Pediatric Ingestions and Toxicologic Exposures

2020 ◽  
pp. 611-623
Author(s):  
Vincent Calleo ◽  
Richard Cantor
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Pediatric Patient ◽  
Pediatric Patients ◽  
Sick Child ◽  
Medical Intervention ◽  
Severe Toxicity ◽  
Recreational Drugs ◽  
Gastrointestinal Decontamination

For the majority of emergency medicine providers, one of the most anxiety-provoking patients is a very sick child. This is especially true when pediatric patients present to the emergency department after a toxicologic exposure. Pediatric ingestions and toxicologic exposures are extremely common. Although only a small percentage of toxicologic exposures result in death, severe toxicity is frequently seen and requires substantial medical intervention. This chapter focuses on the approach to a poisoned pediatric patient (including gastrointestinal decontamination and common toxidromes) and common medications ingested by pediatric patients and their treatments. It also briefly discusses some recreational drugs that are commonly used in the pediatric community.

scholarly journals A Near Brush with Death: A Case Report on Oral Foreign Body Impalement

2019 ◽  
Vol 2 (1) ◽  
pp. 13-17 ◽  
Author(s):  
Rachel Christner ◽  
Marisa Homer ◽  
Oliver Atar ◽  
Brian Hynes
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Foreign Body ◽  
Emergency Room ◽  
Operating Room ◽  
Pediatric Patient ◽  
Pediatric Patients ◽  
Conscious Sedation ◽  
Upper Airway

We describe a case of an 11-month-old baby presenting to the emergency room with a foreign body in the upper airway. After unsuccessfully attempting to remove the foreign body in the emergency department, the otolaryngologist was consulted. The patient was taken to the operating room, and a comb was successfully removed under conscious sedation. This case illustrates the need of a well-considered strategy for managing the airway of a pediatric patient with a foreign body, while also demonstrating the unique challenges of treating pediatric patients.

scholarly journals Pediatric Training Crisis of Emergency Medicine Residency during the COVID-19 Pandemic

Children ◽  
2022 ◽  
Vol 9 (1) ◽  
pp. 32
Author(s):  
Yan-Bo Huang ◽  
Yu-Ru Lin ◽  
Shang-Kai Hung ◽  
Yu-Che Chang ◽  
Chip-Jin Ng ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Pediatric Patient ◽  
Pediatric Patients ◽  
Viral Disease ◽  
Patient Volume ◽  
Clinical Exposure ◽  
Global Pandemic ◽  
Pediatric Diseases ◽  
Epidemic Period ◽  
Average Patient

Coronavirus disease 2019 (COVID-19) is an emerging viral disease that has caused a global pandemic. Among emergency department (ED) patients, pediatric patient volume mostly and continuously decreased during the pandemic period. Decreased pediatric patient volume in a prolonged period could results in inadequate pediatric training of Emergency Medicine (EM) residents. We collected data regarding pediatric patients who were first seen by EM resident physicians between 1 February 2019, and 31 January 2021, which was divided into pre-epidemic and epidemic periods by 1 February 2020. A significant reduction in pediatric patients per hour (PPH) of EM residents was noted in the epidemic period (from 1.55 to 0.81, p < 0.001). The average patient number was reduced significantly in the classification of infection (from 9.50 to 4.00, p < 0.001), respiratory system (from 84.00 to 22.00, p < 0.001), gastrointestinal system (from 52.00 to 34.00, p = 0.007), otolaryngology (from 4.00 to 2.00, p = 0.022). Among the diagnoses of infectious disease, the most obvious drop was noted in the diagnosis of influenza and enterovirus infection. Reduced pediatric patient volume affected clinical exposure to pediatric EM training of EM residency. Changes in the proportion of pediatric diseases presented in the ED may induce inadequate experience with common and specific pediatric diseases.

Toxicologic Emergencies

2019 ◽  
pp. 340-359
Author(s):  
Michael A. Darracq ◽  
Danielle Holtz
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Environmental Exposures ◽  
Clinical Effects ◽  
Recreational Drugs ◽  
Appropriate Treatment ◽  
Wide Range ◽  
Standardized Exams

Toxicologic emergencies are common presentations to the emergency department (ED), and knowledge of the appropriate management of these situations, including available antidotes, is critical to the practice of emergency medicine. Most toxicologic emergencies are due to intentional overdoses or use of recreational drugs, but they can also be due to work or environmental exposures or, more frightening, to acts of terrorism or war. These potential terrorism agents are usually asked about on standardized exams. This chapter presents questions related to the diagnosis, clinical effects, and most appropriate treatment of a wide range of these toxicologic emergencies.

scholarly journals Emergency medicine airway leads: a rapid response distributed educational model for emergency department COVID-19 airway management

CJEM ◽  
2021 ◽  
Author(s):  
Adam Harris ◽  
Lorri Beatty ◽  
Nicholas Sowers ◽  
Sam G. Campbell ◽  
David Petrie ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Airway Management ◽  
Rapid Response ◽  
Educational Model

scholarly journals Predictive factors for prolonged hospitalisation in acute pyelonephritis patients admitted to the emergency medicine ward

2021 ◽  
pp. 102490792110009
Author(s):  
Howard Tat Chun Chan ◽  
Ling Yan Leung ◽  
Alex Kwok Keung Law ◽  
Chi Hung Cheng ◽  
Colin A Graham
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Length Of Stay ◽  
Acute Pyelonephritis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Prolonged Length ◽  
Reactive Protein ◽  
Prolonged Hospital ◽  
Emergency Medicine Ward

Background: Acute pyelonephritis is a bacterial infection of the upper urinary tract. Patients can be admitted to a variety of wards for treatment. However, at the Prince of Wales Hospital in Hong Kong, they are managed initially in the emergency medicine ward. The aim of the study is to identify the risk factors that are associated with a prolonged hospital length of stay. Methods: This was a retrospective cohort study conducted in Prince of Wales Hospital. The study recruited patients who were admitted to the emergency medicine ward between 1 January 2014 and 31 December 2017. These patients presented with clinical features of pyelonephritis, received antibiotic treatment and had a discharge diagnosis of pyelonephritis. The length of stay was measured and any length of stay over 72 h was considered to be prolonged. Results: There were 271 patients admitted to the emergency medicine ward, and 118 (44%) had a prolonged hospital length of stay. Univariate and multivariate analyses showed that the only statistically significant predictor of prolonged length of stay was a raised C-reactive protein (odds ratio 1.01; 95% confidence 1.01–1.02; p < 0.0001). Out of 271 patients, 261 received antibiotics in the emergency department. All 10 patients (8.5%) who did not receive antibiotics in emergency department had a prolonged length of stay (p = 0.0002). Conclusion: In this series of acute pyelonephritis treated in the emergency medicine ward, raised C-reactive protein levels were predictive for prolonged length of stay. Patients who did not receive antibiotics in the emergency department prior to emergency medicine ward admission had prolonged length of stay.

Presentation and Referral Patterns in Pediatric Closed Hand Fractures

Hand ◽  
2021 ◽  
pp. 155894472110085
Author(s):  
Landis R. Walsh ◽  
Laura C. Nuzzi ◽  
Amir H. Taghinia ◽  
Brian I. Labow
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Pediatric Patients ◽  
Primary Care Providers ◽  
Care Providers ◽  
Referral Patterns ◽  
Old Patients ◽  
Hand Surgeon ◽  
Hand Fractures ◽  
The Mean

Background Although pediatric hand fractures are common and generally have good outcomes, they remain a considerable source of anxiety for non–hand surgeons, who are less familiar with these injuries. We hypothesized that this anxiety may manifest as inefficiency in referral patterns. Methods The records of pediatric patients with isolated, closed hand fractures without concurrent trauma seen at our institution by a hand surgeon between January 2017 and December 2018 were retrospectively reviewed. Results There were 454 patients included; 62.1% were men, and the mean age was 9.6 years at initial encounter. Most patients (89.6%) were treated nonoperatively and incurred few complications (0.5%). Roughly half of all cases (n = 262) initially presented to an outside provider. Of these, 24.0% (n = 64 of 262) were evaluated by 2+ providers before a hand surgeon. Most commonly, these patients were referred from an outside emergency department (ED) to our ED before hand surgeon evaluation (n = 45 of 64). Forty-seven patients required surgery; however, none were performed urgently. Although a greater proportion of 7- to 11-year-old patients saw 2+ providers prior to a hand surgeon ( P = .007), fewer required surgery ( P < .001). Conclusions Pediatric closed hand fractures are mainly treated nonoperatively and nonemergently with generally excellent outcomes. Our data suggest that many patients continue to be referred through the ED or multiple EDs/providers for treatment. These inefficient referral patterns demonstrate the need for better education for ED and primary care providers, as well as better communication between these providers and local pediatric hand surgeons. Advancements in these areas are likely to improve efficiency of care and decrease costs.

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