Utility of Non-Invasive Monitoring of Cardiac Output and Cerebral Oximetry during Pain Management of Children with Sickle Cell Disease in the Pediatric Emergency Department.

Pain crisis in children with sickle cell disease (SCD) is typically managed with intravenous fluids and parenteral opioids in the pediatric emergency department. Electrical cardiometry (EC) can be utilized to measure cardiac output (CO) and cardiac index (CI) non-invasively. Near-infrared spectroscopy (NIRS) measuring cerebral (rCO₂) and splanchnic regional (rSO₂) mixed venous oxygenation non-invasively has been utilized for monitoring children with SCD.

Internet Usage by Parents Prior to Seeking Care at a Pediatric Emergency Department: Observational Study.

Background: Little is known about how parents utilize medical information on the Internet prior to an emergency department (ED) visit.

Objective: The objective of the study was to determine the proportion of parents who accessed the Internet for medical information related to their child's illness in the 24 hours prior to an ED visit (IPED), to identify the websites used, and to understand how the content contributed to the decision to visit the ED.

Methods: A 40-question interview was conducted with parents presenting to an ED within a freestanding children's hospital.

Pediatric Surfer's Myelopathy.

Background: We present the case of the youngest known patient diagnosed with surfer's myelopathy. Surfer's myelopathy is a rare nontraumatic myelopathy. The most likely etiology, presumably, is arterial insufficiency related to spine hyperextension.

Hot asphalt burns: a review of injuries and management options.

Hot asphalt burns to human tissue can increase the likelihood of infection and potential conversion of partial thickness to full-thickness injuries. Successful intervention for hot asphalt burns requires immediate and effective cooling of the asphalt on the tissue followed by subsequent gradual removal of the cooled asphalt. A review of the literature reveals that multiple substances have been used to remove asphalt, including topical antibiotics, petroleum jelly, a commercial product known as De-Solv-It (ORANGE-SOL, Chandler, AZ), sunflower oil, baby oil, liquid paraffin, butter, mayonnaise, and moist-exposed burn ointment (MEBO).

Ketamine and intraocular pressure in children.

Study Objective: We determine the increase in intraocular pressure during pediatric procedural sedation with ketamine, and the proportion of children whose increase might be clinically important (at least 5 mm Hg).

Methods: We prospectively enrolled children aged 8 to 18 years, chosen to receive ketamine sedation in a pediatric emergency department. We measured intraocular pressure before sedation, immediately after ketamine administration, 2 minutes post-drug administration, and every 5 minutes thereafter until recovery or 30 minutes after the final dose.

Is elevated creatinine a reliable marker for methanol toxicity in nitromethane-containing model fuel ingestions in children?

Context: In the absence of a rapid serum methanol level estimation, it is difficult to assess the risk from unintentional childhood ingestion of model fuels containing methanol and nitromethane (MFNM). Previous reports have documented false elevations of serum creatinine from the nitromethane in these fuels, suggesting its utility as a readily available marker of significant methanol ingestion.

Method: We performed a 2-year retrospective chart review of cases of ingestion of MFNM in children, with both a methanol level and measured creatinine level.

A case of hypercalcemia and gastric necrosis from hot pack ingestion.

Hot packs (instant hot compresses) are frequently used to relieve pain. We report a patient who had significant complications from ingestion of a hot pack containing calcium salts. A 35-year-old male swallowed three hot packs, and developed hematemesis, severe abdominal pain, and hypercalcemia (21.

Evaluation of cerebral oxygenation during procedural sedation in children using near infrared spectroscopy.

Study Objective: We evaluate the utility of near infrared spectroscopy monitoring and its correlation to conventional respiratory monitors during changes in cardiorespiratory characteristics during pediatric procedural sedation.

Methods: In this prospective observational study of 100 children, cerebral oxygenation (rSO(2)), pulse oximetry (SpO(2)), and end-tidal carbon dioxide (etco(2)) were monitored continuously. Values were manually recorded at least every 3 minutes from baseline until 30 minutes after sedative administration, resulting in 1,515 triplicate (simultaneous near infrared spectroscopy/etco(2)/SpO(2)) measurements.