Pediatric emergency care
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We report a 21-month-old boy with a sutured laceration of the left upper eyelid with drainage of cerebrospinal fluid. Careful evaluation, including computerized tomography, revealed a penetrating injury of the left orbital wall and a linear bone fracture. The wound was resutured carefully. There was no cerebrospinal fluid leakage in the postoperative follow-up period.
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Pediatric emergency care · Aug 2018
Observational StudyChanges in Pediatric-Sized Endotracheal Tube Cuff Pressure With Elevation Gain: Observations in Ex Vivo Simulations and In Vivo Air Medical Transport.
Prolonged excessive endotracheal cuff pressure greater than 30 cmH2O is thought to cause ischemic airway injury. Excessive cuff pressure with altitude gain during air medical transport has been previously described in adult patients. It is poorly understood how pediatric-sized endotracheal tube (ETT) cuffs behave with atmospheric pressure change during flight. ⋯ Children who are intubated with cuffed ETTs for air medical transport are subject to excessive endotracheal cuff pressure at even low flight altitudes. Endotracheal tube size did not affect the degree of cuff pressure change, contrary to previous study. These findings need to be validated and correlated to patient clinical outcomes. The implications of these data need to be considered clinically particularly for prolonged transport of intubated pediatric patients at elevation.
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Pediatric emergency care · Aug 2018
Assessing Dehydration Employing End-Tidal Carbon Dioxide in Children With Vomiting and Diarrhea.
Serum bicarbonate reflects dehydration severity in children with gastroenteritis. Previous work in children receiving intravenous rehydration has correlated end-tidal carbon dioxide (EtCO2) with serum bicarbonate. We evaluated whether EtCO2 predicts weight change in children with vomiting and/or diarrhea. ⋯ The limited accuracy of EtCO2 measurement to predict 5% or more dehydration precludes its use as a tool to assess dehydration severity in children. End-tidal carbon dioxide monitoring does not have the ability to identify those children with 5% or more dehydration in a cohort of children with vomiting and/or diarrhea presenting for ED care.
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Pediatric emergency care · Aug 2018
Case ReportsCongenital Vallecular Cyst as a Cause of Neonatal Stridor and Apnea.
An infant who presents with stridor and apnea constitutes a challenge for emergency physicians in terms of diagnosis and management. Among the rarest of causes for these symptoms, congenital vallecular cysts can cause devastating outcomes if left undiagnosed. ⋯ The process by which the infant was stabilized, correctly diagnosed, and successfully treated for a life-threatening airway obstruction is explained. After a discussion of vallecular cysts, methods for preparing for and executing proper airway management in an infant who presents with apnea and stridor are considered.
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Pediatric emergency care · Aug 2018
Identification of Optic Nerve Swelling Using Point-of-Care Ocular Ultrasound in Children.
The aim of this study was to determine the feasibility and accuracy of point-of-care (POC) ocular ultrasound (US) when performed by a pediatric emergency medicine (PEM) physician to detect optic nerve abnormalities concerning for swelling, as compared with the fundus examination performed by an ophthalmologist. ⋯ The results of our study suggest that POC ocular US performed by PEM physicians was feasible and determined to be sensitive but nonspecific in the detection of optic nerve swelling. Additional larger studies may determine generalizability to other nonophthalmologist physicians performing POC ocular US.