PEMP 0317 Pneumothorax In Pediatric Patients.pdf


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INTRODUCING

POINTS & PEARLS
POINTS & P
EARLS
A Quick-Read

Review Of Key

Points & Clinic

al Pearl

s, July 2016
Pediatric Severe
Traumatic Brain
Injury:
An Evidence-Ba
sed Review
Points



Cervical artery
Pearls
dissections involv
vertebral arterie
e the carotid or
s. An intimal
tear creates a
dolumen with
pseuintram
Cervical artery
later lead to vessel ural hematoma, which
dissections can
can
occlusion, throm
even
with minor traum
tion, embolus,
a or spontaneous occur
pseudoaneurysm, bus formaly.
Cervical artery
or rupture.
dissections from
Maintain a high
caused by direct
blunt trauma
index of suspic
are
blow to the neck,
artery dissections
ion of
sion or contra
hyperextenin patients presen cervical
lateral rotatio
risk factors or
ting with
n, intraoral traum
or skull-base
with
any concerning
fractur
a,
finding.
associated
occur spontaneous es. However, they can also
ly
or
with
minor
average, sympt
trauma. On
Early administratio
oms occur 2 to
n of antiplatelet
3 days after the
traumatic event.
anticoagulants
significantly reduce agents or
• Cervical artery
stroke in cervica
s the risk of
dissections may
l
artery
headache, facial
present with
dissections.
pain, or neck
pain and may
associated with
Cervical artery
be
neurological
dissection is not
symptoms, dysgeu
sia, pulsatile
cation for throm
a contrainditinnitu
bolytics for ischem
Risk factors includ s, or cervical radiculopath
ic stroke.
y.
vascular abnorm e connective tissue diseas
e and
• Cervical artery
• Liberal screen alities.
dissection is not
ing criteria are
for thrombolytic
a contraindica
recommende
High-risk findin
tion
s for ischemic
d.
gs
stroke. Patien
acute strokes
cal deficits, Glasgo include lateralizing neurol
ts with
can receive throm
ogiw
bolytic
Coma Scale score
when cervical
s safely even
cal hematoma,
artery dissect
< 8, cervibruit, thrill or
ion is suspected.
thrombolytics,
crepitus, anisoc
Horner syndro
After
antipla
telet agents and
oria,
me, cervical spine
tion should be
anticoagulaFort type II or
fracture, and
delayed for 24
III
Le

fractur
hours.
Patien
es.
• Though digital
ts diagnosed
with a cervica
subtraction angiog
tion should be
l artery dissec
gold standard
raphy is the
admitted and
for diagnosis
closely monito
Follow-up imagin
of cervical artery
sections, compu
red.
g is needed to
disted
progression in
assess disease
an accepted choice tomographic angiography
7 to 10 days.
is
• Due to the
and 95% to 100% , with 98% to 100% sensitivity
lack of data, blood
specificity while
pressure manag
ment targets
risks and delays
having fewer
are up to indivi
ecompared to angiog
dual
on
provid
specifi
ers based
c patient charac
netic resonance
raphy. Magteristics.
angiography
is also an alterna
but is not sensiti
Issue Author
tive,
ve for vertebral
• Early admin
artery dissect
istratio
ion.
Rhonda Cadena
with antiplatelet n of antithrombotic therap
Assistant Professo , MD
y
agents (eg, aspirin
r, Departments
Emergency Medicine
of Neurology,
lants (eg, hepari
Neurosurgery,
, University of
n) has been shown ) or anticoaguand
North Carolina,
Points & Pearls
reduce the risk
Chapel Hill, NC
Contributor
of stroke in cervica to significantly
tions. There is
l artery dissecJeremy Kim,
no clear benefi
MD
Department of
t of one agent
another, but many
Emergency Medicine
over
Sinai, New York,
prefer heparin
, Icahn School
NY
of Medicine at
an acute throm
in the setting
Mount
bus
of
contraindications or vessel occlusion. If there
are
to antithrombot
vascular treatm
ic therapy, endoent should be
considered.
July 2016 • Emerg
Access your issue
by scanning with
ency Medicine
your smartph
Practice
one or tablet
rs
1
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about
sponde
saying
First Re EB Medicine.rsAllare
rights
reserved.
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what you
Syndrom
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ctice to
h
my pra
rniation
this issu
change ns, even wit
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e will
tio
5. Cereb
This issu nk of dissec
Figure
thi
ays
alw
a.
traum
minor
d
enjoye
ions. I
E quest
CM
nt
Excelle g them.
1
rin
answe
I will now
s issue,
ding thi
ferently.
After rea dizziness dif
2
te
evalua
a
CTA as
rally use
re libe dissection.
mo
l
3
I wil
l for
ing too
screen








ences

and
Refer
dence
portant
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et al. Inci
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kar JN,
Mandre on: a populat ectional
ecti
RD, Jr.,
ss-s
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, Brown
12. (Cro
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024448
Lee VH of cervical arte (10):1809-18
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ents) DOLevi C, et al.
for
nt
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tme
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Neurol.
n trea
study;
Hayter
pal. Lancet
gulatio
kus HS,
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-1153.
treatme
3: Tran
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nt cere
(6):1150
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al. Blu
sillar hern
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2009;67 1d6
nes: the
4: Ton
LN, et
Trauma.
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t guideli Trauma.
13e318
ery dis
lier BC, managemen
htly
TA.0b0
ma. J
e
/
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adult
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tion for
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In
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Ass
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ms
Differen
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. (Practic
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71- 477
M, et al. ons: the
sympto features tha of 213 childr sentenant
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