Perineal Injury via Personal Watercraft Hydrostatic Jet: A Case Report.

BACKGROUND: Traumatic injuries resulting from personal watercraft hydrostatic jets are expected to increase as personal watercrafts are affordable, portable, and used in an increasingly wide range of locales. CASE PRESENTATION: This case study presents an unusual severe perineal injury in a 17-year-old adolescent girl resulting from a fall from a personal watercraft and contact with the vehicle's hydrostatic jet. This case report provides an overview of the mechanism, treatment, and prevention of personal watercraft injuries. CONCLUSION: Knowledge of this mechanism's potential for serious morbidity and mortality, patient assessment and management principles, and injury prevention strategies are essential to providing effective trauma center care.

Uncuffed Endotracheal Tubes: Not Appropriate for Pediatric Critical Care Transport.

OBJECTIVE: The effect of using uncuffed endotracheal tubes in children during interfacility critical care transport has not yet been assessed. We hypothesized that many children with uncuffed endotracheal tubes experience complications leading to replacement with a cuffed tube after arrival at a tertiary pediatric care facility. METHODS: We conducted a retrospective case review of all intubated patients transported by our dedicated pediatric critical care transport team to our pediatric intensive care unit over a 3-year period. The incidence of urgent reintubation was studied. RESULTS: A total of 213 children were referred for transport with an endotracheal tube in place, with 55 of those with an uncuffed endotracheal tube (25.8% of all intubated patients). Of those with uncuffed tubes, 24 patients needed their tubes replaced on an urgent basis by the medical team because of issues with ineffective ventilation (43.6% of patients with uncuffed tubes or 11.3% of all intubated patients). No cuffed tubes required replacement. CONCLUSION: Placing an uncuffed endotracheal tube in the critically ill child who is referred to tertiary pediatric care results in a significant number of these patients undergoing a repeat laryngoscopy, with all associated risks, to replace the uncuffed tube with a cuffed tube.

Pediatric Extracorporeal Cardiopulmonary Resuscitation Patient With Traumatic Subarachnoid Hemorrhage and Takotsubo Syndrome.

Takotsubo syndrome is rare in pediatric patients but must be considered in patients with subarachnoid hemorrhage with pulmonary edema and cardiomyopathy. A systematic, collaborative approach is needed to facilitate emergent transfer of patients where extracorporeal cardiopulmonary resuscitation (e-CPR) is used as a lifesaving measure. Extracorporeal membrane oxygenation (ECMO) use in transport requires preplanning, role delineation, resources, and research efforts to be successful. We present an unusual transport case of successful e-CPR/ECMO treatment of Takotsubo syndrome in a 12-year-old boy with an isolated traumatic intracranial injury, cardiomyopathy with pulmonary edema, and multiple cardiac arrests.

Emergent Interhospital Transport of Pediatric Patient With a Berlin Heart Device.

Ventricular assist devices (VADs) for the mechanical support of cardiac failure are being used more frequently in children of increasingly younger age. These children have significant and multiple medical comorbidities, and their length of hospital stay has been increasing. As this population of hospitalized VAD-supported children increases, so does the possibility of their need for interfacility transport for specialized diagnostic or therapeutic procedures. Reports on such transports are limited to 3 children who underwent scheduled elective transfers. We report our experience with a child with a Berlin Heart EXCOR left ventricular assist device (Berlin Heart, Berlin, Germany) who required emergent interfacility transport between our hospital and an affiliated institution.

Laparoscopic repair of left paraduodenal hernia.

Paraduodenal hernia is an uncommon cause of acute abdominal pain; however, it is the commonest of internal herniation. Computer tomography of the abdomen is diagnostic. Although it is a rare cause of intestinal obstruction, it is estimated that more than half of paraduodenal hernias develop symptoms. We present a case of left paraduodenal hernia that presented with acute abdominal pain and a left upper abdominal mass. Symptoms resolved spontaneously and a planned Laparoscopic repair was performed. The malpositioned small intestine was reduced from the hernia sac and the hernial orifice was closed. The patient made a rapid recovery with no recurrence of symptoms at 3-year follow-up.