That’s Twisted – A Review of Pediatric Volvulus
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Pediatric volvulus is associated with a high morbidity and mortality rate but remains a challenging diagnosis. This review highlights pearls and pitfalls of diagnosis and management.
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High risk and low incidence diseases: Pediatric digestive volvulus. Am J Emerg Med. 2024 Aug;82:153-160. doi: 10.1016/j.ajem.2024.06.012. Epub 2024 Jun 14. PMID: 38908340.
Ultrasound + Pediatric Appendicitis Risk Calculator = Rule Out?
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This was a single center retrospective study at a tertiary pediatric ED of patients with suspected pediatric appendicitis. The authors found that combining a low pediatric Appendicitis Risk Calculator (pARC) result with a nondiagnostic ultrasound results in a high negative predictive value for appendicitis.
Source
Identification of children with a nondiagnostic ultrasound at a low appendicitis risk using a pediatric Appendicitis Risk Calculator. Acad Emerg Med. Published online July 21, 2024.
Water Beads – An Expanding Hazard
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There are an increasing number of water bead related injuries in children, with the majority occurring in children less than five. While most cases can be treated and released from the ED, water bead injury can be serious and even deadly.
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Pediatric water bead-related visits to United States emergency departments. Am J Emerg Med. 2024 Jul 28:84:81-86. doi: 10.1016/j.ajem.2024.07.048. Online ahead of print. PMID: 39096713
Mesenteric Ischemia – What You Need to Know
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This is a concise review on the diagnosis and management of mesenteric ischemia.
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Just the facts: Evaluation and management of mesenteric ischemia. CJEM. 2024 May;26(5):316-318. doi: 10.1007/s43678-024-00696-2. Epub 2024 May 7. PMID: 38714638.
Can We Rule Out Pediatric Appendicitis If Appendix Not Seen on Ultrasound?
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In pediatric patients who have an Alvarado score 6 and below, the absence of free fluid or periappendiceal fat inflammation, when the appendix was not visualized on ultrasound, had a negative predictive value of 99.4% for appendicitis.
Source
Predictive values of indirect ultrasound signs for low risk of acute appendicitis in paediatric patients without visualisation of the appendix on ultrasound. Emerg Med J. 2024 May 10:emermed-2023-213466. doi: 10.1136/emermed-2023-213466. Online ahead of print. PMID: 38729752
Think Outside the Zone – How to Manage Penetrating Neck Injuries
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This review article illustrates the evidence-based “no-zone” approach in managing penetrating neck injuries, with a reliance on clinical symptoms as well as multidetector computed tomographic angiography (MDCTA) to mitigate unnecessary invasive tests and negative explorations.
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Diagnostic Approach to Penetrating Neck Trauma: What You Need to Know. J Trauma Acute Care Surg. 2024 Mar 25. doi: 10.1097/TA.0000000000004292. Epub ahead of print. PMID: 38523116
Seatbelt Sign as a Predictor of Intra-abdominal Injury
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Presence of a seatbelt sign (SBS) was associated with a higher likelihood of intra-abdominal injury and need for surgical intervention.
Source
Prevalence of intra-abdominal injury among patients with seatbelt signs, a systematic review and meta-analysis. Am J Emerg Med. 2024 Feb;76:199-206. doi: 10.1016/j.ajem.2023.11.058. Epub 2023 Dec 3. PMID: 38086186.
When to REBOA – What’s the Right SBP Range?
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REBOA has emerged as a critical intervention for managing hemorrhagic shock, but current guidelines are non-specific. Employing REBOA in unstable trauma patients with SBPs 60-80 mmHg is ideal, before further decompensation and increased mortality.
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Critical systolic blood pressure threshold for endovascular aortic occlusion-A multinational analysis to determine when to place a REBOA. J Trauma Acute Care Surg. 2024 Feb 1;96(2):247-255. doi: 10.1097/TA.0000000000004160. Epub 2023 Oct 19. PMID: 37853558
New Aortic Disease Guidelines for Diagnosis and Management
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This summary of clinical guideline updates for the diagnosis and management of aortic diseases includes recommendation changes surrounding the importance of multidisciplinary care teams and referral to centers with higher case volumes when feasible for potentially better outcomes, transthoracic echocardiogram (TTE) at time of transthoracic aortic aneurysm (TAA), and updated aneurysm size recommendations for repair, to name a few. Keep reading for more details!
Source
Diagnosis and Management of Aortic Diseases. JAMA. 2023 Dec 21;331(4):352-353. doi: 10.1001/jama.2023.23668.
How do We Avoid the Aortic Landmines?
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In this large multicenter observational cohort study, 0.3% of patients presenting with potential acute aortic syndrome (AAS) symptoms ended up having AAS. Clinician gestalt outperformed the available clinical decision rules (CDRs).
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Diagnosis of Acute Aortic Syndrome in the Emergency Department (DAShED) study: an observational cohort study of people attending the emergency department with symptoms consistent with acute aortic syndrome. Emerg Med J. 2024;41(3):136-144. Published 2024 Feb 20.