Pediatric emergency

Objective: Children admitted to hospital commonly require peripheral intravenous catheters (PIVCs) for treatment. This study sought to address a gap in the literature about current practice in the securement and dressing of PIVCs in paediatric acute care, and to ascertain the duration and failure of these devices. Methods: A prospective cohort study conducted at the Royal Children's Hospital in Queensland, Australia. All patients aged 0-15 years, who presented to the ED between 16 July and 16 October 2012, and had a PIVC inserted prior to emergent admission to the hospital were included. Results: Of 458 participants, median device duration was 29 h (IQR 13-58 h), and ranged from less than 1 h to 16 days. One quarter (113/456, 24.8%) of PIVCs were removed due to device failure, presenting as: infiltration (65/456, 14.3%); accidental dislodgement (23/456, 5.0%); blockage (12/456, 2.6%); phlebitis (7/456, 1.5%); or 'other' (6/456, 1.3%). PIVC securement and dressings were predominantly bordered polyurethane dressings and splints (n = 457/458, 99.8%). PIVC placement in the antecubital fossa, in comparison to the hand, was significantly associated with an increased risk for failure (P = 0.03). No other patient and device characteristics had a significant association with device failure (P > 0.05). The median dwell time of PIVCs that failed was significantly longer than the PIVCs that did not fail (44.0 vs 25.5 h; P = 0.002). Less than half (53/113, 46.9%) of failed catheters were replaced with a new PIVC. Conclusions: Observed failure rates were high for a clinically essential device; however, there is no established rate of acceptability against which the results can be benchmarked against to facilitate effectiveness of practice. Many PIVCs appeared to remain in place longer than needed. Dressing and securement practice was homogenous. PIVC placement in the antecubital fossa should be minimised to reduce the risk of paediatric PIVC failure.

Suicide is a major public health problem that affects people of all ages, including children. A child's decision to commit suicide is influenced by many social and psychological factors, as well as mental illness and addiction. Aim of this paper is to discuss the large scale of suicidal behaviors among children and adolescents, to select the most common causes and methods of suicide and to present a practical approach to the problem. For this purpose comprehensive review of the literature has been conducted. The most common suicide methods among children and adolescents are: hanging, jumping from a height and poisoning. According to the existing studies, quick reaction in the event of a suicide attempt is essential. The key to life-saving moment is a proper guidance of the child in the emergency department. Children after suicide attempts require long-term care, in which many people are involved like doctors, nurses and parents.

Objectives: Bronchiolitis is the most frequent reason for admission in infants. We set out to compare clinical practice guideline (CPG) recommendations and physician management of bronchiolitis at Paediatric Research in Emergency Departments International Collaborative (PREDICT) sites in Australia and New Zealand as a baseline for prospective trials. Methods: (i) Review of bronchiolitis CPGs from PREDICT sites.

Abstract
OBJECTIVE:
To assess the evidence for the safety and effectiveness of antiemetics on gastroenteritis-induced vomiting in children and adolescents.
DESIGN:
Systematic review.
DATA SOURCES:
The Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE searched from 1980 to March 2012.
METHODS:
Methods included comprehensive searches, data synthesis, meta-analysis and mixed treatment comparisons (MTC).
REVIEW METHODS:
Reference lists were checked, and missing or inconsistent data were sought from trial investigators. Randomised controlled trials comparing antiemetics in participants younger than 18 years and who were vomiting due to acute gastroenteritis. Four meta-analyses and three MTC were carried out.
RESULTS:
10 trials (1479 participants) and five treatments were included: dexamethasone, dimenhydrinate, granisetron, metoclopramide and ondansetron. There was clear evidence that ondansetron (oral or intravenous) compared with placebo increased the proportion of patients with cessation of vomiting (orally administered) (RR 1.44, 95% CI 1.29 to 1.61), reduced the immediate hospital admission rate (orally administered) (RR 0.40, 95% CI 0.19 to 0.83) and the need for intravenous rehydration therapy (orally administered) (RR 0.41, 95% CI 0.29 to 0.59). No significant difference was noted in the revisit rates, but ondansetron was associated with an increase in episodes of diarrhoea. There was no evidence for the use of dexamethasone or metoclopramide and limited evidence that dimenhydrinate or granisetron increased the cessation of vomiting. The MTC analysis suggested that ondansetron was the most likely treatment to stop the child vomiting. Nine studies were carried out in secondary care and one in primary care.
CONCLUSIONS:
This systematic review used a method novel to this clinical area and found clear evidence that ondansetron was the most likely treatment to allow oral rehydration therapy to commence. Given the significance of these results, the authors urge healthcare policy makers to consider the wider use of ondansetron in secondary care. Furthermore, randomised controlled trials are needed to investigate the effectiveness of antiemetic treatment in primary care (including ambulatory care interventions).

Venous canulation itself is a challenge in pediatric anaesthesia. Securing Intravenous access becomes the most difficult task when veins are poorly developed, poorly visible and not palpable. Problems are exaggerated if child is dehydrated and in shock. Peripheral venous access is routinely used for anaesthesia but intraosseous route is rarely used. We report an emergency pediatric case where intraosseous route saved the life of the infant. Peripheral intravenous line was secured for induction of anaesthesia but line got accidentally displaced. Several attempts were made to secure peripheral and central line, which were unsuccessful. Intraosseous route was secured with epidural needle and fluids, reversal agents,antibiotics and emergency drugs were given through intraosseous route only. All anaesthetists should bear in mind that intraosseous route as an easy to secure and safe alternative in emergercies.

Suicide is a major public health problem that affects people of all ages, including children. A child's decision to commit suicide is influenced by many social and psychological factors, as well as mental illness and addiction. Aim of this paper is to discuss the large scale of suicidal behaviors among children and adolescents, to select the most common causes and methods of suicide and to present a practical approach to the problem. For this purpose comprehensive review of the literature has been conducted. The most common suicide methods among children and adolescents are: hanging, jumping from a height and poisoning. According to the existing studies, quick reaction in the event of a suicide attempt is essential. The key to life-saving moment is a proper guidance of the child in the emergency department. Children after suicide attempts require long-term care, in which many people are involved like doctors, nurses and parents.

Pediatrics is the specialty of medical science concerned with the physical, mental, and social health of children from birth to young adulthood. Pediatric care encompasses a broad spectrum of health services ranging from preventive health care to the diagnosis and treatment of acute and chronic diseases.
https://clinicalcasereports.conferenceseries.com/call-for-abstracts.php Pediatrics is a discipline that deals with biological, social, and environmental influences on the developing child and with the impact of disease and dysfunction on development. Children differ from adults anatomically, physiologically, immunologically, psychologically, developmentally, and metabolically.

Pediatric patients are referred for multiple reasons, either for better therapeutic services or diagnostic purposes. The clinical condition of patients at the time of referral can significantly affect the outcome of such patients and there is not much data on this aspect. The overall objective of this study was to study the demographic and clinical profile, the causes for referral, and the outcome of pediatric patients being referred to a single tertiary care hospital. This was a prospective observational study done in the Department of Pediatrics of a single tertiary care hospital in North India over the course of 1 year. Patients referred from other health facilities in the age group 0 to 12 years who were admitted in the pediatric ward of the hospital were enrolled. The primary objective was to study the clinical profile and outcome (mortality) of these patients. The secondary objectives were to study the referral pattern of the referred patients, causes for referral, and the sev...

Objetivos: Evaluar las causas más frecuentes de atenciones por patología reumatológica en el servicio de emergencias de un hospital pediátrico peruano de tercer nivel. Pacientes y Métodos: Se llevó a cabo un estudio descriptivo, observacional y retrospectivo mediante la revisión de la base de datos y registros del servicio de emergencias del hospital, correspondientes al periodo comprendido entre enero 2012 y junio 2014, seleccionándose las atenciones debidas a patología reumatológica. Los datos fueron procesados mediante el programa estadístico SPSS 16.0. Resultados: Durante el periodo evaluado el número total de atenciones en el servicio de emergencias fue de 133484, correspondiendo 835 casos (0,63%) a diagnósticos reumatológicos según la Clasificación Internacional de Enfermedades 10° (CIE-10). La mayoría de los pacientes fueron hombres (450, 53,08%) y la distribución por grupos etáreos fue: 1-4 años 327 (39,16%), 5-9 años 251 (30,02%), 10-14 años 158 (18,98%), mayores de 15 años...

An 11-month-old child presented with what initially appeared to be 2 simple problems, a small elbow effusion followed 1 week later by croup. This case history is presented to remind emergency medicine physicians of the importance of index of suspicion and recognition of the difference between common events occurring in a normal host versus common events occurring in an abnormal host.

The pediatric emergency department (PED) is an important component of the medical services provided by a hospital. The purpose of the study was to describe the patterns of referrals, admissions, and discharges in a PED to determine to what extent the PED is used solely as an emergency unit, as opposed to being used as a part of a set of primary care facilities. Data were recorded from 1200 patient charts, out of 19,000 visits to a PED in Israel in 1988. Variables such as age, sex, ethnicity, and distance between residence and hospital were checked. About half of the patients arrived during the morning shift. There was an inverse relationship between the distance from the patient's home to the hospital and the rate of visits to the PED. Fifty-eight percent of the total were self-referred; this rate increased to 84% during the night shift. Only one quarter of all children had additional laboratory or x-ray tests. Most of the diagnoses did not require emergency services. Eighty-one percent of the patients were discharged from the PED to their community physician. The rate of admissions was low (11%). This study shows that a large part of the PED work is actually primary care. Some of the demographic, cultural, and ethnic reasons for these patterns are reviewed.

Toxic epidermal necrolysis is an uncommon but potentially life-threatening skin reaction that is frequently induced by drugs. The mucocutaneous reaction is characterized by bullous detachment of the epidermis and mucous membranes. We report a case of toxic epidermal necrolysis in a child receiving carbamazepine for 3 weeks; 60% of his body surface area was affected with mucosal involvement of the oropharynx, eyes, gastrointestinal system, and genitalia. His skin signs appeared 1 day after the last dosage increment. He was successfully treated with intravenous immunoglobulin and appropriate infection and wound management. The key to successful outcome includes early recognition, transfer to an intensive care center, prompt withdrawal of the causative agent, appropriate fluid resuscitation, and infection monitoring.

Venous canulation itself is a challenge in pediatric anaesthesia. Securing Intravenous access becomes the most difficult task when veins are poorly developed, poorly visible and not palpable. Problems are exaggerated if child is dehydrated and in shock. Peripheral venous access is routinely used for anaesthesia but intraosseous route is rarely used. We report an emergency pediatric case where intraosseous route saved the life of the infant. Peripheral intravenous line was secured for induction of anaesthesia but line got accidentally displaced. Several attempts were made to secure peripheral and central line, which were unsuccessful. Intraosseous route was secured with epidural needle and fluids, reversal agents,antibiotics and emergency drugs were given through intraosseous route only. All anaesthetists should bear in mind that intraosseous route as an easy to secure and safe alternative in emergercies.

Objective: Children admitted to hospital commonly require peripheral intravenous catheters (PIVCs) for treatment. This study sought to address a gap in the literature about current practice in the securement and dressing of PIVCs in paediatric acute care, and to ascertain the duration and failure of these devices. Methods: A prospective cohort study conducted at the Royal Children's Hospital in Queensland, Australia. All patients aged 0-15 years, who presented to the ED between 16 July and 16 October 2012, and had a PIVC inserted prior to emergent admission to the hospital were included. Results: Of 458 participants, median device duration was 29 h (IQR 13-58 h), and ranged from less than 1 h to 16 days. One quarter (113/456, 24.8%) of PIVCs were removed due to device failure, presenting as: infiltration (65/456, 14.3%); accidental dislodgement (23/456, 5.0%); blockage (12/456, 2.6%); phlebitis (7/456, 1.5%); or 'other' (6/456, 1.3%). PIVC securement and dressings were predominantly bordered polyurethane dressings and splints (n = 457/458, 99.8%). PIVC placement in the antecubital fossa, in comparison to the hand, was significantly associated with an increased risk for failure (P = 0.03). No other patient and device characteristics had a significant association with device failure (P > 0.05). The median dwell time of PIVCs that failed was significantly longer than the PIVCs that did not fail (44.0 vs 25.5 h; P = 0.002). Less than half (53/113, 46.9%) of failed catheters were replaced with a new PIVC. Conclusions: Observed failure rates were high for a clinically essential device; however, there is no established rate of acceptability against which the results can be benchmarked against to facilitate effectiveness of practice. Many PIVCs appeared to remain in place longer than needed. Dressing and securement practice was homogenous. PIVC placement in the antecubital fossa should be minimised to reduce the risk of paediatric PIVC failure.

The aim of this study was to examine emergency medical services providers' use of a new intraosseous needle designed for pediatric patients. This prospective pilot study was conducted between May 2006 and October 2007. After completing an initial training session, the EZ-IO PD was deployed for use on patients. Emergency medical services (EMS) providers completed a telephone data collection process after each insertion attempt. Data regarding insertion failure or success (insertion of needle into the bone with subsequent fluid flow), time to fluid flow, provider comfort with the device, device performance assessment, and recommendation for future use were collected. Two hundred forty-six EMS providers (EMT-P and registered nurses) from 14 EMS agencies consented to participation. Nineteen insertions were completed by 19 different providers during the study period. Successful insertion was achieved in 18 (95%) of 19 patients (95% confidence interval [CI], 85%-100%). Successful insertion was achieved in less than 60 seconds by 13 (72%) of 15 providers (95% CI, 60%-94%; 4 providers, no response). Fourteen out of 17 providers (82%) reported feeling very comfortable (59%) or comfortable (23%) with the device (95% CI, 64%-100%; 2 non-responses). Fourteen (82%) of 17 providers (95% CI, 64%-100%) with a successful insertion felt that the device worked very well, and the remaining 3 (18%) felt that it worked well. Thirteen (78%) of 17 providers (95% CI, 56%-96%) recommended future use of the EZ-IO needle over the Illinois needle. Two providers (11%) recommended the use of both needles, and 2 providers (11%) were unsure if they would recommend one of the intraosseous needles over the other. A total of 5 complications were reported by the providers: infiltration during use (2); slow flow rate (2); and needle dislodgement (1) when moving the patient into the ambulance. This device has a high insertion success rate with our provider group. Most of our EMS providers also felt comfortable using the device and recommend the device for future use.