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Emergency Pediatric Dosing

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1. One or Two Dose Steroid Regimens for Adult Asthma Exacerbation

One or Two Dose Steroid Regimens for Adult Asthma Exacerbation One of Two Dose Steroid Regimens for Adult Asthma Exacerbation | Emergency Medicine | Washington University in St. Louis Open Menu Back Close Menu Search for: Loading... Welcome Our Team Sections Education Alumni Research ECRC Journal Club Events Jermyn Lectures Open Search Vignette It’s a cold, blustery winter day in the local community emergency department where you’ve been moonlighting. You’ve seen half a dozen patients with Flu (...) normal physical exam. After getting two short duo nebs in the ED he feels much better and has improved aeration with faint end-expiratory wheezes. His chest x-ray is clear and he would like to go home. You’ve already decided to give him steroids for this asthma exacerbation, and remember reading that in children, , with the benefit that patients require only 1-2 doses (instead of 5). You wonder if the same holds true for adults (who are basically just big kids anyway). After sending Mr. Z home with 5

2019 Washington University Emergency Medicine Journal Club

2. The Effect of Ibuprofen Dosing Interval on Post-Tonsillectomy Outcomes in Children: A Quality Improvement Study. (Abstract)

to the Emergency Room (ER) for reasons other than PTH. Data was collected from 353 children. Utilizing run chart analysis, it was determined that patients experiencing the 4-hour dosing interval had lower rates of PTH, fewer ER visits, and no increase in postoperative phone calls from caregivers.Patients were treated with standing Acetaminophen 15 mg/kg q6h and Ibuprofen 10 mg/kg q6h for postoperative analgesia from July of 2017 until January of 2018. Starting January of 2018 through November of 2018 (...) The Effect of Ibuprofen Dosing Interval on Post-Tonsillectomy Outcomes in Children: A Quality Improvement Study. In this Quality Improvement (QI project) it was hypothesized that an increase in dosing intervals for postoperative analgesia when alternating Ibuprofen and Acetaminophen would reduce post-tonsillectomy hemorrhage (PTH) rates for those undergoing tonsillectomies with or without adenoidectomy, while maintaining the standard of postoperative analgesia and reducing visits

2020 Rhinology and Laryngology

3. Sirolimus for management of complex vascular anomalies - A proposed dosing regimen for very young infants. (Abstract)

Sirolimus for management of complex vascular anomalies - A proposed dosing regimen for very young infants. Neonates with vascular anomalies causing airway compromise and other complications require early initiation of medical therapy. Sirolimus has emerged as a safe and effective treatment, but standard recommendations for dosing start at seven months. Guidelines are needed for dosing in very young infants, who have reduced hepatic metabolism of sirolimus. We present our experience treating six (...) neonates (mean age 14.8 days) with complicated vascular anomalies. Standard dosing caused supratherapeutic levels in this population. Our modified dosing regimen has resulted in safe therapeutic concentrations. Properly dosed, sirolimus is a viable and potentially lifesaving option for neonates with severe morbidity from vascular anomalies.Copyright © 2017. Published by Elsevier B.V.

2018 International Journal of Pediatric Otorhinolaryngology

4. Single vs. Multiple Privigen Dose Regimens in Pediatric CIDP

Single vs. Multiple Privigen Dose Regimens in Pediatric CIDP Single vs. Multiple Privigen Dose Regimens in Pediatric CIDP - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Single vs. Multiple Privigen Dose (...) Information provided by (Responsible Party): CSL Behring Study Details Study Description Go to Brief Summary: A randomized, open‑label, prospective, multicenter study designed to investigate 2 dose regimens in pediatric subjects 2 to < 17 years of age with confirmed or possible CIDP, either previously exposed to IVIG treatment or unexposed to IVIG treatment Condition or disease Intervention/treatment Phase Pediatric Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) Biological: IgPro10 Phase 4 Study

2018 Clinical Trials

5. Efficacy and Safety of a Multi-dose Regimen of Mebendazole Against Hookworm in Children

will only occur in case of a SAE, SUSAR or other kind of emergency. Primary Purpose: Treatment Official Title: Efficacy and Safety of a Single-dose Regimen and a Multi-dose Regimen of Mebendazole Against Hookworm Infections in School Children: a Randomized Controlled Trial Actual Study Start Date : July 25, 2017 Actual Primary Completion Date : September 15, 2017 Actual Study Completion Date : September 15, 2017 Resource links provided by the National Library of Medicine available for: resources: Arms (...) Efficacy and Safety of a Multi-dose Regimen of Mebendazole Against Hookworm in Children Efficacy and Safety of a Multi-dose Regimen of Mebendazole Against Hookworm in Children - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies

2017 Clinical Trials

6. Safety and Immunogenicity of Different Dosages of High-Dose Quadrivalent Influenza Vaccine in Children 6 Months to 17 Years of Age

Safety and Immunogenicity of Different Dosages of High-Dose Quadrivalent Influenza Vaccine in Children 6 Months to 17 Years of Age Safety and Immunogenicity of Different Dosages of High-Dose Quadrivalent Influenza Vaccine in Children 6 Months to 17 Years of Age - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have (...) reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Safety and Immunogenicity of Different Dosages of High-Dose Quadrivalent Influenza Vaccine in Children 6 Months to 17 Years of Age (QHD04) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT03698279

2018 Clinical Trials

7. Vitamin D Toxicity Associated with Different Vitamin D Dosing Regimens

database Syst Rev. 2011;(2):CD008873. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008873.pub2/abstract See: Vitamin D toxicity, page 6 Randomized Controlled Trials – Lead Poisoning 39. Groleau V, Herold RA, Schall JI, Wagner JL, Dougherty KA, Zemel BS, et al. Blood lead concentration is not altered by high-dose vitamin D supplementation in children and young adults with HIV. J Pediatr Gastroenterol Nutr [Internet]. 2013 Mar [cited 2014 Dec 1];56(3):316-9. Available from: http (...) . Querfeld U, Mak RH. Vitamin D deficiency and toxicity in chronic kidney disease: in search of the therapeutic window. Pediatr Nephrol. 2010 Dec;25(12):2413-30. PubMed: PM20567854 Vitamin D Toxicity Associated with Different Vitamin D Dosing Regimens 8 Additional References 49. Committee to Review Dietary Reference Intakes for Vitamin D and Calcium Food and Nutrition Board. Dietary Reference Intakes for Calcium and Vitamin D [Internet]. Washington (DC): The National Academies Press; 2011[cited 2014 Dec

2014 Canadian Agency for Drugs and Technologies in Health - Rapid Review

8. Vitamin D Toxicity Associated with Different Vitamin D Dosing Regimens

, Wagner JL, Dougherty KA, Zemel BS, et al. Blood lead concentration is not altered by high-dose vitamin D supplementation in children and young adults with HIV. J Pediatr Gastroenterol Nutr [Internet]. 2013 Mar [cited 2014 Dec 1];56(3):316-9. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4132882 PubMed: PM23059649 Non-Randomized Studies Dosing Unspecified 40. Quaggiotto P, Tran H, Bhanugopan M. Vitamin D deficiency remains prevalent despite increased laboratory testing in New South Wales (...) Vitamin D Toxicity Associated with Different Vitamin D Dosing Regimens TITLE: Vitamin D Toxicity Associated with Different Vitamin D Dosing Regimens: Safety DATE: 11 December 2014 RESEARCH QUESTION What is the clinical evidence regarding toxicity associated with different vitamin D dosing regimens? KEY FINDINGS Three systematic reviews (including one meta-analysis), 24 randomized controlled trials (RCTs), and six non-randomized studies were identified containing clinical evidence regarding

2014 Canadian Agency for Drugs and Technologies in Health - Rapid Review

9. Dexmedetomidine as Bolus or Low-dose Infusion for the Prevention of Emergence Agitation with Sevoflurane Anesthesia in Pediatric Patients. Full Text available with Trip Pro

Dexmedetomidine as Bolus or Low-dose Infusion for the Prevention of Emergence Agitation with Sevoflurane Anesthesia in Pediatric Patients. This study was designed to compare the prevention of emergence agitation (EA) of sevoflurane anesthesia by an intraoperative bolus or low-dose infusion of dexmedetomidine in pediatric patients undergoing lower abdominal surgeries.Forty-eight patients, aged 2-12 years, undergoing lower abdominal surgeries with sevoflurane anesthesia were enrolled (...) in this study. Patients were randomly assigned to receive either intravenous bolus over 10 min. 0.4 μg/kg dexmedetomidine (Group I, n = 24) or low-dose infusion 0.4 μg/kg/h of dexmedetomidine (Group II, n = 24) after intubation. Heart rate and mean arterial pressure were recorded before induction, at induction and every 5 min after induction. Observational pain scores (OPS), pediatric anesthesia emergence delirium (PAED) scores, and Ramsay sedation scores (RSS) were recorded on arrival to the postanesthesia

2019 Anesthesia, essays and researches Controlled trial quality: uncertain

10. Dosing Errors Made by Paramedics During Pediatric Patient Simulations After Implementation of a State-Wide Pediatric Drug Dosing Reference. (Abstract)

Dosing Errors Made by Paramedics During Pediatric Patient Simulations After Implementation of a State-Wide Pediatric Drug Dosing Reference. Background: Drug dosing errors occur at a high rate for prehospital pediatric patients. To reduce errors, Michigan implemented a state-wide pediatric dosing reference (PDR), with doses listed in milliliters, the requirement that doses be drawn into a smaller syringe from a pre-loaded syringe using a stopcock, and dilution of certain drugs to different (...) to carry out all the steps to administer a drug dose. Two evaluators scored crew performance via direct observation and video review. An error was defined as ≥ 20% difference compared to the weight-appropriate dose. Descriptive statistics were utilized. Results: A total of 142 simulations were completed. The majority of crews were (58.3%) Emergency Medical Technician-Paramedic (EMTP)/EMTP. For the cardiac arrest scenario, 51/70 (72.9%; 95% CI: 60.9%, 82.8%) epinephrine doses were correct. There were 6

2019 Prehospital emergency care

11. Efficacy and safety of multiple doses of tapentadol oral solution in the treatment of moderate to severe acute pain in children aged 2 to <18 years - a randomized, double-blind, placebo-controlled trial Full Text available with Trip Pro

and biological products in pediatric patients–FDA. Final rule. Fed Regist. 1998;63(231):66631–66672. - American Academy of Pediatrics, American Pain Society. The assessment and management of acute pain in infants, children, and adolescents. Pediatrics. 2001;108(3):793–797. doi:10.1542/peds.108.3.793 - - Association of Paediatric Anaesthetists of Great Britain and Ireland. Good practice in postoperative and procedural pain management, 2nd edition. Paediatr Anaesth. 2012;22(suppl1):1–79. doi:10.1111/j.1460 (...) Create a file for external citation management software Create file Cancel Actions Cite Share Permalink Copy Page navigation J Pain Res Actions . 2019 Nov 13;12:3099-3112. doi: 10.2147/JPR.S207010. eCollection 2019. Efficacy and Safety of Multiple Doses of Tapentadol Oral Solution in the Treatment of Moderate to Severe Acute Pain in Children Aged 2 to , , , , Affiliations Expand Affiliations 1 Grünenthal GmbH, Aachen, Germany. 2 Division of Paediatric Pharmacology and Pharmacometrics, University

2020 EvidenceUpdates

12. Radiation Safety in Children with Congenital and Acquired Heart Disease: A Scientific Position Statement on Multimodality Dose Optimization from the Image Gently Alliance

decisionmakingandprogrammaticapproachestoensureappropriatedosemonitoring.Lookingahead,thereisaneedfor standardization of dose metrics across imaging modalities, so as to encourage comparative effectiveness studies across the spectrum of CAHD in children. (J Am Coll Cardiol Img 2017;10:797–818) © 2017 The Authors. Published by Elsevier onbehalfoftheAmericanCollegeofCardiologyFoundation.ThisisanopenaccessarticleundertheCCBY-NC-NDlicense (http://creativecommons.org/licenses/by-nc-nd/4.0/). From the a Department of Pediatrics, Duke University Medical Center, Durham, North Carolina (...) ). Regardless of the imaging modality, optimization strategies almost always vary depend- ing on the patient size or body habitus. Strategies for dose optimization in adults typically cannot simply be applied to children. For practitioners engaged in pediatric medical imaging procedures that use ionizing radiation, it is necessary to understand theuniqueneedsofchildrenandthechallengesof optimized imaging across the spectrum of pediatric patients from the premature neonate to the adult- sized adolescent

2017 Heart Rhythm Society

13. Improving efficiency of pediatric emergency asthma treatment by using metered dose inhaler. (Abstract)

Improving efficiency of pediatric emergency asthma treatment by using metered dose inhaler. Evidence suggests using metered dose inhaler (MDI) to treat acute asthma in the Emergency Department reduces length of stay, though methods of implementation are lacking. We modified a treatment pathway to recommend use of MDI for mild-moderate asthma in a pediatric ED.A baseline review assessed discharged patients >2 years with an asthma diagnosis and non-emergent Emergency Severity Index triage

2018 Journal of Asthma

14. Repeat Intravenous Ketamine Dosing in Children Undergoing Emergency Department Procedural Sedation. (Abstract)

Repeat Intravenous Ketamine Dosing in Children Undergoing Emergency Department Procedural Sedation. Patients undergoing procedural sedation with intravenous ketamine often receive repeat doses to maintain dissociation; however, data between doses are lacking.The purpose of this study was to characterize the frequency, time interval, and dosages of ketamine received by children undergoing procedural sedation and to explore the effects of age and body mass index on these parameters.This (...) was a retrospective study of patients 1 to 18 years of age undergoing procedural sedation with intravenous ketamine in a pediatric emergency department between October 2016 and June 2017. Total repeat ketamine dosages were standardized to a 1-h sedation.Four hundred nineteen patients were included in the analysis. The median sedation time was 33.0 minutes (interquartile range [IQR] 25.0-45.0). Three hundred sixty-three patients (86.6%) received at least 1 repeat ketamine dose. The median time between doses

2018 Journal of Emergency Medicine

15. Assessment of Emergency Department Antibiotic Discharge Prescription Dosing Errors for Pediatric Patients in a Community Hospital Health System. (Abstract)

Assessment of Emergency Department Antibiotic Discharge Prescription Dosing Errors for Pediatric Patients in a Community Hospital Health System. We quantify and describe emergency department antibiotic discharge prescription dosing errors for pediatric patients in a community hospital health system.This was a retrospective chart review evaluating emergency department discharge prescriptions written between July 1, 2014, and June 30, 2015. Pediatric patients who received a prescription (...) for an oral antibiotic were included in error analysis if they had a weight updated in the electronic medical record during the encounter. We used a predefined threshold of +10% variance from the recommended dose to quantify error. Prescriber, environmental, and antibiotic specific data were also collected to identify variables associated with high incidence of error.Among the 1934 prescriptions included in our error analysis, we detected 776 (40%) dosing errors. Of the prescriptions reviewed, 288 (15

2018 Pediatric Emergency Care

16. Single dose oral midazolam for minor emergency department procedures in children: a retrospective cohort study Full Text available with Trip Pro

Single dose oral midazolam for minor emergency department procedures in children: a retrospective cohort study In the pediatric emergency department, patients are commonly treated with a single dose of oral midazolam for minor procedures. We sought to evaluate the effect of this treatment on procedure completion rates.We conducted a single-center retrospective cohort study of all patients who were treated with pre-procedure oral midazolam between January 2011 and June 2016. The primary outcome (...) was the procedure completion rate.During the study period, 1,504 patients were treated with oral midazolam as per department protocol; 1,467 received midazolam and 37 declined midazolam. Oral midazolam was used in 14 different types of emergency department procedures. The procedure completion rates in the treatment and non-treatment groups were 1,402/1,467 (95.6%) and 24/37 (64.8%), respectively (difference 30.7%; 95% confidence interval [CI] 17.3%-46.8%); p<0.0001. Treatment group patients had procedure

2018 Journal of pain research

17. A single dose of dezocine suppresses emergence agitation in preschool children anesthetized with sevoflurane-remifentanil. Full Text available with Trip Pro

A single dose of dezocine suppresses emergence agitation in preschool children anesthetized with sevoflurane-remifentanil. Emergence agitation (EA) is a common phenomenon in preschool children during emergence from general anesthesia. This study evaluated the safety and efficacy of dezocine for emergence agitation in preschool children anesthetized with sevoflurane-remifentanil.A total of 100 preschool children, scheduled for elective laparoscopic repair of an inguinal hernia by high ligation (...) undergone laparoscopic repair of an inguinal hernia by high ligation of the hernia sac under sevoflurane-remifentanil anesthesia.A single dose of dezocine suppresses emergence agitation in preschool children anesthetized with sevoflurane-remifentanil effectively: A double-blind, prospective, randomized, controlled study, Chinese Clinical Trial Registry (ID: ChiCTR-IOR-16010033), retrospectively registered on November 21, 2016.

2017 BMC Anesthesiology

18. Optimization of Methylphenidate Extended-Release Chewable Tablet Dose in Children with ADHD: Open-Label Dose Optimization in a Laboratory Classroom Study. Full Text available with Trip Pro

Optimization of Methylphenidate Extended-Release Chewable Tablet Dose in Children with ADHD: Open-Label Dose Optimization in a Laboratory Classroom Study. To examine methylphenidate extended-release chewable tablets (MPH ERCT) dose patterns, attention-deficit/hyperactivity disorder (ADHD) symptom scores, and safety during the 6-week, open-label (OL) dose-optimization period of a phase 3, laboratory classroom study.Boys and girls (6-12 years) diagnosed with ADHD were enrolled. MPH ERCT (...) ) at baseline to 12.4 (7.88) at OL week 5, with similar improvement patterns for hyperactivity/impulsivity and inattentiveness subscale scores. Participants optimized to MPH ERCT 50/60 mg/day had a significantly higher mean (standard error) ADHD-RS-IV score at baseline compared with participants optimized to MPH ERCT 20 mg/day (42.4 [1.34] vs. 35.1 [2.55]; p = 0.013). Treatment-emergent AEs were reported by 65/90 (72.2%) participants in the dose-optimization period.Dose-optimization period results

2018 Journal of Child and Adolescent Psychopharmacology

19. Single Dose Oral Dexamethasone Versus Multi-dose Prednisolone in the Treatment of Acute Exacerbations of Asthma in Children

Model Description: Randomized, open-label, non-inferiority trial Masking: Single (Outcomes Assessor) Masking Description: The Pediatric Respiratory Assessment Measure score will be performed by a clinician blinded to treatment allocation. Primary Purpose: Treatment Official Title: Single Dose Oral Dexamethasone Versus Multi-dose Prednisolone in the Treatment of Acute Exacerbations of Asthma in Children Who Attend the Emergency Department Actual Study Start Date : July 6, 2011 Actual Primary (...) in children who attend the Emergency Department. This is a randomized, non-inferiority, open-label clinical trial. After informed consent with or without assent, patients will be randomized to either oral dexamethasone 0.3 mg/kg stat or prednisolone 1 mg/kg/day for three days. The primary outcome measure is the comparison between the Pediatric Respiratory Assessment Measure (PRAM) across both groups on Day 4. The PRAM score, a validated, responsive and reliable tool to determine asthma severity

2018 Clinical Trials

20. Pediatric Weight Errors and Resultant Medication Dosing Errors in the Emergency Department. (Abstract)

Pediatric Weight Errors and Resultant Medication Dosing Errors in the Emergency Department. An accurate weight is critical for dosing medications in children. Weight errors can lead to medication-dosing errors.This study examined the frequency and consequences of weight errors occurring at 1 children's hospital and 2 general hospitals.Using an electronic medical record database, 79,000 emergency department encounters of children younger than 5 years were analyzed. Extreme weights were first (...) identified using weight percentiles. Encounters with potential weight errors were further evaluated using a retrospective chart review to determine whether a weight error and medication-dosing error occurred.The percentage of weight errors of total encounters at all 3 institutions was low (0.63% on average), but a large proportion of weight errors led to subsequent medication-dosing errors (34% on average). The children's hospital did not have clinically significantly lower occurrences of weight errors

2017 Pediatric Emergency Care

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