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Portal Venous Gas Emboli after Accidental Ingestion of Concentrated Hydrogen Peroxide
Published online: 13 May 2013
Rebekah A. Burns, Suzanne M. Schmidt
DOI: 10.1016/j.jemermed.2013.02.001
Journal of Emergency Medicine, The, http://www.jem-journal.com/article/S0736-4679%2813%2900132-7/abstract
A 12-year-old boy accidentally ingested a sip of concentrated hydrogen peroxide. He rapidly developed hematemesis and presented to the Emergency Department. His initial work-up was unremarkable, and his symptoms resolved quickly. However, diffuse gas emboli were found within the portal system on abdominal computed tomography. The child was treated with hyperbaric oxygen therapy and later found to have gastric irritation as well as an ulcer on endoscopy. He recovered fully from the incident.
CT Use in Hospitalized Pediatric Trauma Patients: 15-year Trends in a Level I Pediatric and Adult Trauma Center
Bahman S. Roudsari, Kevin J. Psoter, Monica S. Vavilala, Christopher D. Mack, and Jeffrey G. Jarvik
Radiology 2013;267 479-486 http://radiology.rsna.org/cgi/content/abstract/267/2/479?etoc
A total of 64 425 trauma patients 0–54 years of age were admitted during the study period.
Compared with CT usage in adults 19–54 years old, usage in children up to 15 years of age was significantly lower for spine (incidence rate ratio [IRR], 0.89; 95% confidence interval [CI]: 0.85, 0.92), maxillofacial (IRR, 0.89; 95% CI: 0.81, 0.97), and thoracic (IRR, 0.91; 95% CI: 0.84, 0.99) CT.
Increased use of head CT was observed in children up to 15 years old (IRR, 1.09; 95% CI: 1.05, 1.13) and 15–18 years old (IRR, 1.08; 95% CI: 1.04, 1.13).
From 2008 to 2010, usage rates in children up to 15 years old and 15–18 years old was relatively unchanged or slightly decreased for almost all CT types.
BOSTON — “The drumbeat of alarming stories linking concussions among football players and other athletes to brain disease has led to a new and mushrooming American phenomenon: the specialized youth sports concussion clinic, which one day may be as common as a mall at the edge of town.
In the last three years, dozens of youth concussion clinics have opened in nearly 35 states — outpatient centers often connected to large hospitals that are now filled with young athletes complaining of headaches, amnesia, dizziness or problems concentrating. The proliferation of clinics, however, comes at a time when there is still no agreed-upon, established formula for treating the injuries….”
After a plateau from 2000 through 2005, the U.S. infant mortality rate declined by 12% to a rate of 6.05 in 2011. Provisional infant mortality counts for the first half of 2012 suggest a continued downward trend. Infant mortality declined from 2005 through 2011 for all major racial and ethnic groups, with the most rapid decline among non-Hispanic black women. Among leading causes of death, infant mortality declined for four of the five leading causes. Infant mortality rates declined most rapidly from 2005 through 2010 for selected Southern states; still, rates in 2010 remained higher in the South and Midwest than in other regions.
In 2008, the United States ranked 27th in infant mortality rate among Organization for Economic Cooperation and Development countries, and a previous report linked the United States’ relatively unfavorable infant mortality ranking to its higher percentage of preterm births. Despite the recent infant mortality decline, comparing the 2011 U.S. infant mortality rate with the 2008 international rankings would still have the United States ranked 27th.
Definitions
Infant death: Death of an infant before his or her first birthday.
Infant mortality rate: Number of infant deaths per 1,000 live births.
Neonatal mortality rate: Number of deaths before age 28 days per 1,000 live births.
Postneonatal mortality rate: Number of deaths from age 28 days to under 1 year per 1,000 live births.
Preterm birth: Birth before 37 completed weeks of gestation.
Figure 1. Infant, neonatal, and postneonatal mortality rates: United States, 2000 and 2005–2011
NOTE: Data for 2011 are preliminary.
SOURCE: CDC/NCHS, National Vital Statistics System, mortality data set.
Figure 2. Percent change in infant mortality rates, by race and ethnicity: United States, 2005–2011
NOTE: Data for 2011 are preliminary.
SOURCE: CDC/NCHS, National Vital Statistics System, mortality data set.
Figure 3. Infant mortality rates for the five leading causes of infant death in 2011: United States, 2005 and 2011
NOTE: Data for 2011 are preliminary. SIDS is Sudden infant death syndrome.
SOURCE: CDC/NCHS, National Vital Statistics System, mortality data set.
Figure 4. Decline in infant mortality rates, by state: United States, 2005–2010
Efforts to Address the Medical Needs of Children in a Chemical, Biological, Radiological, or Nuclear Incident
GAO-13-438, Apr 30, 2013
What GAO Found
According to the Department of Health and Human Services (HHS), about 60 percent of the chemical, biological, radiological, and nuclear (CBRN) medical countermeasures in the Strategic National Stockpile (SNS) have been approved for children, but in many instances approval is limited to specific age groups. In addition, about 40 percent of the CBRN countermeasures have not been approved for any pediatric use. Furthermore, some of the countermeasures have not been approved to treat individuals for the specific indications for which they have been stockpiled. For example, ciprofloxacin is stockpiled in the SNS for the treatment of anthrax, plague, and tularemia, but is not approved for these indications. Countermeasures may be used to treat unapproved age groups or indications under an emergency use authorization (EUA) or an Investigational New Drug (IND) application submitted to the Food and Drug Administration (FDA).
HHS faces a variety of economic, regulatory, scientific, and ethical challenges in developing and acquiring pediatric CBRN medical countermeasures. High costs and the high risk of failure associated with testing and research of pharmaceutical products on children, difficulties in meeting regulatory requirements for approving CBRN countermeasures, and scientific and ethical obstacles to safely evaluating countermeasures for children all pose challenges to developing pediatric countermeasures. Despite these challenges, HHS has taken steps to focus agency efforts on the pediatric population, adapt pediatric formulations from existing medical countermeasures, and prepare and review materials for EUAs and INDs in advance of public health emergencies.
HHS addresses dispensing of pediatric medical countermeasures in more than half of its 12 response plans and in its guidance, and seven state and seven local government plans that GAO reviewed included details about pediatric dispensing. Seven of the 12 HHS plans include information about pediatric medical countermeasures; however, HHS officials stated that these plans are intended to provide guidance for emergency response at the federal level, and not at the state or local levels, which is where dispensing would occur. CDC and FDA also provide guidance on pediatric dispensing that state and local governments can use in their planning. For example, CDC developed guidance about receiving, distributing, and dispensing contents from the SNS to help state and local emergency management and public health personnel plan for the use of countermeasures from the SNS. Response plans for all 14 of the state and local governments that GAO reviewed also included details about dispensing to the pediatric population during an emergency. For example, these seven states and seven local governments all adopted some version of a “family member pick-up” policy–sometimes referred to as a “head of household” policy–which would allow adults to pick up medicines for other family members, including children, during an event.
In commenting on a draft of this report, HHS concurred with our findings. HHS emphasized that the needs of the pediatric population have been a priority for HHS and that the department is continuously progressing in this area.
Why GAO Did This Study
The nation remains vulnerable to terrorist and other threats posed by CBRN agents. Medical countermeasures–drugs, vaccines, and medical devices–can prevent or treat the effects of exposure to CBRN agents, and countermeasures are available in the SNS for some of these agents. Children, who make up 25 percent of the population in the United States, are especially vulnerable because many of the countermeasures in the SNS have only been approved for use in adults. HHS leads the federal efforts to develop and acquire countermeasures.
GAO was asked about efforts to address the needs of children in the event of a CBRN incident. This report examines (1) the percentage of CBRN medical countermeasures in the SNS that are approved for pediatric use; (2) the challenges HHS faces in developing and acquiring CBRN medical countermeasures for the pediatric population, and the steps it is taking to address them; and (3) the ways that HHS has addressed the dispensing of pediatric medical countermeasures in its emergency response plans and guidance, and ways that state and local governments have addressed this issue. To address these objectives, GAO reviewed relevant laws, agency documents, and reports, and interviewed HHS officials, industry representatives, and subject-matter experts. GAO also reviewed a stratified sample of emergency response plans from seven state and seven local governments, based on geographic location and population size, to assess how these governments address pediatric dispensing.
For more information, contact Marcia Crosse at (202) 512-7114 or crossem@gao.gov.
Pediatr Emerg Care. 2013 Apr 18. [Epub ahead of print]
National Trends in Emergency Department Use of Urinalysis, Complete Blood Count, and Blood Culture for Fever Without a Source Among Children Aged 2 to 24 Months in the Pneumococcal Conjugate Vaccine 7 Era.
In bivariate and multivariate analyses, CBC orders declined between 2004 and 2009 for visits by all children 2 to 24 months, children 2 to 11 months, and boys 2 to 24 months (adjusted odds ratio [aOR], 0.88 per year [P < 0.01]; aOR, 0.88 [P < 0.05]; and aOR, 0.83 [P < 0.01], respectively). Between 2004 and 2009, ordering neither CBC nor UA increased among all children 2 to 24 months (aOR, 1.10; P < 0.05) and among boys (aOR, 1.16; P < 0.05). Orders for blood cultures declined across the time period in bivariate analysis, but not in multivariate analysis.
The rate of ordering a CBC for children in the 2- to 24-month age group presenting to the ED with FWS declined, a change coincident with the changing epidemiology of serious bacterial infection since the PCV-7 vaccine was introduced.
Evaluation of the Mercy TAPE: Performance Against the Standard for Pediatric Weight Estimation
Annals of Emergency Medicine – 19 April 2013 (10.1016/j.annemergmed.2013.02.021)
Susan M. Abdel-Rahman, Ian M. Paul, Laura P. James, Andrew Lewandowski, Best Pharmaceuticals for Children Act-Pediatric Trials Network
We assessed the performance of 2 new devices (2D- and 3D-Mercy TAPE) to implement the Mercy Method for pediatric weight estimation and contrasted their accuracy with the Broselow method.
The 2D- and 3D-Mercy TAPEs outperform the Broselow tape for pediatric weight estimation and can be used in a wider range of children.
No differences were found between fathers, mothers, and parents of all races/ethnicities regarding their likelihood of giving their very young children OTC cough and cold medications; the same patterns were found across all household incomes…….”
FBI: On April 20, 1999, Eric Davis Harris (1981-1999) and Dylan Bennet Klebold
(1981-1999) killed 12 students and one teacher at Columbine High School in Littleton, Colorado
before committing suicide. The tragedy sparked national debates about school
safety. The FBI assisted local law
enforcement by investigating additional threats and Internet leads, conducting
witness interviews, and processing physical evidence. The FBI’s file details the initial investigation
and contains witness interviews between April 21, 1999 and May 5, 1999.
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