EM Journal Update Journal Reviews

Tags: , August 16th, 2019 Leave a Comment

Cervical Spine Injury Risk Factors in Children with Blunt Trauma

Pediatric cervical spine injuries (CSI) are rare (1-2%) after blunt trauma. Decision rules to identify adults at low risk of cervical spine injury have been developed (NEXUS criteria (Hoffman, NEJM 2000, PMID: 10891516), Canadian C-spine rule (Stiell, JAMA 2001, PMID: 11597285)). A pediatric rule was developed as a subset of the Nexus study (Vicellio, Pediatrics 2001,
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Apneic Oxygenation Reduces Hypoxemia During Endotracheal Intubation in the Pediatric Emergency Department

Oxygenation is particularly important in children undergoing endotracheal intubation. They have higher oxygen consumption than adults and become hypoxemic more quickly with rapid sequence intubation. Apneic oxygenation (AO) is the process of providing a high flow rate of oxygen through a standard nasal cannula prior to endotracheal intubation (ETI) without bag-valve mask ventilation. It is thought that the high flow rate results in nitrogen washout (replacing nitrogen with oxygen) which provides an oxygen reservoir as well as provides some degree of positive end expiratory pressure keeping airways open.
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Levetiracetam versus Phenytoin for Second-Line Treatment of Convulsive Status Epilepticus in Children (ConSEPT): An Open-Label, Multicentre, Randomised Trial

Status epilepticus is associated with significant morbidity and mortality. Benzodiazepines are recommended as first line agents but their efficacy is approximately 50%. The most commonly recommended 2nd line agents are Phenytoin and Fosphenytoin. Their use is associated with an efficacy of approximately 50%. In addition, their use is associated with significant adverse events. Levetiracetam (Keppra) had been proven efficacious in small case series,
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Effect of Intranasal Ketamine Vs Fentanyl on Pain Reduction for Extremity Injuries in Children: The Prime Randomized Clinical Trial

Pain is typically under-treated in children. Intranasal administration of analgesics has the benefits of rapid, needleless administration and a more rapid onset compared to oral administration. Ketamine is used frequently by the intravenous or intramuscular route for procedural sedation due to its efficacy and safety.
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April 12th, 2019 Leave a Comment

PECARN: Febrile Neonate Decision Rule Derivation and Internal Validation

The evaluation and management of febrile neonates remains controversial. Approximately, 10% of these patients will have a serious bacterial infection (SBI). Identification of the febrile neonate at low risk for serious bacterial infection could allow for a reduction in the rates of lumbar puncture, unnecessary antibiotics and hospital admission. The approach to these patients should evolve as the epidemiology changes and new diagnostic tests become available.
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Acute Kidney Injury After Computed Tomography: A Meta-analysis

Imaging is one of the most important diagnostic modalities that physicians utilize. In 2013 alone, over 70 million CT scans were performed. Contrast-enhanced imaging can aid in diagnosing certain pathology and improve image quality. There has historically been a concern for post-contrast acute kidney injury (AKI), which is generally considered an increase in creatinine or a decrease in glomerular filtration rate hours to days after contrast administration.
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Accuracy of the Age-Adjusted Quick SOFA Score in Children

The sepsis 3 guidelines recommended the use of the Sepsis Related Organ Failure Assessment (SOFA) score for early identification of sepsis in adults (Singer 2016, PMID: 26903338). An abbreviated version of SOFA (Quick SOFA or qSOFA) includes variables available at the bedside in the ED (systolic BP, respiratory rate and mental status). The 2017 pediatric surviving sepsis guidelines acknowledge that there is insufficient evidence to endorse a specific sepsis trigger tool and recommend that each institution develop their own recognition bundle (Amer College Critical Care 2017,
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Tags: , , February 13th, 2019 Leave a Comment

Predicting Escalated Care in Infants With Bronchiolitis

Bronchiolitis is the most common lower respiratory tract infection and the most common cause of admission in infants. Approximately 10% will require some airway support. The ability to identify those at risk for escalation of care would allow for appropriate disposition decisions.
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