Pediatric emergency care
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Pediatric emergency care · Sep 2020
Case ReportsPoint-of-Care Ultrasound for Undifferentiated Abdominal Pain in a Pediatric Patient: A Proposed Algorithm.
Abdominal pain is a common presentation in the pediatric emergency department and may pose a diagnostic challenge to the physician. Although most abdominal pain is benign, the presence of abdominal pain may represent a surgical emergency. We present an atypical presentation of perforated appendicitis in a child with 2 weeks of abdominal pain, in whom point-of-care ultrasound expedited diagnosis and patient disposition. We then recommend a diagnostic approach for using point-of-care ultrasound in a pediatric patient with undifferentiated abdominal pain.
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Pediatric emergency care · Sep 2020
Review Case ReportsUncommon Complication of Pediatric Umbilical Hernia-Spontaneous Evisceration: Case Report and Literature Review.
The umbilical hernia is common in children. Most of the cases have a spontaneous regression around the age of 3 years. Complications are very rare, and thus surgery is not routinely indicated before the age of 3 years. We report an exceptional case of spontaneous rupture of an umbilical hernia with emphasis on the management of this rare complication and a literature review of similar cases.
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Pediatric emergency care · Sep 2020
Multicenter Study Observational StudyHemispheric Cerebral Oximetry Monitoring During Pediatric Seizure Activity in a Pediatric Emergency Department.
Sustained neuronal activity during seizures causes cellular perturbations, alterations in cerebral physiology, and potentially neurological injury, a neurological emergency. With variable clinical manifestations of seizures, frequent failure of seizure recognition by providers in pediatric and developmentally challenged patients can increase seizure complications. Neuroresuscitation should include rapid cerebral physiology assessment for increased seizure recognition and optimal neurological outcomes. In neurological emergencies, cerebral oximetry has demonstrated its utility in altered cerebral physiology and a standard combat neurological assessment tool. During adult seizures, cerebral oximetry (regional cerebral oxygen saturation [rcSO2]) has been shown as a useful neurological assessment tool, but research is lacking in pediatric emergency department (PED) seizure patients. ⋯ Hemispheric during-seizure rcSO2 readings significantly correlated with generalized and focal seizures and reflected altered cerebral physiology. Ipsilateral focal seizure rcSO2 readings correlated to the focal side with wide interhemispheric rcSO2 discordance. All postseizure rcSO2 readings returned to preseizure readings, showing altered cerebral physiology resolution. Overall, in generalized or focal seizure, rcSO2 readings were less than 60% or greater than 80%, and in focal seizure, interhemispheric rcSO2 discordance was greater than 10. During seizures, hemispheric rcSO2 readings demonstrated its potential pediatric seizure utility. Utilizing rcSO2 readings related to seizure activity could expedite pediatric and developmentally challenged patients' seizure recognition, cerebral assessment, and interventions especially in pharmacoresistant seizures.
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Pediatric emergency care · Sep 2020
Review Case ReportsTraumatic Abdominal Wall Hernia in Children by Handlebar Injury: When to Suspect, Scan, and Call the Surgeon.
Traumatic abdominal wall hernias (TAWHs) can be defined as a herniation through disrupted musculature and fascia associated with blunt trauma. They are seen in approximately 1% of patients with blunt abdominal trauma. Data on TAWH in the pediatric population are very limited and principally based on case reports and a few case series. ⋯ We describe 2 cases of TAWH due to blunt impact by bicycle handlebars that occurred in our department with a brief literature review. Our objectives are to describe the variable clinical presentations and management of these events. We hope to provide a useful tool for the clinician to increase early clinical suspicion and detection of this insidious injury.
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Pediatric emergency care · Sep 2020
ReviewLessons From the Frontlines: Pandemic Response Among New York City Pediatric Emergency Medicine Fellowship Programs During COVID-19.
The global pandemic novel coronavirus 2019 has upended healthcare and medical education, particularly in disease epicenters such as New York City. In this piece, we seek to describe the collective experiences and lessons learned by the New York City pediatric emergency medicine fellowship directors in clinical, educational, investigative, and psychological domains, in hopes of engendering conversation and informing future disaster response efforts.