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.
{"title":"Emergency care for transgender and gender-diverse children and adolescents.","authors":"Hannah Janeway, Clinton J Coil","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":38199,"journal":{"name":"Pediatric emergency medicine practice","volume":"17 9","pages":"1-20"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38281905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The use of high-flow nasal cannula and noninvasive ventilation has become increasingly common in emergency medicine as a first-line treatment of pediatric patients with respiratory distress secondary to asthma and bronchiolitis. When implemented in clinical practice, close monitoring of vital signs and ventilation parameters is warranted to identify possible signs of respiratory failure. This issue provides evidence-based recommendations for the appropriate use of noninvasive ventilation modalities in pediatric patients including high-flow nasal cannula, continuous positive airway pressure, and bilevel positive airway pressure in the setting of acute respiratory distress. Contraindications and complications associated with these modalities are also discussed.
{"title":"High-flow nasal cannula and noninvasive ventilation in pediatric emergency medicine.","authors":"Daniel Slubowski, Timothy Ruttan","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The use of high-flow nasal cannula and noninvasive ventilation has become increasingly common in emergency medicine as a first-line treatment of pediatric patients with respiratory distress secondary to asthma and bronchiolitis. When implemented in clinical practice, close monitoring of vital signs and ventilation parameters is warranted to identify possible signs of respiratory failure. This issue provides evidence-based recommendations for the appropriate use of noninvasive ventilation modalities in pediatric patients including high-flow nasal cannula, continuous positive airway pressure, and bilevel positive airway pressure in the setting of acute respiratory distress. Contraindications and complications associated with these modalities are also discussed.</p>","PeriodicalId":38199,"journal":{"name":"Pediatric emergency medicine practice","volume":"17 8","pages":"1-24"},"PeriodicalIF":0.0,"publicationDate":"2020-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38163339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Points & Pearls: Mechanical Ventilation of Pediatric Patients in the Emergency Department.","authors":"Kathryn H Pade","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":38199,"journal":{"name":"Pediatric emergency medicine practice","volume":"17 7","pages":"e1-e2"},"PeriodicalIF":0.0,"publicationDate":"2020-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38150566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
When pediatric patients require mechanical ventilation in the emergency department, the emergency clinician should be prepared to select initial ventilator settings and respond to an intubated patient's dynamic physiologic needs to ensure ongoing oxygenation, ventilation, and hemodynamic stability. Pressure-targeted ventilation is generally recommended in pediatric patients, with initial ventilator settings varying depending on age and the etiology of respiratory failure. This issue reviews indications for mechanical ventilation and offers recommendations for ventilator settings and dosing of analgesics, sedatives, and neuromuscular blockers, with a focus on patient populations in whom the approach to mechanical ventilation may be different.
{"title":"Mechanical ventilation of pediatric patients in the emergency department.","authors":"Casey Carr, Courtney W Mangus, J Kate Deanehan","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>When pediatric patients require mechanical ventilation in the emergency department, the emergency clinician should be prepared to select initial ventilator settings and respond to an intubated patient's dynamic physiologic needs to ensure ongoing oxygenation, ventilation, and hemodynamic stability. Pressure-targeted ventilation is generally recommended in pediatric patients, with initial ventilator settings varying depending on age and the etiology of respiratory failure. This issue reviews indications for mechanical ventilation and offers recommendations for ventilator settings and dosing of analgesics, sedatives, and neuromuscular blockers, with a focus on patient populations in whom the approach to mechanical ventilation may be different.</p>","PeriodicalId":38199,"journal":{"name":"Pediatric emergency medicine practice","volume":"17 7","pages":"1-16"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38062189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-30DOI: 10.22470/pemj.2019.00129
J. Yoo, Jung-In Ko, W. Yeo, Taejin Park, S. K. Jung, J. Kwon
Purpose: To study the appropriateness of rabies post-exposure prophylaxis (rPEP) for children with animal bite who visited the emergency department (ED). Methods: The study enrolled children younger than 18 years with animal bite who visited the National Medical Center ED between January 2014 and October 2017. The children’s electronic medical records were retrospectively reviewed. Data for analysis included age, sex, body parts bitten by animals, species of animals, regions where animal bites occurred, history of recent antibiotics therapy and tetanus vaccination, and justification by the 2017 Guidelines for Rabies Control in Korea and implementation of rPEP. In children who underwent unjustified rPEP or did not undergo justified one, we recorded their guardians’ opinion for or against rPEP. Results: Of the 63 enrolled children, rPEP was justified for 38 children by the Korean guidelines. Of the 38 children, 35 actually underwent rPEP. Among the remaining 3 children, 2 did not undergo the prophylaxis as per the guardians’ requests. Among the 25 children whose rPEP was not justified, 8 underwent the prophylaxis. Of these 8 children, 7 did based on the guardians’ requests. Conclusion: In this study, inappropriate rPEP was usually affected by the guardians’ requests, regardless of the criteria for such prophylaxis. Thus, their requests for or against rPEP should be discussed with emergency physicians who are aware of the relevant criteria to prevent occurrence of rabies or unnecessary use of medical resources.
{"title":"Appropriateness of rabies post-exposure prophylaxis in pediatric patients visiting the emergency department due to animal bite","authors":"J. Yoo, Jung-In Ko, W. Yeo, Taejin Park, S. K. Jung, J. Kwon","doi":"10.22470/pemj.2019.00129","DOIUrl":"https://doi.org/10.22470/pemj.2019.00129","url":null,"abstract":"Purpose: To study the appropriateness of rabies post-exposure prophylaxis (rPEP) for children with animal bite who visited the emergency department (ED). Methods: The study enrolled children younger than 18 years with animal bite who visited the National Medical Center ED between January 2014 and October 2017. The children’s electronic medical records were retrospectively reviewed. Data for analysis included age, sex, body parts bitten by animals, species of animals, regions where animal bites occurred, history of recent antibiotics therapy and tetanus vaccination, and justification by the 2017 Guidelines for Rabies Control in Korea and implementation of rPEP. In children who underwent unjustified rPEP or did not undergo justified one, we recorded their guardians’ opinion for or against rPEP. Results: Of the 63 enrolled children, rPEP was justified for 38 children by the Korean guidelines. Of the 38 children, 35 actually underwent rPEP. Among the remaining 3 children, 2 did not undergo the prophylaxis as per the guardians’ requests. Among the 25 children whose rPEP was not justified, 8 underwent the prophylaxis. Of these 8 children, 7 did based on the guardians’ requests. Conclusion: In this study, inappropriate rPEP was usually affected by the guardians’ requests, regardless of the criteria for such prophylaxis. Thus, their requests for or against rPEP should be discussed with emergency physicians who are aware of the relevant criteria to prevent occurrence of rabies or unnecessary use of medical resources.","PeriodicalId":38199,"journal":{"name":"Pediatric emergency medicine practice","volume":"58 1","pages":"23-27"},"PeriodicalIF":0.0,"publicationDate":"2020-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85648502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-30DOI: 10.22470/pemj.2020.00080
Kwang Yeon Kim
Recently, neodymium magnetic beads became popular in Korea. The beads, each 5 mm in diameter, can be connected in dozens to hundreds or even thousands to create the desired shape. As the popularity of magnetic beads increases, ingestion of the beads is presumed to become more frequent. Because infants and toddlers lack communicating skills, the guardians may not recognize swallowing of the beads without witness. This is of particular concern because children who swallow multiple magnets are at risk of abdominal complications such as necrosis, perforation, fistula, and stenosis. Here, we report a child who swallowed multiple neodymium magnetic beads unwitnessed. The case report was exempted by the Institutional Review Board with a waiver for the requirement of informed consent (IRB no. PC20ZAS10072). 여러 개의 자석을 삼킨 소아: 병력 청취를 통한 의심의 중요성
{"title":"A case of ingested multiple magnetic beads: the importance of suspicion based on medical history","authors":"Kwang Yeon Kim","doi":"10.22470/pemj.2020.00080","DOIUrl":"https://doi.org/10.22470/pemj.2020.00080","url":null,"abstract":"Recently, neodymium magnetic beads became popular in Korea. The beads, each 5 mm in diameter, can be connected in dozens to hundreds or even thousands to create the desired shape. As the popularity of magnetic beads increases, ingestion of the beads is presumed to become more frequent. Because infants and toddlers lack communicating skills, the guardians may not recognize swallowing of the beads without witness. This is of particular concern because children who swallow multiple magnets are at risk of abdominal complications such as necrosis, perforation, fistula, and stenosis. Here, we report a child who swallowed multiple neodymium magnetic beads unwitnessed. The case report was exempted by the Institutional Review Board with a waiver for the requirement of informed consent (IRB no. PC20ZAS10072). 여러 개의 자석을 삼킨 소아: 병력 청취를 통한 의심의 중요성","PeriodicalId":38199,"journal":{"name":"Pediatric emergency medicine practice","volume":"42 1","pages":"41-44"},"PeriodicalIF":0.0,"publicationDate":"2020-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85548646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-30DOI: 10.22470/pemj.2019.00164
S. Shin, H. Choi, Bogeum Choi
Purpose: Advanced pediatric emergency centers play an important role in professional treatment of children. We analyzed the characteristics of children who visited an advanced pediatric emergency center. Methods: The study enrolled children younger than 15 years who had visited Keimyung University Dongsan Medical advanced pediatric emergency center between April 2016 and March 2018. We reviewed the children’s age group characteristics, time of visit, triage results by the Korean Triage and Acuity Scale (KTAS), use of the emergency medical service ambulances, emergency department length of stay, final diagnosis, and final disposition. Results: A total 41,355 children (mean age, 3.1 ± 3.0 years) were enrolled, and those aged 1-4 years accounted for 65.7%. The visit was most frequent in December, at night (40.2%), and at holiday hours (30.2%) (c.f., business hours, 11.5%). Fever (33.2%) and eyelid laceration (11.5%) were the most common final diagnoses of diseases and injuries, respectively. The children triaged as the KTAS 1-2 accounted for 5.9% of the study children (c.f., KTAS 3-4, 91.5%). According to time of visit, the proportion of hospitalization (31.4%) and transfer from other hospitals (34.7%) were most frequent at business hours than other times of visit (P < 0.001). Conclusion: The children tended to visit the center with minor diseases or injuries, especially during holidays and at night. Further research is needed for optimizing the roles of advanced pediatric emergency centers, taking into account the characteristics of patients and demand for the centers.
{"title":"Utilization characteristics of an advanced pediatric emergency center: a single center study over 2 years","authors":"S. Shin, H. Choi, Bogeum Choi","doi":"10.22470/pemj.2019.00164","DOIUrl":"https://doi.org/10.22470/pemj.2019.00164","url":null,"abstract":"Purpose: Advanced pediatric emergency centers play an important role in professional treatment of children. We analyzed the characteristics of children who visited an advanced pediatric emergency center. Methods: The study enrolled children younger than 15 years who had visited Keimyung University Dongsan Medical advanced pediatric emergency center between April 2016 and March 2018. We reviewed the children’s age group characteristics, time of visit, triage results by the Korean Triage and Acuity Scale (KTAS), use of the emergency medical service ambulances, emergency department length of stay, final diagnosis, and final disposition. Results: A total 41,355 children (mean age, 3.1 ± 3.0 years) were enrolled, and those aged 1-4 years accounted for 65.7%. The visit was most frequent in December, at night (40.2%), and at holiday hours (30.2%) (c.f., business hours, 11.5%). Fever (33.2%) and eyelid laceration (11.5%) were the most common final diagnoses of diseases and injuries, respectively. The children triaged as the KTAS 1-2 accounted for 5.9% of the study children (c.f., KTAS 3-4, 91.5%). According to time of visit, the proportion of hospitalization (31.4%) and transfer from other hospitals (34.7%) were most frequent at business hours than other times of visit (P < 0.001). Conclusion: The children tended to visit the center with minor diseases or injuries, especially during holidays and at night. Further research is needed for optimizing the roles of advanced pediatric emergency centers, taking into account the characteristics of patients and demand for the centers.","PeriodicalId":38199,"journal":{"name":"Pediatric emergency medicine practice","volume":"17 1","pages":"16-22"},"PeriodicalIF":0.0,"publicationDate":"2020-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86927982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-30DOI: 10.22470/pemj.2019.00143
J. Lee, Dong Hyun Kim, Y. Kwon
Spinal epidural hematoma (EDH) can occur after substantial spinal trauma, originating from thinwalled venous plexus lying to the spinal cord. Clinically significant traumatic spinal EDH occurs uncommonly. Guillain-Barrésyndrome (GBS) is a postinfectious autoimmune demyelinating polyradiculoneuropathy mainly involving motor and/or sensory and autonomic nerves. Clinical manifestations 길랭-바레증후군으로 오인된 외상 척추경막외혈종에서 신경학적 합병증 없이 회복된 소아 1례
can occur after substantial Spinal trauma, originating from thinwalled venous plexus lying to the Spinal cord。Clinically significant traumatic spinal EDH occurs uncommonly。Guillain- Barresyndrome (GBS) is a postinfectious autoimmune demyelinating polyradiculoneuropathy mainly involving motor and/or sensory and autonomic nerves。Clinical manifestations被误认为是吉兰-巴莱综合症的外伤脊椎硬膜外血肿中没有神经并发症恢复的小儿1例
{"title":"Recovery without neurological sequelae of traumatic spinal epidural hematoma masquerading as Guillain-Barré syndrome in a child","authors":"J. Lee, Dong Hyun Kim, Y. Kwon","doi":"10.22470/pemj.2019.00143","DOIUrl":"https://doi.org/10.22470/pemj.2019.00143","url":null,"abstract":"Spinal epidural hematoma (EDH) can occur after substantial spinal trauma, originating from thinwalled venous plexus lying to the spinal cord. Clinically significant traumatic spinal EDH occurs uncommonly. Guillain-Barrésyndrome (GBS) is a postinfectious autoimmune demyelinating polyradiculoneuropathy mainly involving motor and/or sensory and autonomic nerves. Clinical manifestations 길랭-바레증후군으로 오인된 외상 척추경막외혈종에서 신경학적 합병증 없이 회복된 소아 1례","PeriodicalId":38199,"journal":{"name":"Pediatric emergency medicine practice","volume":"11 1","pages":"49-52"},"PeriodicalIF":0.0,"publicationDate":"2020-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84172754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-30DOI: 10.22470/pemj.2019.00136
Soo-Hong Kim, Y. Cho, Hae-Young Kim
The spleen is an intraperitoneal organ, and located in the left upper quadrant, fixed with the gastrosplenic, splenocolic, and splenorenal ligaments. Wandering spleen (also known as ectopic spleen) is a condition in which the spleen is not found in its usual location or presentation. The entity is caused by absence or laxity of the ligaments fixing the spleen. Due to this laxity, splenic vascular pedicle can be twisted easily, incurring splenic torsion. Splenic torsion leads to infarction, requiring prompt diagnosis and treatment. In this report, we present 2 cases of splenic infarction due to torsion of wandering spleen, which was successfully treated with laparoscopic splenectomy. This study was approved by the Institutional Review Board (IRB no. 05-2019-157).
{"title":"Two cases of splenic infarction due to torsion of wandering spleen requiring laparoscopic splenectomy in adolescent girls","authors":"Soo-Hong Kim, Y. Cho, Hae-Young Kim","doi":"10.22470/pemj.2019.00136","DOIUrl":"https://doi.org/10.22470/pemj.2019.00136","url":null,"abstract":"The spleen is an intraperitoneal organ, and located in the left upper quadrant, fixed with the gastrosplenic, splenocolic, and splenorenal ligaments. Wandering spleen (also known as ectopic spleen) is a condition in which the spleen is not found in its usual location or presentation. The entity is caused by absence or laxity of the ligaments fixing the spleen. Due to this laxity, splenic vascular pedicle can be twisted easily, incurring splenic torsion. Splenic torsion leads to infarction, requiring prompt diagnosis and treatment. In this report, we present 2 cases of splenic infarction due to torsion of wandering spleen, which was successfully treated with laparoscopic splenectomy. This study was approved by the Institutional Review Board (IRB no. 05-2019-157).","PeriodicalId":38199,"journal":{"name":"Pediatric emergency medicine practice","volume":"40 1","pages":"45-48"},"PeriodicalIF":0.0,"publicationDate":"2020-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84496696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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