Keywords: cardiac arrest, CPR, bystander (PubMed Search)
Ko YC, Hsieh MJ, Schnaubelt S, Matsuyama T, Cheng A, Greif R. Disparities in layperson resuscitation education: A scoping review [published online ahead of print, 2023 Jul 25]. Am J Emerg Med. 2023;72:137-146. doi:10.1016/j.ajem.2023.07.033
Keywords: Spontaneous Pneumomediastinum, asthma, crepitus, esophagram (PubMed Search)
Roby K, Barkach C, Studzinski D, Novotny N, Akay B, Brahmamdam P. Spontaneous Pneumomediastinum is Not Associated With Esophageal Perforation: Results From a Retrospective, Case-Control Study in a Pediatric Population [published online ahead of print, 2023 Apr 23]. Clin Pediatr (Phila). 2023;99228231166997. doi:10.1177/00099228231166997
Keywords: Drowning, near drowning, CXR (PubMed Search)
This was a retrospective study involving several hospitals in Italy. 135 patients who had drowned (the term used in the article) were included. 4.5% of patients died. Most drowning occurred in July and August. The most common comorbidity was epilepsy in about 10% of patients. Several patients were also witnessed to have trauma and syncope. Early resuscitation, either by bystanders or trained professionals, was paramount in survival.
Children who are conscious at presentation and have mild or no respiratory distress have the best prognosis. A well appearing child should be observed for 6-8 hours, given that 98% of children will present with symptoms within the first 7 hours. A chest xray is not indicated in the asymptomatic patient. Patients who are submerged greater than 25 minutes or without ROSC after 30 minutes have a poor prognosis.
Bottom line: Never swim alone and everyone should be trained in bystander CPR.
Keywords: Hands only CPR, bystander CPR, directions (PubMed Search)
Bystander CPR increases out-of-hospital CPR survival and direction by 911 telecommunicators increases the frequency of bystander CPR. The majority of 911 centers use Medical Priority Dispatch System which walks 911 telecommunicators through a series of questions that give different instructions based on the caller's answers. Studies have shown out-of-hospital cardiac arrests are only recognized between 79-92% of the time and telecommunicator instructions for CPR can take between 176-285 seconds.
This study reviewed recorded 911 calls of patients who were found to be in cardiac arrest. Calls where the caller was not with the patient and confirmed overdoses were some of the call types that were excluded.
Out of 65 reviewed calls, 28% were not recognized during the actual call. When they were reviewed, 8/18 of the calls were deemed to be recognizable. Themes that were noted were: incomplete or delayed recognition assessment (ie uncertainty in breathing), communication gaps (callers were confused with instructions or questions), caller emotional distress, delayed repositioning for chest compressions, non essential questions and assessments, and caller refusal/hesitation or inability to act.
Bottom line: In addition to bystander CPR training, education on the process and questions involved in calling 911 could be helpful in an emergency.
Missel et al. Barriers to the Initiation of Telecommunicator-CPR during 911 Out-of-Hospital Cardiac Arrest Calls: A Qualitative Study. 2023. Prehospital Emergency Care.
Keywords: fever, limp, bacteremia, osteomyelitis, septic joint (PubMed Search)
El Helou R, Landschaft A, Harper MB, Kimia AA. Bacteremia in Children With Fever and Acute Lower Extremity Pain [published online ahead of print, 2023 Apr 4]. Pediatrics. 2023;e2022059504. doi:10.1542/peds.2022-059504
Keywords: handoff, communication, adverse outcomes (PubMed Search)
Sumner BD, Grimsley EA, Cochrane NH, et al. Videographic Assessment of the Quality of EMS to ED Handoff Communication During Pediatric Resuscitations. Prehosp Emerg Care. 2019;23(1):15-21. doi:10.1080/10903127.2018.
Keywords: burns, pediatric (PubMed Search)
Nelson Textbook of Pediatrics
Keywords: ambulance, crash, response, fatality, collision (PubMed Search)
Prehosp Emerg Care. 2023;27(4):455-464. doi:10.1080/10903127.2022.
Keywords: neonatal fever, cellulitis, bacteremia (PubMed Search)
Kaplin, Ron. Clinical Presentation and Approach to Evaluation and Management. Pediatric Emergency Care 2023; 39(3):188-189.
Keywords: IV, EMS, transfer, pediatrics (PubMed Search)
Mangus CW, Canares T, Klein BL, et al. Interhospital Transport of Children With Peripheral Venous Catheters by Private Vehicle: A Mixed Methods Assessment. Pediatr Emerg Care. 2022;38(1):e105-e110. doi:10.1097/PEC.
Keywords: EMS, Alternate destinations, pediatric, EMS, reduce transport times (PubMed Search)
Ward CE, Singletary J, Campanella V, Page C, Simpson JN. Caregiver Perspectives on Including Children in Alternative Emergency Medical Services Disposition Programs: A Qualitative Study [published online ahead of print, 2023 May 5]. Prehosp Emerg Care. 2023;1-9. doi:10.1080/10903127.2023.
Keywords: Ketamine, morphine, fentanyl, pediatrics, EMS, pain control (PubMed Search)
Frawley J, Goyal A, Gappy R, et al. A Comparison of Prehospital Pediatric Analgesic Use of Ketamine and Opioids [published online ahead of print, 2023 Mar 8]. Prehosp Emerg Care. 2023;1-5. doi:10.1080/10903127.2023.
Keywords: Croup, respiratory distress, stridor, URI (PubMed Search)
Scribner C, Patel K, Tunik M. Pediatric Croup Due to Omicron Infection Is More Severe Than Non-COVID Croup. Pediatr Emer Care 2022;00.
Keywords: conjunctivitis, pink eye, eye drops (PubMed Search)
Honkila et al. Effect of Topical Antibiotics on Duration of Acute Infective Conjunctivitis in Children. JAMA Network Open. 2022;5(10):e2234459.
Keywords: intubation, supraglottic, BVM (PubMed Search)
Should EMS place an advanced airway in out of hospital cardiac arrests? Current studies suggest that advanced airway management is not superior to BVM in pediatric out of hospital cardiac arrest (OHCA).
Pediatric OHCA carries a high mortality rate and those that do survive often have a poor neurologic outcome. This study evaluated BVM vs supraglottic airway (SGA) placement vs endotracheal intubation (ETI) in relation to one month survival and favorable neurological outcomes. SGA and ETI were also grouped together and categorized as advanced airway management (AAM).
This study was conducted using the Pan Asian Resuscitation Outcomes Study Clinical Research Network. 3131 pediatric patients were included. 85% received BVM, 11.8% SGA and 2.6 % ETI. In a matched cohort, one month survival and survival with favorable neurological outcome was higher in the BVM group compared to the AAM group and in the BVM group compared to the SGA group. There was no significant difference noted between the ETI group and BVM group.
Bottom line: In this study, AAM was associated with decreased one month survival and less favorable neurological status in pediatric OHCA.
Tham LP, Fook-Chong S, Binte Ahmad NS, Ho AF, Tanaka H, Shin SD, Ko PC, Wong KD, Jirapong S, Rao GVR, Cai W, Al Qahtani S, Ong MEH; Pan-Asian Resuscitation Outcomes Study Clinical Research Network. Pre-hospital airway management and survival outcomes after paediatric out-of-hospital cardiac arrests. Resuscitation. 2022 Apr 26;176:9-18. doi: 10.1016/j.resuscitation.2022.
Kaila et al. Hyperkalemia in a Hemolyzed Sample in Pediatric Patients: Repeat or Do Not Repeat? Pediatric Emergency Care 2022; 00:00-00.
Keywords: Pediatric trauma, blood transfusion, ratios (PubMed Search)
Akl M, Anand T, Reina R et al. Balanced hemostatic resuscitation for bleeding pediatric trauma patients: A nationwide quantitative analysis of outcomes. Journal of Pediatric Surgery 2022. epub ahead of print.
Keywords: intuccesption, air enema, reduction timing (PubMed Search)
Keywords: pediatrics, moderate sedation, airway, laryngospasm. (PubMed Search)
Cosgrove P, Krauss B, Cravero J and Fleegler E. Predictors of Laryngospasm During 276,832 Episodes of Pediatric Procedural Sedation. Annals of Emergency Medicine 2022. epub ahead of print
Keywords: COVID, kids, masking, school (PubMed Search)
This was a multistate, prospective, observational cohort of children and teachers attending in person schools in kindergarden through 12th grade where the school districs had the ability to perform contact tracing and determine primary vs secondary infections. During the study period (6/21-12/21) 46 districts had universal masking policies and 6 districts had optional masking policies.
Districts that optionally masked had 3.6x the rate of secondary transmission compared to universally masked school districts. Optionally masked districts had 26.4 cases of secondary transmission per 100 community acquired cases compared to only 7.3 cases in universally masked districts.
Bottom line: Universial masking was associated with reduced secondary transmission of SARS-CoV2 compared with optional masking policies.
Boutzoukas AE, Zimmerman KO, Inkelas M, et al. School Masking Policies and Secondary SARS-CoV-2 Transmission. Pediatrics. 2022;149 (6):e2022056687.