9-1-1 Activations from Ambulatory Care Centers: A Sicker Pediatric Population.

BACKGROUND: Pediatric patients transferred by Emergency Medical Services (EMS) from urgent care (UC) and office-based physician practices to the emergency department (ED) following activation of the 9-1-1 EMS system are an under-studied population with scarce literature regarding outcomes for these children. The objectives of this study were to describe this population, explore EMS level-of-care transport decisions, and examine ED outcomes. METHODS: This was a retrospective review of patients zero to <15 years of age transported by EMS from UC and office-based physician practices to the ED of two pediatric receiving centers from January 2017 through December 2019. Variables included reason for transfer, level of transport, EMS interventions and medications, ED medications/labs/imaging ordered in the first hour, ED procedures, ED disposition, and demographics. Data were analyzed with descriptive statistics, X test, point biserial correlation, two-sample z test, Mann-Whitney U test, and 2-way ANOVA. RESULTS: A total of 450 EMS transports were included in this study: 382 Advanced Life Support (ALS) runs and 68 Basic Life Support (BLS) runs. The median patient age was 2.66 years, 60.9% were male, and 60.7% had private insurance. Overall, 48.9% of patients were transported from an office-based physician practice and 25.1% were transported from UC. Almost one-half (48.7%) of ALS patients received an EMS intervention or medication, as did 4.41% of BLS patients. Respiratory distress was the most common reason for transport (46.9%). Supplemental oxygen was the most common EMS intervention and albuterol was the most administered EMS medication. There was no significant association between level of transport and ED disposition (P = .23). The in-patient admission rate for transported patients was significantly higher than the general ED admission rate (P <.001). CONCLUSION: This study demonstrates that pediatric patients transferred via EMS after activation of the 9-1-1 system from UC and medical offices are more acutely ill than the general pediatric ED population and are likely sicker than the general pediatric EMS population. Paramedics appear to be making appropriate level-of-care transport decisions.

Metabolic emergencies.

Metabolic diseases can vary as much in clinical presentation as they can in classification, and neonates and infants frequently present with symptoms similar to those seen with other emergencies. Vomiting, alterations in neurologic status, and feeding difficulties are the most prominent features of metabolic emergencies. This article discusses the recognition and management of specific disorders, including diabetic ketoacidosis, congenital adrenal hyperplasia, inborn errors of metabolism, and thyrotoxicosis. Also highlighted are specific laboratory entities, including hypoglycemia, hyponatremia, and metabolic acidosis.

Skatepark-related injuries in a southern California skatepark and their associated short-term disability and healthcare utilization.

OBJECTIVE: To assess the types of injuries, the extent of short-term disability, and the degree of healthcare utilization in skatepark-injured patients. DESIGN: The study design was a prospective case series with 1-year follow-up. SETTING: Level I trauma center and emergency department located in Orange, California. PARTICIPANTS: Subjects age 7 years or older who sustained an injury at a local skatepark and were treated in our emergency department were included in the study. Ninety-five subjects were enrolled with a total of 97 injury encounters. MAIN OUTCOME MEASUREMENTS: Types of injuries, extent of short-term disability, degree of healthcare utilization. RESULTS: Emergency department diagnoses included 57 fractures, 6 dislocations, 15 strains/sprains/contusions, 7 lacerations, 2 dental fractures, 9 head injuries, and 1 intra-abdominal injury. Nine of the emergency department encounters terminated in admission to the hospital. The peak sum of time lost from school, work, parental time lost from work, and specialist visits were found to occur at 1 month postinjury. Similarly, the number of postinjury follow-up medical visits peaked at the 1-month interval. Subject disability was largely categorized as moderate initially, with a subsequent reduction to no disability by the 9th postinjury month. CONCLUSION: Skatepark-related injuries can yield substantial time lost from school and work, considerable short-term disability, and an increase in healthcare resource utilization.

Antiemetic use in pediatric gastroenteritis: a national survey of emergency physicians, pediatricians, and pediatric emergency physicians.

The objective of this study was to review the use of antiemetics for pediatric gastroenteritis and to determine prescribing patterns of physicians. A mailed cross-sectional survey instrument was sent to randomly selected board-certified emergency medicine, pediatric, and pediatric emergency medicine specialists. A total of 1665 surveys were mailed, with 593 completed surveys returned (35.6% response rate). A majority of responders (60.9%) reported using antiemetics for pediatric gastroenteritis at least once in the past year, with a greater than 50% usage for all three specialty groups. Promethazine was the most commonly used antiemetic in all specialties, and per rectum the most common route of administration. Adverse reactions following a single dose of antiemetic were most frequently reported with prochlorperazine. The most common reason for antiemetic use was to prevent further dehydration. The most common concern regarding antiemetic use was potential for side effects. Occasional antiemetic use appears to be a common practice in treating pediatric gastroenteritis, regardless of specialty. Given the absence of literature on efficacy or safety, these drugs should be used only with careful consideration to potential side effects.

Second place winner. Absorption of topical ophthalmic medications presenting as lethargy and apnea in an infant.

The case of a previously healthy 3-week-old infant with lethargy and apnea resulting from topical absorption of ophthalmic antiglaucoma medications is described. This case illustrates the importance of including topical drugs in medication histories and considering them as potential causes of systemic toxicity. It also emphasizes the high level of vigilance that is needed in monitoring infants and small children when prescribing concentrated topical medications that are usually given to adults.