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EM Pediatrics

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By Terren Trott
Elizabeth C Powell, Prashant V Mahajan, Genie Roosevelt, John D Hoyle, Rajender Gattu, Andrea T Cruz, Alexander J Rogers, Shireen M Atabaki, David M Jaffe, T Charles Casper, Octavio Ramilo, Nathan Kuppermann
STUDY OBJECTIVE: To describe the current epidemiology of bacteremia in febrile infants 60 days of age and younger in the Pediatric Emergency Care Applied Research Network (PECARN). METHODS: We conducted a planned secondary analysis of a prospective observational study of febrile infants 60 days of age and younger presenting to any of 26 PECARN emergency departments (2008 to 2013) who had blood cultures obtained. We excluded infants with significant comorbidities or critically ill appearance...
February 2018: Annals of Emergency Medicine
Sonal N Shah, Richard G Bachur, David L Simel, Mark I Neuman
Importance: Pneumonia is a leading cause of morbidity and mortality in children. It is important to identify the clinical symptoms and physical examination findings associated with pneumonia to improve timely diagnosis, prevent significant morbidity, and limit antibiotic overuse. Objective: To systematically review the accuracy of symptoms and physical examination findings in identifying children with radiographic pneumonia. Data Sources and Study Selection: MEDLINE and Embase (1956 to May 2017) were searched, along with reference lists from retrieved articles, to identify diagnostic studies of pediatric pneumonia across a broad age range that had to include children younger than age 5 years (although some studies enrolled children up to age 19 years); 3644 unique articles were identified, of which 23 met inclusion criteria...
August 1, 2017: JAMA: the Journal of the American Medical Association
Halden F Scott, Lina Brou, Sara J Deakyne, Allison Kempe, Diane L Fairclough, Lalit Bajaj
Importance: Improving emergency care of pediatric sepsis is a public health priority, but optimal early diagnostic approaches are unclear. Measurement of lactate levels is associated with improved outcomes in adult septic shock, but pediatric guidelines do not endorse its use, in part because the association between early lactate levels and mortality is unknown in pediatric sepsis. Objective: To determine whether the initial serum lactate level is associated with 30-day mortality in children with suspected sepsis...
March 1, 2017: JAMA Pediatrics
Steven M Green, Mark G Roback, Baruch Krauss
OBJECTIVE: The objective of this study was to assess predictors of emergency department (ED) ketamine-associated laryngospasm using case-control techniques. METHODS: We performed a matched case-control analysis of a sample of 8282 ED ketamine sedations (including 22 occurrences of laryngospasm) assembled from 32 prior published series. We sequentially studied the association of each of 7 clinical variables with laryngospasm by assigning 4 controls to each case while matching for the remaining 6 variables...
November 2010: Pediatric Emergency Care
Mohamed Eltorki, Daniel Rosenfield
No abstract text is available yet for this article.
January 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Leigh-Anne Cioffredi, Ravi Jhaveri
IMPORTANCE: Management of febrile children is an intrinsic aspect of pediatric practice. Febrile children account for 15% of emergency department visits and outcomes range from the presence of serious bacterial infection to benign self-limited illness. OBSERVATIONS: Studies from 1979 to 2015 examining febrile infants and children were included in this review. Management of febrile infants younger than 90 days has evolved considerably in the last 30 years. Increased rates of Escherichia coli urinary tract infections, increasing resistance to ampicillin, and advances in viral diagnostics have had an effect on the approach to caring for these patients...
August 1, 2016: JAMA Pediatrics
Jose E Irazuzta, Fatima Paredes, Viviana Pavlicich, Sara L Domínguez
OBJECTIVE: To assess the efficacy of a high-dose prolonged magnesium sulfate infusion in patients with severe, noninfectious-mediated asthma. DESIGN: Prospective, randomized, open-label study. SETTING: Twenty-nine-bed pediatric emergency department located in a children's hospital in Asuncion, Paraguay. PATIENTS: All patients of 6-16 years old who failed to improve after 2 hours of standard therapy for asthma. INTERVENTIONS: Subjects were randomized to receive magnesium sulfate, 50 mg/kg over 1 hour (bolus) or high-dose prolonged magnesium sulfate infusion of 50 mg/kg/hr for 4 hours (max, 8...
February 2016: Pediatric Critical Care Medicine
James W Antoon, Nicholas M Potisek, Jacob A Lohr
No abstract text is available yet for this article.
September 2015: Pediatrics in Review
Steve Cunningham, Aryelly Rodriguez, Tim Adams, Kathleen A Boyd, Isabella Butcher, Beth Enderby, Morag MacLean, Jonathan McCormick, James Y Paton, Fiona Wee, Huw Thomas, Kay Riding, Steve W Turner, Chris Williams, Emma McIntosh, Steff C Lewis
BACKGROUND: The American Academy of Pediatrics recommends a permissive hypoxaemic target for an oxygen saturation of 90% for children with bronchiolitis, which is consistent with the WHO recommendations for targets in children with lower respiratory tract infections. No evidence exists to support this threshold. We aimed to assess whether the 90% or higher target for management of oxygen supplementation was equivalent to a normoxic 94% or higher target for infants admitted to hospital with viral bronchiolitis...
September 12, 2015: Lancet
Andréa M C Ventura, Huei Hsin Shieh, Albert Bousso, Patrícia F Góes, Iracema de Cássia F O Fernandes, Daniela C de Souza, Rodrigo Locatelli Pedro Paulo, Fabiana Chagas, Alfredo E Gilio
OBJECTIVES: The primary outcome was to compare the effects of dopamine or epinephrine in severe sepsis on 28-day mortality; secondary outcomes were the rate of healthcare-associated infection, the need for other vasoactive drugs, and the multiple organ dysfunction score. DESIGN: Double-blind, prospective, randomized controlled trial from February 1, 2009, to July 31, 2013. SETTING: PICU, Hospital Universitário da Universidade de São Paulo, Brazil...
November 2015: Critical Care Medicine
Ban C H Tsui, Sara Horne, Jenkin Tsui, Gareth N Corry
BACKGROUND: In the event of cardiac arrest, cardiopulmonary resuscitation (CPR) is a well-established technique to maintain oxygenation of tissues and organs until medical equipment and staff are available. During CPR, chest compressions help circulate blood and have been shown in animal models to be a means of short-term oxygenation. In this study, we tested whether gentle chest pressure can generate meaningful tidal volume in paediatric subjects. METHODS: This prospective cohort pilot study recruited children under the age of 17 years and undergoing any surgery requiring general anaesthetic and endotracheal intubation...
July 2015: Resuscitation
Roshdi R Al-Metwalli, Hany A Mowafi, Salah A Ismail
PURPOSE: Extubation laryngospasm is frequently encountered in children undergoing upper airway surgery. Different drugs and techniques have been used for its treatment. The objective of this study was to examine gentle chest compression as an alternative to standard practice for relief of laryngospasm. METHODS: This study was conducted over 4 years on all children scheduled for elective tonsillectomy. During the first 2 years, extubation laryngospasm was managed with 100% O₂ with gentle positive pressure ventilation via a tight-fitting face mask (Standard-Practice Group), whereas in the following 2 years; laryngospasm was managed with 100% O₂ and concurrent gentle chest compression (Chest-Compression Group)...
December 2010: Journal of Anesthesia
Jennifer A Horst, Indi Trehan, Brad W Warner, Brian G Cohn
No abstract text is available yet for this article.
August 2015: Annals of Emergency Medicine
Anne M Gadomski, Melissa B Scribani
BACKGROUND: Bronchiolitis is an acute, viral lower respiratory tract infection affecting infants and is sometimes treated with bronchodilators. OBJECTIVES: To assess the effects of bronchodilators on clinical outcomes in infants (0 to 12 months) with acute bronchiolitis. SEARCH METHODS: We searched CENTRAL 2013, Issue 12, MEDLINE (1966 to January Week 2, 2014) and EMBASE (1998 to January 2014). SELECTION CRITERIA: Randomized controlled trials (RCTs) comparing bronchodilators (other than epinephrine) with placebo for bronchiolitis...
June 17, 2014: Cochrane Database of Systematic Reviews
Julie L Welch, Dylan D Cooper
No abstract text is available yet for this article.
June 2014: Annals of Emergency Medicine
Sarah Curtis, Kent Stobart, Ben Vandermeer, David L Simel, Terry Klassen
CONTEXT: Clinical diagnosis of pediatric meningitis is fundamental; therefore, familiarity with evidence underscoring clinical features suggestive of meningitis is important. OBJECTIVE: To seek evidence supporting accuracy of clinical features of pediatric bacterial meningitis. METHODS: A review of Medline, Embase, the Cumulative Index to Nursing and Allied Health Literature, Web of Science, and PubMed was conducted for all articles of relevance...
November 2010: Pediatrics
Amy C Plint, David W Johnson, Hema Patel, Natasha Wiebe, Rhonda Correll, Rollin Brant, Craig Mitton, Serge Gouin, Maala Bhatt, Gary Joubert, Karen J L Black, Troy Turner, Sandra Whitehouse, Terry P Klassen et al.
BACKGROUND: Although numerous studies have explored the benefit of using nebulized epinephrine or corticosteroids alone to treat infants with bronchiolitis, the effectiveness of combining these medications is not well established. METHODS: We conducted a multicenter, double-blind, placebo-controlled trial in which 800 infants (6 weeks to 12 months of age) with bronchiolitis who were seen in the pediatric emergency department were randomly assigned to one of four study groups...
May 14, 2009: New England Journal of Medicine
François Dubos, Bartosz Korczowski, Denizmen A Aygun, Alain Martinot, Cristina Prat, Annick Galetto-Lacour, Juan Casado-Flores, Erdal Taskin, Francis Leclerc, Carlos Rodrigo, Alain Gervaix, Sandrine Leroy, Dominique Gendrel, Gérard Bréart, Martin Chalumeau
OBJECTIVE: To validate procalcitonin (PCT) level as the best biological marker to distinguish between bacterial and aseptic meningitis in children in the emergency department. DESIGN: Secondary analysis of retrospective multicenter hospital-based cohort studies. SETTING: Six pediatric emergency or intensive care units of tertiary care centers in 5 European countries. PARTICIPANTS: Consecutive children aged 29 days to 18 years with acute meningitis...
December 2008: Archives of Pediatrics & Adolescent Medicine
Howard M Corneli, Joseph J Zorc, Prashant Mahajan, Prashant Majahan, Kathy N Shaw, Richard Holubkov, Scott D Reeves, Richard M Ruddy, Baqir Malik, Kyle A Nelson, Joan S Bregstein, Kathleen M Brown, Matthew N Denenberg, Kathleen A Lillis, Lynn Babcock Cimpello, James W Tsung, Dominic A Borgialli, Marc N Baskin, Getachew Teshome, Mitchell A Goldstein, David Monroe, J Michael Dean, Nathan Kuppermann
BACKGROUND: Bronchiolitis, the most common infection of the lower respiratory tract in infants, is a leading cause of hospitalization in childhood. Corticosteroids are commonly used to treat bronchiolitis, but evidence of their effectiveness is limited. METHODS: We conducted a double-blind, randomized trial comparing a single dose of oral dexamethasone (1 mg per kilogram of body weight) with placebo in 600 children (age range, 2 to 12 months) with a first episode of wheezing diagnosed in the emergency department as moderate-to-severe bronchiolitis (defined by a Respiratory Distress Assessment Instrument score > or =6)...
July 26, 2007: New England Journal of Medicine
Meredith Borland, Ian Jacobs, Barbara King, Debra O'Brien
STUDY OBJECTIVE: We compare the efficacy of intranasal fentanyl versus intravenous morphine in a pediatric population presenting to an emergency department (ED) with acute long-bone fractures. METHODS: We conducted a prospective, randomized, double-blind, placebo-controlled, clinical trial in a tertiary pediatric ED between September 2001 and January 2005. A convenience sample of children aged 7 to 15 years with clinically deformed closed long-bone fractures was included to receive either active intravenous morphine (10 mg/mL) and intranasal placebo or active intranasal concentrated fentanyl (150 microg/mL) and intravenous placebo...
March 2007: Annals of Emergency Medicine
2015-08-27 19:36:26
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