Pediatric emergency care
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Pediatric emergency care · Nov 2023
Clinical Significance of Pneumocephalus in Pediatric Mild Traumatic Brain Injury.
Mild traumatic brain injury (mTBI) comprises most (70%-90%) of all pediatric head trauma cases seeking emergency care. Although most mTBI cases have normal initial head computed tomography scan, a considerable portion of the cases have intracranial imaging abnormalities on computed tomography scan. Whereas other intracranial pathological findings have been extensively studied, little is known about the clinical significance of pneumocephalus in pediatric mTBI. ⋯ Pneumocephalus is associated with increased rates of hospitalization and ciTBI, but not ICU admission, unfavorable outcome, or neurosurgical intervention in pediatric mTBI. Although usually spontaneously resolving pathology, it may occasionally be linked with complications such as cerebrospinal fluid leakage, meningitis, and tension pneumocephalus. Therefore, careful evaluation, close observation, and early detection of complications may prevent adverse outcomes.
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Human mpox (formerly known as monkeypox) is a zoonotic disease that causes a smallpox-like infection in humans. The mpox virus, the causative agent of mpox, was first reported to cause human disease in a 9-month-old infant in the Democratic Republic of the Congo in 1970. Since that time, periodic outbreaks in primarily endemic regions have occurred, typically secondary to transmission from wildlife reservoirs. ⋯ Most of these cases occurred in adults, with the highest frequency among men who had sex with men. Children and adolescents represented only 0.3% of US cases as of September 2022, with most infections in young children the result of direct contact with an infected household member. Although infection remains uncommon in US children and teens, pediatric emergency and urgent care providers should be aware of the clinical features, treatment, and prophylaxis of this important emerging infectious disease.
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Pediatric emergency care · Nov 2023
Skull Base Osteomyelitis in Children: Clinical Characteristics and Potential Implications.
We describe 10 new cases of otogenic (n = 8) and nonotogenic (n = 2) skull base osteomyelitis (SBO) in previously healthy children and review the literature on SBO in the pediatric population. ⋯ Early diagnosis of pediatric SBO can be challenging because the symptoms are often nonspecific. The final diagnosis relies mainly on imaging, preferably magnetic resonance imaging. Surgical intervention is usually mandatory in the otogenic patients, whereas the nonotogenic patients respond well to medical management alone.
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Pediatric emergency care · Oct 2023
Point-of-Care Ultrasonography for the Assessment of Dehydration in Children: A Systematic Review.
Accurate estimation of the degree of dehydration remains a diagnostic challenge. The primary objective was to systematically review the literature on the role of ultrasound in assessment of the degree of dehydration in children. ⋯ This study showed that the quantity and quality of research on the application of POCUS for the assessment of dehydration in children is limited. There is no criterion standard for assessing the degree of dehydration and no universal definition of the degree of dehydration. Thus, more methodologically rigorous studies are required. Current systematic review does not support the routine use of US to determine the severity of dehydration in children. Despite these limitations, the use of POCUS in children with dehydration demonstrates potential. Given the clear increase in IVC size with rehydration, repeated IVC US scans may be helpful in guiding fluid resuscitation in children with dehydration. From different proposed US parameters, IVC/Ao ratio has better diagnostic accuracy in detecting significant dehydration than Ao/IVC ratio and IVC collapsibility index. Despite low to moderate diagnostic performance, US still showed better assessment of dehydration than physician gestalt and World Health Organization score.
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Children and adolescents can present to the emergency department with acute agitation and aggression due to various physical and/or mental health conditions. With acute agitation/aggression, these patients may present a risk of injury to themselves, their caregivers, or emergency department providers/staff. It is imperative for providers to understand how to safely care for these children. ⋯ Without proper training or preparation, physical restraints can lead to significant morbidity and mortality. Given these potential risks, strict guidelines have been set out by the Center for Medicare and Medicaid Services and the Joint Commission regarding the use of physical restraints in the pediatric population. This article will review approaches to the acutely agitated/aggressive patient, the appropriate use of physical restraints, and recommended assessment/documentation of restraints in the acutely agitated/aggressive pediatric patient.