Pediatric emergency care
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Pediatric emergency care · Feb 2023
The Role of Ultrasound in Pediatric Skull Fractures: Determination of Fracture and Optic Nerve Sheath Diameter Measurements.
The aim of the present study was to determine the accuracy of point-of-care ultrasound (POCUS) for detecting skull fractures and to evaluate sonographic measurements of optic nerve sheath diameter (ONSD) and ONSD/eyeball vertical diameter (EVD) ratios in children with head trauma. ⋯ When used with clinical decision rules to minimize the risk for clinically important traumatic brain injury, POCUS seems to be a promising tool to detect skull fractures and calculate ONSD measurements and rates to predict the risk for SOLs and perform further risk stratification of children with minor head trauma.
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Thromboelastography's (TEG's) use in pediatric trauma patients is not widely studied. Identifying clotting cascade defects can direct decision making regarding blood product transfusion. ⋯ Coagulopathic patients based on TEG had higher mortality. All TEG values, as they moved toward transfusion-trigger cut points, were associated with increased mortality.
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Pediatric emergency care · Feb 2023
Ultrasound-Guided Regional Anesthesia of the Femoral Nerve in the Pediatric Emergency Department.
Femur fractures are painful, and use of systemic opioids and other sedatives can be dangerous in pediatric patients. The fascia iliaca compartment nerve block and femoral nerve block are regional anesthesia techniques to provide analgesia by anesthetizing the femoral nerve. They are widely used in adult patients and are associated with good effect and reduced opioid use. Ultrasound (US) guidance of nerve blocks can increase their safety and efficacy. We sought to report on the use and safety of US-guided regional anesthesia of the femoral nerve performed by emergency physicians for femur fractures in 6 pediatric emergency departments. ⋯ Ultrasound-guided regional anesthesia of the femoral nerve is widely performed and can be performed safely on pediatric patients by emergency physicians and trainees in the pediatric emergency department.
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Imaging algorithms for assessment of thoracic trauma in pediatric patients remain controversial, attempting to balance radiation dose and its associated risk with the need for thorough assessment of patients' injuries. This study reviewed the value of chest radiography in detecting traumatic injuries, and the impact that computed tomography (CT) had on clinical management. ⋯ Use of thoracic CT in pediatric trauma patients identifies a significantly greater number of injuries compared with than radiography but significantly increases radiation dose while changing management in only a very small proportion of cases. Despite the relatively small sample size, the findings reflect 2 years of experience at a level 1 trauma center, and this study suggests that it may be reasonable to decrease the frequency of cross-sectional imaging.
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Pediatric emergency care · Feb 2023
Observational StudyIntravenous Fluid Bolus Volume and Resolution of Acute Kidney Injury in Children With Diabetic Ketoacidosis.
To describe trends in creatinine and acute kidney injury (AKI) in children who present with diabetic ketoacidosis (DKA) and receive low versus high intravenous (IV) fluid bolus volumes. Further, to determine whether resolution of AKI is hastened by low versus high bolus volumes. ⋯ Intravenous fluid bolus volume was not associated with resolution of AKI in our cohort of children with DKA.