Dexmedetomidine is a highly selective α2 receptor agonist, this study aimed to investigate the effects of different doses of intranasal dexmedetomidine on the preoperative sedation and postoperative agitation in pediatric with total intravenous anesthesia (TIVA) for adenoidectomy with or without tonsillectomy.This is a double-blind placebo-controlled randomized trial. Pediatric were randomly divided into the D1, D2, and S groups, each group contained 30 patients. Twenty-five to 40 minutes before surgery, the D1 and D2 groups received intranasally dexmedetomidine 1 μg kg or 2 μg kg, respectively, while the S group received saline of the same volume...
September 2018: Medicine (Baltimore)
Chelsea R Majerus, Trevor L Tredway, Nicole K Yun, James M Gerard
OBJECTIVES: Previous studies have not evaluated the utility of obtaining chest radiographs (CXR) in patients with acute asthma exacerbation reporting chest pain. The aims of this study were to evaluate the symptom of chest pain as a predictor for clinicians obtaining a CXR in these patients and to evaluate chest pain as a predictor of a positive CXR finding. METHODS: This was a retrospective chart review of patients, ages 2 to 18 years, presenting for acute asthma exacerbation to the emergency department from August 1, 2014, to March 31, 2016...
September 25, 2018: Pediatric Emergency Care
Michael C McCrory, Sophia S Wang, Avinash K Shetty, Thomas W McLean, Patrick E Lantz, Michael L Cannon
BACKGROUND: Hemophagocytic lymphohistiocytosis (HLH) is an uncommon hyperinflammatory condition in children that may acutely mimic septic shock. Sudden out-of-hospital cardiac arrest in children is also uncommon and may be of unclear etiology upon initial presentation. CASE REPORT: A 10-year-old previously healthy child presented with sudden cardiac arrest after an insidious course of throat pain, fever, and progressive altered mental status. He was subsequently diagnosed with Epstein-Barr virus-associated HLH and suffered cerebral edema and death...
September 22, 2018: Journal of Emergency Medicine
Lydia H Pecker, Sarah Kappa, Adam Greenfest, Deepika S Darbari, Robert Sheppard Nickel
OBJECTIVE: To evaluate the impact of an initiative to increase hydroxyurea use among children with sickle cell anemia (SCA) who presented to the emergency department (ED). STUDY DESIGN: This observational cohort study included children with SCA not taking hydroxyurea who presented to the ED with pain or acute chest syndrome and then attended a Quick-Start Hydroxyurea Initiation Project (Q-SHIP) session. A Q-SHIP session includes a hematologist-led discussion on hydroxyurea, a video of patients talking about hydroxyurea, and a direct offer to start hydroxyurea...
October 2018: Journal of Pediatrics
Matthew J Snyder, Marjorie Guthrie, Stephen Cagle
Appendicitis is one of the most common causes of acute abdominal pain in adults and children, with a lifetime risk of 8.6% in males and 6.7% in females. It is the most common nonobstetric surgical emergency during pregnancy. Findings from the history, physical examination, and laboratory studies aid in the diagnosis of acute appendicitis. Right lower quadrant pain, abdominal rigidity, and periumbilical pain radiating to the right lower quadrant are the best signs for ruling in acute appendicitis in adults. Absent or decreased bowel sounds, a positive psoas sign, a positive obturator sign, and a positive Rovsing sign are most reliable for ruling in acute appendicitis in children...
July 1, 2018: American Family Physician
S Salvatore, L Pensabene, O Borrelli, M Saps, N Thapar, D Concolino, A Staiano, Y Vandenplas
The gut-brain axis has recently emerged as a key modulator of human health and the intestinal microbiome has a well-recognised pivotal role in this strong connection. The aim of this narrative review is to update and summarise the effect and clinical applicability of probiotics in paediatric neurogastroenterology. The Cochrane Database and PubMed were searched using keywords relating to different subtypes of functional gastrointestinal disorders (FGIDs) and their symptoms, those relating to the CNS and related neurological or behavioural dysfunction as well as 'probiotic' OR 'probiotics'...
September 10, 2018: Beneficial Microbes
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