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16.01.2014
There are actually 4 identified testicular appendages, but appendix epididymis and  appendix testis or the most commonly encountered.
Appendix testis is located in the groove between testis and the epididymal head at the upper pole of the testis.
Inflammatory cells infiltrate the twisted appendix testis and are a marker of progression of the disease, not infection.
Recall that normal blood flow does not completely exclude the possibility of testicular torsion.
The most common cause of acute scrotum in prepubertal boys is torsion of the testicular or epididymal appendages.
To identify the signs that can help to differentiate torsion of the appendix testis (AT) and epididymitis and to establish the incidence of the various pathologic entities in boys with an acute scrotum. The aim of the study was to compare historical features, physical examination findings, and testicular color Doppler ultrasound in pediatric patients with epididymitis compared to testicular torsion and torsion of the appendix testes. The purpose of this study was to compare the size, shape, echogenicity, and blood flow of the appendix testis on sonography in control subjects and in patients with a torsed appendix testis and to evaluate the usefulness as well as the limitations of these criteria. We all know that airway management is a critical skill for those of us who care for pediatric patients in the acute environment!
Anticipate that this will be more challenging to achieve in children, particularly infants. Neck flexion will cause ETT to move toward carina: potentially going into mainstem bronchus! Formulas can be useful to estimating initial tube placement, but their performance is variable for each individual patient.
The problem is that ETT’s with a Murphy eye can generate bilateral breath sounds even in the setting of a mainstem bronchial intubation. During intubation, another practitioner places 3 fingers on trachea with inferior finger at the sternal notch. Your successful placement of the ETT through the cords is only the beginning of the airway management! If there is any change in the child’s condition, Re-CONFIRM appropriate position of the ETT! Correct positioning of the endotracheal tube (ETT) during emergent pediatric intubations can be challenging, and incorrect placement may be associated with higher rates of complications. The incidence of endotracheal tube (ETT) malposition in children with various described methods is 15% to 30%. We describe emergency department (ED) intubation practices for children younger than 16 years through multicenter prospective surveillance. Given the distressingly high incidence of ETT malposition in the neonatal population, patients are exposed to ionizing radiation to confirm endotracheal tube (ETT) position. Although bedside ultrasonography can accurately distinguish esophageal from tracheal intubation, it is not used to establish the correct depth of endotracheal tube insertion.
This study aimed to undertake a systematic review and meta-analysis to summarize evidence on the diagnostic value of ultrasonography for the assessment of endotracheal tube placement in adult patients. The aim of this study was to determine the accuracy of standard techniques for estimating oral and nasal tracheal tube length in children and to devise more accurate predictive formulae that can be used at the bedside.
We performed orotracheal intubation in 153 consecutive pediatric patients undergoing cardiac catheterization. Children have rib fractures less often than adults due to anatomic and structural differences. These changes influence risk for fracture with increasing age (particularly elderly patients).
The complaint chest wall does not dissipate a force as well, transmitting more of it inward to the underlying organs (see Pulmonary Contusion). Children have higher rates of associated head, thoracic, and solid organ injuries with rib fractures compared to adults. Rib fractures should be considered a sign of significant, possible multiple, trauma in kids.
With each rib fracture, mortality rate increased in nearly linear fashion up to 8.23% for 7th rib fractured.
Rib fracture number correlates with mortality in adult trauma patients, sharply rising above six fractured ribs. Traumatic injury from motor vehicle crashes is a major cause of morbidity and mortality in the United States. Kessel B1, Dagan J2, Swaid F3, Ashkenazi I2, Olsha O4, Peleg K5, Givon A5; Israel Trauma Group, Alfici R2. Rib cage morphology changes with age and sex are expected to affect thoracic injury mechanisms and tolerance, particularly for vulnerable populations such as pediatrics and the elderly. The purpose of our study was to determine whether adding oblique bilateral rib radiography to the skeletal survey for child abuse significantly increases detection of the number of rib fractures.
Research documents that among children admitted to trauma intensive care units the number of rib fractures sustained indicates the child’s likelihood of having and severity of intrathoracic injury. Rib fractures are considered highly suspicious for nonaccidental injury in the pediatric clinical literature; however, a rib fracture classification system has not been developed. The purpose of the study was to determine if first rib fractures are associated with an increased incidence of thoracic vascular injury in pediatric patients. Rib fractures are uncommon in infancy and, when diagnosed, often raise the suspicion of child abuse. Unfortunately, children are at significant risk for traumatic injuries, whether they be young or old. So, don’t need to reflexively order head and neck CT, but do need to carefully assess. External lacerations of the chin may be sign of force directed posteriorly, leading to crush injury to the condyles.
In small group of pediatric patients, this was found to be 100% sensitive and 88.9% specific. If Panorex shows midline mandible fracture, CT recommended to evaluate for genial tubercle fracture. The future growth of the mandible has to be carefully considered when considering operative management. Patient may require period of hospitalization to ensure adequate pain control to assist with oral intake. If concern for subtle fracture, CT is the best means to truly evaluate the entire mandible.


The aim of the study is to evaluate the utility of a simple tongue blade bite test in predicting mandible fractures and use this test as an alternative screening tool for further workup. Interpersonal violence is a relatively infrequent cause of injury to the craniofacial skeleton in the pediatric population. Maxillofacial fractures in pediatric trauma patients require significant force and frequently are associated with concomitant injuries. Swanson EW1, Susarla SM1, Ghasemzadeh A2, Mundinger GS1, Redett RJ3, Tufaro AP3, Manson PN4, Dorafshar AH5. The Mandible Injury Severity Score (MISS) has been used to evaluate adult mandibular fractures. Smith DM1, Bykowski MR, Cray JJ, Naran S, Rottgers SA, Shakir S, Vecchione L, Schuster L, Losee JE. Optimal management of pediatric mandible fractures demands that the practitioner balance reduction and fixation with preservation of growth potential and function. When determining the optimal treatment strategy for a pediatric mandible fracture, planning must factor in the patient’s age, anatomy, stage of dental development, fracture site, and ability to cooperate with the proposed treatment plan.
This article reviews the current standard of care in imaging considerations for the diagnosis and management of craniomaxillofacial trauma. Pediatric trauma involving the bones of the face is associated with severe injury and disability. In younger children and infants, the differences in anatomy make a traditional cricothyrotomy challenging. Generous proportions of subcutaneous adipose tissue (chunky little babies are cute…) obscures landmarks.
The altered anatomy makes location of the cricothyroid membrane more difficult (if at all possible) and the small size may make it impossible to pass a large cric-tube through. Potential to use this catheter later to convert to a guidewire-assisted percutaneous cricothyrotomy. The most difficult aspect of the procedure is not waiting too long to do it and leading to hypoxic insult. The next most difficult aspect is figuring out how to connect oxygen to the tiny catheter you just placed in the neck. 3-way stop cock can be used to fit into distal end of oxygen tubing and Lure-lock onto the catheter. 1.5 V Silver Oxide replacement battery can be used for watches, thermometers, handheld games, calculators and more. Not sure what you're looking for?Browse the safety advice by selecting the categories you're interested in below. Button batteries and lithium coin batteries are the small, round batteries you find in lots of toys and everyday objects. Lithium coin batteries are the most dangerous as the higher voltage means more energy is released, creating more caustic soda. Watch The One Show feature about button batteries (from 03:00 minutes) and the damage they can do on iPlayer. Button batteries are used in a wide range of toys, gadgets and other everyday objects you’ll find around the house. It’s not just babies and toddlers, who put everything in their mouths, who are at risk from button batteries. In some cases, they may deliberately put a button battery in their mouth or on their tongue to experience the sensation of the electrical charge. Batteries in children’s toys are covered by safety regulations and should be enclosed by a screw and secure. Keep products with batteries well out of reach if the battery compartment isn’t secured with a screw. Keep all spare batteries out of children’s reach and sight, ideally in a high-up, lockable cupboard.
Teach older children that button batteries are dangerous and not to play with them or give them to younger brothers and sisters. Take them straight to the A&E department at your local hospital or dial 999 for an ambulance. Join our mailing list to keep up-to-date with child accident prevention, including the latest news on button batteries. Child Accident Prevention Trust is a registered charity number 1053549 and a company limited by guarantee number 3147845. They can kill a child within hours, but are found in many apparently harmless objects around the home.
NHS England has issued a patient safety alert warning of the risk of death or serious harm from button batteries. In addition, Public Health England is now issuing a note on the dangers to its local centres, for onward distribution to local authorities, and the Institute of Home Safety is writing to all its members.
We’ve also developed two new, engaging and cost-effective resources to help you raise awareness. If you’re interested in rolling out a local campaign, why not co-brand flyers and posters with your organisation’s logo? Sign up to our CAPT emailing lists to get relevant news, topic briefings and other child accident prevention news each month.
Sonographic appearances of torsion of the appendix testis and appendix epididymis in children. The purpose of this retrospective study was to characterize the features of these lesions as viewed on sonographic (US) and color Doppler US examination.
Differentiation of epididymitis and appendix testis torsion by clinical and ultrasound signs in children. A retrospective review of the medical records of 66 boys presenting with clinical aspects of acute scrotum over a 3-year period was performed. The histological picture of these cases is variable and many show a heavy acute inflammatory cell infiltrate, unlike the response to pure ischaemic necrosis in other organs. Inflamation of the testis and epidididymis in an otherwise healthy child: is it a true bacterial urinary tract infection? Bacterial infection and underlying urological abnormalities are thought to be the main causes, and hence antibiotic treatment and further invasive urinary tract imaging studies are usually recommended. Torsed appendix testis: gray scale and color Doppler sonographic findings compared with normal appendix testis.
Factors Associated with Misplaced Endotracheal Tubes During Intubation in Pediatric Patients.


Accuracy of a Chest X-Ray-Based Method for Predicting the Depth of Insertion of Endotracheal Tubes in Pediatric Patients Undergoing Cardiac Surgery.
Techniques and Trends, Success Rates, and Adverse Events in Emergency Department Pediatric Intubations: A Report From the National Emergency Airway Registry. The concordance of ultrasound technique versus X-ray to confirm endotracheal tube position in neonates. Our objective is to determine if ultrasound technique is concordant with X-ray in determining whether an ETT is deeply positioned or not. Inflating the endotracheal tube cuff with saline to confirm correct depth using bedside ultrasonography.
As indirect sonographic markers of endotracheal tube insertion depth have proven unreliable, a method for visual verification of correct tube depth would be ideal. Ultrasonography for confirmation of endotracheal tube placement: a systematic review and meta-analysis. A prospective comparison of diaphragmatic ultrasound and chest radiography to determine endotracheal tube position in a pediatric emergency department.
Auscultation of bilateral breath sounds does not rule out endobronchial intubation in children. Because of the pliability of younger ribs, pediatric ribs are believed to require more energy to fracture. The thorax is particularly at risk in motor vehicle crashes and is studied extensively by the injury biomechanics community.
In children, because of high elasticity of the chest wall, higher energy levels are necessary for ribs to fracture.
The size and shape variation of the external geometry of the ribs was characterized for males and females aged 0-100 years.
Is the new ACR-SPR practice guideline for addition of oblique views of the ribs to the skeletal survey for child abuse justified? This has been misused in court to argue that children with multiple rib fractures who lack intrathoracic injury have abnormal bone fragility rather than inflicted injury.
As an aid and impetus for rib fracture research, we developed a concise schema for classifying rib fracture types and fracture location that is applicable to infants. However, facial fractures are rare in children compared with adults, resulting in few large studies on patterns of pediatric facial fractures. The presentation of fractures as a result of different causes varies dramatically and can have a direct impact on management.
Analysis of Pediatric Maxillofacial Fractures Requiring Operative Treatment: Characteristics, Management, and Outcomes. The anatomic and developmental differences between the adult and child that impact patterns of injury also affect management and outcomes.
215 mandible fractures in 120 children: demographics, treatment, outcomes, and early growth data.
Careful consideration must be given to the possibility of long-term growth disturbance with various fracture locations and types of treatment. Injury-specific imaging techniques and options for computer-aided surgery as related to craniomaxillofacial trauma are reviewed, including preoperative planning, intraoperative navigation, and intraoperative computed tomography.
Patterns and outcomes of pediatric facial fractures in the United States: a survey of the National Trauma Data Bank. Although much is known about the epidemiology of facial fractures in adults, little is known about national injury patterns and outcomes in children in the US. Unfortunately, most neural synapses don’t function well with that large surge of adrenaline, and it is, therefore, imperative to contemplate how to manage this scenario before it arises. Lots of these objects have buttons and surfaces that young children love to explore and play with. As NHS England issues a safety warning about button batteries, CAPT launches new resources alerting parents to the risks. It advises healthcare staff to treat such incidents as medical emergencies, as button batteries can cause catastrophic haemorrhage if swallowed.
The flyer outlines the risk, provides safety tips and urges parents to seek urgent medical help if they think their child may have swallowed a button battery.
The poster highlights everyday items that use button batteries and calls for parents to take action to keep children safe. And we can support your organisation to run an engaging local awareness campaign to prevent child deaths and injuries from button batteries. While there are many other causes of inguinal and scrotal pain (ex, varicocele, inguinal hernia), one of the common causes is Torsion of the Appendix Testis.
The purpose of this study was to assess the role of bacterial infection in pediatric acute EO. We hypothesized this will result in a different rib fracture-associated pediatric mortality rate. Unfortunately, most samples used in such research generally do not include children or the very elderly, despite the common occurrence of thorax injuries at both ends of the age spectrum.
The purpose of this study was to analyze patterns of associated injuries in children as compared with adults, all of whom presented with rib fractures. Computed tomography (CT) scans from 339 subjects were analyzed to collect between 2700 and 10 400 homologous landmarks from each rib. The purpose of this study was to determine the causes and clinical presentations of rib fractures in infants <12 months old. An institutional review board approved the retrospective review of patients evaluated by the Department of Otolaryngology at a single institution for facial trauma performed from November 1, 2011, to February 27, 2014.
The current study compares facial fractures in a pediatric population as a result of interpersonal violence with other mechanisms of injury. Our primary hypothesis is that ultrasound is equivalent to chest radiography in determining endotracheal tube position within the airway in emergent pediatric intubations. Some of these events are unfortunate and accidental (ex, Submersions), while others are sinister and purposeful (ex, Abuse).
When we think of injury in children, we often immediately consider head trauma (the leading cause of mortality), but let us not overlook thoracic trauma as it is the second leading cause of mortality in children suffering from trauma.
While pulmonary contusions are the the most common intra-thoracic injury, let’s spend a moment contemplating the significance of Rib Fractures.



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