Virtual Coaching and the Reduction of Radial Head Subluxation: A Case Series.

OBJECTIVES: After the establishment of the virtual pediatric emergency medicine clinic at our institution, we noted that several physicians independently began to instruct caregivers virtually on reducing a radial head subluxation. We thus conducted a case series to investigate the number, success, and follow-ups for the virtual reduction of radial head subluxation. METHODS: The electronic medical records at our institution were searched from the inception of the virtual clinic in May 2020 until August 2022 (inclusive), for visits and discharge diagnosis containing the word "elbow" or "arm." RESULTS: Fourteen charts were retrieved; however, 2 were excluded because they were not a suspected radial head subluxation. A virtual reduction was attempted for eight (66.7%) of the 12 patients. In 6 of 8 patients (75.0%), the reduction was deemed successful, and for 2 patients (25.0%), it was deemed unsuccessful. Of the latter, one was found to have a nondisplaced radial neck fracture. All 4 patients (33.3%) for whom a virtual reduction was not attempted were referred to the emergency department. CONCLUSIONS: Virtual video coaching of pulled elbow reduction was completed at our institution with overall good success rate. All the physicians involved noted the essential need and benefits of video conferencing for successfully reducing radial head subluxation. We note that a pediatric population may be more amenable to video-based appointments than other populations due to their caregivers' familiarity with digital technology. Finally, as nonphysician models of healthcare delivery for virtual urgent care visits expand, we propose a checklist based on our experience to ensure patient safety.

Interprofessional education day - an evaluation of an introductory experience for first-year students.

Interprofessional health care teams have been shown to improve patient safety and reduce medical errors, among other benefits. Introducing interprofessional concepts to students in full day events is an established model that allows students to learn together. Our group developed an academic day for first-year students devoted to an introductory interprofessional education (IPE) experience, 'IPE Day'. In total, 438 students representing medicine, dentistry, pharmacy and optometry gathered together, along with 25 facilitators, for IPE Day. Following the day's program, students completed the evaluation consisting of the Interprofessional Collaborative Competencies Attainment Survey and open-ended questions. Narrative responses were analyzed for content and coded using the Canadian Interprofessional Health Collaborative competency domains. Three hundred and eight evaluations were completed. Students reported increased self-ratings of competency across all 20 items (p < 0.05). Their comments were organized into the six domains: interprofessional communication, collaborative leadership, role clarification, patient-centred care, conflict resolution, and team functioning. Based on these findings, we suggest that this IPE activity may be useful for improving learner perceptions about their interprofessional collaborative practice competence.

A Novel Method of Intraosseous Infusion of Adenosine for the Treatment of Supraventricular Tachycardia in an Infant.

Supraventricular tachycardia is a common arrhythmia faced by emergency physicians in the pediatric population. In most cases, antecubital intravenous access can be established, and adenosine can be administered in a rapid and timely fashion. The role and administration of intraosseous adenosine are poorly established. We describe a case where the administration of adenosine was successful via a mixed method administration.

Skull-Embedded Earring due to a Fall: A Complication and Therapeutic Considerations.

Although earring-related injuries are well described, an earring becoming forcefully embedded in the skull is unusual and has not previously been reported in the literature. We present the case of an 11-year-old child who posed interesting therapeutic considerations given this presentation.

Atypical Presentation of Right Ventricular Outflow Tract Ventricular Tachycardia.

BACKGROUND: Ventricular tachycardia (VT) in the pediatric population is rare, has a wide differential diagnosis, and can present in numerous ways. In the absence of underlying heart disease, VT is considered idiopathic and is associated with an excellent prognosis. Right ventricular outflow tract ventricular tachycardia (RVOT-VT) represents the most common form of idiopathic VT. The differential diagnosis, mechanism, presentation, management, and prognosis of RVOT-VT in the pediatric population will be discussed. CASE REPORT: We report a case of RVOT-VT that was incidentally discovered in an 11-year-old girl during an emergency department workup for severe headache. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: It is essential for emergency physicians to have an approach to pediatric VT and appreciate the wide range of potential presentations. Differentiating idiopathic VT, such as RVOT-VT, from more malignant forms of VT can be challenging and requires expert consultation for further diagnostic workup and management.

Complication after treatment for resistant supraventricular tachycardia: the Bezold-Jarisch reflex.

The Bezold-Jarisch reflex may become clinically relevant in times of profound relative hypovolemia. This results in uncoupled cardio inhibition leading to the triad of hypotension, bradycardia and vasodilation.