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Pediatric Emergency Care

Steven G Schauer, Patrick C Ng, Michael D April, Guyon J Hill, Allyson A Arana, Vikhyat S Bebarta
BACKGROUND: Vascular access in critically ill pediatric patients can be challenging with delays potentially leading to worse outcomes. Intraosseous (IO) access has a low rate of complications and can be utilized to administer lifesaving medications. Combat medics are trained to treat adults but may also be required to treat children in the deployed setting. Vascular access in children can be challenging, especially in a hypovolemic state. There are limited data on prehospital lifesaving interventions in children in the combat setting...
March 19, 2019: Pediatric Emergency Care
Jennifer L Rosenthal, Monica K Lieng, James P Marcin, Patrick S Romano
OBJECTIVES: While hospital-hospital transfers of pediatric patients are often necessary, some pediatric transfers are potentially avoidable. Pediatric potentially avoidable transfers (PATs) represent a process with high costs and safety risks but few, if any, benefits. To better understand this issue, we described pediatric interfacility transfers with early discharges. METHODS: We conducted a descriptive study using electronic medical record data at a single-center over a 12-month period to examine characteristics of pediatric patients with a transfer admission source and early discharge...
March 19, 2019: Pediatric Emergency Care
Thomas H Chun, Lauren S Chernick, Fahd A Ahmad, Megan L Ranney, Rohit P Shenoi, T Charles Casper, Joel A Fein, Jackie Grupp-Phelan, B McAninch, Elizabeth C Powell, Julie R Bromberg, James G Linakis, Anthony Spirito
OBJECTIVES: The aim of this study was to understand the prevalence of alcohol and other substance use among teenagers in generalized samples. METHODS: This study compared the alcohol and other substance use of adolescents enrolled in a screening study across 16 Pediatric Emergency Care Applied Research Network emergency departments (EDs) (ASSESS) with those sampled in 2 nationally representative surveys, the Youth Risk Behavior Surveillance System (YRBSS) and the National Survey of Drug Use and Health (NSDUH)...
March 19, 2019: Pediatric Emergency Care
Thaddeus J Puzio, Katherine Cools, William Adamson, Kimberly Erickson
According to the Centers for Disease Control and Prevention, approximately 4.5 million dog bites occur each year in the United States, and more than half of these cases affect children. An estimated 1 in 6 dog bites, representing more than 800,000 bite victims each year, requires some form of medical attention. Historically, pediatric trauma patients who suffer devastating injuries and cardiopulmonary collapse requiring heroic salvage efforts have poor outcomes. We present the first case of extracorporeal membrane oxygenation utilized in a pediatric trauma patient following a severe dog bite injury...
March 19, 2019: Pediatric Emergency Care
Matthew R Mittiga, Mary Frey, Benjamin T Kerrey, Andrea S Rinderknecht, Michelle D Eckerle, Brad Sobolewski, Laurie H Johnson, Jennifer L Oehler, Berkeley L Bennett, Steven Chan, Theresa M Frey, Kelly M Krummen, Claire Lindsay, Kelsey Wolfangel, Alison Richert, Tonya J Masur, Corinne L Bria, Erin F Hoehn, Gary L Geis
Provision of optimal care to critically ill patients in a pediatric emergency department is challenging. Specific challenges include the following: (a) patient presentations are highly variable, representing the full breadth of human disease and injury, and are often unannounced; (b) care team members have highly variable experience and skills and often few meaningful opportunities to practice care delivery as a team; (c) valid data collection, for quality assurance/improvement and clinical research, is limited when relying on traditional approaches such as medical record review or self-report; (d) specific patient presentations are relatively uncommon for individual providers, providing few opportunities to establish and refine the requisite knowledge and skill; and (e) unscientific or random variation in care delivery...
March 14, 2019: Pediatric Emergency Care
Zohar Shamash, Marina Catallozzi, Peter S Dayan, Lauren S Chernick
OBJECTIVES: Expedited partner therapy (EPT) refers to treating sexual partners of patients with sexually transmitted infections by providing prescriptions or medications to give to their partners. Expedited partner therapy is not routinely prescribed in the emergency department (ED). Our objective was to explore adolescent preferences for EPT use in the ED. METHODS: We conducted a mixed-methods study using surveys and semistructured interviews in one urban ED. Sexually active patients aged 15 to 19 years completed an anonymous survey eliciting (1) sexual history and risky sexual behaviors, (2) preferences for partner notification when hypothetically testing positive for an STI, and (3) preferences for EPT...
March 14, 2019: Pediatric Emergency Care
Rachel S Bronheim, Rachana Tyagi
In this report, we describe a 13-year-old with opisthotonos as the presenting symptom of Chiari I malformation. This presentation is rare and has previously been reported only in infants. We describe the physical and radiologic findings, literature regarding Chiari malformation, and differential diagnosis of opisthotonos in this patient.
March 12, 2019: Pediatric Emergency Care
Tian Liang, Eric Roseman, Melanie Gao, Richard Sinert
OBJECTIVE: To evaluate the utility of the Point of Care Ultrasound (POCUS) Focused Assessment with Sonography for Trauma (FAST) examination for diagnosis of intra-abdominal injury (IAI) in children presenting with blunt abdominal trauma. METHODS: We searched medical literature from January 1966 to March 2018 in PubMed, EMBASE, and Web of Science. Prospective studies of POCUS FAST examinations in diagnosing IAI in pediatric trauma were included. Sensitivity, specificity, and likelihood ratios (LR) were calculated using a random-effects model (95% confidence interval)...
March 12, 2019: Pediatric Emergency Care
Peggy Tseng, Yvette Liza Kearl, Ashkon Ansari
Of the multitude of neurologic injuries related to roller-coaster rides, a majority of them are reported about adults. In this case, we present a patient who presented to the pediatric emergency department with new-onset seizure and hemiplegia 2 days after a roller-coaster ride. She was ultimately diagnosed with a subdural hematoma. The acceleration and G forces of roller coasters are hypothesized to cause enough stress and shearing forces that are thought to directly cause subdural hemorrhage.Advances in roller-coaster technology may surpass the passenger's physical capacity for acceleration and rotary forces, and we may see an increased number of medical complications after these rides...
March 12, 2019: Pediatric Emergency Care
Caitlin E Crumm, Erin E Crotty, Catherine M Albert, Amanda B Blair, Jeffrey P Otjen, Kenneth W Feldman
Hemophilia A is characterized by deficiency of factor VIII. We present a unique, illustrative case of an infant with a short history of neck pain and irritability without neurological deficits who was found to have a spinal epidural hematoma. The subsequent investigation for the etiology, including workup for nonaccidental trauma, led to a diagnosis of severe hemophilia A.
March 12, 2019: Pediatric Emergency Care
Wei Hao Lee, Sharon O╩╝Brien, Dmitry Skarin, John A Cheek, Jessica Deitch, Ramesh Nataraja, Simon Craig, Meredith L Borland
BACKGROUND: Undifferentiated abdominal pain is a common pediatric presentation to the emergency department (ED). OBJECTIVES: The objective of this study was to describe the prevalence of clinically significant abdominal pathology (CSAP) including appendicitis, patterns of imaging and pathology tests, and management and outcomes of children with abdominal pain in ED. METHODS: A prospective multicenter observational cohort pilot study of children under the age of 16 years presenting to 4 Australian EDs with abdominal pain was performed for a 1-month period at each site...
March 12, 2019: Pediatric Emergency Care
Kamal Abulebda, Travis Whitfill, Erin E Montgomery, Michele L Kirby, Rami A Ahmed, Dylan D Cooper, Mara E Nitu, Marc A Auerbach, Riad Lutfi, Samer Abu-Sultaneh
OBJECTIVES: The majority of pediatric patients with diabetic ketoacidosis (DKA) present to community emergency departments (CEDs) that are less prepared to care for acutely ill children owing to low pediatric volume and limited pediatric resources and guidelines. This has impacted the quality of care provided to pediatric patients in CEDs. We hypothesized that a simulation-based collaborative program would improve the quality of the care provided to simulated pediatric DKA patients presenting to CEDs...
March 12, 2019: Pediatric Emergency Care
Hayrullah Manyas, Cem Paketci, Derya Okur, Erhan Bayram, Semra Hiz, Uluc Yis
No abstract text is available yet for this article.
March 11, 2019: Pediatric Emergency Care
Julie Fischer, Jayasree Krishnamurthy, Shana Hansen, Patrick T Reeves
BACKGROUND: Pediatric foreign body (FB) injuries to the nasal, aural, and/or oral cavities are well documented. Description of austere foreign body (AFB) injuries involving the rectum, vagina, or penis eludes the current pediatric literature. Austere FBs can be difficult to identify and have the potential to cause serious consequences. We aim to characterize AFB injuries by children and adolescents presenting to emergency departments (EDs) in the United States. METHODS: The National Electronic Injury Surveillance System was queried to include subjects aged 0 to 25 years using a primary search term for diagnosis of foreign body from the period of January 2008 to January 2017...
March 11, 2019: Pediatric Emergency Care
Carlo De Pieri, Sara Brisotto, Federico Marzona, Valentina Dolcemascolo, Paola Elisa Cogo
No abstract text is available yet for this article.
March 11, 2019: Pediatric Emergency Care
Jessica L Moore, Amy P Goldberg, Christine Barron
Substance use and abuse have been documented as both a risk factor in and consequence of involvement in domestic minor sex trafficking (DMST). Domestic minor sex trafficking is defined as the commercial sexual exploitation of children in exchange for money, food, shelter, or any other valued entity. The current investigation sought to describe substance use in a cohort of DMST patients who present for medical evaluation. Findings revealed that 68 patients referred for DMST involvement reported high rates of alcohol/substance use and parental substance abuse...
March 11, 2019: Pediatric Emergency Care
Colette C Mull, Amy D Thompson, Steven M Selbst, Elissa G Miller, David I Rappaport, J Carlton Gartner, Wesley R Bowman
Few practicing emergency physicians will avoid life-changing stressors such as a medical error, personal illness, malpractice litigation, or death of a patient. Many will be unprepared for the toll they will take on their lives. Some may ultimately experience burnout, post-traumatic stress disorder, and suicidal ideation. Medical education, continuing education, and maintenance of certification programs do not teach physicians to recognize helplessness, moral distress, or maladaptive coping mechanisms in themselves...
March 11, 2019: Pediatric Emergency Care
Emily C B Brown, Marcella M Donaruma-Kwoh, Jeffrey P Otjen, Kenneth W Feldman
We describe 3 infants with skull fractures that involved more than 1 skull bone. On further evaluation, 2 of the 3 infants had additional fractures at other sites of the body and the third infant had concerning bruising of the face. Although an accidental mechanism of injury was initially given as the history in each case, law enforcement investigations led all 3 fathers to confess to crushing their infants' skulls out of frustration. These crushes were caused by their arms or hands. Bilateral skull fractures or those involving more than 1 skull bone can be seen in falls as well as in crush injuries...
March 11, 2019: Pediatric Emergency Care
Steven Barron Frazier, Nina M Fitzgerald
Septo-optic dysplasia is a rare congenital heterogeneous malformation comprising at least 2 components of the triad: optic nerve hypoplasia, pituitary hormone abnormalities, and midline brain defects. We report a 2-month-old girl who presented with hypernatremia, constipation, and increased sleepiness with mother's recent appreciation of abnormal eye movements. We discuss the diagnosis and management of this patient who avoided significant morbidity by prompt diagnosis based initially on clinical suspicion...
March 11, 2019: Pediatric Emergency Care
Katelyn Donaldson, Xun Li, Kennith H Sartorelli, Peter Weimersheimer, Susan R Durham
OBJECTIVES: Isolated skull fractures (ISFs) in children are one of the most common emergency department injuries. Recent studies suggest these children may be safely discharged following ED evaluation with little risk of delayed neurological compromise. The aim of this study was to propose an evidence-based protocol for the management of ISF in children in an effort to reduce medically unnecessary hospital admissions. METHODS: Using PubMed and The Cochrane Library databases, a literature search using the search terms (pediatric OR child) AND skull fracture AND (isolated OR linear) was performed...
March 7, 2019: Pediatric Emergency Care
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