Pediatric emergency care
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Pediatric emergency care · May 2022
Multicenter StudyPain Prevalence Among Children Visiting Pediatric Emergency Departments.
The main purpose of this study was to investigate the prevalence, characteristics, and intensity of children's pain in emergency departments. The secondary purpose was to evaluate the interobserver agreement regarding the level of pain perceived by professionals, parents, and children. ⋯ Pain is a common symptom among emergency department patients, and its evaluation should therefore be obligatory. We found low interrater agreement on pain levels between patients, professionals, and parents, which confirms how difficult it is to accurately evaluate pain intensity.
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Pediatric emergency care · May 2022
Pediatric Transport Safety Collaborative: Adverse Events With Parental Presence During Pediatric Critical Care Transport.
In Canada, critically ill pediatric patients require transfer to a tertiary care center for definitive medical and surgical management. Some studies suggest that family accompaniment could compromise care; currently, limited research has examined patient safety and outcomes during pediatric critical care transport with family presence, and no Canada-specific data currently exists. The primary objective of this study was to compare the rate of adverse events during the transport of pediatric patients by a specialized pediatric critical care transport team with parental accompaniment to those without parental accompaniment. Secondary objectives included whether geographic or patient-specific factors affected rates of parental accompaniment and if parental presence during transport was related to patient outcomes. ⋯ This is the first study to compare the effect on adverse event rate and clinically relevant outcomes between transports with and without parental presence during interfacility pediatric critical care transport. Our study found no significant difference in the adverse event rate between transports with and without parental presence.
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Pediatric emergency care · May 2022
Longitudinal Trends in Pediatric Return Visits to US Emergency Departments.
This study aimed to evaluate trends in pediatric emergency department (ED) 72-hour return visits and factors associated with return visits. ⋯ The proportion of 72-hour US pediatric ED return visits is increasing over time. Return visit status was associated with admission/transfer, but otherwise with markers of lower patient acuity. These findings inform quality improvement efforts aimed at improving pediatric transition to outpatient care after an ED encounter.
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Pediatric emergency care · May 2022
When Adenosine Does Not Work: Apparent and Real Adenosine-Resistant Tachycardia.
Supraventricular tachycardia (SVT) is the most common arrhythmia in the pediatric population. Adenosine is widely accepted as the first-line pharmacological treatment for hemodynamically stable SVT, constituting a class I recommendation in the 2020 American Heart Association guidelines for pediatric life support (2020 American Heart Association Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care). As most pediatric SVTs are dependent on the atrioventricular node (AVN) for their propagation, and adenosine acts primarily on the AVN, adenosine will frequently terminate the arrhythmia. ⋯ Because of its very short half-life, there is confusion between improper delivery, failure to have any effect on the tachycardia, or transient termination. There are some pediatric SVTs, which are not AVN dependent, and which truly are refractory to adenosine. Simultaneous electrocardiogram recording during administration can provide important information to differentiate between adenosine resistance and transient adenosine effect, thus guiding further management.
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Pediatric emergency care · May 2022
Intubation During Pediatric Cardiac Arrest in the Emergency Department Is Associated With Reduced First-Pass Success.
Airway compromise and respiratory failure are leading causes of pediatric cardiac arrest making advanced airway management central to pediatric resuscitation. Previous literature has demonstrated that achieving first-pass success (FPS) is associated with fewer adverse events. In cardiac arrest for adult patients, increasing number of intubation attempts is associated with lower likelihood of return of spontaneous circulation (ROSC) and favorable neurologic outcome. There is limited evidence regarding advanced airway management for pediatric out-of-hospital cardiac arrest (OHCA) in the emergency department (ED). The purpose of this study was to compare FPS in pediatric OHCA and non-cardiac arrest patients in the ED. ⋯ In this study, we found that pediatric OHCA is associated with reduced FPS in the ED. Although additional studies are needed, rescuers should prioritize restoring effective oxygenation and ventilation and optimizing intubation conditions before an advanced airway attempt.