Current opinion in pediatrics
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Mild traumatic brain injury (mTBI) accompanied by concussion is a common presenting complaint among children presenting to emergency departments (EDs). There is wide practice variation regarding diagnosis and management of sports-related concussions in children. Our aim is to review the most recent evidence and expert recommendations regarding initial diagnosis and management of sports-related concussions in children. ⋯ Further research on both the incidence of sports-related concussions in children and management paradigms is needed. The role of novel imaging modalities in clinical assessment also needs to be elucidated. An individualized approach to evaluation and management of sports-related concussions is recommended. It should incorporate standard symptom assessment, neuropsychological testing and postural stability testing.
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Curr. Opin. Pediatr. · Jun 2009
ReviewUpdate on epinephrine (adrenaline) for pediatric emergencies.
Epinephrine (adrenaline) is a medication widely used in the pediatric emergency department. This article reviews the most recent evidence and recommendations behind the many applications of epinephrine as they apply to the care of children in emergency departments. ⋯ Epinephrine is the recommended first-line treatment for anaphylaxis and moderate-to-severe croup. Its role in asthma and bronchiolitis is less clear. Traditional beta2-agonists are seen as first-line therapies for moderate bronchiolitis and asthma exacerbations. Epinephrine may have a role for subsets of patients with both of these illnesses. The preferred route for parenteral treatment is intramuscular. Epinephrine is well tolerated as an adjunct to local anesthesia when used in digital blocks in digits with normal perfusion. Although autoinjectors allow faster access to epinephrine for anaphylaxis, there are many issues surrounding their use and indications.
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Advanced airway management in children can be challenging, and the potential for morbidity following failed attempts is high. ⋯ Pediatric providers are encouraged to develop familiarity with emerging rescue ventilation devices, as well as recent advances in the practice of rapid sequence induction and laryngoscopy.
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Curr. Opin. Pediatr. · Jun 2009
ReviewSedation for emergent diagnostic imaging studies in pediatric patients.
To review and summarize current literature regarding sedation for imaging studies in pediatric patients in the Emergency Department and acute care setting. ⋯ Although avoiding sedation for diagnostic imaging studies is optimal, there are multiple agents with reasonable safety profiles that can be utilized by personnel trained in pediatric airway management in order to obtain adequate emergent imaging studies.
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Curr. Opin. Pediatr. · Apr 2009
ReviewAre prophylactic antibiotics indicated after a urinary tract infection?
Many children with urinary tract infection (UTI) and urinary tract abnormality such as vesicoureteral reflux (VUR) are given prophylactic antibiotic to prevent recurrence of UTI and permanent kidney damage. Occasionally, children with normal urinary tract receive prophylactic antibiotic to alleviate the patient suffering and family inconvenience associated with recurrent symptomatic UTI. These recommendations are mostly opinion-based and are derived from studies that were not randomized and were done before the current renal imaging modalities became available. The purpose of this review is to discuss these recommendations in the context of recent research findings. ⋯ It is advisable that, until the results of more appropriately designed studies become available, UTI in young children is considered as a risk factor for renal scarring and each patient is treated with prudence.