Pediatric emergency care
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Pediatric emergency care · Feb 2021
Evaluation of Ventricle Size Measurements in Infants by Pediatric Emergency Medicine Physicians.
The identification of hydrocephalus in infants by pediatric emergency medicine (PEM) physicians using cranial point-of-care ultrasound (POCUS) has not been evaluated. We aimed to conduct a pilot/proof-of-concept study to evaluate whether PEM physicians can identify hydrocephalus (anterior horn width >5 mm) in 15 infants (mean 69 ± 42 days old) from the neonatal intensive care unit using POCUS. Our exploratory aims were to determine the test characteristics of cranial POCUS performed by PEM physicians for diagnosing hydrocephalus and the interrater reliability between measurements made by the PEM physicians and the radiologist. ⋯ While the PEM physicians in our study were able to determine the absence of hydrocephalus in infants with high specificity using cranial POCUS, there was insufficient evidence to support the use of this modality for identifying hydrocephalus. Future studies with more participants are warranted to accurately determine test characteristics.
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Pediatric emergency care · Feb 2021
Observational StudyImplementing Paper Documentation During an Influenza Surge in a Pediatric Emergency Department.
We hypothesized that a paper documentation and discharge bundle can expedite patient care during an influenza-related surge. ⋯ Implementation of paper charting during an influenza-related surge was associated with shorter physician to discharge times when compared with patient visits documented in the electronic health record. A paper bundle may improve patient throughput and decrease emergency department overcrowding during influenza or coronavirus disease-related surge.
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Pediatric emergency care · Feb 2021
Point-of-Care Ultrasound Used to Diagnose Sternal Fractures Missed by Conventional Imaging.
Sternal fractures have often been associated with high-impact thoracic trauma. In children, this is not always the case. ⋯ The following 2 cases describe sternal fractures that were missed by traditional imaging modalities, including a fracture missed by chest computed tomography. They also highlight other potential causative mechanisms for sternal fractures in children, including hyperflexion injuries and low-mechanism motor vehicle accidents.
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Fundamental to the practice of pediatric emergency medicine is making timely and accurate diagnoses. However, studies have shown errors in this process are common. A number of factors in the emergency department environment as well as identifiable errant patterns of thinking can contribute to such challenges. ⋯ Reviewing how these 2 styles of thinking are applied in clinical practice provides a framework for understanding specific cognitive errors. This article uses illustrative examples to introduce many of these common errors, providing context for how and why they occur. In addition, a practical approach to reducing the risk of such errors is offered.
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Pediatric emergency care · Feb 2021
Case ReportsRupture of the Corpus Cavernosum in a Pediatric Patient.
Pediatric penile pain is an uncommon complaint and is associated with a wide differential diagnosis including infectious, inflammatory, traumatic, and idiopathic conditions. Penile fractures, anatomically known as rupture of the corpus cavernosum, are almost exclusively reported in sexually mature patients and usually involve forceful manipulation during sexual activity. Rupture of the corpus cavernosum is a true urologic emergency. ⋯ Our patient was urgently taken to the operating room for repair of his injury. Thanks to the timely surgical correction, there were no postsurgical complications, and he was discharged home on postoperative day 1. This case demonstrates that although most reports of corpus cavernosum injuries are associated with sexual intercourse, other modes are possible and should be considered for acute-onset penile pain in pediatric patients.