Synthetic Cannabinoid Exposure in Adolescents Presenting for Emergency Care.

OBJECTIVE: The objective of this study was to characterize the clinical picture and management of synthetic cannabinoid exposure in a cohort of adolescents. METHODS: Using the 45 participating sites of the Toxicology Investigators Consortium Registry, a North American database, we conducted an observational study of a prospectively collected cohort. We identified all adolescent (12-19 years) cases of synthetic cannabinoid exposure who have received medical toxicology consultation between January 2012 and December 2016. Clinical and demographic data were collected including age, sex, circumstances surrounding exposure, coingestants, clinical manifestations, treatment, disposition, and outcome. RESULTS: We identified 75 adolescents who presented to the emergency department with synthetic cannabinoid exposure. Most were male (91%) and between the ages of 16 and 19 (66%). The most common symptoms were neuropsychiatric with 50 adolescents (67%) exhibiting central nervous system (CNS) manifestations. There was no predominant toxidrome, and 9 patients (12%) were mechanically ventilated. Mainstay of treatment was supportive care. No deaths were reported. CONCLUSIONS: Synthetic cannabinoid exposure in adolescents is primarily characterized by CNS manifestations, which are varied and may be life-threatening. Frontline caregivers should maintain a high index of suspicion for synthetic cannabinoids, especially in adolescents who present with unexplained CNS manifestations, as there is no specific toxidrome or confirmatory rapid drug screen to detect them.

Vaping implications for children and youth.

PURPOSE OF REVIEW: The development and uptake of E cigarettes are a relatively recent phenomenon. Because of aggressive marketing, attractive designs, enticing flavors and primarily reactionary legislation, we are now seeing soaring rates of adolescent vaping with associated consequences. This review explores how E cigarettes work, their health implications, epidemiology among youth and current regulatory strategies. RECENT FINDINGS: Recently, the Center for Disease Control and Prevention reported that 27% of high school students had used a tobacco product within the last month, the majority being E-cigarettes in 20.8% of high school students. Vaping has managed to reverse a decades long trend of declining nicotine use among youth. Long-term addiction is not the only concern related to youth vaping; there are also increasing reports of short-term health consequences, such as seizures, acute nicotine toxicity, burns and lung injury. SUMMARY: Industry has created and aggressively marketed a product that is enticing to adolescents. E cigarettes have sleek designs, desirable flavors and social acceptability with perceived safety among youth. This has resulted in epidemic E cigarette use in youth with resultant significant short-term and long-term health concerns. Legislation must include regulations that strictly avoid marketing and sales to youth, as well as reducing access to these products.

Damage control resuscitation in pediatric trauma.

PURPOSE OF REVIEW: Damage control resuscitation is an overall management strategy used in trauma patients to rapidly restore physiologic stability, while mitigating hypothermia, coagulopathy and acidosis. We review the evidence and current practice of damage control resuscitation in pediatric trauma patients with a specific focus on fluid management. RECENT FINDINGS: There have been a number of studies over the last several years examining crystalloid fluid resuscitation, balanced blood product transfusion practice and hemostatic agents in pediatric trauma. Excessive fluid resuscitation has been linked to increased number of ICU days, ventilator days and mortality. Balanced massive transfusion (1 : 1 : 1 product ratio) has not yet been demonstrated to have the same mortality benefits in pediatric trauma patients as in adults. Similarly, tranexamic acid (TXA) has strong evidence to support its use in adult trauma and some evidence in pediatric trauma. SUMMARY: Attention to establishing rapid vascular access and correcting hypothermia and acidosis is essential. A judicious approach to crystalloid resuscitation in the bleeding pediatric trauma patient with early use of blood products in keeping with an organized approach to massive hemorrhage is recommended. The ideal crystalloid volumes and/or blood product ratios in pediatric trauma patients have yet to be determined.

Protecting infants from pertussis.

QUESTION: With the increased rate of pertussis in children, several families have asked me about ways to protect their young infants from pertussis infection. What should I recommend to these families? ANSWER: Pertussis is a preventable disease that is endemic worldwide. In adults pertussis causes a mild coldlike illness followed by a persistent cough. In young infants it can cause apnea, seizures, encephalopathy, bronchopneumonia, and death. Infants younger than 4 months of age account for 86% of all deaths due to pertussis. Cocooning, the vaccination of adults in close contact with infants, is recommended by numerous global and national agencies but is likely to prevent only 20% of cases of pertussis in infants. Vaccination during pregnancy is more effective but not yet approved in Canada. Vaccination at birth has not been shown to be consistently effective and therefore is not recommended at this time.

Trends of intentional drug overdose among youth: a population-based cohort study.

Background: Intentional overdose is the commonest form of self-harm in adolescents globally. We explored temporal trends in intentional overdose among youth.Methods: Using multiple linked healthcare databases, we conducted a population-based cohort study in Ontario, Canada, from 2002 to 2015. We included all patients aged 8 to 19 years who presented to an emergency department (ED) or were hospitalized for intentional overdose, stratifying by age and agent(s) consumed. We determined the annual rate of intentional overdose over time. For context, we contrasted these data against the annual rate of select unintentional injuries (laceration of face or scalp, upper extremity fracture, and accidental burn) in the same group over the same period.Results: We identified 31,419 unique intentional overdose events in youth, with a striking U-shaped trend apparent over the study period. From 2002 to 2010, hospital presentations for intentional overdose gradually declined. However, from 2010 to 2015, ED visits increased by 75% and hospital admissions doubled. The sharpest increases were observed in adolescents aged 14 to 17 years, and the most commonly implicated substances were acetaminophen, antidepressants and Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). Over the study period, intentional overdoses involving antidepressants nearly doubled and those involving acetaminophen increased by 50%. In contrast, we observed steady and sustained declines in rates of hospital care for unintentional injuries in the same population over the same period.Conclusions: Since 2010, intentional overdoses have increased among youth, while other forms of unintentional injury have continued to decline. Further research is needed to understand the reasons for the unexpected rise in intentional overdose in adolescents, and strategies developed to mitigate this phenomenon.