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Authors' Reply to M.S. Raghuraman: "Intranasal Dexmedetomidine for Procedural Sedation in Children, a Suitable Alternative to Chloral Hydrate".
No full textN/
Intranasal Dexmedetomidine for Procedural Sedation in Children, a Suitable Alternative to Chloral Hydrate
No full textSedation is often required for children undergoing diagnostic procedures. Chloral hydrate has been one of the sedative drugs most used in children over the last 3 decades, with supporting evidence for its efficacy and safety. Recently, chloral hydrate was banned in Italy and France, in consideration of evidence of its carcinogenicity and genotoxicity. Dexmedetomidine is a sedative with unique properties that has been increasingly used for procedural sedation in children. Several studies demonstrated its efficacy and safety for sedation in non-painful diagnostic procedures. Dexmedetomidine's impact on respiratory drive and airway patency and tone is much less when compared to the majority of other sedative agents. Administration via the intranasal route allows satisfactory procedural success rates. Studies that specifically compared intranasal dexmedetomidine and chloral hydrate for children undergoing non-painful procedures showed that dexmedetomidine was as effective as and safer than chloral hydrate. For these reasons, we suggest that intranasal dexmedetomidine could be a suitable alternative to chloral hydrate
Acute Abdominal Pain: Recognition and Management of Constipation in the Emergency Department
No full textOBJECTIVE: The main aim of the study was to investigate the incidence and the clinically relevant features of functional constipation in patients evaluated for acute abdominal pain in a tertiary care pediatric emergency department.
METHODS: This is a retrospective study. We analyzed 4394 medical records and recorded the information (demographics, triage code, symptoms, medical history, physical evaluation, laboratory tests, radiological studies, procedures, and treatments) of all patients admitted for acute abdominal pain to the emergency department of the IRCCS Burlo Garofolo, Trieste, during 2010 to 2013.
RESULTS: In this study, a quarter of patients (1020) presenting in the emergency department with acute abdominal pain were affected by functional constipation. Acute pain associated with functional constipation is generally rated from moderate to severe, and the location of the pain on physical evaluation was not a sufficient criterion to guide diagnosis. Isolated vomiting may be present in a minority of cases. Digital rectal exploration was never performed; the majority of patients were treated by means of an enema with prompt relief. Six percent of patients with constipation underwent radiological studies.
CONCLUSIONS: This study confirms that the medical history provides a pivotal role in the diagnosis of functional constipation. Digital rectal exploration and x-rays should be avoided in this setting, whereas an enema plays a useful diagnostic and therapeutic role in our study patients
A boy with sudden headache
No full textHeadache is a common presenting complaint in pediatric emergency departments. The goal of emergent evaluation is to identify those children with potentially life-threatening conditions. We present the case of an adolescent boy presenting with headache and hypertension who was diagnosed with a catecholamine-secreting abdominal paraganglioma. Genetic testing eventually led to the diagnosis of SDHB-related hereditary paraganglioma-pheochromocytoma syndrome. Alarm features ("red flags") in children presenting with headache are reviewed, as well as the main features of paragangliomas and the indications for genetic testing
Farmaci e utilizzo "wrong-label" in pediatria - L'esempio del paracetamolo, del salbutamolo e dell'amoxicillina
No full textTwo thirds of the drugs prescribed for children are off-label. However, off-label is not synonymous with incorrect, since it often represents the most rational, evidence-based therapy. One aspect of the off-label problem in paediatrics depends on the lack of updating the drugs specific Summary Product Characteristics (SPC). This is a frequent problem in Italy. The Authors give the example of three of the most commonly prescribed drugs in paediatrics (acetaminophen, salbutamol and amoxicillin), the SPC which recommends wrong dosages compared to those based on the to-date evidence and recommended by clinical guidelines (“wrong-label”). Reviewing and updating of SPC should be one of the priorities to tackle the off-label problem in the Italian reality
Il dolore acuto del bambino: Dalla misurazione al trattamento, farmacologico e non.
No full textBackground - Pain is a relevant symptom reported by children who require Emergency Unit evaluation, but it is still underestimated and undertreated. Purpose - This review offers simple information about pharmacological and non-pharmacological approaches in the management of pain in emergency settings and in subcentres. Data sources - Found on PubMed articles, using different key-words: pain, procedural pain, children, emergency unit, epidemiology, measurement, management, and treatment. Results - Pain has to be measured before treatment. It can be controlled with non-pharmacological and pharmacological approaches, which have specific guidelines.
Conclusions - Instruments for any kind of pain are available; an insufficient management is attributable to poor knowledge rather than to lack of means
Pain Intensity and Risk of Bone Fracture in Children With Minor Extremity Injuries
No full textInjuries are one of the most common causes of pediatric emergency department (ED) visit. The aim of this study was to investigate the relationship between the intensity of pain at the ED visit of children presenting with an extremity injury and the risk of fracture
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