scholarly journals Epilepsy in Children: From Diagnosis to Treatment with Focus on Emergency

2019 ◽  
Vol 8 (1) ◽  
pp. 39 ◽  
Author(s):  
Carmelo Minardi ◽  
Roberta Minacapelli ◽  
Pietro Valastro ◽  
Francesco Vasile ◽  
Sofia Pitino ◽  
...  
Keyword(s):  
Positive Family History ◽  
Vital Signs ◽  
Pediatric Intensive Care ◽  
Early Death ◽  
Signs And Symptoms ◽  
Neural Cells ◽  
Smoking In Pregnancy ◽  
Multi Stage ◽  
Adequate Dosage ◽  
Children First

Seizures are defined as a transient occurrence of signs and symptoms due to the abnormal, excessive, or synchronous neuronal activity in the brain characterized by abrupt and involuntary skeletal muscle activity. An early diagnosis, treatment, and specific medical support must be performed to prevent Status Epilepticus (SE). Seizure onset, especially in the child population, is related to specific risk factors like positive family history, fever, infections, neurological comorbidity, premature birth, mother’s alcohol abuse, and smoking in pregnancy. Early death risk in children without neurological comorbidity is similar to the general population. Diagnosis is generally based on the identification of continuous or recurrent seizures but Electroencephalogram (EEG) evaluation could be useful if SE condition is suspected. The main goal of therapy is to counteract the pathological mechanism which occurs in SE before neural cells are irreversibly damaged. According to the latest International Guidelines and Recommendations of seizure related diseases, a schematic and multi-stage pharmacological and diagnostic approach is proposed especially in the management of SE and its related causes in children. First measures should focus on early and appropriate drugs administration at adequate dosage, airway management, monitoring vital signs, Pediatric Intensive Care Unit (PICU) admission, and management of parent anxiety.

scholarly journals Epilepsy in Children: From Diagnosis to Treatment

2018 ◽  
Author(s):  
Carmelo Minardi ◽  
Roberta Minacapelli ◽  
Pietro Valastro ◽  
Francesco Vasile ◽  
Sofia Pitino ◽  
...  
Keyword(s):  
Positive Family History ◽  
Vital Signs ◽  
Early Death ◽  
Signs And Symptoms ◽  
Neural Cells ◽  
Multi Stage ◽  
Pathological Mechanism ◽  
Adequate Dosage ◽  
Children First ◽  
Guidelines And Recommendations

Seizures are defined as a transient occurrence of signs and symptoms due to the abnormal, excessive or synchronous neuronal activity in the brain characterized by an abrupt and involuntary skeletal muscles activity. An early diagnosis, treatment and specific medical support must be performed to prevent Status Epilepticus (SE). Seizures’ onset, especially in children population, is related to specific risk factors like positive family history, fever, infections, neurological comorbidity, premature birth, mother’s alcohol abuse and smoke in pregnancy. Early death risk in children without neurological comorbidity is similar to the general population. Diagnosis is generally based on the identification of continuous or recurrent seizures but EEG evaluation could be useful if SE condition in suspected. The main goal of therapy is to contrast pathological mechanism which occurs in SE before neural cells are irreversibly damaged. According to latest International Guidelines and Recommendations of seizures’ related diseases, it is proposed a schematic and multi-stage pharmacological and diagnostic approach especially in the management of SE and its related causes in children. First measures should focus on early and appropriate drugs administration at adequate dosage, airway management, monitoring vital signs, PICU admission and management of parents’ anxiety.

scholarly journals Opioid tapering and weaning protocols in pediatric critical care units: a systematic review

2018 ◽  
Vol 64 (10) ◽  
pp. 909-915 ◽  
Author(s):  
Pedro Bichaff ◽  
Karina T Setani ◽  
Emiliana H. G Motta ◽  
Artur F Delgado ◽  
Werther B Carvalho ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intensive Care ◽  
Initial Dose ◽  
Assessment Tool ◽  
Experimental Studies ◽  
Pediatric Intensive Care ◽  
Signs And Symptoms ◽  
Abstinence Syndrome ◽  
Great Heterogeneity ◽  
Weaning Protocols

SUMMARY OBJECTIVE: Opioid abstinence syndrome is common in the pediatric intensive care environment because sedation is often needed during the children's treatment. There is no specific guideline regarding the management of these patients; and lately, methadone is an important drug for the prevention of abstinence symptoms during the weaning of opioids. This study gathers the available research to establish the initial dose of methadone, the rate of taper and tools to recognize this syndrome and act promptly. METHODS: A systematic review was made from data of four different databases. Forty-nine articles of observational and experimental studies were selected based on the inclusion criteria (critical pediatric patients in acute use of opioids) and exclusion criteria (previous chronic use of opioids, other medications). The data regarding specific themes were separated in sections: initial dose of methadone, use of protocols in clinical practice, abstinence scales and adjuvant drugs. RESULTS: The articles showed a great heterogeneity of ways to calculate the initial dose of methadone. The pediatric intensive care units of the study had different weaning protocols, with a lower incidence of abstinence when a pre-defined sequence of tapering was used. The Withdrawal Assessment Tool – 1 was the most used scale for tapering the opioids, with good sensitivity and specificity for signs and symptoms. CONCLUSION: There is still little evidence of other medications that can help prevent the abstinence syndrome of opioids. This study tries to promote a better practice during opioid weaning.

scholarly journals What women know about breast cancer: In the case of Ethiopia

2021 ◽  
Author(s):  
Yonas Biratu Terfa ◽  
Samuel Abdu Aliyu ◽  
Ebrahim Yimam Reta ◽  
Gugsa Nemera Germossa ◽  
Adugna Olani Akuma
Keyword(s):  
Breast Cancer ◽  
Positive Family History ◽  
Signs And Symptoms ◽  
P Value ◽  
Screening Methods ◽  
Cancer Knowledge ◽  
Childbearing Age ◽  
Cross Sectional ◽  
Breast Cancer Knowledge ◽  
Jimma Town

Background & Aim: Breast cancer is the leading cause of death among women worldwide. Good knowledge of breast cancer enhances timely screening, early detection, and treatment; however, women's knowledge about breast cancer is very low. Thus, this study assesses the level of knowledge regarding breast cancer among women of childbearing age living in Jimma town. Methods & Materials: A community based cross-sectional study was conducted in Jimma town in 2018. Respondents were identified using multistage sampling methods. Data was collected using a standard questionnaire developed by cancer research UK and used in different languages in many parts of the world. Multiple logistic regression analyses were used to identify a variable with a significant association based on OR, with 95%CI and P-value of less than 0.05. Results: Out of 724 respondents, 686 gave their complete responses. The majority of 496 (72.3%) of the respondents were young adults with a mean age of 31, and about 307 (44.8%) of them had completed secondary school (9-12). Only 35% of respondents knew breast cancer; more specifically, 20% had knowledge of risk factors, 45% had knowledge of signs and symptoms, and 39 % had knowledge of screening methods. Maternal age, educational level, marital status, occupation, source of information, and monthly income, and positive family history of breast cancer were significantly associated with women’s breast cancer knowledge. Conclusion: Just over one-third (35%) of women are knowledgeable about breast cancer. However, women's breast cancer knowledge plays a great role in controlling before reaching an advanced stage.

Clinical Factors of High-Flow Nasal Cannula Oxygen Success in Children

2021 ◽  
Author(s):  
Gokce Iplik ◽  
Dincer Yildizdas ◽  
Ahmet Yontem
Keyword(s):  
Success Rate ◽  
Chronic Condition ◽  
Oxygen Therapy ◽  
Vital Signs ◽  
Pediatric Intensive Care ◽  
Pediatric Emergency ◽  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula ◽  
Therapy Success

AbstractThis study was aimed to evaluate the success rate of high-flow nasal cannula (HFNC) oxygen therapy and factors causing therapy failure. This prospective observational study included 131 children who received HFNC oxygen and followed-up in the pediatric emergency department, pediatric clinics, and pediatric intensive care unit between March 2018 and December 2019. The median age was 23.0 months (interquartile range [IQR]: 9.0–92.0) and 65 patients were male (49.6%). The most common reason for requiring HFNC oxygen therapy was pneumonia (n = 75, 57.3%). A complex chronic condition was present in 112 (85.5%) patients. Therapy success was achieved in 116 patients (88.5%). The reason for requiring treatment and the patients' complex chronic condition did not affect the success of the therapy (p = 0.294 and 0.091, respectively). In the first 24 hours of treatment, a significant improvement in pulse rate, respiratory rate, pH, and lactate level were observed in successful HFNC oxygen patients (p < 0.05). In addition, these patients showed a significant improvement in SpO2 and SpO2/FiO2 ratio, and a significant decrease in FiO2 and flow rate (p < 0.05). HFNC oxygen success rate was 95.6% in patients with SpO2/FiO2 ≥ 150 at the 24th hour; it was 58.0% in those with SpO2/FiO2 < 150 (p < 0.001). Caution should be exercised in terms of HFNC oxygen failure in patients with no significant improvement in vital signs and with SpO2/FiO2 < 150 during treatment.

scholarly journals Characterization of Dexmedetomidine Dosing and Safety in Neonates and Infants

2015 ◽  
Vol 20 (2) ◽  
pp. 112-118 ◽  
Author(s):  
Lauren M. Estkowski ◽  
Jennifer L. Morris ◽  
Elizabeth A. Sinclair
Keyword(s):  
Blood Pressure ◽  
Intensive Care Unit ◽  
Heart Rate ◽  
Intensive Care ◽  
Systolic Blood Pressure ◽  
Vital Signs ◽  
Pediatric Intensive Care ◽  
Neonates And Infants ◽  
To Receive

OBJECTIVES: To describe and compare off-label use and cardiovascular (CV) adverse effects of dexmedetomidine in neonates and infants in the pediatric intensive care unit (PICU). METHODS: Patients younger than 12 months with corrected gestational ages of at least 37 weeks who were receiving continuous infusion of dexmedetomidine at a tertiary pediatric referral center between October 2007 and August 2012 were assessed retrospectively. Patients were excluded if dexmedetomidine was used for procedural sedation, postoperative CV surgery, or if postanesthesia infusion weaning orders existed at the time of PICU admission. RESULTS: The median minimum dexmedetomidine dose was similar between infants and neonates at 0.2 mcg/kg/hr (IQR, 0.17–0.3) versus 0.29 mcg/kg/hr (IQR, 0.2–0.31), p = 0.35. The median maximum dose was higher for infants than neonates (0.6 mcg/kg/hr [IQR, 0.4–0.8] vs. 0.4 mcg/kg/hr [IQR, 0.26–0.6], p &lt; 0.01). Additional sedative use was more common in infants than neonates (75/99 [76%] vs. 15/28 [54%], p = 0.02). At least 1 episode of hypotension was noted in 34/127 (27%) patients and was similar between groups. An episode of bradycardia was identified more frequently in infants than neonates (55/99 [56%] vs. 2/28 [7%], p &lt; 0.01). Significant reduction in heart rate and systolic blood pressure was noted when comparing baseline vital signs to lowest heart rate and systolic blood pressure during infusion (p &lt; 0.01). CONCLUSIONS: Dexmedetomidine dose ranges were similar to US Food and Drug Administration–labeled dosages for intensive care unit sedation in adults. More infants than neonates experienced a bradycardia episode, but infants were also more likely to receive higher dosages of dexmedetomidine and additional sedatives.

scholarly journals Characteristics of non-conveyed patients in emergency medical services (EMS): a one-year prospective descriptive and comparative study in a region of Sweden

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Erik Höglund ◽  
Magnus Andersson-Hagiwara ◽  
Agneta Schröder ◽  
Margareta Möller ◽  
Emma Ohlsson-Nevo
Keyword(s):  
Emergency Medical Services ◽  
Vital Signs ◽  
Signs And Symptoms ◽  
Emergency Department Patient ◽  
Medical Services ◽  
Men And Women ◽  
Safety Issues ◽  
Levels Of Care ◽  
Emergency Medical ◽  
Number Of Patients

Abstract Background There has been an increasing demand for emergency medical services (EMS), and a growing number of patients are not conveyed; i.e., they are referred to levels of care other than ambulance conveyance to the emergency department. Patient safety issues have been raised regarding the ability of EMS to decide not to convey patients. To improve non-conveyance guidelines, information is needed about patients who are not conveyed by EMS. Therefore, the purpose of this study was to describe and compare the proportion and characteristics of non-conveyed EMS patients, together with assignment data. Methods A descriptive and comparative consecutive cohort design was undertaken. The decision of whether to convey patients was made by EMS according to a region-specific non-conveyance guideline. Non-conveyed patients’ medical record data were prospectively gathered from February 2016 to January 2017. Analyses was conducted using the chi-squared test, two-sample t test, proportion test and Mann-Whitneys U-test. Results Out of the 23,250 patients served during the study period, 2691 (12%) were not conveyed. For non-conveyed adults, the most commonly used Emergency Signs and Symptoms (ESS) codes were unspecific symptoms/malaise, abdomen/flank/groin pain, and breathing difficulties. For non-conveyed children, the most common ESS codes were breathing difficulties and fever of unclear origin. Most of the non-conveyed patients had normal vital signs. Half of all patients with a designated non-conveyance level of care were referred to self-care. There were statistically significant differences between men and women. Conclusions Fewer patients were non-conveyed in the studied region compared to national and international non-conveyance rates. The differences seen between men and women were not of clinical significance. Follow-up studies are needed to understand what effect patient outcome so that guidelines might improve.

Serotonin Syndrome: Early Management with Cyproheptadine

2001 ◽  
Vol 35 (7-8) ◽  
pp. 870-873 ◽  
Author(s):  
William W McDaniel
Keyword(s):  
Serotonin Syndrome ◽  
Muscle Tone ◽  
Symptomatic Relief ◽  
Vital Signs ◽  
Signs And Symptoms ◽  
Test Dose ◽  
Index Patient ◽  
Early Management ◽  
Rapid Reversal ◽  
Before And After

OBJECTIVE: T o report a psychiatric patient who developed serotonin syndrome after a medication overdose and whose marked mydriasis was quickly reversed by administration of cyproheptadine. This phenomenon was confirmed when other cases of serotonin syndrome were studied. METHOD: In the index patient as well as in three subsequent cases of serotonin syndrome, pupil diameter, muscle tone, mental status, and vital signs were monitored before and after a test dose of cyproheptadine as medications were discontinued and antiserotonergic therapy begun. RESULTS: In each patient, cyproheptadine produced rapid reversal of mydriasis within one hour of the initial dose. Other signs of serotonin syndrome remitted more slowly. As the signs and symptoms of serotonin syndrome remitted and pupils returned to normal size and reactiveness, cyproheptadine therapy seemed to produce mydriasis after each dose. Cessation of therapy after this point did not result in recurrence of symptoms. One patient developed serotonin syndrome twice. Two patients developed serotonin syndrome during treatment with medications that are partial serotonin antagonists (mirtazapine and nefazodone). CONCLUSIONS: Rapid reversal of mydriasis in serotonin syndrome by cyproheptadine may serve as a specific suppressive test for the condition, and possibly may add to our understanding of the syndrome. Treatment with cyproheptadine is not thought to abbreviate the illness, but provides symptomatic relief while symptoms persist.

scholarly journals Community acquired pneumonia (CAP): Epidemiology, clinical presentation, management and outcomes in infants and children presenting to Al Wakra Pediatric Emergency Department (PED)

2021 ◽  
Vol 2021 (2) ◽  
Author(s):  
Ibtihal S Abdelgadir ◽  
Haider Almawashi ◽  
Fawzia M Elgharbawy ◽  
Abdo M Alghazali ◽  
Kryzl D Ponce ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pediatric Intensive Care ◽  
Signs And Symptoms ◽  
Pediatric Emergency ◽  
Community Acquired Pneumonia ◽  
Infants And Children ◽  
Pediatric Emergency Department ◽  
Reactive Protein ◽  
Amoxicillin Clavulanic Acid ◽  
In Infants And Children

Background: Community acquired pneumonia (CAP) is defined clinically as the presence of signs and symptoms of pneumonia in a previously healthy child due to an infection that has been acquired outside the hospital. There is no previous data available from children in Qatar on CAP.Objectives: To evaluate the incidence, clinical features, management, outcomes and, complications in infants and children presenting to Al Wakra Hospital, Qatar with CAP. Methods: This is a prospective, observational, non-interventional study that assessed all children aged 3 months to 14 years, during a period of 12 months, from November 2017 to November 2018. Results: The incidence of CAP was found to be 2.8 per 1000 of all patients presenting to Al Wakra Pediatric Emergency Department Qatar (328 of 116,761patients). The majority of cases were children 1-5 years (58.2%). Fifty-one percent and 61.3% of children admitted to inpatient wards had dyspnoea and tachypnea respectively. This is to be compared to 88.5% and 96.2% of patients respectively admitted to the Pediatric Intensive Care Unit (PICU) with dyspnoea and with tachypnea. C-reactive protein (CRP) more than 50 mg/L was noted in 48.2% of patients admitted to inpatient wards and 26.7% of patients admitted to PICU. Oral amoxicillin was prescribed for 1.5% of patients, amoxicillin/clavulanic acid for 18% of patients, a further 18% had cefuroxime, and 29% had clarithromycin. Intravenous (IV) cefuroxime was the most used IV medication (29.6% of all patients). Nearly 50% of patients were admitted to inpatient wards, with 7.9% transferred to PICU, and only 39.3% discharged home without admission. Conclusion: Community acquired pneumonia represents 0.28% of all studied patients. More than 60% of the patients with CAP were admitted either to inpatient wards or to PICU.

scholarly journals Gastrointestinal manifestations as the initial presentation of COVID 19 in pediatrics

2020 ◽  
Vol 10 (3) ◽  
Author(s):  
Ana Leticia Souza ◽  
Flavia Matos ◽  
Rosana Flintz ◽  
Roberta Marliere ◽  
Mariana Presti ◽  
...  
Keyword(s):  
Pediatric Population ◽  
Gastrointestinal Symptoms ◽  
Pediatric Intensive Care ◽  
Signs And Symptoms ◽  
Positive Serology ◽  
Hospital Unit ◽  
Gastrointestinal Conditions ◽  
Clinical Presentations ◽  
Starting Point ◽  
Initial Symptoms

Initial research on SARS-COV 2 (Severe Acute Respiratory Syndrome Coronavirus 2) appeared to demonstrate that children infected with the virus remained asymptomatic or had only mild to moderate conditions. The most common symptoms were fever and cough. However, in a later phase of the pandemic, numerous other aspects of clinical presentation in the pediatric public were observed, especially gastrointestinal conditions. In the present study, patients monitored at the Pediatric Intensive Care Unit of the Hospital Estadual Adão Pereira Nunes from April 17, 2020 until June 17, 2020, who had detectable PCR-RT (Polymerase Chain Reaction -Trasncriptase) or positive serology for COVID 19 (Coronavirus disease 19). This is a hospital unit that is not a reference for COVID 19, and its target audience is trauma victims.The initial symptoms of most hospitalized patients with clinical suspicion were fever and gastrointestinal symptoms, with significant abdominal pain standing out, mimicking acute abdomen. Signs and symptoms that differ from adults, who have respiratory manifestations as a starting point. Based on the recognition of the different clinical presentations of SARS-COV 2 in the pediatric population, an early diagnosis is possible, with better conduction and outcome.

scholarly journals Conhecimento dos enfermeiros sobre ações de enfermagem e complicações em procedimentos invasivos coronarianos / Knowledge of nurses about nursing actions and complications in coronary invasive procedures

2019 ◽  
Vol 64 (2) ◽  
pp. 76
Author(s):  
Marciel Dos Santos Costa ◽  
Luciana Gonzaga dos Santos Cardoso ◽  
Silmar Maria Da Silva
Keyword(s):  
Nursing Care ◽  
Cardiopulmonary Arrest ◽  
Vital Signs ◽  
Signs And Symptoms ◽  
Fast Time ◽  
Emergency Unit ◽  
Invasive Procedures ◽  
Physical Effort ◽  
Pseudo Aneurysm ◽  
Nurse Knowledge

Objetivo: Verificar o conhecimento de enfermeiros que atuam no setor de hemodinâmica sobre ações de enfermagem e complicações em procedimentos invasivos coronarianos. Método: Pesquisa de campo, descritiva e de análise quantitativa, realizada em dois setores de Hemodinâmica, com 16 enfermeiros que responderam a um formulário contendo questões sobre ações de enfermagem antes, durante e após os procedimentos invasivos coronarianos, orientações para alta e possíveis complicações. Resultados: As ações de enfermagem antes do procedimento mais citadas foram: Orientar o paciente, verificar o tempo de jejum, monitorizar os sinais vitais, verificar histórico de alergias, histórico de doenças prévias, realizar entrevista de enfermagem e verificar a disponibilidade de materiais, equipamentos e medicamentos. Durante o procedimento: Monitorizar o paciente, realizar controle de materiais e medicamentos e verificar a ocorrência de sinais e sintomas. Após o procedimento: Monitorizar os sinais vitais, atentar para a retirada do introdutor, observar o curativo, avaliar o membro puncionado e orientar o paciente. As orientações para a alta mais citadas pelos enfermeiros foram: Atentar para sinais de sangramento ou hematomas, manter repouso ou evitar esforço físico e procurar pronto socorro próximo de casa em caso de hemorragia. As complicações citadas com maior frequência foram: Pseudoaneurisma, hematoma, hemorragia e parada cardiorrespiratória.  Conclusão: O presente estudo foi útil para a identificação de fragilidades na assistência de enfermagem aos pacientes submetidos ao CC ou ATCP, que podem ser corrigidas por meio de orientações ou treinamentos, com a finalidade de reduzir possíveis erros durante a realização dos cuidados de enfermagem a estes pacientes. Descritores: Enfermeiras e enfermeiros, Cuidados de enfermagem, Conhecimento, Serviço hospitalar de cardiologia, HemodinâmicaABSTRACT:Objective: To evaluate the nurse knowledge in the Hemodynamic area regarding the nursing care and complications in coronary invasive procedures. Method: A descriptive and quantitative fieldwork performed in two Hemodynamic areas involving 16 nurses who had answered a form containing nurse care questions before, during and after the coronary invasive procedures, guidance concerning the discharge and the possible complications. Results: The most cited nursing care items before the procedures were: to guide the patient, check the fast time, monitor the vital signs, check the allergy history, the previous diseases history, make a nursing interview and check the material, equipment and drugs availability. During the procedure: to monitor the patient, control the material and drugs and check the occurrence of signs and symptoms. After the procedure: to monitor the vital signs, be attentive to the introducer removal, observe the dressing, assess the punctured limb and guide the patient. Regarding the discharge guidance, the most cited ones by the nurses were: to be attentive to the bleeding signs or hematomas, keep at rest or avoid physical effort and go to the nearest emergency unit in case of hemorrhage. The most frequent cited complications were: pseudo aneurysm, hematoma, hemorrhage and cardiopulmonary arrest. Conclusion: The current study was relevant to identify the fragilities in the nursing care regarding the patients undergone to CC or PTCA which may be corrected through the nursing guidance or training, aiming to diminish the possible mistakes occurred during the nursing care given to these patients.Keywords: Nurses; Nursing care; Knowledge; Cardiology service, hospital; Hemodynamics  

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