Pediatric emergency care
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Pediatric emergency care · Jun 2022
The Initial Approach to the Multisystem Pediatric Trauma Patient.
Trauma remains the leading cause of morbidity and mortality in children and youth 1 to 19 years old in the United States. Providing timely care with a systematic approach is essential for emergently addressing life-threatening injuries and ongoing assessment. The primary survey is focused on identifying and managing life-threatening injuries. ⋯ Over the past decade, there have been important advances in the evidence supporting the management of multisystem trauma in the pediatric patient by the emergency medicine clinician. In addition, the emergence of diagnostics, such as point-of-care ultrasound, aids decision making in the evaluation and management of the pediatric trauma patient. The purpose of this article is to review the initial systematic diagnostic approach and the emergent management of multisystem injuries from blunt force trauma in children in the emergency department and provide insight into the aspects of care that are still evolving.
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Pediatric emergency care · Jun 2022
Use of Outpatient Opioids Prescribed From a Pediatric Acute Care Setting.
Deaths due to prescription opioid overdoses are at record high levels. Limiting the amount of opioid prescribed has been suggested as a prevention strategy, but little is known about how much is needed to adequately treat acutely painful conditions for outpatients. The purpose of this study was to quantify the usage of opioids prescribed from the pediatric emergency departments of a Midwestern tertiary care children's hospital system. ⋯ Prescribed opioid doses exceeded used doses by a factor of 6. Lower extremity fractures required more doses than other acutely painful conditions. We should consider limiting doses prescribed to decrease excess opioids available for misuse and abuse.
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Pediatric emergency care · Jun 2022
External Validation of the PediBIRN Screening Tool for Abusive Head Trauma in Pediatric Emergency Department Settings.
We conducted a retrospective, secondary analysis of an existing, deidentified, prospective data set captured to derive a bruising CDR. Subjects were patients under 3 years with bruising and confirmed acute head trauma. An expert medical panel had previously identified patients with AHT. Measures of the CDR's AHT screening performance (sensitivity, specificity, likelihood ratios) were calculated with 95% confidence intervals (CIs). ⋯ The PediBIRN 4-variable CDR demonstrated AHT screening sensitivity in the pediatric ED equivalent to pediatric intensive care unit and other inpatient settings, but lower specificity. Further study of a simplified 3-variable PediBIRN AHT screening tool for the ED setting is warranted.
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Pediatric emergency care · Jun 2022
Do Your Kids Vape?: Investigating Parent Knowledge of Adolescent e-Cigarette Use.
This study aimed to evaluate parental knowledge of their adolescent's e-cigarette use and their awareness of negative effects. ⋯ It seems guardians are generally aware of their adolescent's e-cigarette use, and both parents and adolescents are aware of the negative side effects of e-cigarettes on health. We did not investigate whether guardians discussed their concerns on e-cigarette usage with their adolescents. It is also unclear what specific health consequences guardians and adolescents are aware of. These may be points of further investigation and intervention.
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Pediatric emergency care · Jun 2022
Acute Acalculous Cholecystitis: Think of Hepatitis A Infection and Do Not Underestimate Pain.
A 14-year-old adolescent girl presented with severe abdominal pain, tenderness, and guarding in the right upper quadrant associated with nonbilious vomiting, scleral icterus, and fever. Laboratory tests were consistent with acute hepatitis A virus-related cholestatic hepatitis. A point-of-care ultrasound showed mild gallbladder wall thickening with increased color Doppler flow and pericholecystic fluid collection, in the absence of gallstones or biliary ducts dilatation, thus suggesting acute acalculous cholecystitis. Both the clinical symptoms and the point-of-care ultrasound findings completely resolved within 1 week after admission with conservative treatment.