Improving Care for Sickle Cell Pain Crisis Using a Multidisciplinary Approach.

Objectives: Frequent hospitalizations for sickle cell disease (SCD) vaso-occlusive crises (VOCs) are associated with school absenteeism, emotional distress, and financial hardships. Our goal was to decrease hospital days for VOC admissions by 40% over a 5-year period.

Methods: From October 2011 to September 2016, a multidisciplinary quality-improvement project was conducted with a plan-do-study-act methodology.

Understanding Liability Risks and Protections for Pediatric Providers During Disasters.

Although most health care providers will go through their careers without experiencing a major disaster in their local communities, if one does occur, it can be life and career altering. The American Academy of Pediatrics has been at the forefront of providing education and advocacy on the critical importance of disaster preparedness. From experiences over the past decade, new evidence and analysis have broadened our understanding that the concept of preparedness is also applicable to addressing the unique professional liability risks that can occur when caring for patients and families during a disaster.

Understanding Liability Risks and Protections for Pediatric Providers During Disasters.

Although most health care providers will go through their careers without experiencing a major disaster in their local communities, if one does occur, it can be life and career altering. The American Academy of Pediatrics has been in the forefront of providing education and advocacy on the critical importance of disaster preparedness. From experiences over the past decade, new evidence and analysis have broadened our understanding that the concept of preparedness is also applicable to addressing the unique professional liability risks that can occur when caring for patients and families during a disaster.

Effects of alcohol-based hand hygiene solutions on breath alcohol detection in the emergency department.

This study aimed to investigate the effects of alcohol-based hand hygiene solution (ABHS) use by care providers on point-of-care alcohol breath analyzer interpretation under different clinically relevant conditions. Among each test condition (foam vehicle with immediate testing, gel vehicle with immediate testing, allowing hands to dry after the use of ABHS, and donning gloves after the use of ABHS), alcohol was detected in breath at 1 minute after use of ABHS. Because the use of ABHS by individuals administering breath alcohol detection may result in false-positive detection of alcohol, staff using these devices should consider traditional hand hygiene with soap and water.

Cost-effectiveness of point-of-care testing for dehydration in the pediatric ED.

Objectives: Acute gastroenteritis (AGE) and subsequent dehydration account for a large proportion of pediatric emergency department (PED) visits. Point-of-care (POC) testing has been used in conjunction with clinical assessment to determine the degree of dehydration. Despite the wide acceptance of POC testing, little formal cost-effective analysis of POC testing in the PED exists.

In situ pediatric trauma simulation: assessing the impact and feasibility of an interdisciplinary pediatric in situ trauma care quality improvement simulation program.

Objective: This study aimed to evaluate the feasibility and measure the impact of an in situ interdisciplinary pediatric trauma quality improvement simulation program.

Methods: Twenty-two monthly simulations were conducted in a tertiary care pediatric emergency department with the aim of improving the quality of pediatric trauma (February 2010 to November 2012). Each session included 20 minutes of simulated patient care, followed by 30 minutes of debriefing that focused on teamwork, communication, and the identification of gaps in care.

Nasal disc battery removal: a novel technique using a magnetic device.

Disc batteries as foreign bodies present challenges in both diagnosis and management and carry a high risk for complications. We describe a novel device for disc battery removal using a magnet and basic medical supplies readily available in the emergency department setting. We also review diagnosis, complications, and management recommendations for disc batteries as foreign bodies.

Psychiatric disease and drug abuse.

Purpose Of Review: The term 'dual diagnosis' most commonly refers to the combination of severe mental illness and substance-use disorder (SUD). It is estimated that 7-10 million people in the USA alone have at a minimum one psychiatric disorder in addition to a SUD. As many of the psychiatric illnesses implicated have their origins in childhood, the pediatric population is not immune to this 'dual diagnosis', particularly with the increasing availability of street drugs and increasing accessibility to prescription drugs.

Remember the saphenous: ultrasound evaluation and intravenous site selection of peripheral veins in young children.

Objectives: The primary objective of this study was to measure the width and depth of peripheral veins using bedside ultrasound in children younger than 3 years. Secondary objectives included the evaluation of other vein and patient characteristics that may affect intravenous (IV) site selection. Assessment of nursing preferences for peripheral IV site selection was performed.

What do pediatric residents know about malpractice?

Objective: The objective was to assess pediatric residents' attitudes toward and knowledge about medical malpractice before and after an educational intervention.

Methods: A survey of pediatric residents at our academic tertiary-care center was conducted before and 6 months after an educational workshop.

Results: Of 71 eligible residents, 46 (65%) completed surveys.

A randomized controlled trial of capnography in the correction of simulated endotracheal tube dislodgement.

Objectives: Unrecognized dislodgement of an endotracheal tube (ETT) during the transport of an intubated patient can have life-threatening consequences. Standard methods to monitor these patients, such as pulse oximetry and physical examination, are both subject to inaccuracies with patient movement and ambient noise. Capnography provides a continuous and objective measure of ventilation that can alert a provider immediately to an airway problem.

Detection of hypoventilation by capnography and its association with hypoxia in children undergoing sedation with ketamine.

Objectives: Hypopneic hypoventilation, a decrease in tidal volume without a change in respiratory rate, is not easily detected by standard monitoring practices during sedation but can be detected by capnography. Our goal was to determine the frequency of hypopneic hypoventilation and its association with hypoxia in children undergoing sedation with ketamine.

Methods: Children who received intravenous ketamine with or without midazolam for sedation in a pediatric emergency department were prospectively enrolled.

A recession's impact on pediatric emergency household spending and attitudes about health-care reform.

Background: We assessed changes in household spending and opinions about health-care insurance reform among parents in the pediatric emergency department (PED) during the current recession.

Methods: We conducted a survey of parents at a PED. Enrollment was in June and July 2009.

Use of bedside ultrasound to assess degree of dehydration in children with gastroenteritis.

Objectives: Prospectively identifying children with significant dehydration from gastroenteritis is difficult in acute care settings. Previous work by our group has shown that bedside ultrasound (US) measurement of the inferior vena cava (IVC) and the aorta (Ao) diameter ratio is correlated with intravascular volume. This study was designed to validate the use of this method in the prospective identification of children with dehydration by investigating whether the IVC/Ao ratio correlated with dehydration in children with acute gastroenteritis.

Positioning for lumbar puncture in children evaluated by bedside ultrasound.

Background: Lumbar punctures are commonly performed in the pediatric emergency department. There is no standard, recommended, optimal position for children who are undergoing the procedure.

Objective: To determine a position for lumbar punctures where the interspinous space is maximized, as measured by bedside ultrasound.

Use of ultrasound measurement of the inferior vena cava diameter as an objective tool in the assessment of children with clinical dehydration.

Objectives: Bedside ultrasonography (US) measurement of the inferior vena cava (IVC) and aorta (Ao) may be useful in objectively assessing children with dehydration. The objectives of this study were 1) to compare the IVC and Ao diameters (IVC/Ao) ratio of dehydrated children with controls and 2) to compare the IVC/Ao ratio before and after intravenous (i.v.

A randomized trial to assess the efficacy of point-of-care testing in decreasing length of stay in a pediatric emergency department.

Objectives: To compare the effect of point-of-care (POC) testing versus traditional laboratory methods on length of stay in a pediatric emergency department (ED).

Methods: This study was a prospective, randomized, controlled trial of patients solely requiring blood work that a POC device was capable of performing. Two hundred twenty-five patients presenting to a tertiary hospital ED in an urban setting enrolled after informed consent.

Hematoma of the labia majora in an adolescent girl.

This is a case report of a 19-year-old woman who presented with a large hematoma of her labia majora after consensual sexual intercourse that required surgical intervention. To our knowledge, this is the first case report of such an entity. The following is a summary of the patient's clinical presentation and management, as well as a review of the literature regarding genital injuries in adolescent girls.

Transitional medicine: will emergency medicine physicians be ready for the growing population of adults with congenital heart disease?

Background: Currently, approximately 85% of children with significant congenital heart problems survive to adolescence and adulthood. This survival rate represents a dramatic improvement in the medical and surgical care of congenital heart disease (CHD) during the last 35 years. Nevertheless, these patients remain at increased risk for significant cardiac problems long after primary interventions are completed.

Pediatric fatality following ingestion of dinitrophenol: postmortem identification of a "dietary supplement".

Dinitrophenol, a chemical currently used as an insecticide, is known to uncouple mitochondrial oxidative phosphorylation. A component of explosives, it has also been used in the past as a food coloring and clothing dye. In the 1930s, physicians prescribed it for weight loss, but this practice was discontinued when reports of cataracts, deaths, and other adverse outcomes came to light.

Utility of bedside bladder ultrasound before urethral catheterization in young children.

Background: Urethral catheterization is the method of choice for obtaining samples for urine culture and urine analysis in infants. Before the procedure, there is little certainty of the presence or amount of urine in the bladder. Consequently, this relatively invasive and uncomfortable procedure often needs to be repeated.

Emergency medicine training programs' educational requirements in the management of psychiatric emergencies: current perspective.

Objective: The purpose of this study was to determine the extent of training in clinical psychiatry that is provided and/or required by emergency medicine (EM) residency training programs and pediatric emergency medicine (PEM) subspecialty residency training programs.

Design/methods: A questionnaire was mailed to 114 EM residency directors and to all 50 PEM fellowship directors. Each director was asked to indicate the amount of psychiatric training that was required of residents or fellows in his or her program.

Advances in clinical forensic medicine.

Clinical forensic medicine is the branch of medicine that deals specifically with cases involving both legal and medical aspects of patient care. A forensic evaluation refers to the detection, collection, and preservation of evidence. Pattern injury recognition, interpretation of injuries, documentation of testimonial and injuries (including photography), reporting requirements, and regulations are all vital components of a forensic evaluation, but are rarely the topic of discussion in training hospitals.

An alternate light source to detect semen.

Unlabelled: The Wood's lamp (WL) has been used in sexual assault evaluations. Recent data have shown that semen does not fluoresce with a WL and that physicians are unable to differentiate semen from other common medicaments using a WL.

Objectives: To determine whether physicians could differentiate semen from other products using an alternate light source (ALS), and to investigate whether a brief training period with the ALS would enhance physicians' ability to differentiate between semen and other commonly used products.