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Pain , pediatrics, emergency

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https://www.readbyqxmd.com/read/29145243/obstructive-internal-hernia-caused-by-mesodiverticular-bands-in-children-two-case-reports-and-a-review-of-the-literature
#1
Mirko Bertozzi, Berardino Melissa, Elisa Magrini, Giuseppe Di Cara, Susanna Esposito, Antonino Apignani
INTRODUCTION: The mesodiverticular band (MDB) is an embryologic remnant of the vitelline circulation, which carries the arterial supply to the Meckel diverticulum. In the event of an error of involution, a patent or nonpatent arterial band persists and extends from the mesentery to the apex of the antimesenteric diverticulum. This creates a snare-like opening through which bowel loops may herniate and become obstructed. This report describes 2 rare cases of small bowel occlusion owing to an internal hernia caused by a MDB...
November 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29126579/chest-pain-as-a-manifestation-of-hypokalemia-in-a-pediatric-patient
#2
Jonathan S Schiffman
Patients presenting to the emergency department with chest pain are common and a cause of significant concern to patients and families and physicians alike. The causes of chest pain are myriad. These causes span diverse categories including cardiovascular, respiratory, abdominal and gastrointestinal, musculoskeletal, psychiatric, hematologic and oncologic, and neurologic Thull-Freedman (2010) [1]. These diverse etiologies present a diagnostic and management challenge to the ER physician who is tasked to minimize unnecessary diagnostics while not missing any significant disease...
November 7, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29122973/capsaicin-cream-for-treatment-of-cannabinoid-hyperemesis-syndrome-in-adolescents-a-case-series
#3
Jessica Graham, Michael Barberio, George Sam Wang
Cannabinoid hyperemesis syndrome (CHS) is an underrecognized diagnosis among adolescents. In the adult literature, it is characterized as nausea, vomiting, and abdominal pain in patients with chronic marijuana use. CHS is often refractory to the standard treatment of nausea and vomiting. Unconventional antiemetics, such as haloperidol, have been successful in alleviating symptoms; however, even 1 dose of haloperidol can lead to grave adverse effects, such as dystonia, extrapyramidal reactions, and neuroleptic malignant syndrome...
November 9, 2017: Pediatrics
https://www.readbyqxmd.com/read/29112108/nitrous-oxide-70-for-procedural-analgosedation-in-a-pediatric-emergency-department-with-or-without-intranasal-fentanyl-analgesic-efficacy-and-adverse-events-if-combined-with-intranasal-fentanyl
#4
Michelle Seiler, Markus A Landolt, Georg Staubli
OBJECTIVES: Nitrous oxide 70% (N20 70%) is an excellent medication for procedural analgosedation in a pediatric emergency department. However, its analgesic efficacy remains uncertain for painful procedures; therefore, a combination with intranasal fentanyl (INF), an opioid, was suggested. This study aimed at observing and assessing the analgesic efficacy and rate of adverse events using N20 70% with and without INF. METHODS: Children who received N20 70% in a tertiary children's hospital emergency department from January 1, 2014 to June 30, 2015 were included in this observational study with prospective data collection...
July 3, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29108736/a-randomized-double-blind-trial-comparing-the-effect-on-pain-of-an-oral-sucrose-solution-vs-placebo-in-children-1-to-3%C3%A2-months-old-undergoing-simple-venipuncture
#5
Serge Gouin, Nathalie Gaucher, Denis Lebel, Marie Pier Desjardins
BACKGROUND: Few clinical trials evaluating the efficacy of oral sweet solutions for procedures in the emergency department (ED) have been published. OBJECTIVES: To compare the efficacy of an oral sucrose solution vs. a placebo in reducing pain in infants undergoing venipuncture without cannulation. METHODS: A randomized, double-blinded clinical trial was conducted in a pediatric ED. Infants 1 to 3 months old were randomly allocated to receive 2 mL of 88% sucrose or 2 mL of placebo, 2 min prior to venipuncture...
November 3, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29084069/patient-reported-pain-outcomes-for-children-attending-an-emergency-department-with-limb-injury
#6
Adrianna D M Clapp, Jennifer Thull-Freedman, Tatum Mitra, Brendan Cord Lethebe, Tyler Williamson, Antonia Schirmer Stang
OBJECTIVES: The aim of this study was to describe patient-reported pain outcomes at various stages of an emergency department (ED) visit for pediatric limb injury. METHODS: This prospective cohort consisted of 905 patients aged 4 to 17 years with acute limb injury and a minimum initial pain score of 4/10. Patients reported pain scores and treatments offered and received at each stage of their ED visit. Multiple logistic regression was used to identify predictors for severe pain on initial assessment and moderate or severe pain at ED discharge...
October 27, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29077648/initial-pain-management-in-pediatric-acute-pancreatitis-opioid-vs-non-opioid
#7
Amit S Grover, Paul D Mitchell, Shannon F Manzi, Victor L Fox
Nearly all patients with acute pancreatitis (AP) experience some degree of abdominal pain that is severe enough to prompt medical evaluation and necessitate analgesia. Effective analgesia is a priority in caring for such patients. Despite its importance, strategies for pain management in AP have been poorly studied, particularly in the field of pediatrics. Currently, no published data examine the management of pain due to acute pancreatitis in children at the time of initial presentation. Management approaches are often extrapolated from adult practice and based on anecdotal experience in the absence of objective data...
October 27, 2017: Journal of Pediatric Gastroenterology and Nutrition
https://www.readbyqxmd.com/read/29061192/an-unusual-complication-of-the-traditional-treatment-of-a-closed-fracture-generalized-tetanus-a-case-report
#8
Landry W Tchuenkam, Emmanuel K Ndame, Marc L Guifo, Celestin Danwang, Ginette C Kalla, Arthur Essomba
BACKGROUND: Tetanus is a severe infectious disease that can lead to death. The clinical manifestations are due to an exotoxin secreted by Clostridium tetani, a spore-producing Gram-positive bacillus. The penetration of the germ is made through a skin opening, independently of the size of the wound. CASE PRESENTATION: A 13-year-old black African boy of the Bantu ethnic group with unknown tetanus vaccination status presented to our pediatric emergency room for the management of chest and vertebral pains which started a few days after traditional treatment by scarification and herbal and leaf ointment...
October 24, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/29054492/a-cost-analysis-of-an-interdisciplinary-pediatric-chronic-pain-clinic
#9
Nicole E Mahrer, Jeffrey I Gold, Michael Luu, Patricia Herman
Chronic pain is characterized by high rates of functional impairment, healthcare utilization, and associated costs. Research supports the use of comprehensive, interdisciplinary treatment approaches. However, many hospitals hesitate to offer this full range of services, especially to Medi-Cal/Medicaid patients whose services are reimbursed at low rates. This cost analysis examines the impact on hospital and insurance costs of patients' enrollment in an interdisciplinary pediatric pain clinic, which includes medication management, psychotherapy, biofeedback, acupuncture, and massage...
October 17, 2017: Journal of Pain: Official Journal of the American Pain Society
https://www.readbyqxmd.com/read/29049268/patient-and-parent-satisfaction-with-sling-use-after-pediatric-upper-extremity-fractures-a-randomized-controlled-trial-of-a-customized-cast-sling-versus-standard-cast-and-sling
#10
Aristides I Cruz, Steven F DeFroda, Joseph A Gil, Heather Hansen, Alexandre Bolous, Michaela Procaccini, Mark R Zonfrillo
BACKGROUND: Long arm cast immobilization after operative and nonoperative treatment of pediatric upper extremity fractures is common. The use of a sling to aid in carrying the casted extremity as well as provide further immobilization is also common practice. Off-the-shelf slings vary in quality and fit, can be confusing for parents/patients to apply, and lead to frustration and dissatisfaction with its use. The purpose of this investigation was to compare patient/parent centered outcomes after the use of a customized sling compared with a standard sling by utilizing a prospective, randomized-controlled trial...
October 18, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/29049233/pediatric-types-i-and-vi-choledochal-cysts-complicated-with-acute-pancreatitis-and-spontaneous-perforation-a-case-report-and-literature-review
#11
Ching-Chung Tsai, Po-Kai Huang, Hsien-Kuan Liu, Yu-Tsun Su, Ming-Chun Yang, Ming-Lun Yeh
RATIONALE: Choledochal cysts are a congenital disorder of the common bile duct that can cause progressive biliary obstruction and biliary cirrhosis. They were classified by Todani into five types. Of these, type VI choledochal cysts are rarely reported in the literature. PATIENT CONCERNS: A 22-month-old girl presented with intermittent epigastralgia for approximately 10 days and fever for three days. Fasting and total parenteral nutrition were administered after admission...
October 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29048520/pain-acceptance-as-a-predictor-of-medical-utilization-and-school-absenteeism-in-adolescents-with-chronic-pain
#12
Michelle A Clementi, Grace S Kao, Evelyn Monico
Objective: Identifying factors contributing to high medical utilization and productivity loss is important, given the high cost of pediatric chronic pain. The current study examined chronic pain acceptance as a predictor of medical utilization and school absenteeism in adolescents with chronic pain. Methods: In all, 122 adolescents (aged 12-21 years) with chronic pain and their parents/guardians completed questionnaires assessing medical visits (past 6 months), medication usage, and number of school absences (past month)...
October 12, 2017: Journal of Pediatric Psychology
https://www.readbyqxmd.com/read/29048481/parental-bonding-in-adolescents-with-and-without-chronic-pain
#13
Subhadra Evans, Claudia Moloney, Laura C Seidman, Lonnie K Zeltzer, Jennie C I Tsao
Parental responses influence children's pain; however, the specific role of parental bonding in pediatric pain has not been examined. Depressive symptomology is frequently reported in children with chronic pain (CP) and may play a role in the relationship between parental bonding and pain. This study examined the connections between maternal/paternal bonding (perceived care and control) and symptoms of pain and depression in adolescents with CP and in healthy adolescents. Participants included 116 adolescents (aged 12-17) with CP ( n  = 55) and without ( n  = 61)...
August 29, 2017: Journal of Pediatric Psychology
https://www.readbyqxmd.com/read/29021235/oral-analgesics-utilization-for-children-with-musculoskeletal-injury-ouch-trial-an-rct
#14
RANDOMIZED CONTROLLED TRIAL
Sylvie Le May, Samina Ali, Amy C Plint, Benoit Mâsse, Gina Neto, Marie-Christine Auclair, Amy L Drendel, Ariane Ballard, Christelle Khadra, Edith Villeneuve, Stefan Parent, Patrick J McGrath, Grégoire Leclair, Serge Gouin
BACKGROUND: Musculoskeletal injuries (MSK-Is) are a common and painful condition among children that remains poorly treated in the emergency department (ED). We aimed to test the efficacy of a combination of an anti-inflammatory drug with an opioid for pain management of MSK-I in children presenting to the ED. METHODS: In this randomized, double-blinded, placebo-controlled trial, we enrolled children between 6 and 17 years presenting to the ED with an MSK-I and a pain score >29 mm on the visual analog scale (VAS)...
November 2017: Pediatrics
https://www.readbyqxmd.com/read/29016519/clinical-decision-rule-to-identify-orbital-wall-fracture-among-children-retrospective-derivation-and-validation-study
#15
So Hyun Paek, Jin Hee Jung, Young Ho Kwak, Do Kyun Kim, Jin Hee Lee, Jae Yun Jung, Sohee Oh
OBJECTIVES: Head and face injuries are leading causes of emergency department visits in children. There is yet no clinical decision rule on face CT such as pediatric head CT rules. The goal was to develop and validate a clinical decision rule for identifying orbital wall fractures in children with periorbital trauma in the emergency department. METHODS: This was a retrospective derivation and validation study. Children younger than 18 years who underwent orbit CT after periorbital trauma were included between January 2011 and December 2013 in 3 emergency centers...
October 9, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28992868/definitive-diagnosis-of-children-presenting-to-a-pediatric-emergency-department-with-fever-and-extremity-pain
#16
Nicolas V Vardiabasis, John A Schlechter
BACKGROUND: Children who present to the emergency department (ED) with complaint of fever and new-onset joint or extremity pain can be a diagnostic dilemma for many emergency and consulting physicians. OBJECTIVES: The purpose of our study was to identify the etiologies of pediatric fever and extremity pain presenting to a tertiary care pediatric ED and to define factors that were associated with advanced imaging, admission, and surgical intervention. METHODS: The electronic medical records of children presenting to our institution's pediatric ED with fever and extremity pain were retrospectively reviewed...
September 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28988737/hematometrocolpos-disguised-as-abdominal-pain
#17
Ramy Saleh, George Katzenbach, James Espinosa
BACKGROUND: Hematometrocolpos caused by an imperforate hymen is a common form of vaginal outflow obstruction. This is a rare pediatric anomaly that can present with atypical or vague symptomatology, such as abdominal pain or constipation or urinary retention in the setting of amenorrhea. It is essential to obtain a gynecologic history and inquire about menstrual cycles to properly evaluate a young female with such a common complaint as abdominal pain. Failure to perform a gynecologic examination in the emergency department setting may delay diagnosis and appropriate care for this rare condition, which can lead to serious complications...
November 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28982637/pediatric-chronic-patients-at-outpatient-clinics-a-study-in-a-latin-american-university-hospital
#18
Renata A Alveno, Caroline V Miranda, Caroline G Passone, Aurora R Waetge, Elza S Hojo, Sylvia C L Farhat, Vicente Odone-Filho, Uenis Tannuri, Werther B Carvalho, Magda Carneiro-Sampaio, Clovis A Silva
OBJECTIVE: To describe the characteristics of children and adolescentes with chronic diseases of outpatient clinics at a tertiary university hospital. METHODS: A cross-sectional study was performed with 16,237 patients with chronic diseases followed-up in one year. The data were collected through the electronic system, according to the number of physician appointments in 23 pediatric specialties. Patients were divided in two groups: children (0-9 years) and adolescents (10-19 years)...
October 2, 2017: Jornal de Pediatria
https://www.readbyqxmd.com/read/28982533/radiology-report-disclaimers-increase-the-use-of-abdominal-ct-in-the-work-up-of-pediatric-abdominal-pain
#19
Scott M Alter, Brian Walsh, Patrick J Lenehan, Richard D Shih
OBJECTIVE: Pediatric abdominal pain is commonly evaluated in the emergency department (ED) initially by ultrasonography (U/S). Radiology reports often include commentary about U/S limitations and possible need for additional testing or evaluation independent of study interpretation. We sought to determine if presence of a "disclaimer" is associated with additional imaging. METHODS: Design: Retrospective cohort. SETTING: Community ED with volume of 85,000 annual visits...
September 14, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28976457/revisiting-the-appendiceal-diameter-via-ultrasound-for-the-diagnosis-of-acute-appendicitis
#20
Henry P Chicaiza, Laurie Malia, Christine H Mulvey, Sharon R Smith
OBJECTIVES: This study aims to investigate the optimal outer appendiceal diameter via ultrasound for the diagnosis of acute appendicitis. METHODS: A retrospective chart review was conducted on patients (ages, 2-18 years) presenting to an urban pediatric emergency department between January 1, 2009 and December 31, 2010 with suspected acute appendicitis. Children were considered as having "suspected acute appendicitis" if they (1) presented with acute abdominal pain and had either a surgical consult or an abdominal ultrasound, or (2) presented or transferred with the stated suspicion of acute appendicitis...
October 2, 2017: Pediatric Emergency Care
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