Facial Artery Pseudoaneurysm in a Child Diagnosed With Point-of-Care Ultrasound
This case describes a 3-year-old boy who was brought to the pediatric emergency department for evaluation of facial swelling. The patient's history was remarkable for a deep facial laceration 5 days prior that required surgical repair in the operating room. On the day of presentation, he was noted to have mild swelling and tenderness to palpation of the left jaw below the mandible, in the same location as his recent laceration repair. Point-of-care ultrasound (POCUS) revealed a pseudoaneurysm with an arterial feeding vessel. This was confirmed by radiology-performed ultrasound, and the patient underwent a coil embolization...
Source: Pediatric Emergency Care - October 1, 2019 Category: Emergency Medicine Tags: Ultrasound Case Review Source Type: research

Acute Upper Extremity Edema in a 10-Year-Old Girl as Presenting Symptom of a Rare Cancer
Acute onset upper extremity edema can pose a diagnostic challenge for the emergency physician, with conditions ranging from mild local allergic reactions to deep venous thrombosis to underlying life threatening conditions. We discuss a case of a 10-year-old female with upper extremity edema and the diagnostic considerations, which ultimately led to uncovering a malignant etiology. This case represents a rare presentation of her underlying diagnosis, anaplastic large cell lymphoma. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - October 1, 2019 Category: Emergency Medicine Tags: Illustrative Cases Source Type: research

Late-Onset Vitamin K Deficiency Presenting as Scrotal Bruising and Mediastinal Mass
Although there are several reports of intracranial hemorrhage associated with vitamin K deficient bleeding, there are few reported cases of extracranial manifestations, specifically involving the thymus. Here, we discuss the unique case of a 4-week-old infant presenting with scrotal discoloration, respiratory distress, and widened mediastinum, found to have thymic hemorrhage related to confirmed coagulopathy secondary to late-onset vitamin K deficiency bleeding of the newborn. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - October 1, 2019 Category: Emergency Medicine Tags: Illustrative Cases Source Type: research

Hopkins Syndrome: Post Flaccid Paralysis After an Asthma Exacerbation
We report a rare case of a 22-month-old who developed flaccid paralysis of her right arm shortly after she was hospitalized for an asthma exacerbation. There are many etiologies of acute flaccid paralysis; however, because of the uncommon presentation of a focalized finding, establishing the diagnosis of this patient was difficult in the emergency department setting. Associated with asthma exacerbations, Hopkins syndrome is a paralytic illness that resembles poliomyelitis. This case highlights the challenges of evaluating a child with monoparesis and establishing an association with asthma amyotrophy. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - October 1, 2019 Category: Emergency Medicine Tags: Illustrative Cases Source Type: research

Acute Painless Lower Gastrointestinal Bleed That Mimics Meckel Diverticulum
Conclusions Gastrointestinal duplication cyst is an uncommon condition and can rarely present with lower gastrointestinal bleed with heterotopic gastric mucosa. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - October 1, 2019 Category: Emergency Medicine Tags: Illustrative Cases Source Type: research

Traumatic Retroclival Epidural Hematoma
We present the case of a 7-year-old previously healthy girl with traumatic retroclival epidural hematoma after a fall from a swing. She presented with a Glasgow Coma Scale score of 15 with severe neck pain and limitation of cervical movements in all directions. Radiological examination revealed retroclival epidural hematoma, and the patient was managed conservatively with good recovery. Although conservative management leads to good recovery in most cases, retroclival epidural hematomas should always be kept in mind regardless of the severity of trauma. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - October 1, 2019 Category: Emergency Medicine Tags: Illustrative Cases Source Type: research

Multiple Splenic Infarcts Complicating Plasmodium vivax Malaria
We report a case of splenic infarction with acute kidney injury in a case of P. vivax malaria in a 13-year-old male child who presented to the emergency department with severe pain in the left hypochondrium. The patient was managed with intravenous artesunate and oral primaquine. Pain in left hypochondrium in children with P. vivax malaria due to splenic infarction needs to be evaluated for any surgical emergency like rupture or abscess. A review of literature of the unusual but serious complication is presented along with the case report. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - October 1, 2019 Category: Emergency Medicine Tags: Illustrative Cases Source Type: research

Active Seizures in Children Are Often Subtle and Unrecognized by Prehospital Providers
Early recognition and treatment of seizures is essential for optimal patient outcomes. Seizure activity, particularly in young children, can be subtle and often go unrecognized by providers. This case series retrospectively identified 7 cases of pediatric patients (14 years and younger) who presented to the emergency department with active seizure activity that was unrecognized by the prehospital care providers. The presentation of these patients, their clinical signs of seizure, and emergency department disposition are highlighted in this series. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - October 1, 2019 Category: Emergency Medicine Tags: Illustrative Cases Source Type: research

Facial Artery Pseudoaneurysm in a Child Diagnosed With Point of Care Ultrasound
This case describes a 3-year-old boy who was brought to the pediatric emergency department for evaluation of facial swelling. The patient's history was remarkable for a deep facial laceration 5 days prior that required surgical repair in the operating room. On the day of presentation, he was noted to have mild swelling and tenderness to palpation of the left jaw below the mandible, in the same location as his recent laceration repair. Point-of-care ultrasound (POCUS) revealed a pseudoaneurysm with an arterial feeding vessel. This was confirmed by radiology-performed ultrasound, and the patient underwent a coil embolization...
Source: Pediatric Emergency Care - October 1, 2019 Category: Emergency Medicine Tags: Ultrasound Case Review Source Type: research

Ethanol Intoxication of Young Children
No abstract available (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - October 1, 2019 Category: Emergency Medicine Tags: CME Review Article Source Type: research

Ethanol Intoxication of Young Children
Ethanol intoxication of infants and young children can be a challenging diagnosis in the pediatric emergency department, and features of the poisoning may differ in comparison with adolescents. The sources of ethanol exposures in this age are varied and include unintentional, malicious, and iatrogenic etiologies. Young children exposed to ethanol often present with mixed clinical signs and symptoms that may not fit the traditional ethanol or sedative-hypnotic toxidrome. Pediatric ethanol intoxications are often managed supportively, and recovery is usually rapid. The purpose of this review is to describe the sources of eth...
Source: Pediatric Emergency Care - October 1, 2019 Category: Emergency Medicine Tags: CME Review Article Source Type: research

Factors Associated With Length of Stay in Emergency Departments for Pediatric Patients With Psychiatric Problems
Objectives Length of stay (LOS) and boarding for pediatric psychiatric patients presenting in the emergency department (ED) have been understudied, despite evidence that children with psychiatric disorders experience longer LOS relative to those without. This investigation examined correlates of LOS and boarding among youth with psychiatric disorders presenting to the ED in a large, statewide database. Methods Using the 2010 to 2013 Florida ED discharge database, generalized linear mixed models were used to examine for associations between LOS and patient and hospital characteristics among pediatric patients ( (Source...
Source: Pediatric Emergency Care - October 1, 2019 Category: Emergency Medicine Tags: Original Articles Source Type: research

Just-in-Time Training for Intraosseous Needle Placement and Defibrillator Use in a Pediatric Emergency Department
Objectives Just-in-time training (JITT) is a method of simulation-based training where the training occurs within the clinical environment in a concise manner. Just-in-time training has shown effects at the learner, patient, and system-wide levels. We evaluated a JITT curriculum for the procedures of intraosseous (IO) needle placement and defibrillator use in a pediatric emergency department (ED) by comparing the trainees' comfort level in performing those procedures independently (Kirkpatrick level 2a) and trainees' knowledge of the procedures/equipment (Kirkpatrick level 2b) before and after the JITT. Methods The st...
Source: Pediatric Emergency Care - October 1, 2019 Category: Emergency Medicine Tags: Original Articles Source Type: research

A Comparison of Pediatric Weight Estimation Methods for Emergency Resuscitation
Conclusions Parental estimation was the most accurate method in every age group. The next best alternative is the Broselow tape in children aged 5 years or younger and the Mercy method in children aged older than 5 years. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - October 1, 2019 Category: Emergency Medicine Tags: Original Articles Source Type: research

Presentation and Investigation of Pediatric Bone and Joint Infections in the Pediatric Emergency Department
The objective of this study was to evaluate the presenting features of bone and joint infections with a view to identify distinguishing trends that will be useful for pediatric emergency departments. Methods We performed a retrospective review of patient records over a 12-year period in the pediatric emergency department of a large regional pediatric teaching center serving a diverse population. Results There were 88 cases of osteoarticular infections during the study period. Pain, fever, and impaired function were commonly reported, but overall, there was inconsistency in the presenting features. Inflammatory makers...
Source: Pediatric Emergency Care - October 1, 2019 Category: Emergency Medicine Tags: Original Articles Source Type: research

Acute Mercury Poisoning in a Group of School Children
Conclusions Elemental mercury exposure is potentially toxic; its symptomatology varies, especially in children. Secure storage of mercury and other toxic substances and provision of information about this subject to individuals who might be exposed to mercury and their families might help to prevent mercury poisoning. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - October 1, 2019 Category: Emergency Medicine Tags: Original Articles Source Type: research

Hyaluronidase-Assisted Resuscitation in Kenya for Severely Dehydrated Children
Conclusions Hyaluronidase-assisted subcutaneous resuscitation is a feasible alternative to IV hydration in moderately to severely dehydrated children with difficult to obtain IV access in resource-limited areas. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - October 1, 2019 Category: Emergency Medicine Tags: Original Articles Source Type: research

In-Flight Injuries Involving Children on Commercial Airline Flights
Conclusions Pediatric IFIs are relatively infrequent given the total passenger traffic but are not negligible. Unrestrained lap children are prone to IFIs, particularly during meal service or turbulence, but not only then. Children occupying aisle seats are vulnerable to injury from fallen objects, aisle traffic, and burns from mishandled hot items. The possible protection from using in-flight child restraints might extend beyond takeoff and landing operations or during turbulence. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - October 1, 2019 Category: Emergency Medicine Tags: Original Articles Source Type: research

Is Intussusception a Middle-of-the-Night Emergency?
Objectives Intussusception is the most common abdominal emergency in pediatric patients aged 6 months to 3 years. There is often a delay in diagnosis, as the presentation can be confused for viral gastroenteritis. Given this scenario, we questioned the practice of performing emergency reductions in children during the night when minimal support staff are available. Pneumatic reduction is not a benign procedure, with the most significant risk being bowel perforation. We performed this analysis to determine whether it would be safe to delay reduction in these patients until normal working hours when more support staff are ...
Source: Pediatric Emergency Care - October 1, 2019 Category: Emergency Medicine Tags: Original Articles Source Type: research

Understanding the Constipation Conundrum: Predictors of Obtaining an Abdominal Radiograph During the Emergency Department Evaluation of Pediatric Constipation
The objectives of this study were to identify predictors associated with obtaining an AR and to determine if ARs were associated with a longer length of stay (LOS) among children with constipation evaluated in the ED. Methods A review of billing and electronic health records was conducted in an academic pediatric ED for children ages 0 to 17 years who had a primary discharge diagnosis of constipation from July 2013 to June 2014. Logistic regression was used to identify predictors for obtaining an AR. Differences in mean LOS were analyzed using linear regression. Results In total, 326 children met inclusion criteria, ...
Source: Pediatric Emergency Care - October 1, 2019 Category: Emergency Medicine Tags: Original Articles Source Type: research

Interfacility Transport Shock Index Is Associated With Decreased Survival in Children
Background Shock index, the ratio of heart rate to systolic blood pressure that changes with age, is associated with mortality in adults after trauma and in children with sepsis. We assessed the utility of shock index to predict sepsis diagnosis and survival in children requiring interfacility transport to a tertiary care center. Methods We studied children aged 1 month to 21 years who had at least 2 sets of vital signs recorded during interfacility transport to the Children’s Hospital of Pittsburgh by our critical care transport team. Subjects were divided into 4 age groups: group 1 ( (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - October 1, 2019 Category: Emergency Medicine Tags: Original Articles Source Type: research

Procalcitonin Levels in Critically Ill Children With Status Asthmaticus
Conclusions Serum PCT level was not elevated to greater than 0.5 ng/mL in 75% of this cohort of critically ill children with SA admitted to PICU. Presence of CXR infiltrates was not associated with higher PCT levels. Large clinical trials are needed to study the diagnostic and predictive role of PCT in this patient population. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - October 1, 2019 Category: Emergency Medicine Tags: Original Articles Source Type: research

Testing for Urinary Tract Infection in the Influenza/Respiratory Syncytial Virus–Positive Febrile Infant Aged 2 to 12 Months
Conclusions Our population of 2- to 12-month-old febrile infants with positive influenza/RSV testing, who did not have risk factors to make their risk of UTI higher than 1%, may not have required evaluation with urinalysis or urine culture. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - October 1, 2019 Category: Emergency Medicine Tags: Original Articles Source Type: research

Evaluation of the Association of Early Elevated Lactate With Outcomes in Children With Severe Sepsis or Septic Shock
Conclusions Although our single center study did not demonstrate that an elevated early lactate is associated with mortality in pediatric severe sepsis, L0 did correlate strongly with PRISM-III, the most robust measure of mortality risk in pediatrics. Therefore, early lactate measurement may be important as an early biomarker of disease severity. These data should be validated in a larger, multicenter, prospective study. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - October 1, 2019 Category: Emergency Medicine Tags: Original Articles Source Type: research

Cold Panniculitis After Ice Therapy for Supraventricular Tachycardia
A late preterm infant presenting with supraventricular tachycardia (SVT) was admitted to the pediatric intensive care unit because of poor systolic function seen on echocardiogram. The hospitalization was complicated by multiple breakthrough episodes of SVT requiring ice placed on the face during each repeat episode. The infant was later diagnosed as having cold panniculitis secondary to the application of ice to the face on multiple occasions. In children who are hemodynamically stable during SVT episodes, ice is used as first-line treatment. It is important to be aware of how often ice is being applied to the face and th...
Source: Pediatric Emergency Care - September 1, 2019 Category: Emergency Medicine Tags: Illustrative Cases Source Type: research

A Rare Cause of Shock in an Infant: Cor Triatriatum
We report a case of an 8-week-old boy who had several weeks of viral symptoms and eventually presented to the emergency department in shock. An echocardiogram revealed the diagnosis of cor triatriatum, a rare congenital heart disease that requires urgent surgical repair. In this article, we review the evaluation and management of such patients and emphasize the importance of considering congenital heart disease in the differential diagnosis for an infant in shock. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - September 1, 2019 Category: Emergency Medicine Tags: Illustrative Cases Source Type: research

Amitraz: A Perpetual Silent Menace Among Children in Developing Countries—A Case Report
Amitraz is an acaricide and insecticide used to treat ticks, which infest domestic animals in developing countries. Because of its widespread use, it is one of the common poisons unintentionally consumed by infants and children when left unsupervised. A 3-year-old boy was brought with unintentional consumption of Amitraz. On examination, he was found to be progressively drowsy, with an irregular pulse, bradycardia, and hypotension. He was treated with atropine, intravenous fluids, and dopamine infusion; hemodynamic stability was achieved within 36 hours after ingestion. Amitraz is an unusual but deadly poison unintentional...
Source: Pediatric Emergency Care - September 1, 2019 Category: Emergency Medicine Tags: Illustrative Cases Source Type: research

Ventricular Tachycardia Induced by Propafenone Intoxication in a Pediatric Patient
We describe a case of a 3-year-old male patient unintentionally ingesting 300 mg (20 mg/kg) of propafenone and presenting with ventricular tachycardia with QT prolongation. Two boli of intravenous hypertonic sodium bicarbonate (total amount of 3 mEq/kg), followed by 3-hours continuous infusion of 1 mEq kg−1 h−1 sodium bicarbonate, were able to restore the clinical conditions of the patient. With this case report, we aim to highlight the existing challenge in the therapeutic management of propafenone intoxication that finds intravenous hypertonic bicarbonate to be a useful tool also in pediatric population. (Sou...
Source: Pediatric Emergency Care - September 1, 2019 Category: Emergency Medicine Tags: Illustrative Cases Source Type: research

Transcutaneous Pacing of a 4-Year-Old Child
Complete heart block is rare in children and is usually owing to congenital abnormalities. These children are often pacemaker dependent. However, pacemaker complications can require emergency interventions, including external pacing. This case presents a child in complete heart block requiring external pacing and then discusses some of the literature behind such interventions. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - September 1, 2019 Category: Emergency Medicine Tags: Illustrative Cases Source Type: research

Anti–N-Methyl-D-Aspartate Receptor Encephalitis: A Challenging Diagnosis in the Emergency Department
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an underdiagnosed disease that has been described thus far only in case series. Patients, the majority of which are females, develop neuropsychiatric symptoms that can often be misdiagnosed as purely psychiatric illness. Although teratomas are nearly pathognomonic for anti-NMDAR encephalitis, these are less common in children and males. This case illustrates some common features of anti-NMDAR encephalitis and some of the challenges in diagnosis. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - September 1, 2019 Category: Emergency Medicine Tags: Illustrative Cases Source Type: research

Sialocele Following Traumatic Dental Procedure: A Case Report and Review of Dental Complications
We present a case of a 17-year-old girl with sialadenitis and sialocele due to trauma sustained from a dental procedure. Our objectives are to review relevant literature and anatomy of the floor of the mouth and salivary glands and discuss potential complications of dental procedures. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - September 1, 2019 Category: Emergency Medicine Tags: Illustrative Cases Source Type: research

The Visualization of a Foreign Body in a Patient's Subglottic Region Using Point-of-Care Ultrasonography
Point-of-care ultrasonography is a real-time dynamic examination that is useful for evaluating the location of foreign bodies in a patient's gastrointestinal tract and soft tissue. In particular, it is useful for identifying radiolucent foreign bodies that are difficult to visualize using routine x-ray examinations. This case study describes the visualization of a radiolucent foreign body in a patient's subglottic region using point-of-care ultrasonography. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - September 1, 2019 Category: Emergency Medicine Tags: Ultrasound Case Review Source Type: research

The Problematic 2014 American Academy of Pediatrics Bronchiolitis Guidelines
This article describes the clinical challenges of evaluating and managing a heterogeneous disease syndrome presenting as undifferentiated patients to the emergency department. Although the 2014 American Academy of Pediatrics bronchiolitis guidelines and the multiple international guidelines that they closely mirror have made a good faith attempt to provide clinicians with the best evidence-based recommendations possible, they have all failed to address practical, front-line clinical challenges. The therapeutic nihilism of the guidelines and the dissonance between many of the recommendations and frontline realities have had...
Source: Pediatric Emergency Care - September 1, 2019 Category: Emergency Medicine Tags: Review Articles Source Type: research

Resurgence of Vaccine-Preventable Disease: Ethics in the Pediatric Emergency Department
After a decades-long reduction in vaccine-preventable illnesses worldwide, there has been a reappearance of childhood illnesses once thought to be eradicated. This resurgence in illnesses such as polio and measles is a consequence of multifactorial events leading to decreased vaccination rates. A lack of resources in poor and war-torn countries, coupled with increasing global travel, and decisions to delay or defer vaccinations because of inaccurate studies further emphasized by media have combined to result in current state of frequent local and widespread epidemics, specifically the current outbreak of measles. As provid...
Source: Pediatric Emergency Care - September 1, 2019 Category: Emergency Medicine Tags: Review Articles Source Type: research

Quality Improvement Initiative to Improve Abuse Screening Among Infants With Extremity Fractures
Objectives The aim of this study was to evaluate the effectiveness of clinical pathway implementation and quality improvement (QI) interventions to increase the percentage of infants with extremity fractures undergoing evaluation for suspected physical abuse, including skeletal survey (SS), and consultation with social work, and/or Child Protection Team. Methods Charts were retrospectively reviewed to establish percentage of infants less than 12 months old with extremity fractures undergoing an SS and consultation during the prepathway (January 1, 2012 to December 31, 2013) and postpathway (January 1, 2014 to June 30,...
Source: Pediatric Emergency Care - September 1, 2019 Category: Emergency Medicine Tags: Original Research-QI Source Type: research

Pediatric Weight Errors and Resultant Medication Dosing Errors in the Emergency Department
Conclusions Weight errors were uncommon at the 3 emergency departments that we studied, but they led to weight-based medication-dosing errors that had the potential to cause harm. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - September 1, 2019 Category: Emergency Medicine Tags: Original Articles Source Type: research

Epidemiologic Characteristics of Pediatric Trauma Patients Receiving Prehospital Care in Kigali, Rwanda
Conclusions In this cohort of Rwandan pediatric trauma patients, injuries to the extremities and craniofacial regions were most common. Theses traumatic patterns were predominantly due to road traffic injury, suggesting that interventions addressing the prevention of this mechanism, and treatment of the associated injury patterns, may be beneficial in the Rwandan setting. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - September 1, 2019 Category: Emergency Medicine Tags: Original Articles Source Type: research

Emergency Provider Use of Plain Radiographs in the Evaluation of Pediatric Constipation
Conclusions This survey suggests that many PEM providers obtain radiographs to convince families of the diagnosis of constipation. This is not a viable management plan given the risks of radiation as well as costs. There remains room for improvement as we attempt to reduce use of radiation in the evaluation of common pediatric illnesses. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - September 1, 2019 Category: Emergency Medicine Tags: Original Articles Source Type: research

Pediatric Dog Bite Prevention: Are We Barking Up the Wrong Tree or Just Not Barking Loud Enough?
Conclusions Pediatric dog bites continue to occur frequently, and the associated factors did not change over the 10-year period: young age of child, bites to the craniofacial region, and dogs familiar to the child. Although accurate medical documentation of dog bites is a prerequisite to develop effective prevention strategies, current medical documentation of dog bites may be misguided. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - September 1, 2019 Category: Emergency Medicine Tags: Original Articles Source Type: research

The Evaluation of Trauma Care: The Comparison of 2 High-Level Pediatric Emergency Departments in the United States and Turkey
Conclusions This is the first study that compared pediatric trauma care and outcome at a level 1 pediatric trauma center in the United States and a pediatric hospital in Turkey. Our findings highlight the opportunities to improve pediatric trauma care in Turkey. Specifically, there is a need for national trauma registries, enhanced trauma education, and standardized trauma patient care protocols. In addition, efforts should be directed toward improving prehospital care through better integration within the health care system and physician participation in educating prehospital providers. Data and organized trauma care wi...
Source: Pediatric Emergency Care - September 1, 2019 Category: Emergency Medicine Tags: Original Articles Source Type: research

Experience With a Care Process Model in the Evaluation of Pediatric Musculoskeletal Infections in a Pediatric Emergency Department
This study describes the implementation and impact of a CPM for the evaluation of musculoskeletal infections in a pediatric emergency department (ED). Methods A retrospective pre-post intervention study was performed to analyze the impact of a musculoskeletal infection CPM. Patients were identified retrospectively through electronic order history for imaging of an extremity or joint and recommended laboratory tests. Clinical outcomes evaluated included hospital length of stay (LOS), time to magnetic resonance imaging (MRI), time to administration of antibiotics, hospital admission rate, and 30-day readmission rate. Res...
Source: Pediatric Emergency Care - September 1, 2019 Category: Emergency Medicine Tags: Original Articles Source Type: research

Clinical Characteristics of Allergy to Hymenoptera Stings
Objective The purpose of this study was to evaluate the clinical characteristics of allergy to stings from the Hymenoptera order of insects in a hospital in Thailand. Methods A descriptive retrospective analytical study was carried out in inpatients and outpatients suffering from Hymenoptera stings from 2009 to 2013 in Siriraj Hospital. Results Medical records of 386 patients with an allergy to Hymenoptera stings were evaluated. Anaphylaxis was more common in patients younger than 15 years, who comprised 22.3% of patients in this study. The most common sting type was from wasps (58.3%). Eighty-five percent of patie...
Source: Pediatric Emergency Care - September 1, 2019 Category: Emergency Medicine Tags: Original Articles Source Type: research

Occult Head Injury in Children Less Than 2 Years With Suspected Child Abuse in the Emergency Department
Conclusions No clinically significant brain injury (requiring intervention) was seen in this cohort. These findings support delaying imaging in neurologically intact children to obtain MRI after hospital admission, thus, limiting radiation exposure. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - September 1, 2019 Category: Emergency Medicine Tags: Original Articles Source Type: research

Previous Emergency Medical Services Use by Victims of Child Homicide
Introduction The medical diagnoses and frequency of emergency department visits made by children who are later given a diagnosis of maltreatment do not differ much from those of nonabused children. However, the type of medical complaints and frequency of emergency medical services (EMS) use by child homicide victims before their death are not known. We compared EMS use between child homicide victims and children who died from natural causes before their death. Methods This was a retrospective case-control study of children 0 to 5 years old who died in Houston, Texas, from 2005 to 2010. Cases were child homicide victim...
Source: Pediatric Emergency Care - September 1, 2019 Category: Emergency Medicine Tags: Original Articles Source Type: research

Ovarian Torsion in a Pediatric Patient: The Importance of Repeat Imaging
A previously healthy 10-year-old girl presented to the emergency department with a 1-day history of abdominal pain. She was afebrile with an elevated white blood cell count and a negative pelvic ultrasound. The pain resolved while in hospital, and the patient was discharged home. The patient returned 10 days later, and the pain now migrated from the left flank to the subumbilical region. The patient now had an elevated white blood cell count and C-reactive protein. On pelvic ultrasound, the patient had a large midline mass and a normal right ovary. The patient was taken to the operating room where she was found to have a t...
Source: Pediatric Emergency Care - August 1, 2019 Category: Emergency Medicine Tags: Illustrative Cases Source Type: research

Gastric Emphysema: A Cannot-Miss Emergency Medicine Diagnosis
We report a case of gastric emphysema with portal venous gas likely attributable to a gastric outlet obstruction and gastric mucosal defect in a 17-year-old girl with a chief complaint of syncope that was diagnosed in the emergency department and treated conservatively. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - August 1, 2019 Category: Emergency Medicine Tags: Illustrative Cases Source Type: research

An Uncommon Diagnosis in a Child Presenting With Double Vision and Imbalance
Acute disseminated encephalomyelitis (ADEM) is exceptionally uncommon, with approximately 3 pediatric cases reported in the United States each year. Given the uncommon nature of ADEM, most of the current data rely heavily on case reports. The overwhelming majority of cases have been reported after an acute viral infection or vaccination. Although up to 90% of cases exhibit full remission after intravenous steroids, those in which treatment is delayed can display debilitating sequelae. Here, we present a case of ADEM in a 7-year-old boy who presented with double vision and imbalance with no recent history of acute viral inf...
Source: Pediatric Emergency Care - August 1, 2019 Category: Emergency Medicine Tags: Illustrative Cases Source Type: research

Pneumonia in a Teenager Hiding a Fire-Eating Stunt
Pneumonia in children due to hydrocarbon aspiration is usually the result of an uncommon accidental event. However, an acute and severe type of pneumonia induced by hydrocarbon aspiration is occasionally experienced by entertainers known as fire-eaters. Different approaches to treat fire-eater's pneumonia appear in the literature. Although there is no consensus regarding the management of this condition, the use of antibiotic therapy is well recognized and recommended by some, whereas others recommend only supportive treatment. Steroids are indicated in severe cases. Here, we report the case of a boy who developed severe ...
Source: Pediatric Emergency Care - August 1, 2019 Category: Emergency Medicine Tags: Illustrative Cases Source Type: research

Aripiprazole Toxicity With a Biphasic Course of Somnolence
Conclusion It is important to recognize the need for a longer observation period after a significant aripiprazole overdose as a variable course of somnolence may be witnessed. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - August 1, 2019 Category: Emergency Medicine Tags: Illustrative Cases Source Type: research

Emergency Management of the Ingested Magnet: An Algorithmic Approach
Conclusions Our case represents the missed diagnosis of 4 magnets ingested separately over time. Emergency department providers may benefit from a clinical algorithm guiding the management of these increasingly prevalent patient presentations to prevent delayed diagnoses and to decrease morbidity. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - August 1, 2019 Category: Emergency Medicine Tags: Illustrative Cases Source Type: research