Pediatric emergency medicine practice最新文献

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The effect of medically-attended injury experience on the use of home safety equipment 医疗护理伤害经验对使用家庭安全设备的影响

Pediatric emergency medicine practice

Pub Date : 2020-11-05 DOI: 10.22470/pemj.2020.00059

I. Jeong, S. Jung, Joohyun Suh, K. Ahn, J. A. Bae

Purpose: To assess the effect of medically-attended injury (MAI) on the use of home safety equipment, we analyzed the differences in parents’ perception and attitude about injury prevention, and use of home safety equipment depending on the children’s MAI experiences. Methods: From March 2018 through February 2019, we surveyed parents of children aged 5 years or younger via a mobile phone. The parents were divided into the MAI and non-MAI groups. The mobile survey focused on the perception and attitude about injury prevention, and use of home safety equipment (if not used, barriers). Results: Of the 204 parents, 75 (36.8%) reported their children’s MAI, comprising the MAI group. This group used the safety equipment more frequently than the non-MAI group (odds ratio, 7.03; 95% confidence interval, 3.39-14.59; P < 0.001). No significant differences between the 2 groups were found in the perception and attitude about injury prevention, barriers to the use of the equipment, and the type of the equipment in use. Conclusion: Parents’ experience in their children’s MAIs was associated with the use of home safety equipment, but it did not affect their perception and attitude about injury prevention. A visit to the emergency department with MAI is an opportunity for education on injury prevention and changes of the attitude.

目的:探讨医伴伤害(MAI)对家庭安全设备使用的影响，分析不同医伴伤害经历的家长对伤害预防和家庭安全设备使用的认知和态度的差异。方法:2018年3月至2019年2月，通过手机对5岁及以下儿童的父母进行调查。将父母分为MAI组和非MAI组。移动调查的重点是对伤害预防的看法和态度，以及使用家庭安全设备(如果没有使用，屏障)。结果:204名家长中，75名(36.8%)报告其子女患有MAI，构成MAI组。该组使用安全设备的频率高于非mai组(优势比，7.03;95%置信区间为3.39 ~ 14.59;P < 0.001)。两组在预防伤害的认知和态度、使用器械的障碍、使用器械的种类等方面差异无统计学意义。结论:家长在儿童MAIs中的经历与家庭安全设备的使用相关，但不影响其对伤害预防的认知和态度。带着MAI去急诊科是一个教育预防伤害和改变态度的机会。

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引用次数: 0

Points & Pearls: management of pediatric head and neck infections in the emergency department. 要点与要点:急诊儿科头颈部感染的处理。

Pediatric emergency medicine practice

Pub Date : 2020-11-02

Kathryn H Pade

引用次数: 0

Management of pediatric head and neck infections in the emergency department. 急诊儿科头颈部感染的处理

Pediatric emergency medicine practice

Pub Date : 2020-11-01 Epub Date: 2020-11-02

Samira Abudinen-Vasquez, Michelle N Marin

Head and neck infections can spread to nearby structures, compromising the airway and progressing to life-threatening events. Pediatric head and neck infections can be difficult to recognize; emergency clinicians must know the signs and symptoms of head and neck infections for early diagnosis and urgent management in order to prevent complications and decrease hospitalization rates. This issue reviews presenting signs and symptoms of pediatric head and neck infections, discusses when diagnostic studies are indicated, and offers evidence-based recommendations for management. Conditions reviewed include mastoiditis, sinusitis, Ludwig angina, peritonsillar abscess, retropharyngeal abscess, Lemierre syndrome, and acute suppurative thyroiditis.

头颈部感染可扩散到附近的结构，危及气道并发展为危及生命的事件。儿童头颈部感染可能难以识别;急诊临床医生必须了解头颈部感染的体征和症状，以便早期诊断和紧急处理，以防止并发症和降低住院率。本期综述了小儿头颈部感染的体征和症状，讨论了何时需要进行诊断研究，并提供了基于证据的治疗建议。所回顾的疾病包括乳突炎、鼻窦炎、路德维希心绞痛、囊周脓肿、咽后脓肿、Lemierre综合征和急性化脓性甲状腺炎。

引用次数: 0

A case of generalized tonic seizures related to acute myocarditis 急性心肌炎致全身性强直性癫痫1例

Pediatric emergency medicine practice

Pub Date : 2020-10-26 DOI: 10.22470/pemj.2020.00087

J. Yang, J. Na, Jinseok Lee, Da-eun Kim, Jinyoung Song, I. Kang, H. Yeh

Patients with acute myocarditis may experience sudden unconsciousness with involuntary movement due to generalized cerebral hypoperfusion of cardiac etiology, which can be misdiagnosed as a true seizure. Convulsive syncope, which is a syncope accompanied by involuntary movements, differs in clinical implications from seizure. It is challenging to clinically distinguish between convulsive syncope and seizure. Without initial suspicion of cardiac etiology, there is often a diagnostic or therapeutic delay. We describe a 7-year-old girl presenting with seizure, which turned out to be convulsive syncope, caused by acquired complete atrioventricular (AV) block related to acute myocarditis.

急性心肌炎患者可能由于心脏病因的广泛性脑灌注不足而出现突然意识不清和不自主运动，这可能被误诊为真正的癫痫发作。惊厥性晕厥是一种伴有不自主运动的晕厥，在临床意义上不同于癫痫发作。临床上很难区分惊厥性晕厥和癫痫发作。没有最初的怀疑心脏病因，往往有诊断或治疗延误。我们描述了一个7岁的女孩表现为癫痫发作，结果是惊厥性晕厥，由获得性完全房室(AV)传导阻滞引起的急性心肌炎。

引用次数: 0

Association of age-adjusted shock index with mortality in children with trauma: a single-center study in Korea 年龄调整休克指数与创伤儿童死亡率的关系:韩国的单中心研究

Pediatric emergency medicine practice

Pub Date : 2020-10-19 DOI: 10.22470/pemj.2020.00164

E. Yoon, Y. Huh, Yura Ko, Jung Heon Kim

Purpose: This study was performed to investigate the association of high age-adjusted shock index (AASI) with mortality in Korean children with trauma. Methods: The data of children (aged < 15 years) with trauma who visited a university hospital in Korea from 2010 through 2018 were reviewed. High AASI was defined by age groups as follows: < 12 months, ≥ 2.7; 12-23 months, ≥ 2.1; 2-4 years, ≥ 1.9; 5-11 years, ≥ 1.5; and 12-14 years, ≥ 1.1. Age, sex, transfer status, injury mechanism, hypotension, tachycardia, base deficit, hemoglobin concentration, trauma scores, hemorrhage-related procedures (transfusion and surgical interventions), and severe traumatic brain injury were compared according to high AASI and in-hospital mortality. The association of high AASI with the mortality was analyzed using logistic regression. Results: Of the 363 enrolled children, 29 (8.0%) had high AASI and 24 (6.6%) died. The children with high AASI showed worse trauma scores and underwent hemorrhage-related procedures more frequently, without a difference in the rate of the traumatic brain injury. High AASI was associated with in-hospital mortality (survivors, 6.5% vs. non-survivors, 29.2%; P = 0.001). This association remained significant after adjustment (adjusted odds ratio, 6.42; 95% confidence interval, 1.3829.82). The other predictors were Glasgow Coma Scale (for increment of 1 point; 0.62; 0.53-0.72) and age (for increment of 1 year; 0.84; 0.73-0.97). High AASI showed a 29.2% sensitivity and 93.5% specificity for the mortality. Conclusion: High AASI is associated with mortality, and have a high specificity but low sensitivity in Korean children with trauma. This predictor of mortality can be used prior to obtaining the results of laboratory markers of shock.

目的:本研究旨在探讨韩国创伤儿童高年龄调整休克指数(AASI)与死亡率的关系。方法:回顾2010 - 2018年韩国某大学医院收治的创伤儿童(年龄< 15岁)的资料。高AASI按年龄组定义如下:< 12个月，≥2.7;12-23个月，≥2.1;2-4年，≥1.9;5-11岁，≥1.5岁;12-14岁≥1.1。年龄、性别、转移状态、损伤机制、低血压、心动过速、基础缺陷、血红蛋白浓度、创伤评分、出血相关手术(输血和手术干预)和严重外伤性脑损伤根据高AASI和住院死亡率进行比较。采用logistic回归分析高AASI与死亡率的关系。结果:在363例入组儿童中，29例(8.0%)AASI高，24例(6.6%)死亡。高AASI的儿童表现出更差的创伤评分，更频繁地进行出血相关手术，但创伤性脑损伤的发生率没有差异。高AASI与住院死亡率相关(幸存者，6.5% vs.非幸存者，29.2%;P = 0.001)。校正后，这种关联仍然显著(校正优势比为6.42;95%置信区间，1.3829.82)。其他预测指标为格拉斯哥昏迷量表(每增加1点;0.62;0.53-0.72)和年龄(增加1岁;0.84;0.73 - -0.97)。高AASI对死亡率的敏感性为29.2%，特异性为93.5%。结论:高AASI与死亡率相关，在韩国创伤儿童中具有高特异性但低敏感性。这一死亡率预测指标可以在获得实验室休克指标的结果之前使用。

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引用次数: 0

Points & Pearls: Supraglottic airway devices for pediatric airway management in the emergency department. 要点与要点:用于急诊科儿科气道管理的声门上气道装置。

Pediatric emergency medicine practice

Pub Date : 2020-10-02

Arooma Ismail, Jeranil Nunez

引用次数: 0

Calculated decisions: Modified Mallampati classification. 计算决策:修改Mallampati分类。

Pediatric emergency medicine practice

Pub Date : 2020-10-02

Derek Tam, Christopher Tainter

The Modified Mallampati Classification stratifies predicted difficulty of endotracheal intubation based on anatomic features.

改良Mallampati分类基于解剖特征对气管插管预测困难进行分层。

引用次数: 0

Supraglottic airway devices for pediatric airway management in the emergency department. 急诊科用于小儿气道管理的声门上气道装置

Pediatric emergency medicine practice

Pub Date : 2020-10-01 Epub Date: 2020-07-02

Jennifer E Sanders, Louis A Spina

Endotracheal intubation can be difficult in the emergent situation, and it is important to have an appropriate backup strategy. Supraglottic airway devices have provided an alternative method for pediatric airway management that is relatively easy to learn, with a high success rate. This issue reviews the use of supraglottic airway devices in pediatric patients including common devices, indications and techniques for placement, and complications associated with their use. The use of supraglottic airway devices in the patient with a difficult airway is also discussed.

气管插管在紧急情况下可能是困难的，有一个适当的备用策略是很重要的。声门上气道装置为小儿气道管理提供了一种相对容易学习且成功率高的替代方法。本期综述了声门上气道装置在儿科患者中的应用，包括常见设备、放置的适应症和技术，以及与使用相关的并发症。本文还讨论了声门上气道设备在气道困难患者中的应用。

引用次数: 0

Points & Pearls: Emergency care for transgender and gender-diverse children and adolescents. 要点和珍珠:对跨性别和性别多样化的儿童和青少年的紧急护理。

Pediatric emergency medicine practice

Pub Date : 2020-09-02

Samira Abudinen Vasquez, Jeranil Nunez

引用次数: 0

Emergency care for transgender and gender-diverse children and adolescents. 为跨性别和性别多样化的儿童和青少年提供紧急护理。

Pediatric emergency medicine practice

Pub Date : 2020-09-01 Epub Date: 2020-09-02

Hannah Janeway, Clinton J Coil

Transgender and gender-diverse (TGD) youth may present to the emergency department with a range of medical problems and health concerns. Some of these may be directly related to their gender identity, but the vast majority are not. While gender diversity is not considered a mental illness, TGD youth are at increased risk for suicide, anxiety, depression, and other psychological conditions, as well as family rejection, homelessness, food insecurity, and poverty. Lack of knowledge and cultural competency among emergency clinicians can create a barrier to effective care. This issue will review relevant terminology, epidemiology, and clinical best practices. It will help emergency clinicians understand common gender-affirming practices and recognize possible complications.

跨性别和性别多样化(TGD)青年可能会向急诊科提出一系列的医疗问题和健康问题。其中一些可能与他们的性别认同直接相关，但绝大多数都不是。虽然性别多样性不被认为是一种精神疾病，但TGD青年自杀、焦虑、抑郁和其他心理疾病的风险增加，以及家庭排斥、无家可归、粮食不安全和贫困的风险增加。缺乏知识和文化能力的急诊临床医生可以创造有效护理的障碍。本期将回顾相关术语、流行病学和临床最佳实践。它将帮助急诊临床医生了解常见的性别确认做法，并识别可能的并发症。

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