Pediatric emergency care
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Pediatric emergency care · Jan 2022
Use of Opioids and Nonopioid Analgesics to Treat Pediatric Postoperative Pain in the Emergency Department.
The incidence, demographic characteristics, and treatment approaches for pediatric patients who present to the ED with a primary complaint of postoperative pain have not been well described. The purpose of this study was to describe opioid and nonopioid prescribing patterns for pediatric patients evaluated for postoperative pain in the Emergency Department (ED). ⋯ Pediatric patients treated in the ED for postoperative pain were often treated with opioid and nonopioid analgesics, with wide prescriber variability. Further research is warranted to help balance optimal pain management and safe prescribing practices.
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Pediatric emergency care · Jan 2022
Patient Outcomes With Febrile Neutropenia Based on Time to Antibiotics in the Emergency Department.
Although bacteremia in pediatric oncology patients with febrile neutropenia (FN) is not uncommon, sepsis and mortality are rare. Because of the lack of clinically meaningful decision tools to identify high-risk patients with bacteremia, time to antibiotic administration (TTA) is increasingly considered an important quality and safety measure in the emergency department. Because little evidence exists suggesting that this benchmark is beneficial, we sought to determine whether TTA of 60 minutes or less is associated with improved outcomes. ⋯ Time to antibiotic administration of more than 60 minutes did not increase mortality in pediatric oncology patients with FN. Our study adds to the existing literature that TTA of 60 minutes or less does not seem to improve outcomes in pediatric FN. Further larger studies are required to confirm these findings and determine which features predispose pediatric FN patients to morbidity and mortality.
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Pediatric emergency care · Jan 2022
Which Clinical Features of Children on Initial Presentation to the Emergency Department With Head Injury Are Associated With Clinically Important Traumatic Brain Injury, Classification as Abuse, and Poor Prognosis?
Pediatric traumatic brain injury (TBI) and abusive head trauma (AHT) are leading causes of morbidity and mortality. Clinicians may not be aware of AHT at presentation to the emergency department (ED). ⋯ No mechanism of injury reported by the caregiver, seizures, and apnea at the time of presentation to the ED are important features associated with CiTBI, classification as AHT, and poor prognosis. In addition, younger age, retinal hemorrhage, rib, and long bone fractures were found to be important clinical features associated with AHT.
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Pediatric emergency care · Jan 2022
Association of Risk of Mortality in Pediatric Patients Transferred From Scene by Helicopter With Major But Not Minor Injuries.
Helicopter emergency medical services (HEMS) are used for 16% of pediatric trauma. National HEMS guidelines advised that triage criteria be standardized for pediatric patients. A national report found pediatric HEMS associated with decreased mortality compared with ground emergency medical services (GEMS) but did not control for transport time. We hypothesized that the rate of HEMS has decreased nationally and the mortality risk for HEMS to be similar when adjusting for transport time compared with GEMS. ⋯ The rate of HEMS in pediatric trauma has decreased. However, there is room for improvement as 14% of those with minor trauma are transported by HEMS. Given the similar risk of mortality compared with GEMS, further development of guidelines that avoid the unnecessary use of HEMS appears warranted. However, utilization of HEMS for transport of pediatric major trauma should continue.
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This case describes an 18-year-old woman who presented to the pediatric emergency department with 2 days of worsening right knee pain and swelling. The patient's history was remarkable for a motor vehicle accident 12 days before presentation, as well as recent treatment for a gonococcal sexually transmitted infection 9 days before presentation. Her examination was notable for a large area of fluctuance of her right knee without overlying erythema or appreciable intraarticular effusion. ⋯ This was confirmed by radiology ultrasound, and the patient was seen by an orthopedic surgeon who recommended conservative management without aspiration of the fluid collection. To our knowledge, this is the first reported case of a Morel-Lavallee lesion being diagnosed by POCUS in a pediatric patient. This case demonstrates the utility of POCUS in facilitating the prompt recognition of shear injuries in children and guiding management in the emergency department.