Category: Pediatrics
Keywords: trauma arrest, ROSC, blunt, penetrating (PubMed Search)
Posted: 10/20/2023 by Jenny Guyther, MD
(Updated: 8/31/2024)
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Selesner L, Yorkgitis B, Martin M, et al. Emergency department thoracotomy in children: A Pediatric Trauma Society, Western Trauma Association, and Eastern Association for the Surgery of Trauma systematic review and practice management guideline. J Trauma Acute Care Surg. 2023;95(3):432-441. doi:10.1097/TA.
Category: EMS
Keywords: BVM, tidal volume, TV, ALS, BLS (PubMed Search)
Posted: 10/18/2023 by Jenny Guyther, MD
(Updated: 8/31/2024)
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The typical bag valve mask ventilator (BVM) for adults has a reservoir volume between 1500-2000 mL depending on the manufacturer while the volume is between 500-1000 mL for a pediatric BVM. When trying to obtain the recommended tidal volume of 6-8 mL/kg (500-600 mL for the typical adult), one thought was that a pediatric BVM could be used with adult patients so as to avoid iatrogenic barotrauma. This has been studied on manakins using an oral pharyngeal airway, supraglottic airway and endotracheal tubes (ETT) and has been successful. This study attempted to obtain the same results in the back of a moving ambulance. Paramedics and EMTs, squeezing pediatric and adult BVMs with one hand, bagged adult manakins in the back of a moving ambulance (without lights and sirens). The average tidal volume was recorded using various types of airways (i-gel, King airway and ETT).
Volumes delivered with the pediatric BVM were significantly lower than the tidal volumes with adult BVMs across all airway types suggesting that in the moving ambulance, using pediatric BVMs on an adult patient would not be appropriate.
The I-Gel and King airway provided similar tidal volumes which were not statistically different than volume delivered through the ETT.
EMTs consistently delivered 50% less tidal volumes compared to paramedics. The authors suggested that perhaps the additional training and pathophysiology knowledge that paramedics have could also be important with a skill that is considered basic.
Sun et al. Are Pediatric Manual Resuscitators Only Fit for Pediatric Use? A Comparison of Ventilation Volumes in a Moving Ambulance. Prehospital Emergency Care 2023, 27:4, 501-505.
Category: EMS
Keywords: cardiac arrest, CPR, bystander (PubMed Search)
Posted: 9/20/2023 by Jenny Guyther, MD
(Updated: 8/31/2024)
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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
Category: Pediatrics
Keywords: Spontaneous Pneumomediastinum, asthma, crepitus, esophagram (PubMed Search)
Posted: 9/15/2023 by Jenny Guyther, MD
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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
Category: Pediatrics
Keywords: Drowning, near drowning, CXR (PubMed Search)
Posted: 8/18/2023 by Jenny Guyther, MD
(Updated: 8/31/2024)
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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.
Category: EMS
Keywords: Hands only CPR, bystander CPR, directions (PubMed Search)
Posted: 8/16/2023 by Jenny Guyther, MD
(Updated: 8/31/2024)
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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.
Category: Pediatrics
Keywords: fever, limp, bacteremia, osteomyelitis, septic joint (PubMed Search)
Posted: 7/21/2023 by Jenny Guyther, MD
(Updated: 8/31/2024)
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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
Category: EMS
Keywords: handoff, communication, adverse outcomes (PubMed Search)
Posted: 7/19/2023 by Jenny Guyther, MD
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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.
Category: Pediatrics
Keywords: burns, pediatric (PubMed Search)
Posted: 7/7/2023 by Jenny Guyther, MD
(Updated: 8/31/2024)
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Kliegman, R. M., MD, Stanton, B. F., MD, St Geme, J., MD, & Schor, N. F., MD PhD. (2015). Nelson Textbook of Pediatrics (20th ed.). Elsevier Health Sciences.
Category: EMS
Keywords: ambulance, crash, response, fatality, collision (PubMed Search)
Posted: 6/22/2023 by Jenny Guyther, MD
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Prehosp Emerg Care. 2023;27(4):455-464. doi:10.1080/10903127.2022.
Category: Pediatrics
Keywords: neonatal fever, cellulitis, bacteremia (PubMed Search)
Posted: 6/16/2023 by Jenny Guyther, MD
(Updated: 8/31/2024)
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Kaplin, Ron. Clinical Presentation and Approach to Evaluation and Management. Pediatric Emergency Care 2023; 39(3):188-189.
Category: Pediatrics
Keywords: IV, EMS, transfer, pediatrics (PubMed Search)
Posted: 5/19/2023 by Jenny Guyther, MD
(Updated: 8/31/2024)
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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.
Category: Misc
Keywords: EMS, Alternate destinations, pediatric, EMS, reduce transport times (PubMed Search)
Posted: 5/17/2023 by Jenny Guyther, MD
(Updated: 8/31/2024)
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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.
Category: Pediatrics
Keywords: Ketamine, morphine, fentanyl, pediatrics, EMS, pain control (PubMed Search)
Posted: 4/21/2023 by Jenny Guyther, MD
(Updated: 8/31/2024)
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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.
Category: Pediatrics
Keywords: Croup, respiratory distress, stridor, URI (PubMed Search)
Posted: 3/17/2023 by Jenny Guyther, MD
(Updated: 8/31/2024)
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Scribner C, Patel K, Tunik M. Pediatric Croup Due to Omicron Infection Is More Severe Than Non-COVID Croup. Pediatr Emer Care 2022;00.
Category: Pediatrics
Keywords: conjunctivitis, pink eye, eye drops (PubMed Search)
Posted: 2/17/2023 by Jenny Guyther, MD
(Updated: 8/31/2024)
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Honkila et al. Effect of Topical Antibiotics on Duration of Acute Infective Conjunctivitis in Children. JAMA Network Open. 2022;5(10):e2234459.
Category: Pediatrics
Keywords: intubation, supraglottic, BVM (PubMed Search)
Posted: 1/20/2023 by Jenny Guyther, MD
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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.
Category: Pediatrics
Posted: 12/16/2022 by Jenny Guyther, MD
(Updated: 8/31/2024)
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Kaila et al. Hyperkalemia in a Hemolyzed Sample in Pediatric Patients: Repeat or Do Not Repeat? Pediatric Emergency Care 2022; 00:00-00.
Category: Pediatrics
Keywords: Pediatric trauma, blood transfusion, ratios (PubMed Search)
Posted: 11/18/2022 by Jenny Guyther, MD
(Updated: 8/31/2024)
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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.
Category: Pediatrics
Keywords: intuccesption, air enema, reduction timing (PubMed Search)
Posted: 10/21/2022 by Jenny Guyther, MD
(Updated: 8/31/2024)
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