Showing posts with label emergency medicine. Show all posts
Showing posts with label emergency medicine. Show all posts

Wednesday, October 21, 2015

Cardiopulmonary Resuscitation and a Metronome: A Study That Puts the Two Together to Improve Chest Compression Administration


By: Lewis First, MD, MS; Editor-in-Chief     

          When one thinks of a metronome, it’s usually to help a child or adult practice keeping the tempo in a piece of music they are trying to play.  Yet Zimmerman et al. (doi: 10.1542/peds.2015-1858) decided to try a metronome in a prospective simulation-based crossover randomized controlled trial of residents, fellows, nurses, and medical students randomly assigned to do chest compressions on a manikin with or without a metronome to keep the tempo of those compressions. 
        The authors looked at rate and depth of compressions as the participants did rounds of compressions with and without the metronome going.  Rather than compress the findings of this study in this blog, we will encourage you to read the study for yourselves and see if your resuscitation room warrants buying a metronome as a valuable addition to the equipment you already have available in your office, emergency or inpatient setting.   Beat a path to reading this article to learn more.

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Monday, September 28, 2015

When Your Back Is Turned: ER Visits for Medication Ingestions and Unsupervised Children


By: Joann Schulte  DO, MPH; Editorial Board Member 

     Open the bottle by getting through the safety lid, dose appropriately and then have your child swallow the
pill or liquid.   It’s funny how a young child won’t do that when you or your spouse wants that to happen.   And as soon as your back is turned, it’s amazing what a child can get into and swallow.    
     But at least children are doing less unsupervised ingestions of medications   according to new research published this month in Pediatrics.  Lovegrove et al. with the Centers for Disease Control and Prevention (doi: 10.1542/peds.2015-2092) found that the estimated number of pediatric emergency room (ER) visits for unsupervised  medication exposures has declined since 2010.  The Atlanta researchers used data from the National Electronic Injury Surveillance System/Cooperative Adverse Drug Event Surveillance Project for the years 2004-2013.  Their data comes from a public health surveillance system that draws from a nationally representative sample of hospitals with at least six pediatric beds and an ER that operates 24 hours a day.  Since 2010, the number of ER visits has declined an average of 6.7% annually to an estimated total of 59,092 estimated visits in 2013.  The estimated number of visits for an unsupervised ingestion at the peak in 2010 was 75,842.
      The decline in ER visits is good news, but what the children are swallowing is still reason for concern.  Among single substance ingestions in this study, children most frequently swallowed solid prescription medications (45.9^), over the counter (OTC) solid medications (22.3%) and   liquid OTC medications (12.4%).  Nine percent of the ingestions involved more than one medication.
      Among prescription drugs, 260 different medications were swallowed by children, most frequently opioids (13.8%) and benzodiazepines (12.7%).  The OTC liquids most frequently reported were acetaminophen (32.9%), cold/cough remedies (27.5%), ibuprofen (15.7%) and diphenhydramine (15.6%).
     The CDC researchers suggested that OTC oral medications are an important topic for further prevention efforts since only four OTC medications (named in above paragraph) account for 91% of such ingestions.  Most such medications have child resistant packaging, but that packaging requires a parent or other adult to put the safety cap back on the medication and secure it after each use.   Newer products now being tested incorporate passive safety features such as flow restriction and single use packaging which can offer a secondary safety barrier.  The FDA is strongly considering the use of such packaging as a mandate on OTC liquid acetaminophen products. 
      The report showing the decline in  unsupervised pediatric ingestions is good news, but also evidence that more effort is needed to keep young children from still gaining access to medications when a supervising adult or older child is not around.

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Wednesday, August 26, 2015

Are We “Choosing Wisely” to Reduce the Frequency of CT Scans in Children? New Study Tells All!

By: Lewis First, MD, MS; Editor-in-Chief 

          Our journal along with many other peer-reviewed pediatric journals have certainly published our share of studies suggesting the potential radiation risks of computed tomography (CT)  scans—especially multiple CT scan exposures in the same child.  This has led to lower dosages of radiation when children need to use this imaging modality as well as a national campaign to “Image Gently” or to avoid overuse of this readily accessible technology unless it’s medically or surgically indicated relative to other radiologic options.  
       So are trends in CT scanning improving?  Parker et al. (doi: 10.1542/peds.2015-0995) opted to assess these trends in a study being released this week in Pediatrics.  The authors performed a cross-sectional study of 33 tertiary care children’s hospitals using data from the Pediatric Health Information System between 2004 and 2012 looking at trends in not just CT but also ultrasound (US) and magnetic resonance imaging (MRI) for ten leading pediatric diagnoses recorded in this extensive dataset.   
      The results show that CT utilization is decreasing for most of the leading diagnoses and US and MRI trends and that alternative radiologic modalities are increasing.  Just what do the trends show more specifically for what disease?  The answers can be found by carefully scanning through the extensive data shared in this interesting study and then reassuring families that just because a CT scanner is available, doesn’t mean that the benefit of using it outweighs some radiation risks when less risky modalities may exist.

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Monday, July 13, 2015

Checking for Occult Fractures in the Setting of Abuse: Not the Automatic One Might Expect


By: Lewis First, MD, MS; Editor-in-Chief  

     We have certainly seen studies in our journal and others strongly demonstrating the importance of checking for occult fractures in children who are victims of physical abuse or in infants who have non-accidental traumatic brain injuries given the yield of finding such fractures in these injured children. So does it happen as a standard of diagnostic evaluation?  
      Sadly no—at least as per the study results reported by Wood et al. (doi: 10.1542/peds.2014-3977) in a retrospective study of more than 2500 abused children from more than 350 hospitals released this week in our journal.  The authors looked at inter-hospital variations and identified a variety of factors at the child and hospital level that influence the probability that occult fractures are or are not sought after. 
      For example, a smaller hospital with less young injured patients may be less apt to think about checking for occult fractures than one that is larger and sadly sees more of these patients.  The bottom line is that many injured children as a result of abuse and non-accidental injury are not being evaluated for occult fractures despite the importance of doing so.   
     How important is this?  Dr. Kristine Campbell, a specialist in the prevention of child abuse and neglect further comments on the ramifications of what this study suggests in an accompanying commentary (doi: 10.1542/peds.2015-0694).Hopefully forgetting to think about and in turn diagnose occult fractures does not happen in your local emergency room or in your practice when patients with alleged abuse are being evaluated –and if for some reason, you need a reminder to get a skeletal survey, this study and commentary should provide the painful reminder you need.

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