Trichobezoar presenting with chief complaints of chest pain, weight loss, and gastrointestinal bleeding.

Abdominal pain is a frequent presenting complaint in pediatric patients seeking acute medical care. We report the case of an adolescent female who presented with nonspecific complaints of chest pain, faintness, and weight loss and whose diagnosis was determined only after the disclosure of trichophagia.

The evaluation and treatment of the child with an apparent febrile seizure.

A febrile seizure is broadly defined as a seizure accompanied by fever (temperature 38.0 degrees Centigrade/100.4 degrees Fahrenheit, or more) in a child between 6- and 60-months-of-age in the absence of known causes such as central nervous system infection or metabolic derangement. This article will provide evidence-based strategies devoted to diagnosing and managing febrile seizures in the current era of reduced prevalence of occult serious bacterial illness and successful use of observation as opposed to routine cerebrospinal fluid analysis.

Summary of NIH Medical-Surgical Emergency Research Roundtable held on April 30 to May 1, 2009.

STUDY OBJECTIVE: In 2003, the Institute of Medicine Committee on the Future of Emergency Care in the United States Health System convened and identified a crisis in emergency care in the United States, including a need to enhance the research base for emergency care. As a result, the National Institutes of Health (NIH) formed an NIH Task Force on Research in Emergency Medicine to enhance NIH support for emergency care research. Members of the NIH Task Force and academic leaders in emergency care participated in 3 roundtable discussions to prioritize current opportunities for enhancing and conducting emergency care research. The objectives of these discussions were to identify key research questions essential to advancing the scientific underpinnings of emergency care and to discuss the barriers and best means to advance research by exploring the role of research networks and collaboration between the NIH and the emergency care community. METHODS: The Medical-Surgical Research Roundtable was convened on April 30 to May 1, 2009. Before the roundtable, the emergency care domains to be discussed were selected and experts in each of the fields were invited to participate in the roundtable. Domain experts were asked to identify research priorities and challenges and separate them into mechanistic, translational, and clinical categories. After the conference, the lists were circulated among the participants and revised to reach a consensus. RESULTS: Emergency care research is characterized by focus on the timing, sequence, and time sensitivity of disease processes and treatment effects. Rapidly identifying the phenotype and genotype of patients manifesting a specific disease process and the mechanistic reasons for heterogeneity in outcome are important challenges in emergency care research. Other research priorities include the need to elucidate the timing, sequence, and duration of causal molecular and cellular events involved in time-critical illnesses and injuries, and the development of treatments capable of halting or reversing them; the need for novel animal models; and the need to understand why there are regional differences in outcome for the same disease processes. Important barriers to emergency care research include a limited number of trained investigators and experienced mentors, limited research infrastructure and support, and regulatory hurdles. The science of emergency care may be advanced by facilitating the following: (1) training emergency care investigators with research training programs; (2) developing emergency care clinical research networks; (3) integrating emergency care research into Clinical and Translational Science Awards; (4) developing emergency care-specific initiatives within the existing structure of NIH institutes and centers; (5) involving emergency specialists in grant review and research advisory processes; (6) supporting learn-phase or small, clinical trials; and (7) performing research to address ethical and regulatory issues. CONCLUSION: Enhancing the research base supporting the care of medical and surgical emergencies will require progress in specific mechanistic, translational, and clinical domains; effective collaboration of academic investigators across traditional clinical and scientific boundaries; federal support of research in high-priority areas; and overcoming limitations in available infrastructure, research training, and access to patient populations.

Point-of-Care Ultrasound in Pediatric Clinical Care.

IMPORTANCE: Point-of-care (POC) ultrasound has been used by a variety of nonradiologist physicians. Recently, POC ultrasound use by pediatricians has received increased attention with the practice of both established and novel applications. OBJECTIVES: To review various uses of ultrasound by pediatricians, discuss challenges and potential pitfalls as pediatric physicians seek to use ultrasound in their practices, and consider various areas of research needs and opportunities. EVIDENCE REVIEW: Available English-language publications from 1970 through December 31, 2014. FINDINGS: Limited research supports the notion that many POC ultrasound applications practiced by nonradiologist pediatricians can assist in clinical decision making and procedural success. Future challenges include the need for institutions to train and credential large numbers of health care professionals in the use of pediatric POC ultrasound, as well as the necessity of diverse research efforts, including the establishment of pediatric-specific norms, consideration of optimal educational strategies, and inquiry intended to identify best practices for clinical effectiveness and efficiency. CONCLUSIONS AND RELEVANCE: Although considerable effort needs to be devoted to the continued development of pediatric POC ultrasound, there is potential for useful application in a variety of clinical and educational settings.

First-time wheezing in infants during respiratory syncytial virus season: chest radiograph findings.

OBJECTIVES: To evaluate the prevalence of pathologic chest radiographs in infants presenting with a first episode of wheezing during respiratory syncytial virus (RSV) seasons and to compare demographics and clinical variables between patients with benign and pathologic chest radiographs. METHODS: We conducted a descriptive study of infants presenting to the emergency departments and urgent care centers of two tertiary care children's hospitals. All previously healthy infants aged 0 to 12 months presenting with a first episode of wheezing were eligible. Signs and symptoms were recorded, and then a chest radiograph was obtained. After the completion of the study, all chest radiographs were reviewed by two pediatric radiologists blinded to the child's clinical presentation and diagnosis. Associations between signs and symptoms and chest radiograph findings were evaluated. RESULTS: A total of 140 patients were enrolled. One (0.7%) patient had a cardiac anomaly, and 23 patients (16%) had an infiltrate versus atelectasis. The cardiac anomaly was suspected based on the clinical signs and symptoms present prior to obtaining the chest radiograph. Of the 23 patients with infiltrate/atelectasis, only eight (35%) were febrile, 12 (52%) were tachypneic, and nine (39%) were hypoxemic. CONCLUSION: Seventeen percent of 140 previously healthy infants presenting with a first episode of wheezing during RSV seasons had a pathologic chest radiograph. However, only one patient (0.7%) had a cardiac anomaly, and all others had chest radiograph findings consistent with a respiratory tract infection.