Pediatric emergency care
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Pediatric emergency care · Jun 2015
Review Case ReportsFatal and near-fatal grape aspiration in children.
Choking remains an important cause of morbidity and mortality in young children. Whole seedless grapes are a popular fruit snack to give to young children. We present 3 cases of grape aspiration, discussing the emergency care from basic life support to specialist treatment. The lessons learned will be applicable to a wide range of health professionals from frontline emergency medical service personnel to physicians and nurses working in a hospital.
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Pediatric emergency care · Jun 2015
ReviewOrbeez: The Magic Water Absorbing Bead-Risk of Pediatric Bowel Obstruction?
In December 2012, the U.S. Consumer Product Safety Commission recalled the water-absorbing toy WaterBalz after reports of small intestine obstruction after ingestion by children. Orbeez, another water-absorbing bead, remains available and is marketed as a children's toy. We sought to determine the extent to which Orbeez enlarge in various liquid media and the potential risk for bowel obstruction. ⋯ Orbeez beads enlarge to a different extent in different liquid media. It is unlikely that Orbeez beads would expand to sizes or demonstrate clumping that would be concerning for intestinal obstruction.
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Migraine headache is common in pediatrics and is frequently assessed in emergency departments. Altered cardiac conduction, including prolongation of the QTc interval on electrocardiogram, has been observed in adults during migraine headache and resolves interictally. Prolonged QTc is associated with life-threatening arrhythmia, and many acute and prophylactic therapies for migraine can further prolong the QTc interval. It is the objective of this prospective cohort study to examine whether the QTc interval prolongs significantly during periods of acute migraine headache in children. ⋯ Thirteen patients with migraine (mean age, 11.6 ± 2.6 years) were evaluated. Mean QTc interval during headache was significantly longer than the QTc interval in the absence of headache (437.9 ± 27.7 ms compared with 419.3 ± 29.9 ms; p = 0.04). Three patients (23%) had unequivocal prolongation of the QTc (>460 ms) during the migraine, two of which normalized with headache resolution. The mean increase in QTc during headache did not reach or exceed 30 ms (p = 0.86) CONCLUSIONS: This study is the first to illustrate a connection between QTc prolongation and acute migraine headache in children. If confirmed in future studies, children should be monitored for QTc prolongation during the acute treatment of migraine in the emergency department when using medications that can lengthen the QTc interval.
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Pediatric emergency care · Jun 2015
ReviewRadiographic evaluation of pediatric cerebrospinal fluid shunt malfunction in the emergency setting.
Children with ventricular cerebrospinal fluid shunts for treatment of hydrocephalus require frequent evaluation for potential shunt malfunction. Current practice relies heavily on neuroimaging, particularly cranial computed tomography, which repeatedly exposes children to ionizing radiation. Rapid cranial magnetic resonance imaging is a new radiation-sparing alternative to CT for evaluation of potential shunt malfunction. We review the diagnostic test performance, radiation exposure, advantages, and limitations of the major neuroimaging modalities available to providers caring for children with possible shunt malfunction in the emergent setting.