Pediatric emergency care
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Pediatric emergency care · Feb 2021
Meta AnalysisThe Utility of the Focused Assessment With Sonography in Trauma Examination in Pediatric Blunt Abdominal Trauma: A Systematic Review and Meta-Analysis.
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. ⋯ In a hemodynamically stable child presenting with blunt abdominal trauma, a positive POCUS FAST examination result means that IAI is likely, but a negative examination result alone cannot preclude further diagnostic workup for IAI. The need for computed tomography scan may be obviated in a subset of low-risk pediatric blunt abdominal trauma patients presenting with a Glasgow Coma Scale of 14 to 15, a normal abdominal examination result, and a negative POCUS FAST result.
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Pediatric emergency care · Feb 2021
Case ReportsAn Unusual Foreign Object Attached to a Child's Finger: Emergency Department Management and Subsequent Intervention.
Strangulation injuries due to foreign objects are uncommon presentations of hand and finger injuries presenting to the emergency department (ED). Ring avulsion and hair tourniquet injuries are more commonly recognized mechanisms of strangulation, and algorithms for subsequent management and emergent treatment exist for these injuries. It is important to distinguish between hand injuries that can be managed in the setting of the ED and those that need emergent surgical management upon patient presentation. ⋯ D). The distal aspect of the digit was unable to be visualized, and communication with the patient was difficult secondary to distress and young age. Multiple attempts were made to remove the object in the ED by multiple health care providers, when concern for degloving injury prompted the patient to be taken to the operating room for removal with an electric saw by the hand surgeon and orthopedic team.
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Pediatric emergency care · Feb 2021
Case ReportsRupture of the Corpus Cavernosum in a Pediatric Patient.
Pediatric penile pain is an uncommon complaint and is associated with a wide differential diagnosis including infectious, inflammatory, traumatic, and idiopathic conditions. Penile fractures, anatomically known as rupture of the corpus cavernosum, are almost exclusively reported in sexually mature patients and usually involve forceful manipulation during sexual activity. Rupture of the corpus cavernosum is a true urologic emergency. ⋯ Our patient was urgently taken to the operating room for repair of his injury. Thanks to the timely surgical correction, there were no postsurgical complications, and he was discharged home on postoperative day 1. This case demonstrates that although most reports of corpus cavernosum injuries are associated with sexual intercourse, other modes are possible and should be considered for acute-onset penile pain in pediatric patients.
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Pediatric emergency care · Feb 2021
Evaluation of Ventricle Size Measurements in Infants by Pediatric Emergency Medicine Physicians.
The identification of hydrocephalus in infants by pediatric emergency medicine (PEM) physicians using cranial point-of-care ultrasound (POCUS) has not been evaluated. We aimed to conduct a pilot/proof-of-concept study to evaluate whether PEM physicians can identify hydrocephalus (anterior horn width >5 mm) in 15 infants (mean 69 ± 42 days old) from the neonatal intensive care unit using POCUS. Our exploratory aims were to determine the test characteristics of cranial POCUS performed by PEM physicians for diagnosing hydrocephalus and the interrater reliability between measurements made by the PEM physicians and the radiologist. ⋯ While the PEM physicians in our study were able to determine the absence of hydrocephalus in infants with high specificity using cranial POCUS, there was insufficient evidence to support the use of this modality for identifying hydrocephalus. Future studies with more participants are warranted to accurately determine test characteristics.
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Pediatric emergency care · Feb 2021
A Comprehensive Pediatric Acute Sexual Assault Protocol: From Emergency Department to Outpatient Follow-up.
Close medical follow-up after pediatric acute sexual assault is recommended and may mitigate adverse consequences and decrease long-term comorbidities. The objectives are to (1) examine adherence to a comprehensive outpatient medical follow-up protocol after evaluation in the emergency department in a pediatric population and (2) identify characteristics associated with patient adherence to inform the utilization of a medical follow-up protocol after pediatric acute sexual assault. ⋯ (1) Caregivers should be integrated into the evaluation to facilitate compliance with follow-up; (2) child abuse specialists may be consulted to facilitate specific interventions and recommendations; (3) professionals should work as a multidisciplinary team; and (4) the patient's psychological status should be evaluated, and mental health interventions recommended.