Annals of emergency medicine
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We report a rare case of acute upper airway obstruction caused by spontaneous retropharyngeal hemorrhage as a result of hemophilia A in a 16-year-old pediatric patient who routinely received factor VIII replacement. Initial diagnosis was delayed because the patient presented with symptoms, such as throat pain and odynophagia, similar to those of common benign upper airway infections. Within 2 days of the initial presentation of symptoms, the patient went into respiratory failure as a result of retropharyngeal hemorrhage. The possibility of spontaneous retropharyngeal or epiglottic hemorrhage or hematoma should be considered as a cause of rapidly progressing odynophagia and dyspnea by hemophilia patients.
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We describe emergency department (ED) intubation practices for children younger than 16 years through multicenter prospective surveillance. ⋯ Because we sampled only 10 centers and most of the intubations were by trainees, our results may not be generalizable to the typical ED setting. We found that premedication is now uncommon, etomidate is the predominant induction agent, and rocuronium and video laryngoscopy are used increasingly. First-attempt failure is most common in infants.
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Case Reports
The Use of Ophthalmic Ultrasonography to Identify Retinal Injuries Associated With Abusive Head Trauma.
Abusive head trauma includes any nonaccidental injury inflicted to a child's head and body. It is often characterized by, but not limited to, the repetitive acceleration-deceleration forces with or without blunt head impact. It has a mortality rate of 30%, and 80% of survivors experience permanent neurologic damage. ⋯ Dilated ophthalmic examinations and autopsy reports confirmed retinoschisis and other forms of retinal hemorrhages that were too numerous to count, multilayered, and extending to the periphery in all 11 patients. One patient did not have a dilated ophthalmic examination; however, traumatic retinoschisis and retinal hemorrhages were confirmed on autopsy. Ocular point-of-care ultrasonography is a promising tool to investigate abusive head trauma through the identification of traumatic retinoschisis and retinal hemorrhages when pupillary dilatation and direct ophthalmic examination is delayed.
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Emergency physicians are using free open access medical education (FOAM) resources at an increasing rate. The extent to which FOAM resources cover the breadth of emergency medicine core content is unknown. We hypothesize that the content of FOAM resources does not provide comprehensive or balanced coverage of the scope of knowledge necessary for emergency medicine providers. Our objective is to quantify emergency medicine core content covered by FOAM resources and identify the predominant FOAM topics. ⋯ The data suggest an imbalanced and incomplete coverage of emergency medicine core content in FOAM. The study is limited by its retrospective design and use of a single referral Web site to obtain available FOAM resources. More comprehensive and balanced coverage of emergency medicine core content is needed if FOAM is to serve as a primary educational resource.