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201-205 of 205 results by Jenny Guyther
Acute ischemic stroke occurs in 3.3/100,000 children per year. Up to 30% of these are caused by varicella. This can be diagnosed if the patient has had varicella infection within the past 12 months, has a unilateral stenosis of a great vessel, and has a positive PCR or IgG from the CSF.
Treatment includes anticoagulation, acyclovir for at least 7 days and steroids for 3-5 days.
Outcome is normally good and spontaneous improvement can be seen.
Inflammation of other arteries, including other areas of the brain, can also be seen. Treatment options for this can include high dose glucocorticoids and possibly immunosuppresive agents.
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Children frequently present with "pink eye" to the ED. When they do, parents often expect antibiotics. How many of these kids actually need them? Previous studies have shown approximately 54% of acute conjunctivitis was bacterial, but antibiotics were prescribed in 80-95% of cases.
A prospective study in a suburban children's hospital published in 2007, showed that 87% of the cases during the study period were bacterial. The most common type of bacteria was nontypeable H. influenza followed by S. pneumoniae.
Topical antibiotic treatment has been shown to improve remission rates by 6-10 days.
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Epidemiology:
Trampoline injuries doubled between 1991 and 1996, increasing from 39,000 injuries per year to more then 83,000 injuries per year. Injury rates and trampoline sales peaked in 2004 and have been decreasing since; however, hospitalization rates are still between 3% and 14%.
Risk Factors:
¾ of injuries occur when multiple people are on the trampoline at once
Smaller participants were 14x more likely to be injured then their heavier playmates
Falls account for 27-39% of all injuries
Springs and frames account for 20% of injuries
Up to ½ of injuries occur despite adult supervision
Injury types:
Lower extremity injuries are more common than upper extremity
Head and neck injuries accounted for 10-17% of trampoline injuries
Unique Injuries:
Proximal tibial fractures
Manubriosternal dislocations and sternal injuries
Vertebral artery dissection
Atlanto-axial subluxation
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Conventional pediatric nasal cannula can safely deliver up to 4 lpm but are limited by cooling and drying of the airway. This leads to decreased airway patency, nasal mucosal injury, bleeding and possibly increase in coagulase negative staph infections.
HFNC delivers flow up to 40 lpm with 95-100% relative humidity at a controlled temperature. In infants, the initial flow rate is set between 2-4 lpm and can be increased to 8 lpm. Older children and can be started at 10 lpm and increased as high as 40 lpm. Oxygen is also adjustable.
Studies have shown improved comfort, respiratory rate and oxygenation compared to nasal CPAP.
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We often ask our pediatric patients if there vaccines are up to date, but what does this mean?
Hepatitis B: birth, 2 and 6 months
Diphtheria/Tetanus and Acellular Pertussis: 2, 4 and 6 months
Pneumococcal vaccine: 2, 4 and 6 months
Haemophilus influenzae B : 2, 4 and 6 months
Polio: 2, 4 and 6 months
Rotavirus: 2 and 4 months or 2, 4 and 6 months depending on the brand.
Influenza: 6 months and older
Children less than 8 years old should receive 2 doses of flu vaccine at least 4 weeks apart during the first flu season that they are immunized. Children older than 2 years are eligible for the nasal vaccine if they do not have asthma, wheezing in the past 12 months or other medical conditions that predispose them to flu complications.
To see the full vaccine schedule including exact time frames between doses and catch up schedules, see: http://www.cdc.gov/vaccines/