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https://www.readbyqxmd.com/read/28332374/comparison-of-dexmedetomidine-and-fentanyl-as-an-adjuvant-to-ropivacaine-for-postoperative-epidural-analgesia-in-pediatric-orthopedic-surgery
#1
Sang Jun Park, Seokyung Shin, Shin Hyung Kim, Hyun Woo Kim, Seung Hyun Kim, Hae Yoon Do, Yong Seon Choi
PURPOSE: Opioids are commonly used as an epidural adjuvant to local anesthetics, but are associated with potentially serious side effects, such as respiratory depression. The aim of this study was to compare the efficacy and safety of dexmedetomidine with that of fentanyl as an adjuvant to epidural ropivacaine in pediatric orthopedic surgery. MATERIALS AND METHODS: This study enrolled 60 children (3-12 years old) scheduled for orthopedic surgery of the lower extremities and lumbar epidural patient-controlled analgesia (PCA)...
May 2017: Yonsei Medical Journal
https://www.readbyqxmd.com/read/28328689/adult-chest-pain-in-the-pediatric-emergency-department-treatment-and-timeliness-from-door-in-to-door-out
#2
Jeffrey H Sacks, Peter B Flueckiger, Philip R Spandorfer, William T Mahle, Brian E Costello
OBJECTIVES: The American College of Cardiology Foundation/American Heart Association guidelines for acute coronary syndrome (ACS) recommend immediate aspirin (ASA) administration, an electrocardiogram (ECG) in less than 10 minutes, and a door-in to door-out (DIDO) time less than 30 minutes for interfacility transfer. We sought to determine if compliance is hindered when adults with suspected ACS present to pediatric facilities. METHODS: Visits to the 2 tertiary care emergency departments of a pediatric healthcare system using an adult chest pain protocol were examined from October 2006 to September 2012...
March 21, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28291658/how-do-they-get-here-does-the-method-of-transportation-impact-salvage-for-patients-with-testicular-torsion
#3
D A Weiss, N Tsarouhas, M C Carr, A Kalmus, S A Zderic
INTRODUCTION: A growing number of patients are arriving at our tertiary care center for evaluation of possible testicular torsion using ambulance or helicopter transport. In many cases the parents arrive by car before the patient arrives. Are these advanced methods of medical transport worth the expense and risk in the case of suspected testicular torsion? OBJECTIVE: We evaluated the total number of patients presenting to our emergency room for suspected testicular torsion to see if the means of transport affected testicular survival...
January 23, 2017: Journal of Pediatric Urology
https://www.readbyqxmd.com/read/28283018/tramadol-vs-dexmedetomidine-for-emergence-agitation-control-in-pediatric-patients-undergoing-adenotonsillectomy-with-sevoflurane-anesthesia-prospective-randomized-controlled-clinical-study
#4
Nurdan Bedirli, Mehmet Akçabay, Ulku Emik
BACKGROUND: This study was designed to compare the efficacy of an intraoperative single dose administration of tramadol and dexmedetomidine on hemodynamics and postoperative recovery profile including pain, sedation, emerge reactions in pediatric patients undergoing adenotonsillectomy with sevoflurane anesthesia. METHODS: Seventy-seven patient, aged 2-12, undergoing adenotonsillectomy with sevoflurane anesthesia was enrolled in this study. Patients were randomly assigned to receive either intravenous 2 mg/kg tramadol (Group T; n = 39) or 1 μg/kg dexmedetomidine (Group D; n = 38) after intubation...
March 11, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28281001/acute-complete-paraplegia-of-8-year-old-girl-caused-by-spinal-cord-infarction-following-minor-trauma-complicated-with-longitudinal-signal-change-of-spinal-cord
#5
Kosei Nagata, Yuji Tanaka, Hiroyuki Kanai, Yasushi Oshima
INTRODUCTION: Spinal cord infarction followed by minor trauma in pediatric patients is rare and causes serious paralysis. Fibrocartilaginous embolism (FCE) is a possible diagnosis and there have been no consecutive magnetic resonance imaging (MRI) reports. Here, we report a case of an acute complete paraplegia with spinal cord infarction and longitudinal spinal cord signal change following minor trauma in an 8-year-old girl. CASE DESCRIPTION: An 8-year-old girl presented to our hospital emergency services with total paraplegia 2 h after she hit her back and neck after doing a handstand and falling down...
March 9, 2017: European Spine Journal
https://www.readbyqxmd.com/read/28272118/common-pediatric-pain-disorders-and-their-clinical-associations
#6
Theresa Donnelly, Aneeka Bott, Minh Bui, Shuxiang Goh, Tiina Jaaniste, Cindy Chapman, Matthew Crawford, John L Hopper, David Champion
BACKGROUND: Common childhood pain conditions (non-migraine headache, migraine, recurrent abdominal pain, growing pains, low back pain) and persistent pains are often associated with each other and have significant implications in later life. Emerging evidence suggests additional associations between these pain conditions and restless legs syndrome, iron deficiency, anxiety and depression. The aim of this cross-sectional study in pediatric twin individuals and their siblings was to investigate these associations...
March 7, 2017: Clinical Journal of Pain
https://www.readbyqxmd.com/read/28265317/inguinoscrotal-pathology
#7
REVIEW
Luis Guerra, Michael Leonard
Infants, children, and adolescents with inguinoscrotal pathology comprise a significant proportion of emergency department and outpatient visits. Visits to the emergency department primarily comprise individuals presenting with scrotal pain due to testicular torsion or torsion of the testicular appendages. At such time, immediate urological consultation is sought. Outpatient visits comprise those individuals with undescended testes, hydroceles, and varicoceles. Rare, but important problems, such as pediatric testicular tumours, may also present in the office setting...
January 2017: Canadian Urological Association Journal, Journal de L'Association des Urologues du Canada
https://www.readbyqxmd.com/read/28262381/pediatric-sepsis-secondary-to-an-occult-dental-abscess-a%C3%A2-case-report
#8
Peter Holmberg, Thomas Hellmich, James Homme
BACKGROUND: In general, hematogenous spread of bacteria in children is uncommon. Bacteremia, however, is a known complication of dental procedures and severe caries, but is infrequently associated with primary, asymptomatic, non-procedural-related, dentoalveolar infection. CASE REPORT: The patient is a 7-year-old previously healthy boy who presented to the Emergency Department (ED) with "fever, mottling, and shaking chills." In the ED, he appeared systemically ill with fever, mottling, delayed capillary refill, and rigors...
March 2, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28258881/ultrasound-for-diagnosis-of-appendicitis-in-a-community-hospital-emergency-department-has-a-high-rate-of-nondiagnostic-studies
#9
Scott M Alter, Brian Walsh, Patrick J Lenehan, Richard D Shih
BACKGROUND: Radiation concerns are changing the way emergency physicians evaluate patients. This is especially prevalent in pediatrics, and exemplified by abdominal pain management. Large academic center-based studies suggest appendix ultrasound (U/S) is sensitive and specific for appendicitis, with low nondiagnostic rates. OBJECTIVES: We sought to determine the diagnostic rate of appendix U/S and incidence of follow-up computed tomography (CT) imaging for pediatric patients at a community hospital...
February 28, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28248841/ewings-sarcoma-a-case-of-respiratory-distress-and-opacification-that-was-not-pneumonia
#10
Jordee M Wells, Sandra P Spencer
The Ewing sarcoma family of tumors typically appears in the second decade of life with regional pain and swelling of a long bone. The following case presents a pediatric patient, aged 4 years, given a diagnosis of Ewing sarcoma of the rib with the initial presentation of respiratory distress, hypoxia, and pleural effusion. Respiratory distress accounts for a large majority of emergency department visits annually, so it is the distinct responsibility of the emergency department physician to avoid premature closure in attributing the most common diagnoses to account for the presenting symptoms...
February 28, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28238501/is-tachycardia-at-discharge-from-the-pediatric-emergency-department-a-cause-for-concern-a%C3%A2-nonconcurrent-cohort-study
#11
Paria M Wilson, Todd A Florin, Guixia Huang, Matthew Fenchel, Matthew R Mittiga
STUDY OBJECTIVE: We evaluate the association between discharge tachycardia and (1) emergency department (ED) and urgent care revisit and (2) receipt of clinically important intervention at the revisit. METHODS: The study included a nonconcurrent cohort of children aged 0 to younger than 19 years, discharged from 2 pediatric EDs and 4 pediatric urgent care centers in 2013. The primary exposure was discharge tachycardia (last recorded pulse rate ≥99th percentile for age)...
February 23, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28238158/acute-kidney-injury-during-a-pediatric-sickle-cell-vaso-occlusive-pain-crisis
#12
Sujatha Baddam, Inmaculada Aban, Lee Hilliard, Thomas Howard, David Askenazi, Jeffrey D Lebensburger
BACKGROUND: Patients who develop sickle cell disease (SCD) nephropathy are at a high risk for mortality. The pathophysiology of vaso-occlusive pain crisis may contribute to acute kidney injury (AKI). Non-steroidal anti-inflammatory drugs, known inducers of AKI, are used to treat pain crises. Multiple gaps exist in the knowledge about the impact of AKI in SCD. METHODS: We conducted a 2-year retrospective review of AKI events in patients admitted for vaso-occlusive crisis...
February 25, 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/28228009/emergency-ultrasonography-of-the-gastrointestinal-tract-of-children
#13
Jae-Yeon Hwang
Ultrasonography (US) is widely used to evaluate most body parts in pediatric patients because it is simple, noninvasive, easy to use, and applicable in a wide variety of clinical situations. US is the modality of choice for the initial evaluation of acute abdominal pain in pediatric patients because of their small body habitus and the presence of less fat tissue in the abdominal wall and peritoneal cavity. The most important factor in performing pediatric emergency US is the graded compression technique and selection of the proper transducer...
January 25, 2017: Ultrasonography
https://www.readbyqxmd.com/read/28216208/a-rare-case-of-pediatric-lumbar-spinal-ependymoma-mimicking-meningitis
#14
Ezeali Mike Ekuma, Kiyoshi Ito, Akihiro Chiba, Yosuke Hara, Kohei Kanaya, Tetsuyoshi Horiuchi, Samuel Ohaegbulam, Kazuhiro Hongo
Spontaneous acute subarachnoid hemorrhage (SAH) from lumbar ependymoma in children is rare. We report a case of a14-year-old boy who developed sudden radicular low back pain while playing baseball. He was initially managed conservatively in a local hospital for suspected lumbar disc herniation, but later developed meningeal symptoms and fever before being referred to our hospital. There he underwent a diagnostic lumbar puncture in the emergency room; his cerebrospinal fluid suggested an SAH. Physical examination showed meningeal signs and cauda equina features...
February 12, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28214369/diagnostic-accuracy-of-history-physical-exam-laboratory-tests-and-point-of-care-ultrasound-for-pediatric-acute-appendicitis-in-the-emergency-department-a-systematic-review-and-meta-analysis
#15
Roshanak Benabbas, Mark Hanna, Jay Shah, Richard Sinert
BACKGROUND: Acute appendicitis (AA) is the most common surgical emergency in children. Accurate and timely diagnosis is crucial but challenging due to atypical presentations and the inherent difficulty of obtaining a reliable history and physical examination in younger children. OBJECTIVES: To determine the utility of history, physical exam, laboratory tests, Pediatric Appendicitis Score (PAS) and Emergency Department-Point-of-Care Ultrasound (ED-POCUS) in the diagnosis of AA in ED pediatric patients...
February 18, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28193257/bell-s-palsy-in-children-bellpic-protocol-for-a-multicentre-placebo-controlled-randomized-trial
#16
Franz E Babl, Mark T Mackay, Meredith L Borland, David W Herd, Amit Kochar, Jason Hort, Arjun Rao, John A Cheek, Jeremy Furyk, Lisa Barrow, Shane George, Michael Zhang, Kaya Gardiner, Katherine J Lee, Andrew Davidson, Robert Berkowitz, Frank Sullivan, Emily Porrello, Kim Marie Dalziel, Vicki Anderson, Ed Oakley, Sandy Hopper, Fiona Williams, Catherine Wilson, Amanda Williams, Stuart R Dalziel
BACKGROUND: Bell's palsy or acute idiopathic lower motor neurone facial paralysis is characterized by sudden onset paralysis or weakness of the muscles to one side of the face controlled by the facial nerve. While there is high level evidence in adults demonstrating an improvement in the rate of complete recovery of facial nerve function when treated with steroids compared with placebo, similar high level studies on the use of steroids in Bell's palsy in children are not available. The aim of this study is to assess the utility of steroids in Bell's palsy in children in a randomised placebo-controlled trial...
February 13, 2017: BMC Pediatrics
https://www.readbyqxmd.com/read/28190665/intranasal-fentanyl-and-inhaled-nitrous-oxide-for-fracture-reduction-the-fan-observational-study
#17
J Hoeffe, E Doyon Trottier, B Bailey, D Shellshear, M Lagacé, C Sutter, G Grimard, R Cook, F E Babl
INTRODUCTION: Procedural sedation and analgesia (PSA) are frequently used for fracture reduction in pediatric emergency departments (ED). Combining intranasal (IN) fentanyl with inhalation of nitrous oxide (N2O) allow for short recovery time and obviates painful and time-consuming IV access insertions. METHODS: We performed a bicentric, prospective, observational cohort study. Patients aged 4-18years were included if they received combined PSA with IN fentanyl and N2O for the reduction of mildly/moderately displaced fracture or of dislocation...
January 5, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28187061/bronchopulmonary-disease-caused-by-flagellated-protozoa-infection-in-15-chinese-children
#18
Jinrong Liu, Shaogang Li, Huimin Li, Yimu Fan, Haiming Yang, Hui Xu, Yuelin Shen, Shunying Zhao
BACKGROUND: Bronchopulmonary disease caused by flagellated protozoa infection (BPFP) is thought to be rare in children but may be an emerging or underestimated disease, especially in developing countries. METHODS: In this study, we retrospectively reviewed records of 15 patients who were presented with a cough, wheezing or bronchopulmonary disease of unknown causes during admission, and patients who were finally diagnosed with BPFP from January 2014 to January 2015 were enrolled...
April 2017: Pediatric Infectious Disease Journal
https://www.readbyqxmd.com/read/28186860/traumatic-rib-injury-patterns-imaging-pitfalls-complications-and-treatment
#19
Brett S Talbot, Christopher P Gange, Apeksha Chaturvedi, Nina Klionsky, Susan K Hobbs, Abhishek Chaturvedi
The ribs are frequently affected by blunt or penetrating injury to the thorax. In the emergency department setting, it is vital for the interpreting radiologist to not only identify the presence of rib injuries but also alert the clinician about organ-specific injury, specific traumatic patterns, and acute rib trauma complications that require emergent attention. Rib injuries can be separated into specific morphologic fracture patterns that include stress, buckle, nondisplaced, displaced, segmental, and pathologic fractures...
March 2017: Radiographics: a Review Publication of the Radiological Society of North America, Inc
https://www.readbyqxmd.com/read/28165762/extended-release-guanfacine-in-pediatric-anxiety-disorders-a-pilot-randomized-placebo-controlled-trial
#20
Jeffrey R Strawn, Scott N Compton, Brigitte Robertson, Anne Marie Albano, Mohamed Hamdani, Moira A Rynn
OBJECTIVE: This is a feasibility study evaluating the safety, tolerability, and potential anxiolytic efficacy of the α2 agonist guanfacine extended-release (GXR) in children and adolescents with generalized anxiety disorder (GAD), separation anxiety disorder (SAD), or social phobia/social anxiety disorder. METHODS: Youth aged 6-17 years with a primary diagnosis of GAD, SAD, and/or social anxiety disorder were treated with flexibly dosed GXR (1-6 mg daily, n = 62) or placebo (n = 21) for 12 weeks...
February 2017: Journal of Child and Adolescent Psychopharmacology
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