Search

Background A pediatric emergency medicine and critical care fellowship was recently developed in Kenya through the University of Nairobi/Kenyatta National Hospital and AIC Kijabe Hospital. As part of this training, a week-long trauma and emergency medicine course was developed with emphasis on trauma and emergency medicine procedures. Given limited resources, we developed a course with simulation of procedures centered around utilization of a goat cadaver. Objective The aim of the study was to describe fellow and faculty experiences and perspectives when using a goat cadaver to teach emergency medicine procedures by simulation in Kijabe, Kenya. Methods A 5-day course was given to 2 fellows with a variety of didactics and simulations after which fellows completed a questionnaire to rate their satisfaction with the content and teaching effectiveness. Results The course was rated very highly, with an average content satisfaction score of 4.5 5 and average teaching effectiveness score of 4.4 of 5. Qualitative faculty feedback was positive, with specific learnings allowing ongoing adaptation of this model. Conclusions A goat cadaver is a cost-effective resource not often considered that can be adequately used to teach several emergency medicine skills by simulation.

General pediatricians have been involved for decades in bringing health to the world’s children with preventive and public health interventions. Building on this, this article seeks to explore the necessary concepts and components that would facilitate a rapid response for critically ill or injured pediatric patients to become a life-saving reality for all children. It has been shown that emergency care can be done practically, cost-effectively, and is necessary to save the lives of children who will, just like children in the USA, suffer from critical illness and injury as a matter of living. There is a challenge to the pediatric emergency medicine community to facilitate the training and delivery of rapid pediatric response worldwide, with the recognition that emergency care is a specialty of rapid team formation to identify critically ill children, and rapid action to resuscitate them.

We recognize the possibility of a needle stick can be an overwhelming fear for a child. We seek to review the needle-less options available to medical personnel for the treatment of pain and anxiety in children. We found that many new needle-less options exist for the treatment of pain and anxiety. Pharmacological measures, beyond the oral and enteral routes of medication administration, include intra-nasal and topical routes. Non-pharmacological treatments, including distraction techniques and oral sucrose for infants, are increasingly being recognized as viable treatments as the scientific community begins to study the effects these interventions can have on pediatric pain. There are many options to treat pediatric pain and anxiety that do not involve the use of a needle. Using needle-less methods of treatment helps pediatric care providers send a message of partnership with children and families.

Background Emergency providers often attribute stridor to croup in pediatric patients. However, even in children who are having other symptoms of a viral etiology, several other causes need to be considered. Case A 6-month-old term male without significant past medical history presented to the emergency department with stridor with likely underlying laryngospasm. He was initially ascribed the diagnosis of croup and was discharged home after receiving steroids and racemic epinephrine. However, he returned hours later after a seizure event at home. A thorough evaluation revealed an ionized calcium of 0.49 mmol/L, and further history revealed the patient was being fed a coconut water-based homemade solution for several months. He was subsequently found to have rickets and delay in milestone achievement. Awareness of hypocalcemia as a possible cause of laryngospasm is important because of the potential life-threatening effects of critically low calcium. Hypocalcemia should be included in the differential diagnosis of any child who presents with stridor, especially if lacking other symptoms of a viral illness.

Objective Burnout is a syndrome in which a reduced sense of personal accomplishment, depersonalization, and emotional exhaustion develop in response to prolonged stress. It is well known that physicians suffer high rates of burnout; emergency medicine physicians experience significantly increased rates of burnout, whereas physicians in other specialties, like pediatrics, may be spared. Pediatric emergency medicine physicians are on the frontline of care for the critically ill child, which could put them at high risk for burnout. This study evaluates the rate of burnout in pediatric emergency medicine physicians. Methods We conducted a survey assessing burnout using a sample of pediatric emergency medicine physicians who subscribe to an open Listserv server maintained by Brown University. Burnout was measured using a validated instrument, the Maslach Burnout Inventory-Human Services Survey, which was distributed by e-mail to the study group. Results Respondents averaged a score of 9 (95% confidence interval [CI], 8-10), 23 (95% CI, 21-25), and 39 (95% CI, 38-40) in the subscales of depersonalization, emotional exhaustion, and personal accomplishment, respectively. This placed our cohort into the average range for all subscales. The percentage of respondents who scored in the high levels of burnout (moderate to high scores in both depersonalization and emotional exhaustion and low to moderate scores in personal accomplishment) was 25% (95% CI, 18-32). Conclusions Unlike previous literature showing burnout prevalence in excess of 60% in emergency medicine physicians and 38% in pediatricians, our pediatric emergency medicine physicians fared better with only 25% (95% CI, 18-32), showing elevated levels of burnout.

OBJECTIVE: Conducted electrical weapons (CEWs) such as the TASER are often used by law enforcement (LE) personnel during suspect apprehension. Previous studies have reported an excellent safety profile and few adverse outcomes with CEW use in adults. We analyzed the safety and injury profile of CEWs when used during LE apprehension of children and adolescents, a potentially vulnerable population. METHODS: Consecutive CEW uses by LE officers against criminal suspects were tracked at 10 LE agencies and entered into a database as part of an ongoing multicenter injury surveillance program. All CEW uses against minors younger than 18 years were retrieved for analysis. Primary outcomes included the incidence and type of mild, moderate, and severe CEW-related injury, as assessed by physician reviewers in each case. Ultimate outcomes, suspect demographics, and circumstances surrounding LE involvement are reported secondarily. RESULTS: Of 2026 consecutive CEW uses, 100 (4.9%) were uses against minor suspects. Suspects ranged from 13 to 17 years, with a mean age of 16.1 (SD, 0.99) years (median, 16 years). There were no significant (moderate or severe) injuries reported (0%; 97.5% confidence interval, 0.0%-3.6%). Twenty suspects (20%; 95% confidence interval, 12.7%-29.1%) were noted to sustain 34 mild injuries. The majority of these injuries (67.6%) were expected superficial punctures from CEW probes. Other mild injuries included superficial abrasions and contusions in 7 cases (7%). CONCLUSIONS: None of the minor suspects studied sustained significant injury, and only 20% reported minor injuries, mostly from the expected probe puncture sites. These data suggest that adolescents are not at a substantially higher risk than adults for serious injuries after CEW use. Language: en

INTRODUCTION: Despite research demonstrating the overall safety of Conducted Electrical Weapons (CEWs), commonly known by the brand name TASER(®), concerns remain regarding cardiac safety. The addition of cardiac biomonitoring capability to a CEW could prove useful and even lifesaving in the rare event of a medical crisis by detecting and analyzing cardiac rhythms during the period immediately after CEW discharge. OBJECTIVE: To combine an electrocardiogram (ECG) device with a CEW to detect and store ECG signals while still allowing the CEW to perform its primary function of delivering an incapacitating electrical discharge. METHODS: This work was performed in three phases. In Phase 1 standard law enforcement issue CEW cartridges were modified to demonstrate transmission of ECG signals. In Phase 2, a miniaturized ECG recorder was combined with a standard issue CEW and tested. In Phase 3, a prototype CEW with on-board cardiac biomonitoring was tested on human volunteers to assess its ability to perform its primary function of electrical incapacitation. RESULTS: Bench testing demonstrated that slightly modified CEW cartridge wires transmitted simulated ECG signals produced by an ECG rhythm generator and from a human volunteer. Ultimately, a modified CEW incorporating ECG monitoring successfully delivered incapacitating current to human volunteers and successfully recorded ECG signals from subcutaneous CEW probes after firing. CONCLUSION: An ECG recording device was successfully incorporated into a standard issue CEW without impeding the functioning of the device. This serves as proof-of-concept that safety measures such as cardiac biomonitoring can be incorporated into CEWs and possibly other law enforcement devices.Copyright © 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved. Language: en

OBJECTIVES: Current trauma resuscitation protocols from the American College of Surgeons, Committee on Trauma, recommend intravascular volume expansion to treat shock after major trauma, assuming that hemorrhage is present. However, this assumption may not be correct. The purpose of this study was to identify the proportion of children with severe shock after trauma presenting with isolated head injury versus hemorrhagic injury. METHODS: A retrospective review of all pediatric trauma patients (aged 0-15 years) was conducted over a 5-year period. Severe shock was defined as the presence of both an elevated blood lactate level and low blood pressure for age. Traumatic injuries were classified as hemorrhagic injuries, head injuries, combined hemorrhagic and head injuries, or other injuries, by analyzing International Classification of Diseases, Ninth Revision diagnostic codes. RESULTS: A total of 31 (5%) of 680 pediatric trauma patients presented with severe shock. Among these 31 pediatric trauma patients, 9 (29%) had isolated head injury. Isolated head injury among children with shock was most frequently observed among children younger than 5 years (50%), and a decreased trend was noted with increasing age (23% for children 5-11 years and 0% for children 12-15 years [P = 0.03, Cochran-Armitage exact trend test]). CONCLUSIONS: Isolated head injury was observed in 29% of children 0 to 15 years of age with severe shock after trauma and in 50% of children younger than 5 years. Head injury is an important cause of severe shock in pediatric trauma, particularly among young children. Language: en