Assessing the New Norm: A Simulation Study to Assess Pediatric Emergency Physician Success in Critical Procedures With an Air Purifying Respirator.

INTRODUCTION: Physicians caring for patients with COVID-19 are at high risk for contracting the disease, thus, significant emphasis has been placed on personal protective equipment (PPE). The study aims to assess the impact of advanced PPE across 4 common procedures: endotracheal intubation, bag-valve mask ventilation, intraosseous (IO) insertion, and lumbar puncture (LP) performed by pediatric emergency physicians. METHOD: Physicians performed the procedures in a simulated environment. Lumbar puncture and IO were performed with standard precautions versus an air purifying respirator (APR). A direct comparison was drawn for endotracheal intubation and bag-valve mask ventilation between 2 commonly used APRs. Success rate and number of attempts toward successful completion was recorded for all 4 procedures. Physicians filled out a postprocedure survey to assess their ease of use of the APR. RESULTS: Twenty participants performed IO and LP using an APR and standard precautions. There was no statistical difference in the success rate, number of attempts, average time, or maintenance of sterility (LP only) for both procedures. Twenty total participants divided across 2 types of APR groups performed intubation and BMV. Success rate and number of attempts had no statistical difference for both procedures. Physician feedback surveys to assess the ease of use of APR compared with standard precautions had no statistically significant difference for all 4 procedures. CONCLUSIONS: Wearing increased levels of PPE did not impact procedural success, length of time, sterility, number of attempts, or the physicians' ease in our study. Physicians should be encouraged to wear all appropriate PPE.

Oculocardiac Reflex: An Underrecognized But Important Association With Orbital Trap Door Fractures.

ABSTRACT: Blowout fractures of the floor of the orbit can serve as a "trap door" for extraocular muscles. Presentation of inferior orbital muscle entrapment classically involves an upward gaze restriction. Diplopia and exophthalmos can also be present. Rarely, orbital fractures can result in an oculocardiac reflex, which is a triad of bradycardia, syncope, and nausea. The purpose of this study was to describe a patient who had orbital floor fracture with symptoms highly suggestive for oculocardiac reflex after a traumatic injury. Although entrapment of extraocular muscles does require early intervention to prevent ischemia and tissue necrosis, the presence of oculocardiac reflex warrants emergent evaluation and management by an ophthalmologist due to the risk of developing arrhythmias. Frequently, there may be none or very subtle clinical findings present, and abnormal motility may be the only apparent clinical sign, which can be difficult to assess in very young and uncooperative children; therefore, a high index of suspicion must be maintained for early identification and management as well as a reduction of complications.

Impact of the Use of the Beanie on the Neurodevelopmental Outcomes of Preterm Infants With Plagiocephaly: A Pilot Study.

Background Deformational plagiocephaly (DP) is the abnormal flattening of the skull. Infants with DP have been found to have abnormal brain shape and asymmetry associated with worse neurodevelopmental outcomes on the Bayley Scales of Infant and Toddler Development-III (BSID-III) compared to those without DP. In 2009, the FDA approved a repositioning Beanie, the TortleTM (Tortle Products LLC, Greenwood Village, CO), for the prevention of flat head syndrome.  Purpose Our goal was to assess the impact of the use of the Beanie on the neurodevelopment of preterm infants with DP admitted in the neonatal intensive care unit (NICU) using the BSID-III. Methods Subjects were identified using a retrospective chart review of infants during January 2013-2017. Infants of less than 32 weeks of gestational age, under 1500 g birth weight, and attending the high-risk follow-up clinic were included in the study. Neurodevelopmental assessment of patients' cognition, language, motor development using the BSID-III was performed at the 12-month and 24-month follow-up visits. The BSID-III scores for patients who used the Beanie were compared to those who did not. Results A total of 207 patients met the inclusion criteria. The gestational age ranged from 22.5 to 31.5 weeks with a median and mean gestational age of 26.4 weeks and 26.5 weeks respectively. Of the patients, 105 were females and 102 males. The birth weight ranged between 460 g and 1460 g with a mean of 879 g and a median of 860 g. The Beanie was used in 32 patients; 31 patients were found to use the Beanie at 12 months and 16 patients at 24 months. Of note, 12-month Bayley cognition scores were found to be statistically improved in babies who used the Beanie versus those who did not (p: 0.02). The statistical significance was not appreciated at 24 months, which could be due to a decrease in the sample size. Conclusion  The Beanie is an inexpensive and simple way to help prevent DP in preterm infants, which in turn could improve the aforementioned outcomes.

Coronavirus Disease (COVID-19) and Pediatric Patients: A Review of Epidemiology, Symptomatology, Laboratory and Imaging Results to Guide the Development of a Management Algorithm.

Coronavirus disease (COVID-19) has been declared a worldwide pandemic. Compared to adults, there has been a significantly smaller number of reported cases of COVID-19 in the pediatric population, although the incidence is increasing every day. This article looks to review specific epidemiological factors, symptomatology, laboratory and imaging workup, and other relevant metrics derived from the limited published literature that are specific to the pediatric population, to provide a review for the pediatric practitioner and guide, in part, the creation of a clinical algorithm for the management of COVID-19 in the pediatric population that can be utilized by pediatric institutions.

Pediatric Myocarditis Protocol: An Algorithm for Early Identification and Management with Retrospective Analysis for Validation.

Myocarditis is an inflammatory disease of the myocardium with numerous different etiologies, the vast majority of which are infectious in origin. Patients afflicted with myocarditis can have variable presentations from flu-like symptoms to cardiogenic shock and sudden death, thus making the diagnosis difficult. The purpose of this study is the development of an algorithm for early identification and management of myocarditis based on a review of the published data and available literature. To validate the efficacy of this algorithm, a retrospective chart review of all the patient's presenting symptoms and diagnostic workup, treatment, and clinical progression was performed and applied to the algorithm to investigate whether they could be diagnosed at the time of presentation. Retrospective chart review was performed and all the patient's diagnosed with myocarditis between the years 2009 and 2017 were included in the study. 12 patients were identified on chart review and the algorithm was found to be 100% accurate at identifying all myocarditis patients at presentation by using the symptom identification.