Pediatric emergency care最新文献

{"title":"Ultrasound-Guided Hematoma Block for Distal Forearm Fracture Reduction in Adolescent With History of Difficult Airway: A Case Report.","authors":"Richard J Gawel, Aaron E Chen","doi":"10.1097/PEC.0000000000003268","DOIUrl":"10.1097/PEC.0000000000003268","url":null,"abstract":"<p><strong>Abstract: </strong>Distal forearm fractures are frequently encountered in the pediatric emergency department and often require reduction. Procedural sedation is commonly used to facilitate reduction of these injuries, although it can be associated with potentially severe complications, particularly in patients with cardiorespiratory comorbidities. The ultrasound-guided hematoma block has been gaining popularity as an analgesic alternative in adult patients, but literature supporting its use in pediatric patients is limited. We describe a point-of-care ultrasound-guided hematoma block used to facilitate successful reduction of a distal radius fracture in an adolescent patient with a history of a difficult airway for whom procedural sedation would have posed considerable risk.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"143-145"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142036570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Highlights From the 2023 Revision of Pediatric Tactical Emergency Casualty Care Guidelines.","authors":"Andrew L Garrett, Amina Elsherbiny, Geoffrey L Shapiro","doi":"10.1097/PEC.0000000000003292","DOIUrl":"10.1097/PEC.0000000000003292","url":null,"abstract":"<p><strong>Abstract: </strong>In 2023 the Committee for Tactical Emergency Casualty Care (C-TECC) issued updated Pediatric Tactical Emergency Casualty Care (TECC) Guidelines ( Guidelines ) that focus on the delivery of stabilizing care of children who are the victims of high-threat incidents such as an active shooter event. The Guidelines provide evidence-based and best practice recommendations to those individuals and departments that specifically provide operational medical support to law enforcement agencies caring for children in this uniquely dangerous environment where traditional resources may not be available. This article highlights key takeaway points from the Guidelines , including several updates since the first version was released in 2013.The evidence base for the care of children in this environment is lacking, and medical care delivered in the high-threat environment is inconsistent and often not optimized for the care of infants and children. The Guidelines are supported from the existing literature base where possible, and where it is not, by consensus as to the current best practices as determined by iterative deliberations among the diverse and experienced group of stakeholders who are members of C-TECC. The Guidelines provide patient assessment and management information specific to the care of children in the following 3 dynamic phases of the high-threat environment: Direct Threat, Indirect Threat, and Evacuation . The phases represent a continuum of risk to the patient and the responder ranging from extreme (such as ongoing gunfire) to minimal (during movement toward definitive medical care).The high-threat environment is dynamic and there is competing safety, tactical/operational, and patient care priorities for responders when infants and children are injured. The Guidelines provide recommendations on the type of medical and psychological care that should be considered under each phase of threat and establishes the context for how and why to deliver (or potentially defer) certain interventions under some circumstances in order the maximize the opportunity for a good outcome for an injured pediatric patient. The Guidelines also emphasize the importance of synergizing hospital-based pediatric trauma care with those law enforcement and fire/emergency medical services that may provide field care to children under high-threat circumstances.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"154-157"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11776877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142472332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Automated Finger Compression for Capillary Refill Time Measurement in Pediatrics.","authors":"Amanda J Nickel, Shen Jiang, Akira Nishisaki","doi":"10.1097/PEC.0000000000003290","DOIUrl":"10.1097/PEC.0000000000003290","url":null,"abstract":"","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"e4"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current Evidence on the Care of Young Infants With Hypothermia in the Emergency Department.","authors":"Sriram Ramgopal, Yu Hsiang J Lo, Nicholas M Potisek, Nathan M Money, Elizabeth E Halvorson, Andrea T Cruz, Alexander J Rogers","doi":"10.1097/PEC.0000000000003259","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003259","url":null,"abstract":"<p><strong>Abstract: </strong>The presence of hypothermia among young infants in the emergency department may be a sign of serious or invasive bacterial infections, or invasive herpes simplex viral infection. However, hypothermia may also occur due to a variety of other infectious and noninfectious conditions or environmental exposure. In some settings, hypothermia may represent a protective, energy-conserving response to illness. Recent efforts have enhanced our understanding of the prevalence of serious infections among infants with hypothermia, although challenges remain due to lack of standardized definitions and comprehensive guidelines. There exists extensive variation in the care of young infants with hypothermia. Risk factors for serious bacterial infections in infants with hypothermia, as identified in single-center and multicenter retrospective studies, include lower temperatures, older age, and abnormalities in blood and urine testing. Given the absence of clear guidelines, management of infants with hypothermia relies heavily on clinician judgment and shared decision making, guided by individual patient assessments and risk factors. This review article summarizes existing evidence and identifies gaps in the management of infants (<90 days) with hypothermia in the emergency department.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":"41 2","pages":"146-151"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Point-of-Care Ultrasound of a Pediatric Mediastinal Mass: A Case Report.","authors":"Phoebe Greenwald, Joni E Rabiner","doi":"10.1097/PEC.0000000000003329","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003329","url":null,"abstract":"<p><strong>Abstract: </strong>Point-of-care ultrasound may be used for identification of thoracic pathology, including mediastinal masses. In this case report, we describe the case of an otherwise healthy 17-year-old boy who presented with generalized pruritis. Point-of-care ultrasound was useful in identifying a complex cystic and solid mediastinal mass extending into the thoracic cavities as well as an associated pericardial effusion.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143041045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Procedural Entrustment Alignment Between Pediatric Residents and Their Preceptors in the Pediatric Emergency Department.","authors":"Michael P Goldman, Martin D Slade, Katherine Gielissen, Alexander W Hirsch, Elizabeth A Prabhu, Dana W Dunne, Marc A Auerbach","doi":"10.1097/PEC.0000000000003330","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003330","url":null,"abstract":"<p><strong>Objective: </strong>Entrustment describes the balance of supervision and autonomy between resident and preceptor to complete doctoring tasks like procedures. Entrustment alignment between resident and preceptor facilitates safe, successful outcomes, and promotes learning. Study objectives describe procedural entrustment alignment between senior pediatric residents and their preceptors and report the impact of a simulation-based formative assessment (SFA) on entrustment alignment.</p><p><strong>Methods: </strong>This prospective observational study enrolled a convenience sample of senior pediatric residents in 2023. The SFA was videoed, consisted of obtaining informed consent and performing simulated procedures (laceration [LAC] and lumbar puncture [LP]). Residents self-assessed their entrustability pre/post-SFA. A PEM preceptor panel individually rated videos of the residents. PEM panel's scores were compared to residents' scores on both an 8-point scale and the dichotomized variable of needing \"in versus out\" of the room entrustment.</p><p><strong>Results: </strong>Twenty-four residents' SFAs were rated by 9 panelists. Before the SFA, entrustment alignments on the 8-point scale were as follows: resident LAC 4.08 vs PEM panel 4.97 (P < 0.001), and resident LP 4.75 vs PEM panel 5.31 (P = 0.15). After the SFA, entrustment alignments were as follows: resident LAC 5.21 vs PEM panel 4.97 (P = 0.32), and resident LP 5.54 vs PEM panel 5.31 (P = 0.52). The dichotomized analyses revealed improved alignment post-SFA: LAC-pre-kappa = 0.03 vs LAC-post 0.46, and LP-pre-kappa = (-0.03) vs LP-post = 0.24.</p><p><strong>Conclusions: </strong>Our findings indicate senior pediatric residents desire less entrustment (more supervision) for procedures but better align with preceptors after an SFA. This work offers insight into procedural entrustment decision making and the potential of SFA's to facilitate procedural learning.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a Helmet Distribution Program in the Pediatric Emergency Department.","authors":"Nicolas Delacruz, Kathryn Varghese, Allan Pulliam, Angelica Almader-Ruiz, Ee Tein Tay","doi":"10.1097/PEC.0000000000003233","DOIUrl":"10.1097/PEC.0000000000003233","url":null,"abstract":"<p><strong>Objective: </strong>Bicycle helmet use has repeatedly been shown to protect riders from serious injury. Despite this, a majority of children and adolescents do not regularly wear helmets. Our primary objective was to determine if an emergency department (ED)-based helmet distribution program could increase the amount of time children report wearing helmets.</p><p><strong>Methods: </strong>This was a prospective cohort study of children aged 3 to 17 years presenting to the ED of an urban, tertiary care hospital. Participants were surveyed on their helmet use habits and perceptions regarding the efficacy and importance of helmets. Participants then received a bicycle helmet along with safety counseling in the ED and bicycle safety handouts provided by the American Academy of Pediatrics. Participants were contacted for follow-up 8 weeks after enrollment.</p><p><strong>Results: </strong>We enrolled a total of 94 patients. Post-intervention surveys were obtained from 47% of participants. Our helmet program resulted in a statistically significant increase in the amount of time children reported wearing bicycle helmets. Prior to ED intervention, 48% of participants reported wearing a helmet \"most of the time\" or \"all of the time.\" After participating, 86% of participants indicated that they wore a helmet \"most of the time\" or \"all of the time.\" Participants indicated a variety of reasons for not wearing helmets. Of all patients contacted for follow-up, 16% indicated that they were involved in an accident after participating where the helmet they were given prevented a head injury.</p><p><strong>Conclusions: </strong>Helmet distribution programs based in the pediatric ED increase rates of bicycle helmet usage among pediatric patients. Additional study is needed to determine effect on head injury prevention.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"6-10"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141477209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preferences for Management of Pediatric Pneumonia: A Clinician Survey of Artificially Generated Patient Cases.","authors":"Sriram Ramgopal, Thomas Belanger, Douglas Lorenz, Susan C Lipsett, Mark I Neuman, David Liebovitz, Todd A Florin","doi":"10.1097/PEC.0000000000003231","DOIUrl":"10.1097/PEC.0000000000003231","url":null,"abstract":"<p><strong>Background: </strong>It is unknown which factors are associated with chest radiograph (CXR) and antibiotic use for suspected community-acquired pneumonia (CAP) in children. We evaluated factors associated with CXR and antibiotic preferences among clinicians for children with suspected CAP using case scenarios generated through artificial intelligence (AI).</p><p><strong>Methods: </strong>We performed a survey of general pediatric, pediatric emergency medicine, and emergency medicine attending physicians employed by a private physician contractor. Respondents were given 5 unique, AI-generated case scenarios. We used generalized estimating equations to identify factors associated with CXR and antibiotic use. We evaluated the cluster-weighted correlation between clinician suspicion and clinical prediction model risk estimates for CAP using 2 predictive models.</p><p><strong>Results: </strong>A total of 172 respondents provided responses to 839 scenarios. Factors associated with CXR acquisition (OR, [95% CI]) included presence of crackles (4.17 [2.19, 7.95]), prior pneumonia (2.38 [1.32, 4.20]), chest pain (1.90 [1.18, 3.05]) and fever (1.82 [1.32, 2.52]). The decision to use antibiotics before knowledge of CXR results included past hospitalization for pneumonia (4.24 [1.88, 9.57]), focal decreased breath sounds (3.86 [1.98, 7.52]), and crackles (3.45 [2.15, 5.53]). After revealing CXR results to clinicians, these results were the sole predictor associated with antibiotic decision-making. Suspicion for CAP correlated with one of 2 prediction models for CAP (Spearman's rho = 0.25). Factors associated with a greater suspicion of pneumonia included prior pneumonia, duration of illness, worsening course of illness, shortness of breath, vomiting, decreased oral intake or urinary output, respiratory distress, head nodding, focal decreased breath sounds, focal rhonchi, fever, and crackles, and lower pulse oximetry.</p><p><strong>Conclusions: </strong>Ordering preferences for CXRs demonstrated similarities and differences with evidence-based risk models for CAP. Clinicians relied heavily on CXR findings to guide antibiotic ordering. These findings can be used within decision support systems to promote evidence-based management practices for pediatric CAP.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"41-49"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141477210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hair Today, OR Tomorrow: A Multicenter Case Series of Gastric Bezoars in Children Diagnosed With Point-of-Care Ultrasound.","authors":"Rahul D Shah, Allie Grither, Stephanie G Cohen, Liliana Morales-Perez, Joni Rabiner, Antonio Riera","doi":"10.1097/PEC.0000000000003238","DOIUrl":"10.1097/PEC.0000000000003238","url":null,"abstract":"<p><strong>Abstract: </strong>Point-of-care ultrasound (POCUS) can expedite the diagnosis of pediatric abdominal pathologies including appendicitis and intussusception. In this patient series, we present cases from multiple pediatric emergency departments that demonstrate the use of POCUS in the diagnosis of trichobezoars in children. POCUS findings include the presence of an intragastric hyperechoic mass or a hyperechoic arch and associated posterior acoustic shadowing. These findings in the appropriate clinical context should prompt further diagnostic imaging and/or surgical consultation for removal.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"63-67"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Review of Point-of-Care Diaphragmatic Ultrasound in Emergency Medicine: Background, Techniques, Achieving Competency, Research, and Recommendations.","authors":"Sigmund J Kharasch, Sonja Salandy, Paloma Hoover, Virginia Kharasch","doi":"10.1097/PEC.0000000000003251","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003251","url":null,"abstract":"<p><strong>Abstract: </strong>The diaphragm is the major muscle of inspiration accounting for approximately 70% of the inspired tidal volume. Point-of-care diaphragmatic ultrasound offers the ability to quantitatively assess diaphragmatic function, perform serial evaluations over time, and visualize structures above and below the diaphragm. Although interest in point-of-care ultrasound (POCUS) of the diaphragm is developing in the emergency medicine, assessment of the diaphragm and its function is not recognized as a core application by national organizations or expert guidelines. As a result, it is infrequently performed, and its potential value in research or clinical practice may not be fully appreciated. The purpose of this review is to describe the developmental aspects of the diaphragm as it pertains to POCUS, discuss the POCUS techniques for evaluating diaphragmatic function, address competency acquisition in this POCUS application, summarize relevant research in the ED, and provide a summary of recommendations for further research and clinical utilization of POCUS in diaphragm evaluation.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":"41 1","pages":"68-74"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}