1,721,013 research outputs found
Urgent X‐Rays in Children With Unexplained Haematemesis Help Rule Out Button Battery Ingestion
Full text linkAim: The ingestion of foreign bodies, particularly button batteries, is a significant concern in paediatric care, especially in chil-
dren under 4 years of age. This study aims to review unwitnessed button battery ingestion in infants and toddlers, considering
the serious complications and the higher risk in children under 2 years old.
Method: A literature review was conducted on studies published between 1983 and 2025 using the terms ‘disk battery’, ‘button
battery’, ‘ingestion’, and ‘unwitnessed’. Fifteen studies were included, reporting a total of 41 cases of unwitnessed button battery
ingestion.
Results: The median age of patients was 18 months. Common symptoms included dysphagia, vomiting, fever, drooling and he-
matemesis. The average time to presentation at the emergency department was 72 h. Diagnostic delays were often due to initial
misidentification of the battery as a coin. Radiographic imaging of the chest and abdomen identified the battery in 92% of cases,
highlighting the diagnostic value of X- rays.
Conclusion: Prompt chest and abdominal X- rays are recommended for children under 4 years presenting with unexplained he-
matemesis to rapidly identify button battery ingestion, minimise diagnostic delays and improve clinical outcomes
L'ossigenoterapia
No full textOxygen supplementation represents a fundamental therapy in several clinical conditions,
both acute and chronic. Starting from some concepts of respiratory physiopathology, this
paper discusses the approach to a child with respiratory distress and respiratory failure,
focuses on the main signs and symptoms of hypoxia, hypercapnia and increased work of
breathing and explains the methods to assess the severity of the clinical status, highlighting the relevance of the SpO2/FiO2 ratio (peripheral oxygen saturation/inspiratory oxygen fraction). Furthermore, this work aims to summarize the main methods of oxygen delivery, their relative indications, by underlining advantages and possible complications
such as blow-by oxygen, low flow nasal cannula and face mask (simple, Venturi, rebreathing and non-rebreathing). The focus is on two new oxygen delivery devices, High Flow
Nasal Cannula (HFNC) and Continuous Positive Airway Pressure (CPAP), which in recent
years have more and more been used not only in emergency units but also in paediatric
wards
Ketorolac use in the emergency department in children: a systematic review and meta-analysis
Full text linkAcute pain is a frequent reason for pediatric patients visiting the emergency department (ED). Non-steroidal anti-inflammatory drugs (NSAIDs) and opioids are often used to manage pain in this setting. This systematic review and meta-analysis evaluates the effectiveness of ketorolac, a NSAIDs, in managing acute pain in children in the ED, comparing its efficacy and potential advantages over other pain management options. The search was conducted in PubMed and Web of Science, for English-language articles published from 1991 to February 2023. Only randomized controlled trials (RCTs) evaluating the analgesic effect of ketorolac in commonly painful conditions such as migraine, traumatic and non-traumatic musculoskeletal pain, abdominal pain, and renal colic treated in the ED were included. Pediatric studies were specifically selected. A meta-analysis was subsequently conducted to compare efficacy of ketorolac with other analgesic medications. Eight RCTs have investigated the efficacy of ketorolac for acute pain in children in the ED, reflecting limited pediatric evidence. Ketorolac showed variable effectiveness for conditions such as migraine, musculoskeletal trauma, acute abdominal pain, renal colic, and vaso-occlusive crisis in sickle cell disease. The meta-analysis revealed no significant differences in analgesic performance between ketorolac and other drugs, including opioids and other NSAIDs. The risk of bias across the studies was evaluated. However, the evidence remains insufficient to confidently recommend a specific intervention, highlighting the need for further research to guide clinical decision-making. Conclusion: Despite its limitations, the systematic review highlights that ketorolac seems effective for managing acute pain in pediatric ED patients, but not superior to other analgesic drugs. It emphasizes the necessity for further research to define optimal dosing, administration methods, and its comparative effectiveness with other analgesics across various clinical scenarios
Case Report: Simil-Appendicitis Presentation May Precede Cardiac Involvement in MIS-C Patient
Full text linkIntroduction: Multisystem inflammatory syndrome in children (MIS-C) is a new clinical entity characterized by a systemic hyperinflammation triggered by SARS-CoV-2 infection in children and adolescents. This condition could potentially involve all organs with main complications concerning cardiovascular system. Despite up to 90% of patients complain gastrointestinal symptoms (nausea, vomit, and diarrhea), a presentation mimicking acute appendicitis has rarely been reported, and can be the presenting feature of the disease, potentially leading to misdiagnosis and delayed treatment.
Case Description: A 15-year-old boy presented to the Emergency Department for a 2-day history of fever, vomiting, and mild abdominal pain. One month before, the patient complained ageusia and anosmia while his mother tested positive for Sars-CoV2 nasopharyngeal swab. At admission, laboratory tests showed leukocytosis with lymphopenia and elevation of inflammatory markers, while cardiac enzymes, electrocardiogram and echocardiography were unremarkable. An abdominal ultrasound displayed a thickening of terminal ileus and cecum with ascites. Because of the worsening abdominal pain and a physical examination suggestive of acute appendicitis, a laparoscopy was performed but no surgical condition was found. After surgery, fever and generalized malaise persisted, so a cardiac evaluation was repeated, showing a relevant increase in inflammatory markers and cardiac enzymes. Electrocardiogram demonstrated a QTc prolongation with mild decrease in left ventricular ejection fraction at echocardiogram. A MIS-C was diagnosed and intravenous immunoglobulin along with a steroid treatment started. After 36 h, the patient presented a complete clinical recovery with fever cessation. Cardiac anomalies normalized in 3 weeks. Conclusion: MIS-C has been defined as a systemic inflammation, involving at least two organs, after a previous SARS-CoV2 infection in children and adolescents. Physicians should be aware that while gastrointestinal manifestations are common, a pseudo appendicitis presentation may also occur, leading to misdiagnosis and delayed treatment. This report suggests that in patients with symptoms suggestive of an acute appendicitis, the presence of lymphopenia, hypoalbuminemia and ultrasound images of terminal ileus inflammation, should raise the suspect for MIS-C even without initial overt signs of cardiac involvement
Respiratory polygraphy in subjects with bronchopulmonary dysplasia: a retrospective study
No full textPeriodic assessment of the need for oxygen supplementation and/or mechanical ventilation in children with severe bronchopulmonary dysplasia (BPD) is crucial. The aim of the study was to analyze the indications and results of respiratory polygraphies (RP) performed in preterm infants with BPD followed at a tertiary university hospital
Ketorolac analgesia in the emergency department in adults: systematic review and meta-analysis
No full textBackground and objective: Acute painful conditions are a common reason to emergency department (ED) referral, and a broad variety of analgesic drugs may be used. Among them, ketorolac is a Non-Steroidal Anti-Inflammatory Drug (NSAID) increasingly used in the last two decades. In order to clarify the available evidence about the use of ketorolac in the ED setting, a systematic review and meta-analysis was performed. Databases and data treatment: A search was performed in PubMed for English written articles updated to February 2023. Only randomized controlled trials regarding adult patients with acute painful conditions treated in the ED were selected. A meta-analysis was performed to evaluate the effectiveness of ketorolac in different pain conditions. Results: : Forty randomized controlled trials were selected including studies focused on acute renal colic, headache, traumatic and non-traumatic musculoskeletal pain, and biliary colic. In these studies, ketorolac was mainly compared to opioids and in general showed a similar analgesic efficacy. On the other hand, when compared to other NSAIDs, ketorolac does not seem to have a stronger analgesic effect. Conclusion: s: This systematic review indicates that ketorolac is a valuable option, alternative to opioids, to induce analgesia in adult ED patients, as our meta-analysis showed no significant difference in efficacy compared to opioids or other NSAIDs. Nevertheless, the evidence regarding its efficacy compared to other commonly NSAIDs is still limited and should be further explored in future studies
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