The use of ultrasound-guided regional anesthesia is growing as a modality for analgesia provision within the pediatric emergency department. We present a case in which a paravenous saphenous nerve ...block was used for anesthesia during incision and drainage of a lower extremity abscess. We further review the technique and literature concerning this straightforward and effective procedure.
Septic arthritis is one potential cause of pediatric joint effusion and pain that may lead to significant morbidity. We present a case where point-of-care ultrasound was used to identify and aspirate ...a joint effusion in a pediatric patient with septic arthritis of the ankle, facilitating timely diagnosis and care. We review the technique for arthrocentesis of the ankle and literature on point-of-care ultrasound in the diagnosis of pediatric septic arthritis.
Gastric ultrasound (US) is a growing modality within the point-of-care ultrasound (POCUS) field. It provides the ability to directly measure an individual patient's gastric content and has potential ...use as both a clinical and a research tool. Here, we review the historical development of current gastric US models and their clinical application within the field of general anesthesia, describe the US findings and technique for using POCUS to assess gastric content, and discuss the current and potential applications of gastric POCUS within the emergency department.
Ultrasound-guided regional anesthesia is a growing modality within the pediatric emergency department. Here we present a case where a posterior tibial nerve block was used for anesthesia during ...foreign body removal from the plantar foot. We further review the technique and literature regarding this straightforward and highly effective procedure.
Abdominal pain in the pregnant adolescent presents a diagnostic dilemma with potential life-threatening etiologies. We present a case where point-of-care ultrasound was used to facilitate diagnosis ...and expedite lifesaving management of a ruptured ectopic pregnancy. We further review the technique and literature for first-trimester transabdominal point-of-care ultrasound.
Point of care ultrasound (POCUS) has undergone important growth in the field of Pediatric Emergency Medicine (PEM) in the last 14 years and is recognized as a critical diagnostic tool in the care of ...ill and injured children. The first PEM POCUS fellowship was established in 2010. Now, there are currently 30 ultrasound fellowships that offer training to PEM physicians. In 2014, 46 PEM POCUS leaders established the P2 (PEM POCUS) Network (www.P2network.org). This serves as a platform for sharing expertise, building research collaborations, and offering mentorship in the use of POCUS in PEM. In 2019, a multinational group of experts in PEM POCUS published the first consensus guidelines for prioritizing core applications of POCUS, which are fundamental to PEM fellowship training 1. In 2022, the international research priorities for PEM POCUS were published 2. In the same year, the development of a consensus-based definition of focused assessment with sonography for trauma (FAST) in children was established 3.
Background
The Pediatric Emergency Medicine (PEM) Point‐of‐care Ultrasound (POCUS) Network (P2Network) was established in 2014 to provide a platform for international collaboration among experts, ...including multicenter research. The objective of this study was to use expert consensus to identify and prioritize PEM POCUS topics, to inform future collaborative multicenter research.
Methods
Online surveys were administered in a two‐stage, modified Delphi study. A steering committee of 16 PEM POCUS experts was identified within the P2Network, with representation from the United States, Canada, Italy, and Australia. We solicited the participation of international PEM POCUS experts through professional society mailing lists, research networks, social media, and “word of mouth.” After each round, responses were refined by the steering committee before being reissued to participants to determine the ranking of all the research questions based on means and to identify the high‐level consensus topics. The final stage was a modified Hanlon process of prioritization round (HPP), which emphasized relevance, impact, and feasibility.
Results
Fifty‐four eligible participants (16.6%) provided 191 items to Survey 1 (Round 1). These were refined and consolidated into 52 research questions by the steering committee. These were issued for rating in Survey 2 (Round 2), which had 45 participants. At the completion of Round 2, all questions were ranked with six research questions reaching high‐level consensus. Thirty‐one research questions with mean ratings above neutral were selected for the HPP round. Highly ranked topics included clinical applications of POCUS to evaluate and manage children with shock, cardiac arrest, thoracoabdominal trauma, suspected cardiac failure, atraumatic limp, and intussusception.
Conclusions
This consensus study has established a research agenda to inform future international multicenter PEM POCUS trials. This study has highlighted the ongoing need for high‐quality evidence for PEM POCUS applications to guide clinical practice.
Comprehensive Review of Patulin Control Methods in Foods Moake, Matthew M.; Padilla‐Zakour, Olga I.; Worobo, Randy W.
Comprehensive reviews in food science and food safety,
January 2005, 2005-Jan, 2005-01-00, 20050101, Volume:
4, Issue:
1
Journal Article
Peer reviewed
ABSTRACT
The mycotoxin, patulin (4‐hydroxy‐4H‐furo 3, 2c pyran‐26H‐one), is produced by a number of fungi common to fruit‐ and vegetable‐based products, most notably apples. Despite patulin's ...original discovery as an antibiotic, it has come under heavy scrutiny for its potential negative health effects. Studies investigating these health effects have proved inconclusive, but there is little doubt as to the potential danger inherent in the contamination of food products by patulin. The danger posed by patulin necessitates its control and removal from foods products, creating a demand for handling and processing techniques capable of doing so, preferably at low cost to industry. With this being the case, much research has been devoted to understanding the basic chemical and biological nature of patulin, as well as its interaction within foods and food production. While past resarch has elucidated a great deal, patulin contamination continues to be a challenge for athe food industry. Here, we review in depth the past research on patulin with an emphasis upon its influence within the food industry, including its regulation, health effects, biosynthesis, detection, quantification, distribution within foods, and control, during the various stages of apple juice production. Finally, key areas where future patulin research should focus to best control the patulin contamination problem within the food industry are addressed.
There is debate regarding the timing of procedural sedation and analgesia (PSA) in relation to fasting status. Point-of-care ultrasound (POCUS) provides the ability to measure gastric content and is ...being used as a surrogate for aspiration risk in anesthesia. We sought to evaluate the gastric content of pediatric emergency department (PED) patients undergoing PSA using POCUS.
We performed a prospective observational study using a convenience sample of pediatric patients undergoing PSA between July 1, 2018, and June 30, 2019. Following a brief history, gastric content was measured using POCUS in both supine and right lateral decubitus positions at 2-hour intervals until the time of PSA. Qualitative content and calculated volume were classified based on the Perlas Model of anesthesia "Risk" assessment.
Ninety-three patients were enrolled with 61.3% male and mean age of 6.5 years. Gastric content was determined in 92 patients. There were 79.3% that had "high risk" content at the time of PSA, with a median fasting time of 6.25 hours and no serious adverse events. Fasting duration had a weak to moderate ability to predict "risk" category (area under the curve = 0.73), with no patient (n = 17) who underwent multiple evaluations awaiting PSA progressing from "high" to "low risk."
The majority of PED patients undergoing PSA at our institution had "high risk" gastric content with no clinically significant change occurring during serial evaluations. This calls into question the utility of delaying PSA based upon fasting status and lends support to a more comprehensive risk-benefit approach when planning pediatric PSA.
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