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No, I don’t give TXA to kids with isolated headinjuries We want to stop any clot breakdown to try and slow any potential bleeding. What about headinjury , though? Along came the CRASH 3 trial, another huge study looking specifically at TXA in traumatic brain injury. This is not good. in the TXA group vs 53.7%
We last pondered this in 2011 Morsel , just a couple years after PECARN headinjury data was published. So, it would seem that now is an opportune time for a Rebaked Morsel on Closed HeadInjury and the application of PECARN for children less than 3 months of age. PECARN Works too! Clinical Judgement is also important!
We have mentioned the Glasgow Coma Scale in multiple delicious morsels: Minor closed headinjuries in <3 month olds and in the rebaked morsel , Blunt cerebrovascular injury , Cerebral edema in DKA , Pediatric Trauma Pitfalls , and Carbon monoxide poisoning.
A 3-year-old boy is brought to the ED by his anxious parents following a headinjury he sustained while playing in the playground. He was running when he tripped and bumped his head against the metal steps. You consider the role of such imaging in investigating pediatricheadinjuries –.
In addition to the recently published low risk intra-abdominal injury validation, we have another new tool to use this summer as school breaks, underdeveloped frontal lobes, and high speeds leave us inundated with blunt trauma. Increased flexibility of pediatric C-spine predisposes to SCIWORA and other cord injuries.
One-liner… Traumatic brain injury (TBI) is a leading cause of mortality and morbidity in paediatric populations, and fever is associated with worse outcomes. A 12-year-old boy presents with a significant headinjury following a road traffic accident. Pediatr Crit Care Med. At the scene, his lowest GCS was 5 (E1V2M2).
Recent literature suggests that pediatric patients take longer to recover from mild traumatic brain injury compared to adults, and persistent post-concussive symptoms (PPCS) after 1 month occur in up to 30% of children after minor headinjury.
Maybe injuries to the spleen or kidney come to mind. Perhaps thoughts of pelvic injuries or severe headinjury dominate our considerations. Acute Esophageal Variceal Bleeding: Basics Pediatric liver disease may be due to numerous causes. Beyond Varices: Complications of Cirrhotic Portal Hypertension in Pediatrics.
In anticipation of the upcoming EM Cases main episode on Pediatric Polytrauma Dr. Suzanne Beno, Co-director of the Trauma Program at the Hospital for Sick Children in Toronto, tells her Best Case Ever of a child who suffers a severe traumatic headinjury with signs of raised intracranial pressure and cerebral herniation.
Comparison of PECARN, CATCH, and CHALICE rules for children with minor headinjury: a prospective cohort study. He is a […] The post SGEM#412: I Can’t Choose…from all the HeadInjury Prediction Rules first appeared on The Skeptics Guide to Emergency Medicine. So, should we CT scan children with minor headinjury?
Validation of the Pediatric NEXUS II Head Computed Tomography Decision Instrument for Selective Imaging of Pediatric Patients with Blunt Head Trauma. Validation of the Pediatric NEXUS II Head Computed Tomography Decision Instrument for Selective Imaging of Pediatric Patients with Blunt Head Trauma.
Systematic Review of CT Angiography in Guiding Management in Pediatric Oropharyngeal Trauma. March 2023 Date: January 30, 2024 Guest Skeptic: Dr. Alexandra (Ali) Espinel is an Associate professor of pediatrics and otolaryngology at Children’s National Hospital and George Washington University. Laryngoscope. Reference: Curry SD, et al.
In the context of a child with a headinjury- what was the best GCS/ GCS on arrival of the crew? E: Exposure and Environmental Control: Fully expose to check for other life-threatening injuries while maintaining normothermia. In addition, consider if there are any signs of injury with ENT, neurological or respiratory symptoms.
Management of the pediatric trauma patient is challenging regardless of where you work. How do you clear the pediatric c-spine? Are atropine and fentanyl recommended as pre-induction agents in the pediatric trauma patient? Is tranexamic acid recommended in early pediatric trauma like it is in adults? and many more.
Intranasal fentanyl and discharge from the emergency department among children with sickle cell disease and vaso-occlusive pain: A multicenter pediatric emergency medicine perspective. She is a Professor of Pediatrics and Interim Chief of the Section of Pediatric Emergency Medicine at the Medical College of Wisconsin.
The post EM Quick Hits 10 – TXA CRASH-3, CJEM Cellulitis, Double Defib, Serratus Anterior Block, PARC score, Toxic Shock Syndrome appeared first on Emergency Medicine Cases.
Just as pediatric patients are not small adults, geriatric patients are not just old adults. When can anticoagulation medications be safely resumed after an older person has sustained a minor headinjury? What is the utility of the Shock Index in older patients? and many more.
4] Epidemiology: Pneumocephalus is seen in almost all post-craniotomy cases, whereas the incidence of pneumocephalus seen in trauma involving headinjury varies between 3.9% There is no evidence that steroids (D) are beneficial in headinjury. An Pediatr (Engl Ed). 2019 Int J Crit Illn Inj Sci. 2017
Several definitions have been set forth for this common injury, with perhaps the most well accepted definition being introduced by the Centers for Disease Control and World Health Organization. For pediatric patients, we recommend using the PECARN PediatricHeadInjury Algorithm. JAMA Pediatr.
One of the issues that comes up with minor headinjuries is do we need to get advanced imaging. We looked at the Canadian CT Head Rule (CCHR) published by Dr. Ian Stiell in the Lancet 2001 on SGEM#106. The SGEM has also covered the issue of getting CT scans in pediatric patients with minor headinjuries.
Pediatric patients: Post circumcision bleed, head bleeds, bruises. PECARN PediatricHeadInjury/Trauma Algorithm, Canadian CT HeadInjury Rule, Ottawa Knee and Ankle Rules) do not apply to those with hemophilia and should not guide management. Mild hemophilia can be undiagnosed for years. Kitchens CS.
WHEN KIDS FALL OUT PEDIATRIC SYNCOPE [PODCAST]: An in depth look into pediatric syncope, delving into etiologies of sudden cardiac death in children and who should get further work up. Listen to the two part podcast featuring Dr. Andy Sloas & pediatric cardiology expert Dr. Buck Kyle @ PEM ED. Read on here @ ALiEM.
Kirelik is the Medical Director of the Rocky Mountain Pediatric OrthoONE Center for Concussion and is an attending pediatric emergency medicine physician at the Rocky Mountain Hospital for Children in Denver, Colorado. The Canadian CT Head Rule for patients with minor headinjury. 2009;374(9696):1160-1170.
It occurs when a mechanical force to the head injures the brain. This can be from the brain hitting the skull, shear forces from sudden acceleration and deceleration, or direct injury at the point of impact. The severity of headinjuries can be classified according to the GCS. Pediatr Crit Care Med. J Neurotrauma.
Whilst you were busy managing headinjuries and drownings, Ranulf had been out with a group of boys from school this evening. Balanced hemostatic resuscitation for bleeding pediatric trauma patients: A nationwide quantitative analysis of outcomes. J Pediatr Surg. Pediatr Surg Int. 2022 Dec;57(12):986-993.
Pediatrics. Pediatrics. Pediatrics. Relative rest (activities of daily living and reduced screen time) is indicated for the first 12-48 hours, followed by light-intensity physical activity (walking or stationary cycling while avoiding the risk of contact, collision, or fall) as tolerated. 2023 May 1;151(5):e2022059592.
The mother was given headinjury instructions and asked to monitor for any additional problems that arose for his nose or mouth too. Discussion Facial trauma is common and accounts for about 11% of all pediatric emergency room visits. Pediatric Nasal and Septal Fractures. playing, sports, car accidents, etc.).
Added benefit would accrue when a pediatric patient avoids CT images, thereby decreasing the potential risk for a subsequent cancer. Pediatric Emergency Care Applied Research Network headinjury clinical prediction rules are reliable in practice. Risk of brain tumor induction from pediatrichead CT procedures.
Abusive headinjury is the most common cause of death from child abuse. Up to 30% of infants with abusive headinjury may be misdiagnosed on initial presentation. Pediatr Diabetes. Pediatrics in Review. Pediatr Diabetes. Louwers et al. Radiographics. 2006; 26(5):1485-500. 2006 Apr;7(2):75-80.
JAMA Pediatrics 2021 Guest Skeptic: Dr. Catherine Varner is an Assistant Professor and Clinician Investigator in the Department of Family and Community Medicine at the University of Toronto. Background: Concussions or mild traumatic brain injury (mTBI) are commonly diagnosed in the Emergency Department (ED).
A 6 yo girl had significant trauma from an MVC, with headinjury (initial GCS 10, but no intracranial bleeding) and mild orthopedic injuries. Inpatient stay : She quickly awoke and was observed for a couple days, treated for minor orthopedic injuries, and recovered well from the headinjury.
The Pediatric Pain Management Standard 1 for children was published this year to provide guidance to health organizations on how to deliver equitable and quality pain management across hospital settings. IN fentanyl has been safely used to treat pain in pediatric patients. It offers a way to deliver analgesia without IV access.3,
Trench entrapment: is ketamine safe to use for sedation in headinjury? ketamine for sedation of pediatric patients receiving emergency department orthopedic procedures. Emerg Med J. 2004 May 1;21(3):275–80. Ketamine in prehospital care. Emerg Med J. 2004 May 1;21(3):351–4. Gunning M, Perkins Z, Quinn T. Emerg Med J. versus i.m.
mg/kg of IBW Seek to match a patient's minute ventilation with TV and RR after intubation Intentionally match patient's intrinsic RR noted prior to intubation Note that healthy lungs can handle 8 mL/kg, based on IBW, if that is useful for compensation Secure your ETT Thomas Tube Holder is a new ETT holder on Air Care for ETT down to size 6.5
Question and Methods:This prospective multicenter cohort study sought to validate the PECARN intra-abdominal injury and traumatic brain injury rules in order to help reduce the inappropriate use of CTs in the emergency department. Methodology: 3/5 Usefulness: 3/5 Holmes JF, et al. Lancet Child Adolesc Health. 2024 May;8(5):339-347.
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