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Decontamination in Children

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41. CRACKCast E153 – Caustics

undergo endoscopy and be considered for admission. Asymptomatic patients can undergo endoscopy in the emergency department or be discharged with close follow-up monitoring. Gastric emptying or GI decontamination is not indicated for the majority of caustic ingestions. Concentration and pH are the most important characteristics of a substance to predict esophageal and gastric injury. Button batteries lodged in the airway or esophagus require endoscopic retrieval. Rosen’s In Perspective Caustic (...) , formaldehyde, iodine, and concentrated hydrogen peroxide. Most oral injuries are intended for self harm. Some may be accidental (children drinking from water bottle that held an acid). Some household products, such as liquid drain cleaners, continue to have high concentrations of alkali (30% KOH) or acid (93% H2SO4) (Table 148.1). These products often do not have concentration or content information available on the label, making it difficult for clinicians to determine the severity of exposure. Industrial

2018 CandiEM

42. Use of Central Venous Catheters in Neonates - a Framework for Practice

of insertion with 2% Chlorhexidine/ 70% isopropyl alcohol and allow to dry for 30 seconds. 8 Cover baby and surrounding area with sterile drape. 9 Remove outer gloves prior to catheter insertion. 10 Maintain sterile field. After the procedure 11 Secure catheter with umbilical fixation (UAC/UVC) or sterile transparent dressing (PICC). 12 Decontaminate hands after removal of gloves. 13 Complete documentation in the patient notes including insertion record sticker. Comments: NO YES British Association (...) bundles effective in critically ill neonates and children? Intensive Care Med. 2013;39:1352-8. 6. Sinha AK, Murthy V, Nath P, et al. Prevention of late onset sepsis and central line associated blood stream infection in preterm infants. Pediatr Infect Dis J. 2015 ePub Nov 30. 7. Bliss. Intravenous lines and catheters. http://www.bliss.org.uk/intravenous-lines- and-catheters (accessed 22nd December 2015). 8. Dunn PM. Localization of the umbilical catheter by post-mortem measurement. Arch Dis Child

2018 British Association of Perinatal Medicine

43. CRACKCast E165 – Sedative Hypnotics

mental status. CXR = look for pulmonary edema or aspiration Consider neuroimaging +/- EEG to rule out non-convulsive status Management ABCs Intubate as needed Fluids +/- pressors for hypotension (watch out for pulmonary edema) Decontamination Potentially MDAC (but no evidence for improved outcome) Consult your local toxicologist Enhanced Elimination Urine Alkalinization = controversial Hemodialysis serum levels over 100 mcg/mL refractory hypotension renal or cardiac failure acid-base or electrolyte (...) irritation or damage = V/D, esophagitis, hemorrhagic gastritis, and, rarely, gastrointestinal perforation or necrosis Transient hepatic or renal dysfunction can also occur. Dosing Danger The hypnotic oral adult dose=0.5 to 1.0 g. The toxic oral dose = ~ 10 g in adults may be as little as 1.5 g in children. Onset of action is 20 to 30 minutes. Chloral hydrate and ethanol in combination (historically referred to as a “Mickey Finn”) potentiate each other’s action to produce rapid loss of consciousness

2018 CandiEM

44. The use of faecal microbiota transplant as treatment for recurrent or refractory Clostridium difficile infection and other potential indications

or refractory CDI, but non-CDI indica- tions are also considered. These guidelines only apply to adult patients (=18 years); the working party did not consider the role of FMT in the treatment of either CDI or non-CDI indications in children or young people. The guidelines were written with a focus on UK practice, but also with consideration of more global practice as it applied. The diagnosis and management of CDI in general are outside the remit of these guidelines. 4.3. Evidence appraisal Questions

2018 British Society of Gastroenterology

45. Multidisciplinary guidelines for the management of paediatric tracheostomy emergencies

guidelines for the management of paediatric tracheostomy emergencies Corresponding Author Consultant E-mail address: Department of Paediatric Anaesthesia, Manchester University NHS Foundation Trust, Manchester, UK Correspondence to: C. Doherty Email: Consultant Paediatric Intensive Care Medicine, Paediatrics, Birmingham Children's Hospital, Birmingham, UK Tracheostomy Specialist Nurse Department of Paediatric ENT, Manchester University NHS Foundation Trust, Manchester, UK Tracheostomy Specialist Nurse (...) , Burnley, UK Specialty Trainee Department of Paediatric Anaesthesia, Manchester University NHS Foundation Trust, Manchester, UK Professor, Consultant Department of Paediatric Otolaryngology, Royal Manchester Children's Hospital, Manchester, UK Manchester Academic Health Science Centre, Manchester, UK Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK Consultant Department of Paediatric Otolaryngology, Royal

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2018 Association of Paediatric Anaesthetists of Great Britain and Ireland

46. Materials for retrograde filling in root canal therapy. (PubMed)

Materials for retrograde filling in root canal therapy. Root canal therapy is a sequence of treatments involving root canal cleaning, shaping, decontamination and obturation. It is conventionally performed through a hole drilled into the crown of the affected tooth, namely orthograde root canal therapy. For teeth that cannot be treated with orthograde root canal therapy, or for which it has failed, retrograde root filling, which seals the root canal from the root apex, is a good alternative (...) . Many materials, such as amalgam, zinc oxide eugenol and mineral trioxide aggregate (MTA), are generally used. Since none meets all the criteria an ideal material should possess, selecting the most efficacious material is of utmost importance.To determine the effects of different materials used for retrograde filling in children and adults for whom retrograde filling is necessary in order to save the tooth.Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral

2016 Cochrane

47. CRACKCast E120 – Dermatologic presentations

in children and young adults. The etiology is unknown. Clinical presentation includes multiple pink or pigmented oval papules or plaques 1 to 2 cm in diameter on the trunk and proximal extremities. A history may reveal an initial larger patch (“herald patch”) that precedes the widespread eruption. The lesions are parallel to the ribs, forming a Christmas tree–like distribution on the trunk and extremities. “In children, papular or vesicular variants of the disease may occur. Pityriasis rosea is self (...) Infection of the skin caused by staph. Aureus or beta-hemolytic strep. (More surrounding erythema) MRSA may also be involved Usually in children Bullous impetigo is another common form: the toxin released from staphylococcus causing 1-2 cm bullae Ddx: HSV, inflammatory fungal infection, contact dermatitis, pemphigus vulgaris. Treatment: (usually a self limited dz in 3-6 wks.) PO abx for severe or multiple lesions Cephalexin MRSA: Septra Doxy Clindamycin Bullous impetigo: Erythromycin or azithromycin

2017 CandiEM

48. Roadmap for Zoonotic Tuberculosis

safety practices play a central role in the control of many zoonotic diseases, both at the household and the commercial level. Interventions targeting M. bovis will also reduce transmission of other important foodborne diseases; for example, illness caused by Brucella, Campylobacter, Escherichia coli, Salmonella and Listeria spp. Such interventions can be highly cost- and resource-effective. Pasteurization, the decontamination of milk through exposure to high temperatures for a specified period (...) workers, abattoir workers, butchers and livestock traders; ? children and those more likely to consume unpasteurized milk and dairy products; and ? immunocompromised people, such as those living with HIV/AIDS. Cultural practices can influence food consumption behaviours. In many parts of the world, dairy systems often lack specialized equipment for collecting, treating and processing milk, which may be influenced by cultural and/or economic factors. For example, groups such as the Fulani in West

2017 International Union Against TB and Lung Disease

49. Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities

Kong SAR, China), Nalini Singh (Children’s National Medical Center and George Washington University, USA), Evelina Tacconelli (University Hospital Tübingen, Germany), Maha Talaat (CDC Global Disease Detection Programme, Egypt), Akeau Unahalekhaka (Chiang Mai University, Thailand). WHO Steering Group The following WHO experts served on the WHO Steering Group: Benedetta Allegranzi (Department of Service Delivery and Safety), Sergey Eremin (Antimicrobial Resistance Secretariat), Bruce Gordon (Water

2017 World Health Organisation Guidelines

50. Iodine thyroid blocking: Guidelines for use in planning and responding to radiological and nuclear emergencies

) or repeated exposure, unavoidable ingestion of contaminated food and drinking water, and where evacuation is not feasible. Neonates, pregnant and breastfeeding women and people older than 60 years, should not receive repeated ITB due to the risk of adverse effects. The following considerations should be kept in mind when administering ITB: ¦ Children, adolescents, pregnant and breastfeeding women, are most likely to benefit from ITB, whereas individuals over 40 years of age are less likely to benefit from (...) it. 8 / IODINE THYROID BLOCKING ¦ Should the supply of stable iodine be limited, priority should be given to the children and younger adults. ¦ Individuals at risk of exposure to high doses of radioactive iodine (e.g. emergency workers involved in rescue or clean-up operations) are likely to benefit from ITB irre- spective of their age and should be given priority. ¦ People living in iodine deficient areas are more likely to be affected by exposure to radioactive iodine. In such places, national

2017 World Health Organisation Guidelines

51. The Use of Laser Irradiation in Adjunct with Calcium Hydroxide Treatment of Direct Pulp Capping Procedures Leads to Higher Success Rates than Calcium Hydroxide Alone

in the success of direct pulp capping procedures employing laser irradiation to provide hemostasis and decontamination of the pulp exposure before placement of calcium hydroxide. The success rates were determined by the percentage of vital teeth at the final follow-up appointments. This treatment is within the capability of the average general dentistry practice and is likely to be supported by the patient to increase the likelihood of keeping the tooth vital at minimal financial cost. Best Evidence (you may (...) view more info by clicking on the PubMed ID link) PubMed ID Author / Year Patient Group Study type (level of evidence) #1) Javed/2017 687 children and adults in 6 included studies with pulp exposures Meta-Analysis Key results The success rate for maintaining pulpal vitality was significantly higher in the treatment group compared to the control group (log odds ratio = 1.737; 95% confidence interval, 1.304 - 2.171). The meta-analysis found that 80% of the included studies showed that the use

2017 UTHSCSA Dental School CAT Library

52. Introduction to the Centers for Disease Control and Prevention and the Healthcare Infection Control Practices Advisory Committee Guideline for the Prevention of Surgical Site Infections

Site Infections Patient-related factors Age [ ] Obesity or malnutrition [ , , ] Diabetes or hyperglycemia [ ] Smoking [ ] Colonization [ , ] Remote infection [ ] Pre-operative hospital stay [ ] Procedure-related factors Instrument cleaning, decontamination, and sterilization Operating room ventilation [ ] Pre-operative shaving [ ] Surgical skin preparation [ , ] Surgical scrub [ ] Surgical technique [ ] Surgical drains [ ] Tourniquet time [ ] Revision arthroplasty [ ] Procedure duration [ , ] Table (...) tissue and pulmonary infections from community-associated MRSA has increased dramatically, particularly in children and young, immunocompetent adults [ ]. Although initially described as community-associated or community-onset MRSA, this strain is now quite common in healthcare settings and is replacing other strains of MRSA as a cause of HAIs [ ]. The USA300 strain also has become a common pathogen for SSIs; it is the most common form of S. aureus found in SSIs in hospitalized patients

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2017 Surgical Infection Society

53. Video laryngoscopes to help intubation in people with difficult airways

people in hospital. User surveys show that availability, routine use and positive attitudes towards video laryngoscopy have increased over time. K Ke ey uncertainties y uncertainties around the evidence are a lack of evidence for use in children and babies and any published economic evidence. © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 1 of 26The cost cost of video laryngoscopes range from £245 to £7,149 per unit (...) routine induction of anaesthesia in children aged 1 to 8 years, states that more research is needed in the use of video laryngoscopes. Age is a protected characteristic under the Equality Act 2010. Clinical and technical e Clinical and technical evidence vidence A literature search was carried out for this briefing in accordance with the interim process and methods statement. This briefing includes the most relevant or best available published evidence relating to the clinical effectiveness

2019 National Institute for Health and Clinical Excellence - Advice

55. Ultrasound Guidelines: Emergency, Point-of-care, and Clinical Ultrasound Guidelines in Medicine

other emergency US applications. Other Settings or Populations Pediatrics. US is a particularly advantageous diagnostic tool in the management of pediatric patients, in whom radiation exposure is a significant concern. EUS applications such as musculoskeletal evaluation for certain fractures (rib, forearm, skull), and lung for pneumonia may be more advantageous in children than in adults due to patient size and density. 7 US can be associated with increased procedural success and patient safety

2016 American College of Emergency Physicians

56. Quality Standards for Paediatric Gastroenterology, Hepatology & Nutrition

of improvement are required in gastroenterology, hepatology and nutrition to ensure children are receiving timely, high quality services as close to home as possible. It is clear that there is heterogeneity in the way that services are being provided to children across the UK. These standards have been developed alongside the principles laid out by the RCPCH ‘Bringing Networks to Life’ publication that underpins the direction of travel for all paediatric services to be planned and provided through funded (...) managed clinical networks. These standards have been developed using the experience and authority of the RCPCH with the specialist expertise and knowledge of BSPGHAN throughout 2016. Extensive consultation with children and their families together with input from key stakeholders has helped to influence and steer the process of producing a key set of definitive standards. We are committed towards supporting the membership of RCPCH and BSPGHAN by asking commissioners and service planners across the UK

2017 British Society of Paediatric Gastroenterology Hepatology and Nutrition

57. Medication impregnated dressings for central venous catheters reduce the number of bloodstream infections, but the quality of the research is low

dressings halved the frequency of bloodstream infections per 1000 patient days compared with standard polyurethane dressings (RR 0.51, 95% CI 0.33 to 0.78). This was from a meta-analysis of four studies. There was no difference in skin irritation or damage between chlorhexidine gluconate-impregnated dressings and polyurethane dressings. However, this outcome was only examined in two studies in children and new born infants. There was not enough evidence to assess other devices or dressings (...) , such as those impregnated with silver or iodine. What does current guidance say on this issue? NICE guidance from 2012 recommends that the central venous catheter insertion site and surrounding skin should be decontaminated during dressing changes using chlorhexidine gluconate in 70% alcohol, and that a sterile transparent semipermeable (polyurethane) membrane dressing should cover the vascular access device insertion site. NHS England’s “epic3” guidance similarly recommends cleaning the skin

2018 NIHR Dissemination Centre

58. U.S. Cystic Fibrosis Foundation and European Cystic Fibrosis Society consensus recommendations for the management of nontuberculous mycobacteria in individuals with cystic fibrosis

, Sarah E Hempstead , Karsten Koetz , Kathryn A Sabadosa , Isabelle Sermet-Gaudelus , Alan R Smyth , Jakko van Ingen , Richard J Wallace , Kevin L Winthrop , Bruce C Marshall , Charles S Haworth Statistics from Altmetric.com Background Epidemiology of non-tuberculous mycobacteria in individuals with cystic fibrosis Non-tuberculous mycobacteria (NTM) are increasingly being isolated from the sputum of adults and children with cystic fibrosis (CF), both in North America and in Europe. Estimates (...) , with prevalence increasing from 10% in children aged 10 years, to over 30% in adults over the age of 40 years. In individuals with an adult diagnosis of CF, over 50% (mostly females) have NTM-positive airway cultures. There appear to be species-specific differences in age-related prevalence within CF cohorts, with MAC more commonly isolated from adults over 25 years of age, , , , , while MABSC is isolated from all age groups, but peaks between those 11 and 15 years of age in some studies. , There may also

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2016 Cystic Fibrosis Foundation

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