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Patients and Family Resources

all patients and families resources









Resources in Evidence Repository and Individual Compendia

Key Resources

Emergency Medicine Cases Podcast: Emergency management of pediatric seizures - Guidance and podcast

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Helman A

With the help of two of Canada's Pediatric Emergency Medicine seizure experts handpicked by TREKK, Dr. Lawrence Richer and Dr. Angelo Mikrogianakis, we'll give you all the tools you need to approach the child who presents to the ED with a seizure with the utmost confidence.

Emergency Medicine Cases: Practical COVID-19 resources for front line healthcare professionals

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Videos in clinical medicine. Diagnosing otitis media--otoscopy and cerumen removal

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Shaikh N, Hoberman A, Kaleida PH, Ploof DL, Paradise JL

Video instructing how to diagnose otitis media with otoscopy and cerum removal.

Bottom Line: Assessment in the emergency department for patients with head injury

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National Institute for Health and Care Excellence (NICE), National Clincial G...

A NICE pathway brings together all NICE guidance, quality standards and materials to support implementation on a specific topic area. The pathways are interactive and designed to be used online.

Acute Otitis Media- Emergency Management in Children - Flowchart

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Children's Health Queensland Hospital and Health Service

Flowchart of emergency management in children for acute otitis media.

Bottom Line: Autism and the Hospital Emergency Room: A Practical Guide for Health Professionals to Meet the Needs of Individuals with Autism Spectrum Disorders

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Center for Autism & Related Disabilities (CARD)

A practical guide for health professionals to meet the needs of individuals with Autism Spectrum Disorder.

Bottom Line: Autism Information for Paramedics and Emergency Room Staff

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Gammicchia C, Johnson C, Autism Society

Information for paramedics and emergency room staff on providing services to a person on the autism spectrum.

Canadian Association of Emergency Physicians - COVID-19 Information, Resources and Advocacy Centre

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Bottom Line: An Evidence-Based Approach to Minimizing Acute Procedural Pain in the Emergency Department and Beyond. Pediatr Emerg Care 2016;32(1):36-42.

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Ali S, McGrath T, Drendel AL

Objective: This review article aims to provide a summary of several strategies, which are supported by definitive and systematically reviewed evidence, that can be implemented alone or in combination to reduce procedural pain and anxiety for children in t

Clinical guidelines

Clinical Practice Guideline: Updated American College of Critical Care Medicine--pediatric advanced life support guidelines for management of pediatric and neonatal septic shock: relevance to the emergency care clinician (2010)

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Kissoon NO, R. A.; Carcillo, J. A.

Objective: Shock is a major preventable cause of morbidity and mortality in children referred to emergency care. The recently updated American College of Critical Care Medicine guidelines for the management of newborns and children with septic shock emphasize the role of emergency care in improving survival and functional outcomes. Implementation of these guidelines of stepwise use of fluids, antibiotics, and, if necessary, inotropes within the first hour of admission to the emergency department can reduce mortality and neurological morbidity risks 2-fold. Published: 2010.

Video: Procedural sedation and analgesia in children

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Krauss BS, Krauss BA, Green SM.

This video describe procedural sedation and analgesia for children. Published: April 2014.

Video: Managing Procedural Anxiety in Children

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Krauss BS, Krauss BA, Green SM.

This video describes the signs of acute anxiety in children and demonstrates approaches to interacting with children that minimize anxiety and maximize cooperation. Published: April 2016.

Clinical Practice Guideline: Paediatric Emergency Department Asthma Clinical Pathway (2014)

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Expert Content Working Group of the Ontario Lung Association,

The P-EDACP is for patients aged 1 to 17 years presenting with wheeze and/or cough who have a history of asthma and/or prior history of wheezing. Additional tools include medication guidelines and pre-printed physicians orders (PPO) for each of the four severity levels, a patient education checklist, and discharge instructions with integrated prescription.

Guidelines: Guidelines for Managing the Client with Intellectual Disabilites in the Emergency Room

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University of Toronto, Centre for Addiction and Mental Health

These guidelines outline ways to optimize the clinical encounter, provide a framework for understanding & assessing the complex medical and mental health issues that arise for persons with intellectual disabilities, and provide a systematic way to evaluate the best approach to treatment and triage.

Clinical Practice Guideline: Acute otitis media - Emergency management in children

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Children's Health Queensland Hospital and Health Service

Children's Health Queensland Statewide Paediatric Guideline for emergency management of acute otitis media in children.

Clinical Practice Guideline: Splinting ABCs: upper and lower extremity splinting in the emergency department

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Sarwark, JF, Maizels, M, Adler, MD & Nicholson, D

This guideline describes preparation and application of plaster and fiberglass short arm splints and short leg splints. Materials and set up for each type of splint are discussed in detail and the advantages and disadvantages of using fiberglass splints are outlined.

Clinical Guideline: Clinical policy: procedural sedation and analgesia in the emergency department

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Godwin SA, Burton JH, Gerardo CJ, Hatten BW, Mace SE, Silvers SM, Fesmire FM,...

This clinical policy from the American College of Emergency Physicians is the revision of a 2005 clinical policy evaluating critical questions related to procedural sedation in the emergency department.

Clinical Guideline: Clinical practice guideline for emergency department ketamine dissociative sedation: 2011 update

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Green SM, Roback MG, Kennedy RM, Krauss B

This update of an evidence-based clinical practice guideline critically discusses indications, contrindications, personnel requirements, monitoring, dosing, coadministered medications, recovery issues, and future research questions for ketamine dissociative sedation.

Clinical Practice Guideline: Relief of pain and anxiety in pediatric patients in emergency medical systems

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Fein JA, Zempsky WT, Cravero JP, Committee on Pediatric Emergency Medicine an...

Control of pain and stress for children is a vital component of emergency medical care. Timely administration of analgesia affects the entire emergency medical experience and can have a lasting effect on a childs and familys reaction to current and future medical care. A systematic approach to pain management and anxiolysis, including staff education and protocol development, can provide comfort to children in the emergency setting and improve staff and family satisfaction.

Clinical Practice Guideline: Emergency department use of oral ondansetron for acute gastroenteritis-related vomiting in infants and children

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Cheng A

This article examines evidence for the use of oral ondansetron for acute gastroenteritis-related vomiting in infants and children, and provides a recommendation for treatment based on the evidence-based review.

Guidelines: Agitation Treatment for Pediatric Emergency Patients

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Hilt RJ, Woodward TA, Henderson SW, Jellinek MS

Guideline based on a review of the existing literature & review of expert opinions for the management of agitated children in an emergency department setting.

Guidelines: Constipation

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Royal Children's Hospital Melbourne

These clinical practice guidelines cover the description, etiology, diagnosis and management of constipation in children.

Clinical Practice Guideline: Emergency department diagnosis and treatment of anaphylaxis: a practice parameter

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Campbell RL, Li JT, Nicklas RA, Sadosty AT, Members of the Joint Task Force P...

The recommendations made in this document about the management of anaphylaxis apply to anaphylaxis that occurs in an ED setting. Some of these recommendations might be different if anaphylaxis occurs in an office setting.

Clinical Practice Guidelines: Clinical Policy for Well-Appearing Infants and Children Younger Than 2 Years of Age Presenting to the Emergency Department With Fever

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American College of Emergency Physicians Clinical Policies Subcommittee (Writ...

This clinical policy from the American College of Emergency Physicians addresses key issues for well-appearing infants and children younger than 2 years presenting to the emergency department with fever.

Acute management of croup in the emergency department

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Ortiz-Alvarez O,

Acute management of croup in the emergency department.

Clinical Practice Guideline: Effective Management of Pain and Anxiety for the Pediatric Patient in the Emergency Department.

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Young VB

A summary of what to expect with pediatric patients experiencing pain and anxiety.

Clinical Practice Guideline: Management of acute pediatric pain in the emergency department.

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Ruest S,Anderson A.

This article provides a summary of recommendations for the multimodal and multidisciplinary approach to acute pediatric pain management and highlights recent research on this topic.

Clinical Practice Guideline: Italian guidelines on the assessment and management of pediatric head injury in the emergency department.

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Da Dalt L, Parri N, Amigoni A, Nocerino A, Selmin F, Manara R, et al.

We aim to formulate evidence-based recommendations to assist physicians decision-making in the assessment and management of children younger than 16 years presenting to the emergency department (ED) following a blunt head trauma with no suspicion of non-accidental injury.

Clinical Practice Guideline: A Practice Guideline for Postreduction Management of Intussusception of Children in the Emergency Department.

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Kwon H, Lee JH, Jeong JH, Yang HR, Kwak YH, Kim DK, et al.

Objective: The aim of this study was to evaluate the effects of a practice guideline of postreduction management of intussusception in children on the length of stay (LOS) from reduction in the pediatric emergency department (PED) and on the incidence of recurrence.

Emergency management of the paediatric patient with generalized convulsive status epilepticus

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Friedman J.

The present guideline paper addresses the emergency management of generalized convulsive status epilepticus (CSE) in children and infants older than one month of age. It replaces the previous statement from 1996, and includes a new treatment algorithm and table of recommended medications, reflecting new evidence and the evolution of clinical practice over the past 15 years. The document focuses on the acute pharmacological management of CSE, but some issues regarding supportive care, diagnostic approach and treatment of refractory CSE are discussed.

Managing acute pain in children presenting to the emergency department without opioids

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Corrie E Chumpitazi1,Cindy Chang2,Zaza Atanelov3,Ann M Dietrich4,Samuel Hiu-F...

Summaries of systematic reviews

Cochrane Summary: Local anaesthesia (numbing medicine) that is directly applied to the skin can provide pain control for repair of skin lacerations

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Tayeb BO, Eidelman A, Eidelman CL, McNicol ED, Carr DB

To assess whether benefits of noninvasive topical anaesthetic application occur at the expense of decreased analgesic efficacy. To compare the efficacy of various singlecomponent or multicomponent topical anaesthetic agents for repair of dermal laceration

Evidence Summary: Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 2: Can emergency physicians safely rule in or rule out paediatric intussusception in the emergency department using bedside ultrasound?

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Raymond-Dufresne , Ghanayem H,

This summary investigates the diagnostic use of bedside ultrasound for paediatric intussusception in the emergency department.

Evidence Summary: Towards evidence based medicine for paediatricians. Question 3. Does the administration of glucagon improve the rate of radiological reduction in children with acute intestinal intussusception?

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Cachat F, Ramseyer P,

This summary examines the relationship between glucagon and the rate of radiological reduction for acute intestinal intussusception.

Cochrane Summary: Inhaled corticosteroids for acute asthma following emergency department discharge (2012)

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Edmonds, ML, Milan, SJ, Brenner, BE, Camargo, CA, Rowe, BH,

Acuteasthma is a common cause of visits toemergencydepartments (ED) and the majority of patients are treated and discharged home. Some people will have arelapseofacuteasthma within two weeks of being discharged after apparently successful treatment. Beta2-agonist drugs are used to open the muscles in the airways and corticosteroids drugs are used to reduce inflammation of the swollen airways.Corticosteroidscan be inhaled (ICS) or swallowed as a tablet (so-calledoralcorticosteroids). ICS may reduceadverse effectsand get to the airways more directly thanoralcorticosteroids. Thisreviewof trials found that there was insufficient evidence that inhaling corticosteroids as well as taking the drugs orally is better thanoraluse alone, afteremergencydepartment treatment for an asthma attack. There is also insufficient evidence that taking ICS alone is as good as taking them orally, although there is some evidence to support using ICS alone for mild asthma attacks afteremergencydepartment discharge. Moreresearchis needed.

Cochrane Summary: What are the effects of educational interventions delivered to children and/or their families, who have experienced an emergency department visit with their asthma within the previous 12 months? (2010)

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Boyd, M, Lasserson, TJ, McKean, MC, Gibson, PG, Ducharme, FM, Haby, M,

Asthma care for children in our society is common and costly. There is now evidence that educationalinterventionfor children who have attended theemergencydepartment for asthma lowers theriskof the need for futureemergencydepartment visits and hospital admissions. Thisreviewlooked at studies which compared usual care for asthma to more intensive educational programmes and the results showed astatistically significantreduction in the treatment groups needing subsequentemergencydepartment visits or hospital admissions. We were not able to determine the most effective type, duration or intensity ofeducationthat should be offered to children to offer the best asthma outcomes.

Cochrane Summary: Magnesium sulfate for treating exacerbations of acute asthma in the emergency department (2009)

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Rowe, BH, Bretzlaff, J, Bourdon, C, Bota, G, Blitz, S, Camargo, CA,

In an asthma attack, the airways (passages to the lungs) narrow from muscle spasms and swelling (inflammation). Bronchodilator drugs (reliever inhalers) can be used to relax the muscles and open the airways, and corticosteroid drugs to reduce the inflammation. Magnesium sulfate is a drug that can also affect muscles, and may reduce inflammation as well. It can be given through a drip in the veins (intravenously). Thereviewof trials found thatintravenousmagnesium sulfate in addition to bronchodilators seems to be safe and beneficial for people with severe asthma attacks, or those for whom bronchodilators are not working.

Cochrane Summary: Early emergency department treatment of acute asthma with systemic corticosteroids (2008)

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Rowe, BH, Spooner, C, Ducharme, F, Bretzlaff, J, Bota, G,

In an asthma attack, the airways (passages to the lungs) narrow from muscle spasms and swelling (inflammation). Bronchodilators (reliever inhalers to open up the lungs and airways) can be used for the spasms, and corticosteroids for the swelling.Corticosteroidscan be inhaled, or taken by mouth (orally) or through a drip into the veins (intravenously). Thereviewof trials found thatsystemic(oralorintravenous) corticosteroids reduce the need for people with asthma attacks to stay in hospital, with fewadverse effects.

Review: Evaluation and Management of Pediatric Febrile Seizures in the Emergency Department

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Hampers LC, Spina LA

This review describes the differences between simple and complex febrile seizures in pediatric patients. The document provides an overview of clinical assessment, laboratory testing, imaging and discharge instructions.

Overviews of systematic reviews

Overview of Systematic Reviews: What works and what's safe in pediatric emergency procedural sedation: an overview of reviews

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Hartling L, Milne A, Foisy M, Lang E, Sinclair D, Klassen TP, Evered L

This overview of systematic reviews examines the safety and efficacy of sedative agents commonly used for procedural sedation (propofol, ketamine, nitrous oxide, midazolam) in children in the ED or similar settings.

Systematic reviews

Systematic Review: Intravenous vs intramuscular ketamine for pediatric procedural sedation by emergency medicine specialists: a review

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Deasy C, Babl FE

This review investigated existing evidence to determine whether ketamine should be best administered intravenously or intramuscularly.

Review: Febrile seizures: emergency medicine perspective

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Kimia AA, Bachur RG, Torres A, Harper MB

This review describes current evidence on the evaluation of febrile seizures in the acute setting, the need for further outpatient assessment, and predictors regarding long-term outcomes of these patients

Review: Emergency Medicine Myths: Computed Tomography of the Head Prior to Lumbar Puncture in Adults with Suspected Bacterial Meningitis - Due Diligence or Antiquated Practice?

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April MD, Long B, Koyfman A

Objective: To review the evidence regarding the utility of obtaining head CT prior to lumbar puncture in adults with suspected bacterial meningitis.

Cochrane Systematic Review: Traditional Chinese medicine for epilepsy

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Li Q, Chen XY, He L, Zhou D

OBJECTIVES: To determine the effectiveness and safety of traditional Chinese medicine in people with epilepsy.

Cochrane Systematic Review: Chinese herbal medicine Huangqi type formulations for nephrotic syndrome

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Feng M, Yuan W, Zhang R, Fu P, Wu T

OBJECTIVES: To assess the benefits and harms of Huangqi and Huangqi type formulations in treating nephrotic syndrome in any age group, either as sole agents or in addition to other drug therapies.

Cochrane Systematic Review: Chinese herbal medicine for atopic eczema

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Zhang W, Leonard T, Bath-Hextall FJ, Chambers C, Lee C, Humphreys R, William...

OBJECTIVES: To assess the effects of Chinese herbal mixtures in the treatment of atopic eczema.

Cochrane Systematic Review: Rapid viral diagnosis for acute febrile respiratory illness in children in the Emergency Department

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Doan Q, Enarson P, Kissoon N, Klassen TP, Johnson DW.

Objectives: To determine the effect of rapid viral testing in the ED on the rate of precautionary testing, antibiotic use, and length of ED visit.

Cochrane Systematic Review: Early emergency department treatment of acute asthma with systemic corticosteroids

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Rowe BH, Spooner C, Ducharme FM, Bretzlaff JA, Bota GW.

Objectives: To determine the benefit of treating patients with acute asthma with systemic corticosteroids within an hour of presenting to the emergency department (ED).

Cochrane Systematic Review: Early use of inhaled corticosteroids in the emergency department treatment of acute asthma

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Edmonds ML, Milan SJ, Camargo CA Jr, Pollack CV, Rowe BH.

Objectives: To determine the benefit of ICS for the treatment of patients with acute asthma managed in the emergency department (ED).

Cochrane Systematic Review: Inhaled steroids for acute asthma following emergency department discharge

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Edmonds ML, Milan SJ, Brenner BE, Camargo CA Jr, Rowe BH.

Objectives: To determine the effectiveness of ICS on outcomes in the treatment of acute asthma following discharge from the ED. To quantify the effectiveness of ICS therapy on acute asthma following ED discharge, when used in addition to, or as a substitute for, systemic corticosteroids.

Cochrane Systematic Review: Interventions for educating children who are at risk of asthma-related emergency department attendance

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Boyd M, Lasserson TJ, McKean MC, Gibson PG, Ducharme FM, Haby M.

Objectives: To conduct a systematic review of the literature and update the previous review as to whether asthma education leads to improved health outcomes in children who have attended the emergency room for asthma.

Cochrane Systematic Review: Intravenous beta2-agonists for acute asthma in the emergency department

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Travers A, Jones AP, Kelly K, Barker SJ, Camargo CA, Rowe BH.

Objectives: To determine the benefit of intravenous (IV) beta2-agonists for severe acute asthma treated in the emergency department.

Cochrane Systematic Review: Magnesium sulfate for treating exacerbations of acute asthma in the emergency department

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Rowe BH, Bretzlaff JA, Bourdon C, Bota GW, Camargo CA Jr.

Objectives: To examine the effect of additional intravenous magnesium sulfate in patients with acute asthma managed in the emergency department.

Cochrane Systematic Review: Emergency intubation for acutely ill and injured patients

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Lecky F, Bryden D, Little R, Tong N, Moulton C

OBJECTIVES: To determine in acutely ill and injured patients who have real or anticipated problems in maintaining an adequate airway whether emergency endotracheal intubation, as opposed to other airway management techniques, improves the outcome in terms of survival, degree of disability at discharge or length of stay and complications occurring in hospital.

Cochrane Systematic Review: Tranexamic acid for reducing mortality in emergency and urgent surgery

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Perel P, Ker K, Morales Uribe CH, Roberts I

OBJECTIVES: To assess the effects of tranexamic acid on mortality, blood transfusion and thromboembolic events in adults undergoing emergency or urgent surgery.

Cochrane Systematic Review: Emergency interventions for hyperkalaemia

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Mahoney BA, Smith WA, Lo DS, Tsoi K, Tonelli M, Clase CM

OBJECTIVES: To review randomised evidence informing the emergency (i.e. acute, rather than chronic) management of hyperkalaemia

Systematic Review: Sedation and analgesia for pediatric fracture reduction in the emergency department: a systematic review

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Migita RT, Klein EJ, Garrison MM

This review assessed the safety and efficacy of various forms of analgesia and sedation for fracture reduction in pediatric patients in the emergency department, as observed in randomized controlled trials in pediatric populations.

Systematic Review: Predictors of emesis and recovery agitation with emergency department ketamine sedation: an individual-patient data meta-analysis of 8,282 children

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Green SM, Roback MG, Krauss B, Brown L, McGlone RG, Agrawal D, McKee M, Weiss...

Ketamine is widely used in emergency departments (EDs) to facilitate painful procedures; however, existing descriptors of predictors of emesis and recovery agitation are derived from relatively small studies.

Systematic Review: Predictors of airway and respiratory adverse events with ketamine sedation in the emergency department: an individual-patient data meta-analysis of 8,282 children

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Green SM, Roback MG, Krauss B, Brown L, McGlone RG, Agrawal D, McKee M, Weiss...

Although ketamine is one of the most commonly used sedatives to facilitate painful procedures for children in the emergency department (ED), existing studies have not been large enough to identify clinical factors that are predictive of uncommon airway and respiratory adverse events.

Systematic Review: Clinical policy: evidence-based approach to pharmacologic agents used in pediatric sedation and analgesia in the emergency department

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Mace SE, Barata IA, Cravero JP, Dalsey WC, Godwin SA, Kennedy RM, Malley KC, ...

This document is a clinical policy on pediatric procedural sedation.

Cochrane Systematic Review: Inhaled steroids for acute asthma following emergency department discharge (2012)

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Edmonds, ML, Milan, SJ, Brenner, BE, Camargo, CA Jr, Rowe, BH,

Objectives: To determine the effectiveness of ICS on outcomes in the treatment of acute asthma following discharge from the ED. To quantify the effectiveness of ICS therapy on acute asthma following ED discharge, when used in addition to, or as a substitute for, systemic corticosteroids.

Cochrane Systematic Review: Interventions for educating children who are at risk of asthma-related emergency department attendance (2009)

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Boyd, M, Lasserson, TJ, McKean, MC, Gibson, PG, Ducharme, FM, Haby, M,

Objectives: To conduct a systematic review of the literature and update the previous review as to whether asthma education leads to improved health outcomes in children who have attended the emergency room for asthma.

Cochrane Systematic Review: Magnesium sulfate for treating exacerbations of acute asthma in the emergency department (2000)

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Rowe, BH, Bretzlaff, JA, Bourdon, C, Bota, GW, Camargo, CA Jr,

Objectives: To examine the effect of additional intravenous magnesium sulfate in patients with acute asthma managed in the emergency department. Seven trials were included (5 adult, 2 pediatric).

Cochrane Systematic Review: Early emergency department treatment of acute asthma with systemic corticosteroids (2000)

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Rowe, BH, Spooner, C, Ducharme, FM, Bretzlaff, JA, Bota, GW,

Objectives: To determine the benefit of treating patients with acute asthma with systemic corticosteroids within an hour of presenting to the emergency department (ED).

Systematic Review: Pain management and sedation for children in the emergency department

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Atkinson P, Chesters A, Heinz P

We provide an overview of published evidence to help clinicians assess, manage, and minimise pain in children presenting to hospital.

Systematic Review: Treatment of children with migraine in the emergency department: a qualitative systematic review

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Bailey B, McManus BC

Objective: To evaluate which treatment could be effective in the emergency department (ED) for children with migraine and status migrainosus, we carried out a qualitative systematic review of randomized controlled trials (RCTs) that evaluated treatment that could be used for those conditions.

Review: Pediatric pain management in the emergency department

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Bauman BH, McManus JG

In this article, the authors review the history of ED pediatric pain management and sedation, discuss special considerations in pediatric pain assessment and management, review various pharmacologic and nonpharmacologic methods of alleviating pain and anxiety, and present ideas to improve the culture of the pediatric ED, so that it can achieve the goal of becoming pain-free.

Systematic Review: Screening injured children for physical abuse or neglect in emergency departments: a systematic review

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Woodman J, Lecky F, Hodes D, Pitt M, Taylor B, Gilbert R

Screening markers are used in emergency departments (EDs) to identify children who should be assessed for possible physicalabuseand neglect. We conducted three systematic reviews evaluating age, repeat attendance and injury type as markers for physicalabuseor neglect in injured children attending EDs.

Review: Understanding and Improving Care for Individuals with Intellectual and Developmental Disabilities in the Emergency Department

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Lusky Y, Lake JK, Durbin J, Perry A, Bullock H, Morris S, Lee JS

The aim of this review was to provide an overview of existing research on patterns and predictors of emergency department use among persons with intellectual and developmental disabilities, to summarize what is known about the care received and to describe interventions to improve emergency care.

Review: Management of agitation in individuals with autism spectrum disorders in the emergency department

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McGonigle JJ, Venkat A, Beresford C, Campbell TP, Gabriels RL

This article describes the challenges that inidividuals with autism spectrum disorder face when receiving treatment in crisis and emergency settings.

Emergency ultrasound-based algorithms for diagnosing blunt abdominal trauma

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Stengel D, Bauwens K, Rademacher G, Ekkernkamp A, Gthoff C,

Review to assess the effects of trauma algorithms that include ultrasound examinations in patients with suspected blunt abdominal trauma.

Review: Pediatric orthopedic injuries: evidence-based management in the emergency department

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Lien J

This issue reviews the etiology and pathophysiology of child-specific fractures, as well as common injuries of the upper and lower extremities.

Review: During the Emergency Department Evaluation of a Well-Appearing Neonate with Fever, Should Empiric Acyclovir Be Initiated?

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Bruno E, Pillus D, Cheng D, Vilke G, Pokrajac N

This review aimed to identify when to initiate testing and treatment for herpes simplex virus infection.

Review: Emergency management of burns: part 1

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Stiles K

Objective: The aim of this article is to give an overview of burns trauma, and to describe the initial assessment and management of patients with these injuries in emergency departments (EDs). Part 1 of 2.

Review: Emergency management of burns: part 2

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Stiles K

Objective: The aim of the two articles is to enhance emergency clinicians knowledge and confidence in burn management, and to build awareness of the life-changing implications of the initial clinical interventions in burn care. Part 2 of 2.

Review: Emergency Care of Pediatric Burns

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Strobel AM, Fey R

Objective: To review emergency care, management and prevention of pediatric burns.

Review: Optimizing emergency management to reduce morbidity and mortality in pediatric burn patients

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Haines E, Fairbrother H

Objective: This article reviews methods for accurate classification and management of the full range of burns seen in pediatric patients.

Review: Lyme Disease: Emergency Department Considerations

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Applegren ND, Kraus CK

Objective: We sought to review the etiology of LD, describe its clinical presentations and sequela, and provide a practical classification and approach to ED management of patients with LD-related presentations.

Review: Diagnosis and Treatment of Central Nervous System Infections in the Emergency Department

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Dorsett M, Liang SY

Objective: This review discusses the clinical signs and symptoms that should lead emergency physicians to consider CNS infection, paying particular attention to the sensitivity and specificity of different clinical findings at the bedside. Subsequently, the diagnostic workup and management of patients for whom there is high clinical suspicion for CNS infection is discussed.

Review: Emergency department management of meningitis and encephalitis

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Fitch MT, Abrahamian FM, Moran GJ, Talan DA

Objective: This article addresses considerations in clinical evaluation, need for CNS imaging before LP, interpretation of cerebrospinal fluid results, standards for and effects of timely antibiotic administration, and recommendations for specific antimicrobial therapy and corticosteroids.

Systematic Review: Suicide Evaluation in the Pediatric Emergency Setting

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Ambrose AJH, Prager LM

Objective: to review current peds education screening tools

Systematic Review: A Systematic Review of Instruments to Identify Mental Health and Substance Use Problems Among Children in the Emergency Department

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Newton AS, Soleimani A, Kirkland SW, Gokiert RJ.

Objective: to investigate the psychometric properties, accuracy, and performance metrics of instruments used in the ED to identify pediatric mental health and substance use problems.

Systematic Review: Literature-based Recommendations for Suicide Assessment in the Emergency Department: A Review

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Ronquillo L, Minassian A, Vilke GM, Wilson MP

Objective: Given the emphasis on screening for suicidal ideation in the general hospital and ED, it is important for Emergency Physicians to be able to understand and perform suicide risk assessment.

Systematic Review: Screening for Suicide Risk in the Pediatric Emergency and Acute Care Setting

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Wintersteen MB, Diamond GS, Fein JA

Objective: reviews epidemiology, psychiatric comorbidities, risk factors, warning signs, screening measures, and issues related to screening for suicide risk in the pediatric emergency department and acute care settings.

Review: Evaluation of Prehospital Management in a Canadian Emergency Department Anaphylaxis Cohort.

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Gabrielli S, Clarke A, Morris J, et al.

To assess prehospital management of anaphylaxis by measuring the effect of epinephrine use compared with antihistamines and corticosteroids on negative outcomes of anaphylaxis (intensive care unit/hospital ward admission, multiple doses of epinephrine in the emergency department [ED], and intravenous fluids given in the ED).

Systematic Review: Pain Management of Pediatric Musculoskeletal Injury in the Emergency Department: A Systematic Review.

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Le May S,Ali S,Khadra C,Drendel AL,Trottier ED,Gouin S,Poonai N.

Objective. To systematically review the most effective pain management for children presenting to the emergency department with musculoskeletal injuries.

Systematic review: Multisystem inflammatory syndrome associated with COVID-19 from the pediatric emergency physician's point of view.

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Junior H, Sakano TMS, Rodrigues RM, et al.

Objective: Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease (COVID-19) is a rare and challenging diagnosis requiring early treatment. The diagnostic criteria involve clinical, laboratory, and complementary tests. This review aims to draw pediatrician attention to this diagnosis, suggesting early treatment strategies, and proposing a pediatric emergency care flowchart.

Rational use of high-flow therapy in infants with bronchiolitis. What do the latest trials tell us?' A Paediatric Research in Emergency Departments International Collaborative perspective.

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O'Brien S, Craig S, Babl FE, Borland ML, Oakley E, Dalziel SR; Paediatric Res...

Over the past decade, the use of high-flow nasal cannulae (HFNC) therapy has increased markedly and it is now utilised not only in the intensive care unit setting but in general paediatric wards and emergency departments. The aim of this systematic review was to summarise and critique the current evidence-base for the use of HFNC in infants with bronchiolitis.

Review: Approach to Pediatric Traumatic Brain Injury in the Emergency Department.

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Belisle S, Lim R, Hochstadter E, Sangha G.

We discuss the initial management of traumatic brain injury based on mild, moderate and severe presentations. Management strategies to address Intracranial Pressure and Cerebral perfusion pressure, the use of oxygenation and ventilation strategies, temperature, correction of metabolic abnormalities and seizure care are discussed.

Review: Emergency Department Implementation of the Brain Trauma Foundation's Pediatric Severe Brain Injury Guideline Recommendations.

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Lumba-Brown A, Totten A, Kochanek PM.

Provides new and updated recommendations applicable to the emergency department management of children with severe traumatic brain injury. Practice-changing takeaways include specific recommendations for administration of 3% hypertonic saline, administration of seizure prophylaxis, and avoiding hyperventilation.

Systematic Review: Diagnostic Accuracy of Point-of-Care Ultrasound for Intussusception in Children Presenting to the Emergency Department: A Systematic Review and Meta-analysis

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Lin-Martore M, Kornblith AE, Kohn MA, Gottlieb M.

Objective: The purpose of this systematic review and meta-analysis was to determine the diagnostic accuracy of POCUS for children with suspected ileocolic intussusception by emergency physicians (EP).

Systematic Review: Inpatient Admission versus Emergency Department Management of Intussusception in Children: A Systemic Review and Meta-Analysis of Outcomes.

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Amuddhu SK, Chen Y, Nah SA.

We performed a systematic review and meta-analysis to compare recurrence rates and length of hospital stay between the groups.

Review: Youth With Autism Spectrum Disorder in the Emergency Department

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Lytle S, Hunt A, Moratschek S, Hall-Mennes M, Sajatovic M.

Youth (aged 0-17 years) with ASD were up to 30 times more likely to present to the ED than youth without ASD. Individuals with ASD who visited the ED were older, more likely to have public insurance, and more likely to have nonurgent ED visits. For youth with ASD, up to 13% of visits were for behavioral or psychiatric problems, whereas for youth without ASD less than 2% were for psychiatric problems. ASD youth were more likely to present for externalizing problems or psychotic symptoms. Youth with ASD were also likely to have repeat visits to the ED and more likely to be admitted to a psychiatric unit or medical floor than youth without ASD.

Review: See-Hear-Feel-Speak: A Protocol for Improving Outcomes in Emergency Department Interactions With Patients With Autism Spectrum Disorder

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Samet D, Luterman S.

The presentation of children and adolescents with autism in the emergency department (ED) poses a unique set of challenges to clinicians and their teams, which have not yet been met. Children and adolescents with autism spectrum disorder (ASD) are more likely than their age and ethnically matched counterparts to visit both pediatric and general EDs and are more likely to use it for primary care complaints and dental care and to present for psychiatric concerns including suicidality. Despite the higher relative frequency, individuals with ASD demonstrate lower patient satisfaction, lower healthcare self-efficacy, and higher odds of unmet healthcare needs related to physical health, mental health, health maintenance, and vaccination. This can be ameliorated by simple strategies regarding communication, sensory and environmental modification, and distraction. After performing a literature review of existing evidence-based recommendations via PubMed as well as resources from autism advocacy and self-advocacy groups, we compiled a 4-step system: "See-Hear-Feel-Speak" an approach conducive to learning with the goal of enabling clinicians and their teams to facilitate patient-centered encounters with pediatric patients with ASD. The protocol meets the practicality requirements defined by published research.

Fluid treatment for children with diabetic ketoacidosis: How do the results of the pediatric emergency care applied research network Fluid Therapies Under Investigation in Diabetic Ketoacidosis (FLUID) Trial change our perspective?

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Glaser N, Kuppermann N.

The optimal fluid treatment protocol for children with diabetic ketoacidosis (DKA) has long been a subject of controversy. Until recently, there was no high-quality evidence from randomized clinical trials to support an optimal guideline, and recommendations were mainly based on theoretical considerations. As a consequence, fluid treatment protocols for children with DKA vary between institutions (and countries). In June 2018, the results from the Fluid Therapies Under Investigation in DKA Trial conducted in the Pediatric Emergency Care Applied Research Network were published. This large, factorial-designed randomized controlled trial assessed neurological outcomes of 1387 children with DKA who were treated with one of four fluid protocols that varied in infusion rate and sodium content. In this commentary, we review and discuss the results of this new study and the implications for clinical care of DKA in children.

Systematic review and validation of prediction rules for identifying children with serious infections in emergency departments and urgent-access primary care.

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Thompson M, Van den Bruel A, Verbakel J, Lakhanpaul M, Haj-Hassan T, Stevens ...

We systematically identified clinical features and laboratory tests which identify serious infection in children attending the ED and primary care. We also identified clinical prediction rules and validated those using existing data sets.

Management protocols for status epilepticus in the pediatric emergency room: systematic review article

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Au CC, Branco RG, Tasker RC.

This systematic review of national or regional guidelines published in English aimed to better understand variance in pre-hospital and emergency department treatment of status epilepticus.

Review: Relief of pain and anxiety in pediatric patients in emergency medical systems

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Fein JA, Zempsky WT, Cravero JP, Committee on Pediatric Emergency Medicine an...

Control of pain and stress for children is a vital component of emergency medical care. Timely administration of analgesia affects the entire emergency medical experience and can have a lasting effect on a child's and family's reaction to current and futu

Intranasal drugs for analgesia and sedation in children admitted to pediatric emergency department: a narrative review

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Pansini V, Curatola A, Gatto A, Lazzareschi I, Ruggiero A, Chiaretti A.

Acute pain is one of the most common symptoms in children admitted to the Pediatric Emergency Department (PED) and its management represents a real clinical challenge for pediatricians.

Key studies

Key Study: Outcome of Pediatric Forearm Fracture Reductions Performed by Pediatric Emergency Medicine Providers Compared With Reductions Performed by Orthopedic Surgeons: A Retrospective Cohort Study

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Milner, D, Krause, E, Hamre, K and Flood, A

The aim of this study was to describe the outcome differences between board-certified orthopedists and pediatric emergency medicine (PEM) physicians conducting forearm fracture reductions.

Key Study: Diagnostic Accuracy of Point-Of-Care Ultrasound for Intussusception Performed by Pediatric Emergency Medicine Physicians.

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Arroyo AC, Zerzan J, Vazquez H, Dickman E, Likourezos A, Hossain R, et al

Objective: Our objective was to determine the diagnostic accuracy of POCUS by novice sonographer pediatric emergency medicine physicians (PEM-Ps) who received focused US training for diagnosing INT.

Key Study: Pediatric Emergency Medicine Point-of-Care Ultrasound for the Diagnosis of Intussusception.

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Trigylidas TE, Hegenbarth MA, Patel L, Kennedy C, O'Rourke K, Kelly JC.

Objectives: The primary objective was to evaluate the accuracy of PEM POCUS in identifying ileocolic intussusception. The secondary objective was to identify factors associated with air enema failure.

Key Study: Rapid fluid resuscitation in pediatrics: testing the American College of Critical Care Medicine guideline (2007)

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Stoner MJG, D. G.; Cohen, D. M.; Fernandez, S. A.; Hall, M. W.

Objective: The 2002 American College of Critical Care Medicine (ACCM) guidelines for the resuscitation of pediatric septic shock suggest that 20 mL/kg of bolus intravenous fluid be given within 5 minutes. Of 3 commonly used, inexpensive methods of fluid delivery, we hypothesized that only use of a manual push-pull system will permit guideline adherence. Published: 2007.

Key study: Identifying persistent postconcussion symptom risk in a pediatric sports medicine clinic

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Howell DR, Zemek R, Brilliant AN, Mannix RC, Master CL, Meehan WP.

To determine if the Predicting Persistent Post-concussive Problems in Pediatrics (5P) clinical risk score, an emergency department (ED)derived and validated tool, is associated with developing PPCS when obtained in a primary care sports concussion setting.

Summary: Emergency preparedness and response: multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19).

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Centers for Disease Control and Prevention

Objective: Providing 1) background information on several cases of a recently reported multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19); and 2) a case definition for this syndrome.

Key Study: Evaluation of bedside sonography performed by emergency physicians to detect intussusception in children in the emergency department.

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Tonson la Tour A, Desjardins MP, Gravel J.

Objective: The aim of our study was to evaluate the test characteristics of point-of-care ultrasound (POCUS) performed by emergency physicians with varying levels of experience among children having undergone diagnostic radiology ultrasound for intussusception in a pediatric emergency department (PED).

Key Study: Oral ondansetron for gastroenteritis in a pediatric emergency department

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Freedman SB, Adler M, Seshadri R, Powell EC

The aim of this trial is to determine whether a single dose of ondansetron would improve outcomes in children with gastroenteritis.

Key Study: Controlled delivery of high vs low humidity vs mist therapy for croup in emergency departments: a randomized controlled trial

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Scolnik, D, Coates, AL, Stephens, D, Da Silva, Z, Lavine, E, Schuh, S,

Objective: To determine whether a significant difference in the clinical Westley croup score exists in children with moderate to severe croup who were admitted to the emergency department and who received either 100% humidity or 40% humidity via nebulizer or blow-by humidity.

Key Study: Clinical prediction model to aid emergency doctors managing febrile children at risk of serious bacterial infections: diagnostic study (2013)

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Nijman RGV, Y.; Thompson, M.; Van Veen, M.; Van Meurs, A. H.; Van Der Lei, J....

Objective: To derive, cross validate, and externally validate a clinical prediction model that assesses the risks of different serious bacterial infections in children with fever at the emergency department. Published: 2013.

Key Study: Serum lactate as a screening tool and predictor of outcome in pediatric patients presenting to the emergency department with suspected infection (2013)

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Reed LC, J.; Cummings, A.; Markwell, S.; Wall, J.; Duong, M.

Objective: No single reliable sepsis biomarker exists for risk stratification and prognostication in pediatric patients presenting to the emergency department (ED). Serum lactate (LA) predicts mortality in septic adults. We sought to determine if serum LA correlated with the diagnosis of sepsis, admission rates, and outcomes in pediatric patients presenting to the ED with suspected infection. Published: 2013.

Key Study: Implementation of goal-directed therapy for children with suspected sepsis in the emergency department (2011)

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Cruz ATP, A. M.; Williams, E. A.; Graf, J. M.; Wuestner, E. R.; Patel, B.

Background: Suboptimal care for children with septic shock includes delayed recognition and inadequate fluid resuscitation. OBJECTIVE: To describe the implementation of an emergency department (ED) protocol for the recognition of septic shock and facilitate adherence to national treatment guidelines. Published: 2011.

Key Study: An emergency department septic shock protocol and care guideline for children initiated at triage (2011)

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Larsen GYM, N.; Greenberg, R.

Background: Unrecognized and undertreated septic shock increases morbidity and mortality. Septic shock in children is defined as sepsis and cardiovascular organ dysfunction, not necessarily with hypotension. OBJECTIVE: Cases of unrecognized and undertreated septic shock in our emergency department (ED) were reviewed with a focus on (1) increased recognition at triage and (2) more aggressive treatment once recognized. We hypothesized that septic shock protocol and care guideline would expedite identification of septic shock, increase compliance with recommended therapy, and improve outcomes.

Key Study: How well do vital signs identify children with serious infections in paediatric emergency care? (2009)

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Thompson MC, N.; Harnden, A.; Mayon-White, R.; Perera, R.; Mant, D.

Objective: To determine whether vital signs identify children with serious infections, and to compare their diagnostic value with that of the Manchester triage score (MTS) and National Institute for Health and Clinical Excellence (NICE) traffic light system of clinical risk factors. Published: 2009.

Key Study: Emergency management of children with severe sepsis in the United Kingdom: the results of the Paediatric Intensive Care Society sepsis audit (2009)

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Inwald DPT, R. C.; Peters, M. J.; Nadel, S.

Objective: To audit current UK practice of the management of severe sepsis in children against the 2002 American College of Critical Care Medicine/Pediatric Advanced Life Support (ACCM-PALS) guideline. Published: 2009.

Key Study: Emergency ultrasound in the detection of pediatric long-bone fractures

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Barata, I, Spencer, R, Suppiah, A, Raio, C, Ward, MF, & Sama, A

Objective: The goal of this study was to assess the agreement between emergency physicians' and radiologists' final assessments of suspected long-bone fractures using emergency ultrasound and radiography, respectively, in the pediatric population.

Key Study: Extremity fracture pain after emergency department reduction and casting: predictors of pain after discharge

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Thompson, RW, Krauss, B, Kim, YJ, Monuteaux, MC, Zerriny, S, & Lee, LK

Objectives: To determine the prevalence of pediatric extremity fracture pain after emergency department (ED) discharge, compare pain severity between fractures requiring simple casting versus sedated reduction and casting, and explore predictors of postdischarge pain.

Key Study: Diagnostic accuracy of bedside emergency ultrasound screening for fractures in pediatric trauma patients

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Sinha, TP, Bhoi, S, Kumar, S, Ramchandani, R, Goswami, A, Kurrey, L, & Ga...

Objective: To assess the diagnostic accuracy of bedside ultrasound for fractures in pediatric trauma patients.

Key Study: Emergency room visits by pediatric fracture patients treated with cast immobilization

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Sawyer, JR, Ivie, CB, Huff, AL, Wheeler, C, Kelly, DM, Beaty, JH, & Canal...

Objectives: To determine when and why pediatric patients with cast complaints return to the emergency room (ER). If this could be determined, educational and treatment strategies may help decrease the number of these visits and the cost of care.

Key Study: Ability of emergency ultrasonography to detect pediatric skull fractures: a prospective, observational study

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Parri N, Crosby BJ, Glass C, Mannelli F, Sforzi I, Schiavone R, Ban KM

Our objective was to determine if bedside ED ultrasound is an accurate diagnostic tool for identifying skull fractures when compared toheadCT.

Key Study: A randomized, controlled trial of i.v. versus i.m. ketamine for sedation of pediatric patients receiving emergency department orthopedic procedures

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Roback MG, Wathen JE, MacKenzie T, Bajaj L

This study compared adverse events, efficacy, and length of sedation of intravenous (i.v.) versus intramuscular (i.m.) ketamine procedural sedation and analgesia for orthopedic procedures in the emergency department (ED).

Key Study: Comparison of propofol/fentanyl versus ketamine/midazolam for brief orthopedic procedural sedation in a pediatric emergency department

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Godambe SA, Elliot V, Matheny D, Pershad J

This study compared the effectiveness of 2 medication regimens, propofol/fentanyl (P/F) and ketamine/midazolam (K/M), for brief orthopedic emergency department procedural sedation.

Key Study: Intravenous ketamine plus midazolam is superior to intranasal midazolam for emergency paediatric procedural sedation

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Acworth JP, Purdie D, Clark RC

This study compared intranasal midazolam (INM) with a combination of intravenous ketamine and intravenous midazolam (IVKM) for sedation of children requiring minor procedures in the emergency department.

Key Study: Does midazolam alter the clinical effects of intravenous ketamine sedation in children? A double-blind, randomized, controlled, emergency department trial

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Wathen JE, Roback MG, Mackenzie T, Bothner JP,

This study was conducted to investigate the frequency and severity of adverse effects, specifically emergence phenomena, experienced by patients receiving intravenous ketamine with or without midazolam for sedation in a pediatric emergency department.

Key Study: Vital Signs Are Not Associated with Self-Reported Acute Pain Intensity in the Emergency Department

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Daoust R, Paquet J, Bailey B, Lavigne G, Piette E, Sanogo K, Chauny JM

Objectives: This study aimed to ascertain the association between self-reported pain intensity and vital signs in both emergency department (ED) patients and a subgroup of patients with diagnosed conditions known to produce significant pain.

Key Study: Association of race and ethnicity with management of abdominal pain in the emergency department

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Johnson TJ, Weaver MD, Borrero S, Davis EM, Myaskovsky L, Zuckerbraun NS, Kra...

Objective: To determine if race/ethnicity-based differences exist in the management of pediatric abdominal pain in emergency departments (EDs).

Key Study: Reliability of the visual analog scale in children with acute pain in the emergency department

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Bailey B, Gravel J, Daoust R

In children, many psychometric properties of the visual analogue scale (VAS) are known, including the minimum clinically significant difference (10mm on a 100-mm VAS). However, its imprecision or reliability is not well known. Thus, in order to determine the reliability of this scale, a prospective cohort study was performed in patients aged 8-17 years presenting to a pediatric emergency department with acute pain.

Key Study: Equivalency of two concentrations of fentanyl administered by the intranasal route for acute analgesia in children in a paediatric emergency department: a randomized controlled trial

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Borland M, Milsom S, Esson A

Objective: Intranasal fentanyl's (INF) effectiveness is established using highly concentrated INF (HINF). Standard concentration INF (SINF) is more widely available. We aimed to illustrate the equivalence of SINF to HINF.

Key Study: Clinical outcomes of children treated with intravenous prochlorperazine for migraine in a pediatric emergency department

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Trottier ED, Bailey B, Dauphin-Pierre S, Gravel J

Objective: To evaluate the rate of treatment failure associated with prochlorperazine used in children with severe migraine in a pediatric ED.

Key Study: Comparative review of the clinical use of intranasal fentanyl versus morphine in a paediatric emergency department

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Borland ML, Clark LJ, Esson A

Objectives: Comparison of intranasal fentanyl (INF) and parenteral morphine in children in an ED. Primary objective was to compare time to analgesia from presentation, with secondary objectives to assess patient profiles, specifics of opiate analgesics used plus rate of i.v. access for analgesia alone.

Key Study: Comparison of four pain scales in children with acute abdominal pain in a pediatric emergency department

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Bailey B, Bergeron S, Gravel J, Daoust R

Study Objective: In children, the agreement between the many scales used to document the intensity of pain is not well known. Thus, to determine the agreement, we evaluate the visual analog scale, the standardized color analog scale, the Wong-Baker FACES Pain Rating Scale, and a verbal numeric scale in children with acute abdominal pain suggestive of appendicitis in a pediatric emergency department (ED).

Key Study: A randomized controlled trial comparing intranasal fentanyl to intravenous morphine for managing acute pain in children in the emergency department

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Borland M, Jacobs I, King B, O'Brien D

Study Objective: We compare the efficacy of intranasal fentanyl versus intravenous morphine in a pediatric population presenting to an emergency department (ED) with acute long-bone fractures.

Key Study: Pain assessment for pediatric patients in the emergency department

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Drendel AL, Brousseau DC, Gorelick MH

Objective: To examine the relationship between pediatric patient visit characteristics and pain score documentation in the emergency department (ED) and determine whether documentation of a pain score is associated with increased analgesic use.

Key Study: Emergency department analgesia for fracture pain

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Brown JC, Klein EJ, Lewis CW, Johnston BD, Cummings P

Study Objectives: We analyze records of all emergency department (ED) patients with extremity or clavicular fractures to describe analgesic use, compare analgesia between adults and children, and compare analgesia between the subset of these adults and children with documented moderate or severe pain. Among children, we compare treatment between pediatric and nonpediatric facilities.

Key Study: Cost Consequence Analysis of Implementing the Low Risk Ankle Rule in Emergency Departments

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Boutis, K, von Keyserlingk, C, Willan, A, Narayanan, UG, Brison, R, Grootendo...

Objective: To examine the costs and consequences of implementing the Low Risk Ankle Rule.

Key Study: Epidemiology of pediatric fractures presenting to emergency departments in the United States

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Naranje, SM, Erali, RA, Warner, WC Jr, Sawyer, JR, & Kelly, DM

Objective: To identify the most frequent pediatric fractures per 1000 population at risk in the United States using the 2010 National Electronic Injury Surveillance System database and 2010 Census information.

Key Study: Management of toddler's fractures in the pediatric emergency department

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Schuh, AM, Whitlock, KB, & Klein, EJ

Objectives: To evaluate current practice in treatment of toddler's fractures, as well as subsequent healthcare utilization and complications.

Key Study: Evidence into practice: emergency physician management of common pediatric fractures

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Boutis, K, Howard, A, Constantine, E, Cuomo, A, & Narayanan, U

Objectives: To determine the proportion of emergency physicians who prescribe removable devices for distal radius buckle fractures and/or nondisplaced distal fibular Salter-Harris I fractures. The investigators also examined follow-up referral patterns for these injuries.

Overview of studies: Emergency presentation of congenital heart disease in children

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EB Medicine

Objective: To address the evaluation and management of pediatric patients with congenital heart defects in the context of the evidence available from the medical literature.

Key Study: The Prevalence of Bruising Among Infants in Pediatric Emergency Departments

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Pierce MC, Magana JN, Kaczor K, Lorenz DJ, Meyers G, Bennett BL, Kanegaye JT

Bruising can indicate abuse for infants. Bruise prevalence among infants in the pediatric emergency department (ED) setting is unknown. Our objective is to determine prevalence of bruising, associated chief complaints, and frequency of abuse evaluations in previously healthy infants presenting to pediatric EDs.

Key Study: Accuracy of a screening instrument to identify potential child abuse in emergency departments

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Louwers EC, Korfage IJ, Affourtit MJ, Ruige M, van den Elzen AP, de Koning HJ...

This study was designed to measure the accuracy of a screening instrument for detection of potential child abuse used in EDs.

Key Study: Emergency department evaluation of child abuse

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Leetch AN, Woolridge D

This review outlines emergency department evaluation of child abuse.

Key Study: Emergency Management of febrile status epilepticus: results of the FEBSTAT study

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Seinfeld S, Shinnar S, Sun S, Hesdorffer DC, Deng X, Shinnar RC, O'Hara K, No...

The FEBSTAT study is a prospective study of the consequences of febrile status epilepticus. Acute management, and the relationship between treatment delay, total seizure duration and associated morbidity are analyzed.

Key Study: Risk of intracranial pathologic conditions requiring emergency intervention after a first complex febrile seizure episode among children

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Teng D, Dayan P, Tyler S, Hauser WA, Chan S, Leary L, Hesdorffer D

Objective: To determine the likelihood of intracranial pathologic conditions requiring emergency neurosurgical or medical intervention among children without meningitis who presented to the pediatric emergency department after a first complex febrile seizure.

Key Study: Emergency department revisits in children with gastroenteritis

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Freedman SB, Thull-Freedman JD, Rumantir M, Atenafu EG, Stephens D

The aim of the study is to determine whether intravenous fluid administration to children with gastroenteritis is independently associated with a reduction in unscheduled emergency department (ED) revisits within 7 days.

Overview of studies: Congenital Heart Disease In Pediatric Patients: Recognizing The Undiagnosed And Managing Complications In The Emergency Department

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Judge P, Meckler G

Objective: This review focuses on the recognition and initial management of patients with undiagnosed congenital heart disease presenting to the ED and touches on considerations for postoperative infants and children with complex congenital heart disease.

Key Study: Epidemiology of Injury-Related Emergency Department Visits in the US Among Youth with Autism Spectrum Disorder

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Kalb LG, Vasa RA, Ballard ED, Woods S, Goldstein M, Wilcox HC

This study aims to use nationally-representative emergency department data to characterize injury-related ED visits among youth with autism spectrum disorder.

Key Study: Parent and health care provider perspectives related to disclosure of autism spectrum disorder in pediatric emergency departments

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Muskat B, Greenblatt A, Nicholas DB, Ratnapalan S, Cohen-Silver J, Newton AS,...

This qualitative study utilized a grounded theory approach and analyzed data from parents and health care providers related to autism spectrum disorder disclosure within two Canadian pediatric emergency departments.

Key Study: Toward Practice Advancement in Emergency Care for Children With Autism Spectrum Disorder

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Nicholas DB, Zwaigenbaum L, Muskat B, Craig WR, Newton AS, Cohen-Silver J, Sh...

The objective of this study was to identify stakeholder perspectives in determining clinical priorities and recommendations to guide emergency department service delivery for children with autism spectrum disorder.

Key Study: Experiences of emergency department care from the perspective of families in which a child has autism spectrum disorder

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Nicholas DB, Zwaigenbaum L, Muskat B, Craig WR, Newton AS, Kilmer C, Greenbla...

In this study, parents and their children with autism spectrum disorder shared their perspectives on emergency department care.

Key Study: Perspectives of Health Care Providers Regarding Emergency Department Care of Children and Youth with Autism Spectrum Disorder

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Zwaigenbaum L, Nicholas DB, Muskat B, Kilmer C, Newton AS, Craig WR,Ratnapala...

This study aimed to characterize the perspectives of health professionals who care for children with autism spectrum disorder in the emergency department, and to determine what strategies could optimize care.

Key Study: Development and evaluation of educational materials for pre-hospital and emergency department personnel on the care of patients with autism spectrum disorder

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McGonigle JJ, Migyanka JM, Glor-Scheib SJ, Cramer R, Fratangeli JJ, Hegde GG,...

This study describes the development of education materials on ASD and the results of training of emergency medical services and emergency department personnel.

Key Study: Psychiatric-related emergency department visits among children with an autism spectrum disorder

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Kalb LG, Stuart EA, Freedman B, Zablotsky B, Vasa R

This study aimed to examine the prevalence and characteristics of psychiatry-related emergency department visits among children with autism spectrum disorder, including the specific reason for visit, as well as the influence of insurance type.

Key Study: Safety and efficacy of milk and molasses enemas in the emergency department

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Vilke GM, DeMers G, Patel N, Castillo EM

The objective of this study was to evaluate the success and complication rates of administering milk and molasses enemas in the ED.

Key Study: Pediatric constipation in the emergency department: evaluation, treatment, and outcomes

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Freedman SB, Thull-Freedman J, Rumantir M, Eltorki M, Schuh S

The primary objective of this study was to determine whether enema administration is associated with 7-day emergency department (ED) revisits for persistent symptoms of pediatric constipation. Secondary objectives focused on assessing other predictors of ED revisits.

Key Study: A randomized trial of enemaversus polyethylene glycol 3350 for fecal disimpaction in children presenting to an emergency department

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Miller MK, Dowd MD, Friesen CA, Walsh-Kelly CM

This study aimed to compare efficacy of enema versus polyethylene glycol (PEG) 3350 for pediatric fecal impaction treatment.

Key Study: Safety and efficacy of milk and molasses enemas compared with sodium phosphate enemas for the treatment of constipation in a pediatric emergency department

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Hansen SE, Whitehill JL, Goto CS, Quintero CA, Darling BE, Davis J

The purpose of this study was to determine the safety and efficacy of routine milk and molasses enemas (MME) compared with sodium phosphate enemas for the treatment of constipation in the pediatric emergency department (ED). A secondary objective included the identification of factors associated with enema selection in the pediatric ED.

Key Study: Emergency department management and short-term outcome of children with constipation

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Miller MK, Dowd MD, Fraker M

The objective of this study was to describe variation in emergency department evaluation and treatment of children with constipation and characteristics and treatments associated with improvement.

Key Study: Predictive factors for short-term symptom persistence in children after emergency department evaluation for constipation

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Patel H, Law A, Gouin S

The objectives of this study were to describe the clinical characteristics of children presenting to the ED with constipation and the ED interventions; to measure short-term symptom resolution at 48 hours and 7 days after the ED visit; and to identify predictive factors associated with poor symptom resolution at 48 hours and 7 days after the ED visit.

Key Study: Increasing visits for anaphylaxis and the benefits of early epinephrine administration: A 4-year study at a pediatric emergency department in Montreal, Canada

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Hochstadter E, Clarke A, De Schryver S, LaVieille S, Alizadehfar R, Joseph L,...

when epinephrine is used for this indication.

Key Study: Intravenous regional anaesthesia (Bier's block) for pediatric forearm fractures in a pediatric emergency department-Experience from 2003 to 2014

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Chua ISY, Chong SL, Ong GYK

The objective of the study was to evaluate the efficacy (length of stay in the emergency department and failure rate of Bier's block) and safety profile (death and major complications) of Bier's block in its use for manipulation and reduction of paediatric forearm fractures.

Key Study: The utility of clinical ultrasonography in identifying distal forearm fractures inthe pediatric emergency department

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Galletebeitia Laka I, Samson F, Gorostiza I, Gonzalez A, Gonzalez C

The aim of this study is to evaluate the utility of point-of-care ultrasound for diagnosing distal forearm fractures in pediatric emergency departments.

Key Study: Reduced Length of Stay and Adverse Events Using Bier Block for Forearm Fracture Reduction in the Pediatric Emergency Department

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Fauteux-Lamarre E, Burstein B, Cheng A, Bretholz A

This study sought to compare Bier block and procedural sedation for forearm fracture reduction.

Key Study: Manipulation and reduction of paediatric fractures of the distal radius and forearm using intranasal diamorphine and 50% oxygen and nitrous oxide in the emergency department: a 2.5-year study

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Kurien T, Price KR, Pearson RG, Dieppe C, Hunter JB

This study presents the results of managing children's fracture of the distal forearm in the ED using intranasal diamorphine and Entonox to allow manipulation and discharge on the same day.

Key Study: Effect of a Computerized Reminder on Splinting of Pediatric Upper Limb Fractures in the Emergency Department

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Mills E, Craig S, Oakley E

The primary objective was to assess if a computerized pop-up reminder increased splint application before X-ray in pediatric emergency department patients with deformed upper limb fractures.

Key Study: Using softcast to treat torus fractures in a paediatric emergency department

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Callender O, Koe S

Wrist torus fractures in children are a frequent reason for Emergency Department (ED) visits. Torus fractures traditionally were treated with a backslab cast in the Children's ED and then referred to the Fracture Clinic. Guidelines were developed in order to standardise the care for children who attended the ED with a torus fracture. All patients who were seen & treated by the Advanced Nurse Practitioner (ANP) over a one year period with a diagnosis of a torus fracture were treated with immobilisation in a softcast. 119 patients met the criteria for inclusion. There were no adverse events recorded and no patient required subsequent visits to the Fracture Clinic. There was a cost savings of 18,596 as compared with the normal referral pathway to the Fracture Clinic.

Key Study: Feasibility of a reduction protocol in the emergency department for diaphyseal forearm fractures in children

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Pesenti S, Litzelmann E, Kahil M, Mallet C, Jehanno P, Mercier JC, Ilharrebor...

The purpose of this study was to analyze the results of diaphyseal forearm fractures in the emergency department in children.

Key Study: A Practice Guideline for Postreduction Management of Intussusception of Children in the Emergency Department

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Kwon H, Lee JH, Jeong JH, Yang HR, Kwak YH, Kim DK, Kim K

Objective: The aim of this study was to evaluate the effects of a practice guideline of postreduction management of intussusception in children on the length of stay (LOS) from reduction in the pediatric emergency department (PED) and on the incidence of recurrence.

Key Study: Is Intussusception a Middle-of-the-Night Emergency?

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Lampl BS, Glaab J, Ayyala RS, Kanchi R, Ruzal-Shapiro CB

Objectives: Intussusception is the most common abdominal emergency in pediatric patients aged 6 months to 3 years. There is often a delay in diagnosis, as the presentation can be confused for viral gastroenteritis. Given this scenario, we questioned the practice of performing emergency reductions in children during the night when minimal support staff are available. Pneumatic reduction is not a benign procedure, with the most significant risk being bowel perforation. We performed this analysis to determine whether it would be safe to delay reduction in these patients until normal working hours when more support staff are available.

Key Study: The role of abdominal radiography in the diagnosis of intussusception when interpreted by pediatric emergency physicians

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Morrison J, Lucas N, Gravel J,

Objective: To evaluate the sensitivity and specificity of abdominal x-rays in the diagnosis of intussusception when interpreted by pediatric emergency physicians.

Key Study: Examining Emergency Department Treatment Processes in Severe Pediatric Traumatic Brain Injury

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Ajdari A, Boyle LN, Kannan N, Rowhani-Rahbar A, Wang J, Mink R, Ries B, Wainw...

Our objectives were to examine the treatment process of acute pediatric TBI and the impact of non-value-added time (NVAT) on patient outcomes.

Key Study: Reducing Head CT Use for Children With Head Injuries in a Community Emergency Department

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Jennings RM, Burtner JJ, Pellicer JF, Nair DK, Bradford MC, Shaffer M, Uspal ...

Clinical decision rules have reduced use of computed tomography (CT) to evaluate minor pediatric head injury in pediatric emergency departments (EDs). CT use remains high in community EDs, where the majority of children seek medical care. We sought to reduce the rate of CT scans used to evaluate pediatric head injury from 29% to 20% in a community ED.

Key Study: Screening for urinary tract infection in infants in the emergency department: which test is best?

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Shaw KN, McGowan KL, Gorelick MH, Schwartz JS

The objective of this study wa to compare rapid tests and screening strategies for detecting urinary tract infection in infants.

Key Study: Clinical prediction models for young febrile infants at the emergency department: an international validation study

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Vos-Kerkhof E, Gomez B, Milcent K, Steyerberg EW, Nijman RG, Smit FJ, Mintegi...

The objective of this study was to assess the diagnostic value of existing clinical prediction models in febrile young infants at risk for serious bacterial infections.

Key Study: Clinical Pathway Effectiveness: Febrile Young Infant Clinical Pathway in a Pediatric Emergency Department

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Murray AL, Alpern E, Lavelle J, Mollen C

The objective of this study was to evaluate the impact of a febrile young infant clinical pathway implemented in a large, urban children's hospital ED on the timeliness and consistency of care.

Key Study: Oral Ondansetron Administration to Nondehydrated Children With Diarrhea and Associated Vomiting in Emergency Departments in Pakistan: A Randomized Controlled Trial

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Freedman SB, Soofi SB, Willan AR, Williamson-Urquhart S, Ali N, Xie J, Dawoud...

Objective: To determine whether single-dose oral ondansetron administration to children with vomiting as a result of acute gastroenteritis without dehydration reduces administration of intravenous fluid rehydration.

Key Study: Implementation of clinical decision support in young children with acute gastroenteritis: a randomized controlled trial at the emergency department

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Geurts D, de Vos-Kerkhof E, Polinder S, Steyerberg E, van der Lei J, Moll H, ...

Objectives: To evaluate feasibility of a nurse-guided clinical decision support system for rehydration treatment in children with AGE, and the impact on diagnostics, treatment, and costs compared with usual care by attending physician.

Key Study: Oral Ondansetron versus Domperidone for Acute Gastroenteritis in Pediatric Emergency Departments: Multicenter Double Blind Randomized Controlled Trial

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Marchetti F, Bonati M, Maestro A, Zanon D, Rovere F, Arrighini A, Barbi E, Be...

Objective: To evaluate whether a single oral dose of ondansetron vs domperidone or placebo improves outcomes in children with gastroenteritis.

Key Study: Emergency Department Treatment of Children With Diarrhea Who Attend Day Care: A Randomized Multidose Trial of a Lactobacillus helveticus and Lactobacillus rhamnosus Combination Probiotic

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Freedman SB, Sherman PM, Willan A, Johnson D, Gouin S, Schuh S; Pediatric Eme...

This study evaluated the rates of day care absenteeism of children with gastroenteritis treated with probiotics.

Key study: Seasonality patterns in croup presentations to emergency departments in Alberta, Canada: a time series analysis

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Rosychuk RJ, Klassen TP, Voaklander DC, Senthilselvan A, Rowe BH

Objective: We examine the monthly patterns of young children who made croup-related visits to EDs in Alberta, Canada.

Key study: Croup presentations to emergency departments in Alberta, Canada: a large population-based study

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Rosychuk RJ, Klassen TP, Metes D, Voaklander DC, Senthilselvan A, Rowe BH

Objective: The objective of this study was to describe the epidemiology of croup presentations to EDs made by infants (

Key study: A Randomized Controlled Study of Silver-Based Burns Dressing in a Pediatric Emergency Department

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Brown M, Dalziel SR, Herd E, Johnson K, Wong She R, Shepherd M

Objective: This study sought to determine whether silver sodium carboxymethyl cellulose dressing is a superior treatment to nanocrystalline silver-coated polyethylene dressing in pediatric patients with partial thickness burns.

Key study: Acute otitis media in children presenting to the emergency department: Is it diagnosed and managed appropriately?

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Niroshan Balasundaram, Dung Phan, Daniel Mazzoni, Elliot Duong, Amy Sweeny, C...

Objective: To describe the diagnostic and management practice in children with acute otitis media (AOM) presenting to the emergency department (ED) and compare diagnosis and management against existing guidelines.

Key Study: Improving Emergency Department Management of Diabetic Ketoacidosis in Children

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Baumer-Mouradian SH, Gray MP, Wolfgram PM, Kopetsky M, Chang F, Brousseau DC,...

Objectives: To use point-of-care (POC) testing to reduce DKA determination time from 86 to 30 minutes and to reduce IV placements in patients without DKA from 85% to 20% over 18 months.

Key Study: Improving Pediatric Diabetic Ketoacidosis Management in Community Emergency Departments Using a Simulation-Based Collaborative Improvement Program

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Abulebda K, Whitfill T, Montgomery EE, Kirby ML, Ahmed RA, Cooper DD, Nitu ME...

Objectives: The majority of pediatric patients with diabetic ketoacidosis (DKA) present to community emergency departments (CEDs) that are less prepared to care for acutely ill children owing to low pediatric volume and limited pediatric resources and guidelines. This has impacted the quality of care provided to pediatric patients in CEDs. We hypothesized that a simulation-based collaborative program would improve the quality of the care provided to simulated pediatric DKA patients presenting to CEDs.

Key Study: Reducing Time to Pain Medication Administration for Pediatric Patients with Long Bone Fractures in the Emergency Department

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Schuman, S S, Regen, R B, Stuart, L H, Harrell, C, Jones, T L, Stewart, B M, ...

The purpose of this quality improvement project was to develop a protocol with the goal to administer pain medication to children presenting with suspected long bone fractures 47 minutes of emergency department arrival.

Key Study: Emergency room closed reduction versus in situ splinting in the treatment of paediatric supracondylar humerus fractures

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Sylvia, SM, Maguire, KJ, Molho, DA, Levens, BJ, Stone, MEJ, Hanstein, R, Schu...

The purpose of this study was to investigate if outcomes or complications differ between two management methods.

Key Study: Management of Paediatric Buckle (Torus) Wrist Fractures in Irish Emergency Departments: A National Survey

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Abdelhady, A, Ahmed, A, Umana, E and O'Donnell, J

Buckle fractures are the most common wrist fractures reported in the paediatric age group. National Institute for Clinical Excellence (NICE) recommends using a non-rigid immobilisation with no follow up for these patients and appropriate discharge advice. A telephone survey was conducted to assess the variation in practice in Irish hospitals regarding the mpediatrianagement of buckle fractures.

Key Study: Multiple interventions improve analgesic treatment of supracondylar humerus fractures in a pediatric emergency department

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Porter, RN, Chafe, RE, Newhook, LA and Murnaghan, KD

To measure the effectiveness of a set of interventions in improving the rate and timeliness of analgesic medication administration, as well as appropriate backslab immobilization (application of a moldable plaster or fiberglass splint), in a pediatric ED.

Key Study: Factors Affecting Family Presence During Fracture Reduction in the Pediatric Emergency Department

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Zhang, A, Yocum, R M, Repplinger, M D, Broman, A T and Kim, M K

The aim of this study was to determine factors related to family members' choice to be present or absent during fracture reductions in a pediatric emergency department (ED), and their satisfaction with that choice.

Key Study: Behavioral Changes in Children After Emergency Department Procedural Sedation

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Pearce, J I, Brousseau, D C, Yan, K, Hainsworth, K R, Hoffmann, R G and Drend...

The purpose of this study was to determine the proportion of children undergoing procedural sedation for fracture reduction in the emergency department (ED) observed to experience negative postdischarge behaviors. Predictors of negative behaviors were evaluated, including anxiety.

Key Study: Etomidate Versus Ketamine: Effective Use in Emergency Procedural Sedation for Pediatric Orthopedic Injuries

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Disel, N R, Yilmaz, H L, Sertdemir, Y, Yesilagac, H and Avci, A

The aim of this study was to compare the induction and recovery times, postsedation observation durations, and adverse effects of etomidate and ketamine in pediatric patients with fractures and/or dislocations requiring closed reduction in the emergency department.

Key Study: Utility of complete trauma series radiographs in alert pediatric patients presenting to Emergency Department of a Tertiary Care Hospital

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Alam Khan T1,Jamil Khattak Y,Awais M,Alam Khan A,Husen Y,Nadeem N,Rehman A.

To assess the utility of trauma series radiographs in the management of alert pediatric patients with traumatic injury and to ascertain whether it is necessary to acquire the entire trauma series in these children.

Key study: Screening for Suicide Risk Among Youths With a Psychotic Disorder in a Pediatric Emergency Department

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DeVylder, J. E., Ryan, T. C., Cwik, M., Jay, S. Y., Wilson, M. E., Goldstein,...

Objective: youths in a pediatric emergency department with psychotic disorder diagnoses (N=87) were screened with the Ask Suicide-Screening Questions

Key study: The Importance of Screening Preteens for Suicide Risk in the Emergency Department

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Lanzillo EC, Horowitz LM, Wharff EA, Sheftall AH, Pao M, Bridge JA

Objective: To describe the prevalence of screening positive for suicide risk in a sample of 10- to 12-year-olds presenting to the emergency department (ED).

Key study: Identification of At-Risk Youth by Suicide Screening in a Pediatric Emergency Department

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Ballard, E. D., Cwik, M., Van Eck, K., Goldstein, M., Alfes, C., Wilson, M. E...

Objective: retrospective review of the implementation of a brief suicide screen for pediatric psychiatric ED patients as standard of care

Key study: Columbia-suicide Severity Rating Scale: Predictive Validity With Adolescent Psychiatric Emergency Patients

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Gipson PY, Agarwala P, Opperman KJ, Horwitz A, King CA

Objective: examined the predictive validity of a highly promising instrument, the Columbia-Suicide Severity Rating Scale (C-SSRS).

Key study: The Current State of Mental Health Services in Canada's Paediatric Emergency Departments

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Leon, S. L., Cappelli, M., Ali, S., Craig, W., Curran, J., Gokiert, R., Klass...

Objective: To describe emergency mental health services in major paediatric centres across Canada.

Key study: The HEADS-ED: A Rapid Mental Health Screening Tool for Pediatric Patients in the Emergency Department

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Cappelli, M., Gray, C., Zemek, R., Cloutier, P., Kennedy, A., Glennie, E., Do...

Objective: developed the rapid screening tool home, education, activities/peers, drugs/alcohol, suicidality, emotions/behavior, discharge resources (HEADS-ED), which is a modification of "HEADS," a mnemonic widely used to obtain a psychosocial history in adolescents.

Key study: Ask Suicide-Screening Questions (ASQ): A Brief Instrument for the Pediatric Emergency Department

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Horowitz, L. M., Bridge, J. A., Teach, S. J., Ballard, E., Klima, J., Rosenst...

Objective: To develop a brief screening instrument to assess the risk for suicide in pediatric emergency department patients.

Key study: Patients' Opinions About Suicide Screening in a Pediatric Emergency Department

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Ballard, E. D., Bosk, A., Snyder, D., Pao, M., Bridge, J. A., Wharff, E. A., ...

Objective: describes pediatric patients' opinions regarding suicide screening in that setting.

Key study: Feasibility of Screening Patients With Nonpsychiatric Complaints for Suicide Risk in a Pediatric Emergency Department: A Good Time to Talk?

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Horowitz, L., Ballard, E., Teach, S. J., Bosk, A., Rosenstein, D. L., Joshi, ...

Objective: As part of an instrument validation study, ED patients (10-21 years old) with both psychiatric and nonpsychiatric presenting complaints were recruited to take part in suicide screening.

Key Study: Predictors of critical care and mortality in bronchiolitis after emergency department discharge

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Schuh S, Kwong J, Holder L, Graves E, Macdonald E, Finkelstein Y

Objectives:To identify the epidemiologic predictors and stratify the risk of critical care unit (CCU) admission or death in bronchiolitis following emergency department discharge. This information has not yet been explored.

Key Study: Effect of oxygen desaturations on subsequent medical visits in infants discharged from the emergency department with bronchiolitis

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Principi T, Coates AL, Parkin PC, Stephens D, DaSilva Z, Schuh S

Objective: To examine whether there is a difference in the proportion of unscheduled medical visits within 72 hours of emergency department discharge in infants with bronchiolitis who have oxygen desaturations to lower than 90% for at least 1 minute during home oximetry monitoring vs those without desaturations.

Key Study: Synthetic Cannabinoid Exposure in Adolescents Presenting for Emergency Care

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Gilley MB, J.; Calello, D. P.; Wax, P.; Finkelstein, Y.; Toxicology Investiga...

The objective of this study was to characterize the clinical picture and management of synthetic cannabinoid exposure in a cohort of adolescents.

Key Study: Drug Misuse in Adolescents Presenting to the Emergency Department

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Finkelstein YG, G.; Hutson, J. R.; Armstrong, J.; Baum, C. R.; Wax, P.; Brent...

Drug misuse is a disturbing, common practice among youth. One in 4 American adolescents reports consuming prescription medications without a clinical indication. We sought to explore current trends of drug misuse in adolescents.

Key Study: Biphasic Reactions in Emergency Department Anaphylaxis Patients: A Prospective Cohort Study

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Liu X, Lee S, Lohse CM, Hardy CT, Campbell RL.

To evaluate biphasic reaction rates and associated risk factors.

Key Study: An economic evaluation of immediate vs non-immediate activation of emergency medical services after epinephrine use for peanut-induced anaphylaxis

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Shaker M, Kanaoka T, Feenan L, Greenhawt M.

To evaluate the cost-effectiveness of this strategy, vs a watchful waiting approach before activating emergency medical services (EMS).

Key Study: Comparison of the psychometric properties of 3 pain scales used in the pediatric emergency department: Visual Analogue Scale, Faces Pain Scale-Revised, and Colour Analogue Scale.

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Le May S, Ballard A, Khadra C, Gouin S, Plint AC, Villeneuve E, Msse B, Tsze ...

The aim of this study was to determine and compare the psychometric properties of 3 self-reported pain scales commonly used in the pediatric emergency department (ED)

Key Study: Ultrasound-guided forearm nerve blocks in kids: a novel method forpaincontrol in the treatment of hand-injuredpediatricpatients in the emergency department.

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Frenkel O,Liebmann O,Fischer JW.

Ultrasound-guided forearm nerve blocks have been shown to safely reduce pain for emergency procedures in the adult emergency department (ED). Although ultrasonography is widely used for forearm nerve blocks in the adult ED and in the pediatric operating room, no study to date has examined its use in the pediatric emergency setting.

Key study: Children with Covid-19 in pediatric emergency departments in Italy.

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Parri N, Lenge M, Buonsenso D, Coronavirus Infection in Public Emergency Depa...

Objective: The Coronavirus Infection in Pediatric Emergency Departments (CONFIDENCE) study involved a cohort of 100 Italian children younger than 18 years of age with Covid-19 confirmed by reverse-transcriptasepolymerase-chain-reaction testing of nasal or nasopharyngeal swabs who were assessed between March 3 and March 27 in 17 pediatric emergency departments. Here, we describe the results of the CONFIDENCE study and compare them with those from three cohorts in previously published analyses.

Key study: Pointofcare lung ultrasound findings in the pediatric emergency clinic during the COVID19 pandemic.

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Tre E, Korkmaz MF, Aksoy FD, et al.

Objective: To describe our experience concerning lung ultrasound (LUS) in the pediatric emergency clinic, and to investigate the diagnostic value of LUS in coronavirus disease-2019 (COVID-19).

Key study: Delayed presentations to emergency departments of children with head injury: A PREDICT Study

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Borland ML, Dalziel SR, Phillips N, et al.

Objective: Existing clinical decision rules guide management for head-injured children presenting 24 hours or sooner after injury, even though some may present greater than 24 hours afterward. We seek to determine the prevalence of traumatic brain injuries for patients presenting to emergency departments greater than 24 hours after injury and identify symptoms and signs to guide management.

Key study: Derivation and initial validation of clinical phenotypes of children presenting with concussion acutely in the emergency department: latent class analysis of a multi-center, prospective cohort, observational study

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Yeates KO, Tang K, Barrowman N, et al.

This study used latent class analysis (LCA) to identify discernible phenotypes among children with acute concussion and examine the association between phenotypes and persistent post-concussive symptoms (PPCS) at 4 and 12 weeks post-injury. We conducted LCA of variables representing pre-injury history, clinical presentation, and parent symptom ratings, derived from a prospective cohort, observational study that recruited participants from August 2013 until June 2015 at nine pediatric emergency departments within the Pediatric Emergency Research Canada network.

Key study: Early versus delayed emergency department presentation following mild traumatic nrain injury and the presence of symptom at 1, 4 and 12 weeks in children

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Gravel J, Ledoux AA, Tang K, et al.

We evaluated the association between timing of presentation and postconcussive symptoms (PCS) at 1, 4 and 12 weeks after injury.

Key study: Low-value diagnostic imaging use in the pediatric emergency department in the United States and Canada

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Cohen E, Rodean J, Diong C, et al.

Objective To compare overall and low-value use of diagnostic imaging across pediatric ED visits in Ontario, Canada, and the United States.

Key study: Reduction of computed tomography use for pediatric closed head injury evaluation at a nonpediatric community emergency department

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Puffenbarger MS, Ahmad FA, Argent M, Gu H, Samson C, Quayle KS, Saito JM.

The purpose of this study was to determine if implementation of a Pediatric Emergency Care Applied Research Network (PECARN)-based Closed Head Injury Assessment Tool could safely decrease computed tomography (CT) use for pediatric head injury evaluation at a nonpediatric community emergency department (ED).

Key study: Reliability of the visio-vestibular examination for concussion among providers in a pediatric emergency department

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Corwin DJ, Arbogast KB, Swann C, et al.

Our objective was to determine the inter-rater (IRR) and test-retest reliability (TRR) of the VVE in a pediatric ED.

Key study: Symptom-guided emergency department discharge instructions for children with concussion

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Brooks TM, Smith MM, Silvis RM, et al.

Objectives: The objective was to evaluate the use and utility of a novel set of emergency department discharge instructions (DIs) for concussion based on a child's ongoing symptoms: symptom-guided DIs (symptom DIs). Differences in clinical outcomes were also assessed.

Key study: The diagnosis of concussion in pediatric emergency departments: a prospective multicenter study

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Boutis K, Gravel J, Freedman SB, et al.

Objectives: We compared the frequency of persistent concussion symptoms in children who were provided the diagnosis of concussion by an emergency physician versus those who met Berlin/Zurich international criteria for this diagnosis. We also determined the clinical variables independently associated with a physician-diagnosed concussion.

Key study: Use of the sport concussion assessment tools in the emergency department to predict persistent post-concussive symptoms in children

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Bressan S, Clarke CJ, Anderson V, et al.

We aim to assess the predictive value of the main SCAT3/ChildSCAT3 components for PPCS when applied in the ED.

Key study: Use of the vestibular and oculomotor examination for concussion in a pediatric emergency department

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Corwin DJ, Propert KJ, Zorc JJ, Zonfrillo MR, Wiebe DJ.

We aimed to measure rates of exam performance after implementation of training and support tools in a pediatric emergency department.

Early predictors of unresponsiveness to high-flow nasal cannula therapy in a pediatric emergency department.

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Er A, alar A, Akgl F, Ulusoy E, itlenbik H, Ylmaz D, et al.

High-flow nasal cannula (HFNC) is a new treatment option for pediatric respiratory distress and we aimed to assess early predictive factors of unresponsiveness to HFNC therapy in a pediatric emergency department (ED). The low initial SpO2 and SF ratio, respiratory acidosis, and SF ratio less than 195 at the first hours of treatment were related to unresponsiveness to HFNC therapy in our pediatric emergency department.

Is there a role for humidified heated high-flow nasal cannula therapy in paediatric emergency departments?

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Long E, Babl FE, Duke T.

We introduced HFNC therapy into a paediatric ED and evaluated its use and failure rates. HFNC therapy may have a role in the paediatric ED as an easily administered and well tolerated form of non-invasive respiratory support, but about one-third of patients required escalation to a higher level of respiratory support. Further studies should assess the safety profile of HFNC in larger series, and define the role of HFNC in key respiratory conditions compared with other possible interventions.

Use of high-flow nasal cannula support in the emergency department reduces the need for intubation in pediatric acute respiratory insufficiency.

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Wing R, James C, Maranda LS, Armsby CC.

The objective of this study was to determine whether the use of heated, humidified, high-flow nasal cannula (HFNC) therapy is associated with a decreased need for intubation in patients presenting to a pediatric emergency department (PED) and admitted to a pediatric intensive care unit (PICU) with acute respiratory insufficiency (ARI). High-flow nasal cannula used early in the development of pediatric ARI is associated with a decreased the need for intubation and mechanical ventilation.

High flow nasal cannula in the emergency department: indications, safety and effectiveness.

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Wang J, Lee KP, Chong SL, Loi M, Lee JH.

While there exists increasing enthusiasm in the use of HHHFNCT in the ED, constant monitoring of the patients and an experienced assessment of their response to treatment are critical and may require additional manpower deployment, which may be challenging, in the busy ED environment. Our experience with the use of HHHFNCT in children is still growing. Continual research in this area remains crucial in helping us better understand the patient types and conditions managed in ED that would most benefit from this device.

The use of high-flow nasal cannula in the pediatric emergency department.

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Slain KN, Shein SL, Rotta AT.

To summarize the current literature describing high-flow nasal cannula use in children, the components and mechanisms of action of a high-flow nasal cannula system, the appropriate clinical applications, and its role in the pediatric emergency department. High-flow nasal cannula should be considered for pediatric emergency department patients with respiratory distress not requiring immediate endotracheal intubation; prospective, pediatric emergency department-specific trials are needed to better determine responsive patient populations, ideal high-flow nasal cannula settings, and comparative efficacy vs. other respiratory support modalities.

Key Study: Assessment of non-routine events and significant physiological disturbances during emergency department evaluation after pediatric head trauma.

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Alberto EC, Harvey AR, Amberson MJ, Zheng Y, Thenappan AA, Oluigbo C, et al

The purpose of this study was to determine the association of non-routine events (NREs) during the initial resuscitation phase with these physiological disturbances.

Key Study: Comparison of minor head trauma management in the emergency departments of a United States and Italian Children's hospital.

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Stopa BM, Amoroso S, Ronfani L, Neri E, Barbi E, Lee LK.

Pediatric head trauma management varies between emergency departments globally. Here we aim to compare the pediatric minor head trauma management between a US and Italian hospital.

Key Study: Computed tomography practice standards for severe pediatric traumatic brain injury in the emergency department: a national survey.

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Yoo G, Leach A, Woods R, Holt T, Hansen G.

Acute medical management of traumatic brain injury (TBI) can be challenging outside of the resuscitation bay, specifically while obtaining a computed tomography (CT) scan of the brain. We sought out to determine the management practices of Canadian traumatologists for pediatric patients with severe TBI requiring CT in the emergency department.

Key Study: The use of Rotterdam CT score for prediction of outcomes in pediatric traumatic brain injury patients admitted to emergency service.

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Katar S, Aydin Ozturk P, Ozel M, Arac S, Evran S, Cevik S, et al.

In this study, we aimed to evaluate the use of the Rotterdam scale on pediatric trauma patients in our country and assess its relationship with lesion type, location and severity, trauma type, and need for surgery.

Key Study: Emergency department discharge following successful radiologic reduction of ileocolic intussusception in children: A protocol based prospective observational study.

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Sujka JA, Dalton B, Gonzalez K, Tarantino C, Schroeder L, Giovanni J, et al

The purpose of our study was to document the results of emergency department (ED) observation and discharge protocol after successful reduction of ileocolic intussusception.

Key Study: Lactic acid level as an outcome predictor in pediatric patients with intussusception in the emergency department.

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Lee JY, Byun YH, Park JS, Lee JS, Ryu JM, Choi SJ.

We aimed to determine whether lactic acid levels are associated with pediatric intussusception outcomes.

Key Study: Management of Intussusception in the Pediatric Emergency Department: Risk Factors for Recurrence.

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Vo A, Levin TL, Taragin B, Khine H.

Our primary objective was to identify risk factors associated with early recurrence. Our secondary objectives included validating risk criteria from prior studies and identifying risk factors for ARE failures.

Key Study: Brief Report: Knowledge and Confidence of Emergency Medical Service Personnel Involving Treatment of an Individual with Autism Spectrum Disorder.

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Wachob D, Pesci LJ.

In order to best respond to an emergency situation, professionals need to have an understanding about Autism Spectrum Disorder (ASD) and techniques that will ensure proper care. The purpose of this study was to determine the knowledge and confidence of EMS personnel on interacting and treating an individual with ASD. Emergency Medical Technicians (EMT), and Paramedics were surveyed on their knowledge of ASD; familiarity or experience with ASD, and level of comfort responding to emergencies involving an individual with ASD. The results found that autism-specific training and resources were associated with higher comfort levels, but not knowledge. It was also determined that newer and younger professionals had higher knowledge and comfort when compared to the more experienced and older professionals.

Key Study: An Australian Cross-Sectional Survey of Parents' Experiences of Emergency Department Visits Among Children with Autism Spectrum Disorder

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Garrick A, Lee ML, Scarffe C, Attwood T, Furley K, Bellgrove MA, et al.

Parents of children with ASD who had attended an Australian emergency department (ED; n = 421) completed a questionnaire relating to their experiences in the ED, including (1) child's reason for presentation and existing comorbidities, (2) quality of care during the visit (3) child's behaviour during visit, e.g. sensory responses to the ED environment, and disruptive behaviours. Children with comorbid ASD and intellectual disability were more likely to present with gastrointestinal issues and seizures, while those with comorbid ASD and oppositional defiant disorder were more likely to present with self-injury. ED staff awareness of ASD-related issues, including communication and expression of pain, were common difficulties for parents. The ED environment (e.g. lights, sounds, waiting areas), exacerbated child anxiety and led to disruptive behaviour.

Key Study: Assessing Ease of Delivering Emergency Care for Patients with Autism Spectrum Disorders.

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Kouo T, Bharadwaj N, Kouo J, Tackett S, Ryan L.

The aim of this study was to develop a method for objectively assessing the delivery of care to children with autism spectrum disorder (ASD) in the emergency department (ED). The TCI reflects difficulty accomplishing core tasks necessary to complete an ED visit. Children with ASD have higher TCIs than neurotypical controls, which puts them at higher risk for care disruptions. Evaluation of initiatives to improve quality of care for children with ASD should focus not only on metrics of overall experience and satisfaction but also how these initiatives affect the ability to effectively administer care.

Key Study: Emergency mental health presentations in children with autism spectrum disorder and attention deficit hyperactivity disorder.

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Bourke EM, Say DF, Carison A, Hill A, Craig S, Hiscock H, et al

To characterise the key features and management of young people presenting to the emergency department (ED) with a mental health (MH) complaint and a known diagnosis of autism spectrum disorder (ASD) or attention deficit hyperactivity disorder (ADHD).

Key Study: Patient- and Family-Centered Care in the Emergency Department for Children With Autism

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Nicholas DB, Muskat B, Zwaigenbaum L, Greenblatt A, Ratnapalan S, Kilmer C, e...

Emergency department (ED) care processes and environments impose unique challenges for children with autism spectrum disorder (ASD). The implementation of patient- and family-centered care (PFCC) emerges as a priority for optimizing ED care. In this article, as part of a larger study, we explore PFCC in the context of ASD. Our aims were to examine how elements of PFCC were experienced and applied relative to ED care for children with ASD. Findings amplify PFCC as integral to effectively serving children with ASD and their families in the ED. Resources that specifically nurture PFCC emerge as practice and program priorities.

Key Study: Case Studies of Challenges in Emergency Care for Children With Autism Spectrum Disorder.

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Gray JM, Roback MG.

Autism spectrum disorder (ASD) affects more than 1% of children in the United States, with the rate of new diagnoses climbing significantly in the last 15 years. Emergent conditions and subsequent visits to the emergency department (ED) can be particularly challenging for children with ASD, most of whom also have comorbidities in addition to their deficits in social communication and interaction. In the emergency setting, these conditions can cause a range of behaviors that result in challenges for health care providers and may result in suboptimal experiences for children with ASD and their families. We present the ED course of 3 children with ASD to illustrate these challenges, emphasize successful strategies, and highlight opportunities for improvement.

Key Study: Caring for Children With Autism in an Emergency Department Setting

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Mannenbach MS, Passe RL, Lovik KK, Larson EM, Laudon SM, Naeve A, et al.

Patients with autism spectrum disorder (ASD) and other developmental delays represent a unique patient population. We described a cohort of children with ASD cared for in an emergency department (ED) setting and the specific health care resources used for their care. The care for children with ASD varied with age and health care issues. There was a high prevalence of psychiatric complaints, and many of these children were boarded in the ED waiting for an inpatient psychiatric bed. Those with psychiatric complaints were more likely to have multiple tests ordered and were more likely to be admitted.

Key Study: Predictors of emergency department use by adolescents and adults with autism spectrum disorder: a prospective cohort study.

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Lunsky Y, Weiss JA, Paquette-Smith M, Durbin A, Tint A, Palucka AM, et al.

To determine predictors of emergency department (ED) visits in a cohort of adolescents and adults with autism spectrum disorder (ASD). A combination of individual and contextual variables may be important for targeting preventative community-based supports for individuals with ASD and their families. In particular, attention should be paid to how caregiver supports, integrative crisis planning and community-based services may assist in preventing or minimising ED use for this vulnerable population.

Key Study: An Exploration of Emergency Department Visits for Home Unintentional Injuries Among Children With Autism Spectrum Disorder for Evidence to Modify Injury Prevention Guidelines

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Jones V, Ryan L, Rooker G, Debinski B, Parnham T, Mahoney P, et al.

Current childhood injury prevention guidance is anchored by a child's age. For example, children are considered at high risk for falls at ages 4 years and less, and guidance for prevention focuses on these ages. However, these guidelines may not be adequate for children with autism spectrum disorders (ASD). Analyses suggest that unintentional home injury prevention for children with ASD may require prevention guidance extended through older ages.

Diabetic Ketoacidosis at Emergency Department Presentation During the First Months of the SARS-CoV-2 Pandemic in Israel: A Multicenter Cross-Sectional Study.

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Jacob R, Weiser G, Krupik D, Takagi D, Peled S, Pines N, et al.

We aimed to examine the impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic on diabetic ketoacidosis (DKA) rates in children with type 1 diabetes (T1D).

Short-term outcomes of pediatric emergency department febrile illnesses.

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Mistry RD, Stevens MW, Gorelick MH.

To describe short-term outcomes relevant to children and their caregivers after evaluation in the emergency department (ED) for febrile illnesses.

Comparing different patterns for managing febrile children in the ED between emergency and pediatric physicians: impact on patient outcome.

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Seow VK, Lin AC, Lin IY, Chen CC, Chen KC, Wang TL, Chong CF.

The management of children with fever of indefinite source still remains controversial. This study aimed to compare different practice patterns between pediatric physicians (PPs) and emergency physicians (EPs) in the management of pediatric fever in the emergency department (ED) and correlate them to existing practice guidelines. Their impact on patient outcomes was also discussed.

Pediatric emergency department nurses' perspectives on fever in children.

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Poirier MP, Davis PH, Gonzalez-del Rey JA, Monroe KW.

Fever is the most common complaint of children seen in a Pediatric Emergency Department (PED). Since pediatric emergency nurses commonly educate parents on fever management, this study sought to examine their knowledge base regarding fever in children.

Prospective evaluation of the risk of serious bacterial infection in children who present to the emergency department with hyperpyrexia (temperature of 106 degrees F or higher).

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Trautner BW, Caviness AC, Gerlacher GR, Demmler G, Macias CG.

The purpose of this study was to determine (1) the risk of serious bacterial infection in children with hyperpyrexia and (2) whether clinical presentation can identify hyperpyrexic patients at risk for serious bacterial infection.

Levetiracetam as an alternative to phenytoin for second-line emergency treatment of children with convulsive status epilepticus: the EcLiPSE RCT

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Appleton RE, Rainford NE, Gamble C, Messahel S, Humphreys A, Hickey H, et al.

To determine whether phenytoin or levetiracetam (Keppra, UCB Pharma, Brussels, Belgium) is the more clinically effective intravenous second-line treatment of paediatric convulsive status epilepticus and to help better inform its management.

Safety and efficacy of buccal midazolam versus rectal diazepam for emergency treatment of seizures in children: a randomised controlled trial

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McIntyre J, Robertson S, Norris E, Appleton R, Whitehouse WP, Phillips B, et al.

Rectal diazepam and buccal midazolam are used for emergency treatment of acute febrile and afebrile (epileptic) seizures in children. We aimed to compare the safety and efficacy of these drugs.

Emergency management of pediatric convulsive status epilepticus: a multicenter study of 542 patients

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Lewena S, Pennington V, Acworth J, Thornton S, Ngo P, McIntyre S, et al.

To perform a multicenter study examining the presentations and emergency management of children with convulsive status epilepticus (CSE) to sites within the Paediatric Research in Emergency Departments International Collaborative.

Key Study: Music to reduce pain and distress in the pediatric emergency department: a randomized clinical trial

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Hartling L, Newton AS, Liang Y, Jou H, Hewson K, Klassen TP, Curtis S

Objective: To compare music with standard care to manage pain and distress.

Emergency department strategies to combat the opioid crisis in children and adolescents

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Cindy D Chang1,Mohsen Saidinejad1,Zaza Atanelov2,Ann M Dietrich3,Samuel Hiu-F...

The opioid crisis has greatly affected not only adults but also children as well. As clinicians develop effective approaches to minimize pain and distress in children, the risks and benefits of opioids must be carefully considered. Children of parents wit

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Emergency Medicine Cases Podcast: Recognition and management of pediatric sepsis and septic shock

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Dr. Sarah Reid & Dr. Gina Neto

Episode 50:In this episode, a continuation of our discussion on Fever from with Ottawa PEM experts, Sarah Reid and Gina Neto, we discuss the pearls and pitfalls in the recognition and management of pediatric sepsis and septic shock. We review the subtle clinical findings that will help you pick up septic shock before its too late as well as key maneuvers and algorithms to stabilize these patients. We cover tips for using IO in children, induction agents of choice, timing of intubation, ionotropes of choice, the indications for steroids in septic shock, and much more.Posted online: August 2014. 

Emergency Medicine Cases Podcast: Pediatric fever without a source

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Dr. Sarah Reid & Dr. Gina Neto

Episode 48:In this episode, with the help of Dr. Sarah Reid and Dr. Gina Neto from the Childrens Hospital of Eastern Ontario, we will elucidate how to deal with fever phobia, when a rectal temp is necessary, how to pick out the kids with fever that we need to worry about, how to work up kids with fever depending on their age, risk factors and clinical picture, who needs a urinalysis, who needs a CXR, who needs blood cultures and who needs an LP, and much more. Posted online: August 2014. 

Emergency Medicine Cases Podcast: Pediatric orthopedics pearls & pitfalls

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Dr. Sanjay Mehta & Dr. Jonathan Pirie

Episode 35:Dr. Sanjay Mehta & Dr. Jonathan Pirie, two experienced Pediatric EM docs from The Hospital for Sick Children in Toronto discuss their approach to a variety of common, occult, challenging and easy to miss pediatric orthopedics diagnoses including: differentiating Septic Arthritis from Transient Synovitis of the hip, Toddlers Fracture, Tillaux Fracture, Suprachondylar Fracture, ACL tear, tibial spine & Segond fractures. They also debate the value of the Ottawa Knee Rules in kids, non-accidental trauma, pediatric orthopedic pain management, the evidence for the best management of Buckle, Greenstick, Salter 1 and 2 distal radius fractures and lateral malleolus fractures. Published online: August 2013. 

Emergency Medicine Cases Podcast: Pediatric gastroenteritis, constipation & bowel obstruction

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Dr. Anna Jarvis & Dr. Stephen Freedman

Episode 19 Part 2:In Part 2 of this pediatric abdominal pain Episode Pediatric Gastroenteritis, Constipation & Bowel Obstruction, Dr. Anna Jarvis & Dr. Stephen Freedman discuss the assessment, work-up and treatment of pediatric gastroenteritis, with particular attention to gastroenteritis & acute abdomen mimics, how best to assess hydration status, the nuances of the use of ondansetron and the prose and cons of various rehydration methods. A detailed discussion of the most common and lethal causes of acute abdomen bowel obstruction in pediatrics follows, including intussesception and midgut volvulus. Finally, the differential diagnosis and best management of the most common cause of pediatric abdominal pain, constipation, is reviewed. Published online: January 2012. 

Emergency Medicine Cases Podcast: Pediatric abdominal pain & appendicitis

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Dr. Anna Jarvis & Dr. Stephen Freedman

Episode 19 Part 1:In Part 1 of this Episode on Pediatric Abdominal Pain, Dr. Anna Jarvis & Dr. Stephen Freedman discuss the nuances of the history, physical and work up of Pediatric Abdominal Pain & Appendicitis and key pearls on how to distinguish serious surgical causes from the very common diagnosis of gastroenteritis. An in-depth discussion on the pearls of the history, physical exam, lab tests, imaging including serial ultrasounds vs CT abdomen, clinical decision rules such as the Alvarado Score, best analgesics and antibiotics in pediatric appendicitis follows. Published online: December 2011.  

Emergency Medicine Cases Podcast: Bronchiolitis

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Dr. Dennis Scolnik & Dr. Sanjay Mehta

Episode 59:This EM Cases episode is on the diagnosis and management of Bronchiolitis. Bronchiolitis is one of the most common diagnoses made in both general and pediatric EDs, and like many pediatric illnesses, theres a wide spectrum of severity of illness as well as a huge variation in practice in treating these children. Bronchiolitis rarely requires any work up yet a lot of resources are used unnecessarily. We need to know when to worry about these kids, as most of them will improve with simple interventions and can be discharged home, while a few will require complex care. Sometimes its difficult to predict which kids will do well and which kids wont.With the help of Dr. Dennis Scolnik, the clinical fellowship program director at Torontos only pediatric emergency department and Dr. Sanjay Mehta, an amazing educator who you might remember from his fantastic work on our Pediatric Ortho episode, well sort through how to assess the child with respiratory illness, how to predict which kids might run into trouble, and what the best evidence-based management of these kids is. 

Emergency Medicine Cases Podcast: Bronchiolitis Part 2

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Dr. Amy Plint

Episode 59B: In response to Episode 59 with Dr. Sanjay Mehta and Dr. Dennis Scolnik on the emergency department diagnosis and management of Bronchiolitis, Dr. Amy Plint, one of Canadas most prominent researchers in Bronchiolitis and the Chair of Pediatric Emergency Research Canada, tells her practical approach to choosing medications in the emergency department, the take home message from her landmark 2009 NEJM study on the use of nebulized epinephrine and dexamethasone for treating Bronchiolitis, and the future of Bronchiolitis research. Published online: February 2015 

Emergency Medicine Cases Podcast: Pediatric Pain Management

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Dr. Samina Ali & Dr. Anthony Crocco

Episode 67: Pain is the most common reason for seeking health care. It accounts for 80% of ED visits. The WHO has declared that “optimal pain treatment is a human right”. As has been shown in multiple ED-based Pediatric pain management studies, Pediatric pain is all too often under-estimated and under-treated. Why does this matter? Under-estimating and under-treating pediatric pain may have not only short term detrimental effects but life-long detrimental effects as well; not to mention, screaming miserable children disturbing other patients in your ED and complaints to the hospital from parents. Whether it’s venipuncture, laceration repair, belly pain or reduction of a fracture we need to have the skills and knowledge to optimize efficient and effective pain management in all the kids we see in the ED. What are the indications for intranasal fentanyl? intranasal ketamine? Why should codeine be contra-indicated in children? How do triage-initaited pain protocols improve pediatric pain management? Which are most effective skin analgesics for venipuncture? To help you make these important pediatric pain management decisions, in this podcast we have one of the most prominent North American researchers and experts in Emergency Pediatric pain management, Dr. Samina Ali and not only the chief of McMaster Children’s ED but also the head of the division of Pediatric EM at McMaster University, Dr. Anthony Crocco.

Emergency Medicine Cases Podcast: Pediatric Procedural Sedation (2016)

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Dr. Amy Drendel

Episode 76: Join Dr. Amy Drendel, a world leader in pediatric pain management and procedural sedation research, as she discusses how best to manage pain and anxiety in

Emergency Medicine Cases Podcast: Management of Acute Pediatric Asthma Exacerbations (2016)

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Dr. Dennis Scolnik & Dr. Sanjay Mehta

Episode 79: In this EM Cases episode on Pediatric Asthma, Dr. Dennis Scolnik and Dr. Sanjay Mehta discuss risk stratification (including the PASS and PRAM scores), indications for CXR, the value of blood gases, MDIs with spacer vs nebulizers for salbutamol and ipatropium bromide, the best way to give corticosteroids, the value of inhaled steroids, the importance of early administration of magnesium sulphate in the sickest kids, and the controversies around the use of ketamine, heliox, high flow nasal cannuala oxygen, NIPPV, epinephrine and IV salbutamol in severe asthma exacerbations. With the multinational and extensive experience of Dr. Dennis Scolnik, the clinical fellowship Program Director at The Hospital for Sick Children in Toronto and Dr. Sanjay Mehta, multiple award winning educator, you'll become more comfortable the next time you are faced with a child presenting with asthma in your ED. Published online: April 2016.

Emergency Medicine Cases Podcast: Cyanotic Infant

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Dr. Gary Joubert & Dr. Anton Helman

Best Case Ever #48: In anticipation of EM Cases’ upcoming episode, Congenital Heart Disease Emergencies, Dr. Gary Joubert discusses his Best Case Ever of a four month old infant who presents with intermittent cyanosis. The Cyanotic Infant can present a significant challenge to the EM provider as the differential is wide, ranging from benign causes such as GERD to life threatening heart disease that may present atypically in a well-appearing child. Dr. Joubert provides some simple clinical pearls to help ED providers along the way. Published online: July 2016. 

Emergency Medicine Cases Podcast: Congenital Heart Disease Emergencies

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Dr. Gary Joubert & Dr. Ashley Strobel

Episode 84: You might be surprised to learn that the prevalence of critical cardiac disease in infants is almost as high as the prevalence of infant sepsis. Critical congenital heart defects are often missed in the ED. For a variety of reasons, there are currently more children with congenital heart disease presenting to the ED than ever before and these numbers will continue to grow in the future. With the goal of learning a practical approach to congenital heart disease emergencies using the child’s age, colour and few simple tests, Dr. Strobel and Dr. Joubert will discuss some key actions, pearls and pitfalls so that the next time you’re faced with that crashing baby in the resuscitation room, you’ll know exactly what to do. This podcast topic was chosen based on a Canada-wide needs assessment by TREKK – translating emergency knowledge for kids. 

Published online: August 2016. 

Emergency Medicine Cases Podcast: Dilute Apple Juice for Gastroenteritis

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Dr. Stephen Freedman & Dr. Anthony Crocco

This is EM Cases Journal Jam podcast on a randomized control trial of dilute apple juice vs PediaLyte for mild pediatric gastroenteritis.

While IV rehydration is required in cases of severe gastroenteritis (which we rarely see in North America) and oral rehydration with electrolyte maintenance solutions is still the mainstay in treating moderate gastroenteritis, could better-tasting, more cost-effective fluids such as diluted apple juice be just as effective as traditional electrolyte solutions in milder cases? Listen to Dr. Justin Morgenstern (@First10EM) interviewing Dr. Stephen Freedman, the world-renowned pediatric EM researcher who put ondansetron for pediatric gastroenteritis on the map about this practice-changing paper. This is followed by a discussion of the topic from Dr. Anthony Crocco, the Division head and medical director of pediatric EM at Hamilton Health Sciences.

 

Emergency Medicine Cases Podcast: Pediatric Trauma

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Dr. Sue Beno, Dr. Faud Alnaji

Management of the pediatric trauma patient is challenging regardless of where you work. In this EM Cases episode, two leading pediatric trauma experts, Dr. Sue Beno from Hospital for Sick Children in Toronto and Dr. Faud Alnaji from Children’s Hospital of Eastern Ontario in Ottawa answer such questions as: what are the most important physiologic and anatomic differences between children and adults that are key to managing the trauma patient? How much fluid should be given prior to blood products? What is the role of POCUS in abdominal trauma? Which patients require abdominal CT?

Emergency Medicine Cases Rapid Review: Congenital Heart Disease Part 1

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Gilbride P, Lloyd T, Cheng E, Calldrige N & Yee M

Learning Objectives

  1. To develop a simple approach to CHD using age, colour and bedside tests
  2. To understand how the hyperoxia test and 4 limb BP narrow the differential diagnosis

Emergency Medicine Cases Rapid Review: Congenital Heart Disease Part 2

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Gilbride P, Lloyd T, Cheng E, Calldrige N & Yee M

Learning Objectives

  1. Investigations for congenital heart disease emergencies
  2. Management of congenital heart disease emergencies

Emergency Medicine Cases Rapid Review: Pediatric Asthma Part 1

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Gilbride P, Lloyd T, Cheng E, Calldrige N & Yee M

Learning Objectives

  1. To assess pediatric asthma severity
  2. To use diagnostic tests effectively for pediatric asthma in the ED

Emergency Medicine Cases Rapid Review: Pediatric Asthma Part 2

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Gilbride P, Lloyd T, Cheng E, Calldrige N & Yee M

Learning Objectives

  1. To review evidence-based treatment options for pediatric asthma
  2. To list the discharge criteria for pediatric asthma from the ED
  3. To communicate effective discharge instructions for pediatric asthma

Emergency Medicine Cases Podcast: Pediatric Physical Abuse Recognition and Management

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Dr. Carmen Coombs and Dr. Alyson Holland

Episode 108: In this EM Cases main episode podcast on Pediatric Physical Abuse Recognition and Management Dr. Carmen Coombs and Dr. Alyson Holland discuss the 6 B’s of child abuse, the TEN-4 FACE decision rule, the Pittsburgh Infant Brain Injury Score, disclosure tips, screening tests, reporting responsibilities and more.

Published online: March 2018

Emergency Medicine Cases Podcast: Burn and Inhalation Injuries

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Episode 124: Burn and inhalation injury patients present to the ED more often than one might think, with a staggering half a million annual visits in the USA alone. It turns out that for all burn patients—from minor to severe—there is a lot of room for improvement in ED management, counselling and disposition. Things like inaccurate estimation of burn size, unnecessary endotracheal intubation, over- and under-estimation of fluid resuscitation volumes, inadequate analgesia and inappropriate wound dressings are just some of the issues where a small change to ED practice patterns could have a huge impact on patient care. In this EM Cases main episode podcast we have the director of the Burn Unit at Hospital for Sick Children, Dr. Joel Fish and EM educator Dr. Maria Ivankovic discuss dozens of pearls and pitfalls in the management of both pediatric and adult burn and inhalation injuries management with a special appearance by airway master George Kovacs to talk about awake intubation in the burn and inhalation injuries patient. Published online: May 2019

Emergency Medicine Cases Podcast: Pediatric UTI Myths and Misperceptions

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Episode 123: On the one hand, UTI is one of the most common bacterial infections in children younger than 2 years of age and could lead to sepsis acutely and theoretically renal failure in the long run. On the other hand, it is important not to over-diagnose UTIs because we know that overuse of antibiotics increases costs, side effects and leads to antibiotic resistance. The first principles questions very much apply here: who to screen, how to screen, and what to do with the screen results. There are risks associated with not having a standardized approach to diagnosing pediatric UTIs. In this EM Cases main episode podcast with Dr. Olivia Ostrow and Dr. Michelle Science we discuss an approach to diagnosing pediatric UTIs whilst revealing some common pediatric UTI myths and misperceptions. Published online: April 2019

Emergency management of the paediatric patient with convulsive status epilepticus

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McKenzie KC, Hahn CD, Friedman JN

This guideline addresses the emergency management of convulsive status epilepticus (CSE) in children and infants older than one month of age. It replaces a previous position statement from 2011, and includes a new treatment algorithm and table of recommended medications based on new evidence and reflecting the evolution of clinical practice over the past several years. This statement emphasizes the importance of timely pharmacological management of CSE, and includes some guidance for diagnostic approach and supportive care.

Website: Pain Assessment and Management Initiative (PAMI)

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Pain Assessment and Management Initiative (PAMI) is an e-Learning and patient safety educational project funded through a grant by the Florida Medical Malpractice Joint Underwriting Association. The overall goal of PAMI is to improve the safety of

Hospital Emergency Treatment of Convulsive Status Epilepticus: Comparison of Pathways From Ten Pediatric Research Centers

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aa

We aimed to evaluate and compare the status epilepticus treatment pathways used by pediatric status epilepticus research group (pSERG) hospitals in the United States and the American Epilepsy Society (AES) status epilepticus guideline.

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TREKK.ca Past Events

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National Capital Conference on Emergency Medicine 2016

Feb 12, 2016 - Feb 13, 2016  | Conference  | Team: News and Events 


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Prairie Annual Pediatric Emergency Medicine Assembly 2016

Apr 07, 2016 - Apr 08, 2016  | Conference  | Team: News and Events 


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Pediatric Emergency Medicine Refresher Course

May 25, 2016, 8:00 am to 5:00 pm  | Course  | Team: News and Events 


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Society Academic Emergency Medicine Annual Meeting

May 10, 2016 - May 13, 2016  | Meeting  | Team: News and Events 


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Emergency Medicine Prairie Annual Meeting (EMPAC)

Apr 30, 2016 - May 01, 2016  | Meeting  | Team: News and Events 


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Saskatchewan Emergency Medicine Annual Conference (SEMAC)

Oct 14, 2016 - Oct 15, 2016  | Conference  | Team: News and Events 


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2019 National Emergency Nurses Association Conference

May 24, 2019 - May 26, 2019  | Announcement  | Team: News and Events  |  


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TREKK update from Terry Klassen

Mar 21, 2013, 11:23 am to 12:30 pm  | Blog  | Team: News and Events 
Tags: Emergency Medicine, Evidence-Based Medicine, Pediatrics, Research


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Western Emergency Department Operations Conference 2016

Apr 28, 2016 - Apr 29, 2016  | Meeting  | Team: News and Events 


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Canadian Association of Emergency Physicians (CAEP)

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Western Emergency Department Operations Conference (WEDOC) 2016

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PERC Annual Meeting

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CAEP Conference 2016

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NENA Conference 2016

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TREKKing Through Friendly Manitoba

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Jan 8th 2013 TREKK Prioritization Committee Meeting

Jan 08, 2013, 1:00 pm to 2:00 pm  | Meeting  | Team: Prioritization Team  > Meetings


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View from the north - David Pontin

May 11, 2013, 3:24 pm to 3:24 pm  | Blog  | Team: News and Events 


TREKK.ca Info Pages

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Emergency Medicine gets full department status at U of S

Posted: Jul 15, 2016  | Announcement  | Team: News and Events 


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Dr. Marilyn Li Pediatric Emergency Medicine Leadership Award

Posted: Jun 02, 2015  | Announcement  | Team: News and Events 


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2nd Annual Emergency Medicine Cases course

Posted: Sep 27, 2016  | Announcement  | Team: News and Events 


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DKA Podcast on Emergency Medicine Cases

Posted: May 01, 2015  | Resource  | Team: News and Events 
Tags: Diabetic ketoacidosis


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Emergency Medicine Cases Bronchiolitis Podcast

Posted: Feb 10, 2015  | Announcement  | Team: News and Events 
Tags: Bronchiolitis


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TREKK Needs Assessment publication in CJEM

Posted: Jan 23, 2017  | Announcement  | Team: News and Events 


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EM Cases - Emergency management of pediatric seizures

Posted: Dec 02, 2015  | Announcement  | Team: News and Events 


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Welcome Dr. Shwetz

Posted: Nov 15, 2021  | Announcement  | Team: News and Events 


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New Chair for the Pediatric Emergency Research Networks

Posted: Jun 02, 2014  | Announcement  | Team: News and Events 


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New Board of Directors Member

Posted: Dec 19, 2016  | Announcement  | Team: News and Events 


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Congratulations Dr. Samina Ali!

Posted: Nov 19, 2018  | Announcement  | Team: News and Events 


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Welcome Dr. Baril

Posted: Nov 15, 2021  | Announcement  | Team: News and Events 


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Dr. Terry Klassen on CTV Morning Live Winnipeg

Posted: Mar 13, 2017  | Announcement  | Team: News and Events 


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Dr. Terry Klassen on CTV Morning Live Winnipeg

Posted: Mar 13, 2017  | Announcement  | Team: News and Events 


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Congenital Heart Defect Awareness Month

Posted: Feb 14, 2017  | Announcement  | Team: News and Events 


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Welcome Dr. Jen Turnbull!

Posted: Jun 21, 2022  | Announcement  | Team: News and Events 


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Rapid Review Series: DKA

Posted: Dec 11, 2017  | Announcement  | Team: News and Events 


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New resources available on trekk.ca!

Posted: Jul 10, 2015  | Resource  | Team: News and Events 


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Guidelines for Pediatric Concussion Launched in Ottawa

Posted: Jun 26, 2014  | Story  | Team: News and Events 
Tags: Concussion


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Gastroenteritis video for parents

Posted: Nov 03, 2016  | Announcement  | Team: News and Events 
Tags: Gastroenteritis


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EM Cases Digest Volume 2: Pediatric Emergencies

Posted: May 04, 2016  | Announcement  | Team: News and Events 


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Couching health evidence in a story

Posted: Mar 18, 2016  | Announcement  | Team: News and Events 


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Heart Month

Posted: Feb 14, 2019  | Announcement  | Team: News and Events 


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New Bottom Line Recommendation: Pain Treatment

Posted: Jul 16, 2018  | Announcement  | Team: News and Events 


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EM Cases Podcast: Cyanotic Infant

Posted: Jul 21, 2016  | Announcement  | Team: News and Events 


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IWK implements TREKK sepsis PedsPac

Posted: Nov 16, 2017  | Announcement  | Team: News and Events 


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New bottom line recommendations for concussion on trekk.ca

Posted: Nov 05, 2014  | Announcement  | Team: News and Events 


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Top 10 ED tips for families

Posted: Jul 15, 2016  | Announcement  | Team: News and Events 


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Reinventing Research: Engaging Patients and Parents

Posted: Jul 14, 2014  | Story  | Team: News and Events 


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Needs Assessment Guidelines and Updates

Posted: Dec 21, 2011  | Project  | Team: Needs Assessment  


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National Emergency Nurses Association Conference

Posted: Feb 18, 2020  | Announcement  | Team: News and Events 


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TREKK Education Session - Brandon, Manitoba

Posted: Apr 09, 2019  | Announcement  | Team: News and Events 


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Treating Gastroenteritis: Evidence for Clinicians

Posted: Apr 10, 2015  | Announcement  | Team: News and Events 
Tags: Gastroenteritis


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TREKK Board Announcement

Posted: May 21, 2019  | Announcement  | Team: News and Events 


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CanadiEM blog: TREKK Series | Bronchiolitis

Posted: Jul 20, 2016  | Blog  | Team: News and Events 


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Reaching Far and Wide- TREKK in the North

Posted: Jul 08, 2021  | Blog  | Team: News and Events 


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TREKK featured in WAVE Magazine

Posted: Feb 22, 2017  | Announcement  | Team: News and Events 


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TREKK Promotional Materials

Posted: May 25, 2015  | Resource  | Team: Communications 


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New topic: febrile status epilepticus

Posted: Aug 18, 2016  | Resource  | Team: News and Events 


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CanadiEM Blog: TREKK Series | Multisystem Trauma

Posted: Sep 08, 2016  | Blog  | Team: News and Events 


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Congratulations Dr. Klassen

Posted: Aug 08, 2014  | Announcement  | Team: News and Events 


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TREKK Scholars & Fellows Program

Posted: Jul 05, 2021  | Announcement  | Team: News and Events 


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NENA Conference 2018

Posted: Feb 15, 2018  | Announcement  | Team: News and Events 


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TREKK 2014-2015 Annual Report Highlights

Posted: Sep 01, 2015  | Announcement  | Team: News and Events 


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Does a child's cough sound like a barking seal? Could be croup

Posted: May 01, 2015  | Announcement  | Team: News and Events 
Tags: Croup, Infection


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Why should Canada invest in emergency care for children:

Posted: Jul 18, 2017  | Announcement  | Team: News and Events 


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2017 Pediatric Emergency Care Conference

Posted: Oct 19, 2017  | Announcement  | Team: News and Events 


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Become a A Pediatric Emergency Care Coordinator (PECC)

Posted: Jul 23, 2021  | Announcement  | Team: News and Events 


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New Bottom Line Recommendation: Fever in Young Infants

Posted: Jul 04, 2019  | Announcement  | Team: News and Events 


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Building a connection: TREKK and NENA

Posted: Jun 30, 2015  | Blog  | Team: News and Events 


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Brain Awareness Week

Posted: Mar 11, 2019  | Announcement  | Team: News and Events 


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Brain Injury Awareness Month 2019

Posted: Jun 13, 2019  | Announcement  | Team: News and Events 


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Asthma Pathway

Posted: Oct 21, 2013  | Module  | Team: ED Clinical Pathways Implementation  > Pathways


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Canada Research Chair in Knowledge Synthesis and Translation

Posted: Jul 16, 2019  | Announcement  | Team: News and Events 


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Webinar: Mobilizing knowledge to improve pediatric health care

Posted: Mar 29, 2016  | Announcement  | Team: News and Events 


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Dr. Amy Plint on wrist buckle fractures

Posted: Oct 06, 2015  | Announcement  | Team: News and Events 


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A summer project to find online resources

Posted: Jun 24, 2013  | Blog  | Team: News and Events 


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2018/19 Annual Report Summary

Posted: Aug 20, 2019  | Announcement  | Team: News and Events 


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Brain Awareness Week

Posted: Mar 15, 2021  | Announcement  | Team: News and Events 


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Profiling pediatric pain expert: Dr. Samina Ali

Posted: Mar 18, 2016  | Announcement  | Team: News and Events 


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Improving mental health care transitions for children and youth

Posted: Jul 12, 2016  | Announcement  | Team: News and Events 


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New Resource- Suicidal Risk Screening & Assessment

Posted: Oct 14, 2021  | Announcement  | Team: News and Events 
Tags: Suicidal Risk Assessment


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New Bottom Line Recommendation: Procedural Pain

Posted: Nov 07, 2016  | Announcement  | Team: News and Events