Management of opioid use disorder in the USA: present status and future directions.

Spleen injuries are among the most frequent trauma-related injuries. At present, they are classified according to the anatomy of the injury. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic derangement, and the associated injuries. The management of splenic trauma patients aims to restore the homeostasis and the normal physiopathology especially considering the modern tools for bleeding management. Thus, the management of splenic trauma should be ultimately multidisciplinary and based on the physiology of the patient, the anatomy of the injury, and the associated lesions. Lastly, as the management of adults and children must be different, children should always be treated in dedicated pediatric trauma centers. In fact, the vast majority of pediatric patients with blunt splenic trauma can be managed non-operatively. This paper presents the World Society of Emergency Surgery (WSES) classification of splenic trauma and the management guidelines.

https://link.springer.com/content/pdf/10.1186/s13017-017-0151-4.pdf

Splenic trauma: WSES classification and guidelines for adult and pediatric patients

The utility of point-of-care ultrasound is well supported by the medical literature. Consequently, pediatric emergency medicine providers have embraced this technology in everyday practice. Recently, the American Academy of Pediatrics published a policy statement endorsing the use of point-of-care ultrasound by pediatric emergency medicine providers.  To date, there is no standard guideline for the practice of point-of-care ultrasound for this specialty. This document serves as an initial step in the detailed “how to” and description of individual point-of-care ultrasound examinations.  Pediatric emergency medicine providers should refer to this paper as reference for published research, objectives for learners, and standardized reporting guidelines.

/pdf/pediatric-emergency-medicine-point-of-care-ultrasound-3xnhe2jeiy.pdf

Pediatric emergency medicine point-of-care ultrasound: summary of the evidence

Context. Clinical effects of hydrocarbon exposure have been reported since 1897. These substances are ubiquitous, and their exposures are common. The specific hydrocarbon and route of exposure will determine the clinical effect, and an understanding of this is helpful in the care of the hydrocarbon-exposed patient. Objective. To complete a comprehensive review of the literature on hydrocarbon toxicity and summarize the findings. Methods. Relevant literature was identified through searches of Medline (PubMed/OVID) and Cochrane Library databases (inclusive of years 1975–2013), as well as from multiple toxicology textbooks. Bibliographies of the identified articles were also reviewed. Search terms included combinations of the following: hydrocarbons, inhalants, encephalopathy, coma, cognitive deficits, inhalant abuse, huffing, sudden sniffing death, toluene, renal tubular acidosis, metabolic acidosis, arrhythmia, dermatitis, and aspiration pneumonitis. All pertinent clinical trials, observational stu...

Hydrocarbon toxicity: A review.

Focused assessment with sonography in trauma (FAST) has been extensively utilized and studied in blunt and penetrating trauma for the past 3 decades. Prior to FAST, invasive procedures such as diagnostic peritoneal lavage and exploratory laparotomy were commonly utilized to diagnose intraabdominal injury. Today the FAST examination has evolved into a more comprehensive study of the abdomen, heart, chest, and inferior vena cava, and many variations in technique, protocols, and interpretation exist. Trauma management strategies such as laparotomy, laparoscopy, endoscopy, computed tomographic angiography, angiographic intervention, serial imaging, and clinical observation have also changed over the years. This state of the art review will discuss the evolution of the FAST examination to its current state in 2017 and evaluate its evolving role in the acute management of the trauma patient. The authors also report on the utility of FAST in special patient populations, such as pediatric and pregnant trauma patients, and the potential for future research, applications, and portions of this examination that may be applicable to radiology-based practice. © RSNA, 2017 Online supplemental material is available for this article.

Focused Assessment with Sonography in Trauma (FAST) in 2017: What Radiologists Can Learn.

The role of focused abdominal sonography for trauma (FAST) in pediatric trauma evaluation.

Children presenting with hip pain or a limp are a diagnostic challenge for the clinician. The differential diagnosis is extensive, and the workup can be broad. This review focuses on differentiating between transient synovitis and septic arthritis of the hip. The role of bedside ultrasound in the clinical evaluation of these patients is addressed, including the technique and appropriate indications for bedside ultrasound of the hip in the emergency department.

The role of ultrasound in the emergency department evaluation of the acutely painful pediatric hip.

Objectives (1) To determine the duration, outcome, and associated findings of urticaria in children seen by general pediatricians; (2) to compare the exposure to foods, medications, insect stings or bites, and the presence of other symptoms in children with urticaria with controls; (3) to determine general pediatricians' management of urticaria. Design Case-control. Participants Children with urticaria seen by Utah Pediatric Practice Based Research Network members between August 1, 1999, and August 31, 2000. Control patients were matched for age and sex. Main Outcome Measures Duration of urticaria; associated symptoms; personal and family history of atopy; medications; ingestion of peanuts, nuts, shellfish, tomatoes, strawberries, or eggs; being stung by an insect; suspected cause, diagnostic studies; treatment. Results Fifty-two cases and 47 controls were enrolled. The mean duration of urticaria was 8.9 days (range, 1-50 days). Seventeen patients (33%) and 1 control patient were taking antibiotics (odds ratio [OR], 22.3; 95% confidence interval [CI], 2.8-176; χ2,P Conclusions Patients were more likely than controls to be taking an antibiotic and were more likely to have a personal or family history of atopy or to report ingesting foods commonly associated with urticaria. A viral illness was the most common cause suspected by pediatricians.

https://jamanetwork.com/journals/jamapediatrics/articlepdf/191043/poa10045.pdf

Exposures and outcomes of children with urticaria seen in a pediatric practice-based research network: a case-control study

Exposures and Outcomes of Children With Urticaria Seen in a Pediatric Practice-Based Research Network

OBJECTIVES: The objectives of this study were to evaluate the efficacy and utilization of an observation unit (OU) for admission of pediatric patients after a toxicologic ingestion; compare the characteristics and outcomes of patients admitted to the pediatric OU, inpatient (IP) service, and intensive care unit (ICU) after ingestions using retrospective chart review; and attempt to identify factors associated with unplanned IP admission after an OU admission. METHODS: This was a retrospective chart review of children seen in the emergency department (ED) after potentially toxic suspected ingestions and then admitted to the OU, IP service, or ICU from June 2003 to September 2007. RESULTS: One thousand twenty-three children were seen in the ED for ingestions: 18% were admitted to the OU, 15% to the IP service service, and 6% to the ICU. Observation unit patients had less mental status changes reported and were less frequently given medications while in the ED. Eighty-one percent of OU patients were admitted with poison center recommendation. Ninety-four percent of OU patients were discharged within 24 hours, and less than half of IP service/ICU patients were discharged that quickly. No significant associations were found between specific historical and physical examination or laboratory characteristics in the ED and the need for unplanned IP admission. CONCLUSIONS: Observation unit patients admitted after ingestions were young, typically ingested substances found in the home, and required observation according to poison center recommendations. Ninety-four percent were able to be discharged home within 24 hours even after ingesting some of the most concerning substances such as central nervous system depressants, cardiac/antihypertension medications, hypoglycemics, and opiates. All OU patients did well without any adverse events reported. Many patients requiring prolonged observation after an ingestion, and who do not require ICU care, may be appropriate for OU management. This study suggests a potential underutilization of observation units in this setting. Language: en

Jennifer Plumb

Papers

The role of focused abdominal sonography for trauma (FAST) in pediatric trauma evaluation.

The role of ultrasound in the emergency department evaluation of the acutely painful pediatric hip.

Exposures and outcomes of children with urticaria seen in a pediatric practice-based research network: a case-control study

Exposures and Outcomes of Children With Urticaria Seen in a Pediatric Practice-Based Research Network

Utilization of a pediatric observation unit for toxicologic ingestions