Pediatric emergency care
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Pediatric emergency care · May 2011
Comparative StudyVariation in the self-reported use of computed tomography in clearing the cervical spine of pediatric trauma patients.
Cervical spine injury (CSI) in children can be life-threatening or associated with lifelong disabilities. Whereas screening computed tomography (CT) of the cervical spine is used in the evaluation of adult trauma patients, it has no additional benefit in children when compared with plain film radiography of the cervical spine. Despite this, CT use in the pediatric patient is increasing. We sought to compare the self-reported utilization of screening cervical spine CT among pediatric emergency medicine (PEM) physicians and general emergency medicine (non-PEM) physicians. ⋯ In response to a clinical vignette, non-PEM physicians were more likely to self-report the use of screening CT in pediatric trauma patients than PEM physicians.
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Near-infrared spectroscopy is a noninvasive means of determining real-time changes in regional oxygen saturation of cerebral and somatic tissues. Hypoxic neurologic injuries not only involve devastating effects on patients and their families but also increase health care costs to the society. ⋯ Although 20th century advances in the understanding and management of resuscitation of critically ill and injured children have focused on global parameters (ie, pulse oximetry, capnography, base deficit, lactate, etc), a growing body of evidence now points to regional disturbances in microcirculation that will lead us in a new direction of adjunctive tissue monitoring and response to resuscitation. In the coming years, near-infrared spectroscopy will be accepted as a way for clinicians to more quickly and noninvasively identify patients with altered levels of cerebral and/or somatic tissue oxygenation and, in conjunction with global physiologic parameters, guide efficient and effective resuscitation to improve outcomes for critically ill and injured pediatric patients.
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Pediatric emergency care · May 2011
Randomized Controlled Trial Comparative StudyA randomized comparison of the GlideScope videolaryngoscope to the standard laryngoscopy for intubation by pediatric residents in simulated easy and difficult infant airway scenarios.
Videolaryngoscopy has been developed mainly to assist difficult airway intubation. However, there is a lack of studies demonstrating the real efficacy of its use in children. In this study, we tested the hypothesis that GlideScope (Verathon Inc, Bothell, Wash) videolaryngoscope improves tracheal intubation when used by pediatric residents in an advanced patient simulation model. ⋯ In simulated scenarios of infant NA and difficult airway, when used by pediatric residents, GlideScope did not improve intubation performance when compared with the standard laryngoscope. Nevertheless, GlideScope may be safer for upper jaw injury and could have advantages in the management of complicated airway. Further studies are needed to assess if specific training will improve GlideScope intubation performance and whether the "in simulator" results translate into clinical practice.
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Pediatric emergency care · May 2011
Comparative StudyDetection of hypoventilation by capnography and its association with hypoxia in children undergoing sedation with ketamine.
Hypopneic hypoventilation, a decrease in tidal volume without a change in respiratory rate, is not easily detected by standard monitoring practices during sedation but can be detected by capnography. Our goal was to determine the frequency of hypopneic hypoventilation and its association with hypoxia in children undergoing sedation with ketamine. ⋯ Hypopneic hypoventilation as detected by capnography is common in children undergoing sedation with ketamine with or without midazolam. Hypoxia is frequently preceded by low ET(CO2) levels. Further studies are needed to determine if the addition of routine monitoring with capnography can reduce the frequency of hypoxia in children undergoing sedation.
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Pediatric emergency care · May 2011
Comparative StudyManagement of uncomplicated nail bed lacerations presenting to a children's emergency department.
This study examined the mechanisms of injury and the pattern of care for children who presented to the emergency department with uncomplicated nail bed lacerations. ⋯ Most nail bed injuries in children occur at home, and the door seems to be the major mechanism of injury. Approximately 57% of these are children younger than 5 years. Only 42% of uncomplicated nail bed lacerations are treated by emergency physicians, yet there is no significant difference in outcomes between plastic surgeons and emergency physicians. Our study suggests that there is a role in public education for primary prevention, and with proper training, pediatric emergency physicians can treat uncomplicated nail bed lacerations.