Teen Distracted Reality an Interactive Virtual Education (D.R.I.V.E.): Experience and Impact on Teenage Drivers

Introduction: In 2013, 2,163 teens in the United States ages 16–19 were killed and 243,243 were treated in emergency departments for injuries from motor vehicle crashes. distracted driving (i.e. texting, loud music, or phone conversations) and impaired driving (driving under the influence) play a role in these motor vehicle crashes. Prevention efforts aimed at high-risk teenager driving behavior may encourage safe driving habits. Methods: The Teen D.R.I.V.E. program is a mobile driving simulator that provides teenagers with distracted and impaired driving scenarios. We administered anonymous surveys from April 2015-April 2016 to obtain demographic data and evaluate the program’s impact on their driving behavior. We retrospectively analyzed survey responses using univariate and multivariate statistical analysis. Results: A total of 1374 participants in the survey, however, 50 did not respond to the driving experience portion of the survey. Most participants (70%) were between 16-17 years of age years old and 51% were males. A majority (76%) of respondents had driving experience (26% permit, and 46% license) or had attended a driver’s education course (67%). After experiencing the simulation respondents felt that the consequences of driving distracted (53%) and driving impaired (61%) were worse than previously expected. In addition, participants said that they would never drive distracted (70%) or drive impaired (90%). A majority of participants (72%) feel that simulation is the most effective way to teach driving related topics. Conclusion: Teen D.R.I.V.E. offers a valuable experience to teenagers, teaching them about the dangers of driving distracted and impaired. Participants are likely to never drive impaired compared or distracted. Most teenagers feel simulation teaches these driving lessons most effectively

Are Goods for Guns Good for the Community? An Update of a Community Gun Buyback Program

BACKGROUND: Gun violence remains a leading cause of death in the United States. Community gun buyback programs provide an opportunity to dispose of extraneous firearms. The purpose of this study was to understand the demographics, motivation, child access to firearms and household mental illness of buyback participants in hopes of improving the program\u27s effectiveness. METHODS: A 2015 Injury Free Coalition for Kids gun buyback program which collaborated with local police departments was studied. We administered a 23-item questionnaire survey to gun buyback participants assessing demographic characteristics, motivation for relinquishing firearms, child firearm accessibility, and mental illness/domestic violence history. RESULTS: A total of 186 individuals from Central/Western Massachusetts turned in 339 weapons. Participants received between $25 and$75 in gift cards dependent on what type of gun was turned in, with an average cost of $41/gun. A total of 109 participants (59%) completed the survey. Respondents were mostly white (99%), male (90%) and first-time participants in the program (85.2%). Among survey respondents, 54% turned in firearms for safety reasons . Respondents reported no longer needing/wanting their weapons (47%) and approximately one in eight participants were concerned the firearm(s) were accessible to children. Most respondents (87%) felt the program encouraged neighborhood awareness of firearm safety. Three out of every five participants reported that guns still remained in their homes, additionally; 21% where children could potentially access them and 14% with a history of mental illness/suicide/domestic violence in the home. CONCLUSIONS: Gun buybacks can provide a low-cost means of removing unwanted firearms from the community. Most participants felt their homes were safer after turning in the firearm(s). In homes still possessing guns, emphasis on secure gun storage should continue increasing the safety of children and families. The results of this survey also provided new insights into the association between mental illness/suicide and gun ownership. LEVEL OF EVIDENCE: Level III, Prognostic and Epidemiological

Pediatric Respiratory Emergencies : Upper Airway Obstruction and Infections

Respiratory distress from upper airway obstruction is an unusual but potentially catastrophic emergency in young children. It may be caused by a number of different processes, alone or in combination, including an acute infectious process, a congenital anomaly, or a foreign body in the airway or esophagus. A working knowledge of the anomalies and diseases of the upper airway is of primary importance in pediatric emergency medicine. Classification of airway pathology can be based on the anatomic location, the patient\u27s age, the urgency of the symptoms, and whether it is a congenital or acquired lesion or an infectious or noninfectious process. The starting point for any classification is an appreciation of the unique aspects of pediatric airway anatomy

Underuse of analgesia in very young pediatric patients with isolated painful injuries

STUDY OBJECTIVE: We sought to compare the use of analgesic agents in very young children with that in older children with isolated painful injuries. METHODS: We performed a retrospective chart review of patients seen between 1999 and 2000 in a pediatric emergency department. Patients aged 6 months to 10 years who sustained isolated long bone fractures or second- and third-degree burns were included. Exclusion criteria included head injury, chest or abdominal trauma, and developmental delay or neurologic disorder. Research subjects were separated into 2 study groups: very young (ages 6 to 24 months) and school age (ages 6 to 10 years). RESULTS: One hundred eighty research subjects met the inclusion and exclusion criteria: 96 in the very young group and 84 in the school age group. Research subjects in the very young group received no analgesic agents more often than school age research subjects for all injuries (64.6% versus 47.6%, respectively), all fractures (70.6% versus 48.8%, respectively), displaced fractures (55.0% versus 22.0%, respectively), and all burns (50.0% versus 25.0%, respectively). When analgesic agents were administered, very young patients were less likely to receive narcotics compared with school age patients. Analgesic dosing for both the very young and school age groups was similar and within established guidelines. CONCLUSION: Children younger than 2 years of age receive disproportionately less analgesia than school age children, despite having obviously painful conditions. Emergency physicians should consider special issues involved in assessing and managing pain in very young children

Being a Child in the Midst of Terrorism

Terrorism—a planned, often politically motivated event designed to kill many innocent victims and inflict physical pain, psychological suffering, and fear on an entire community—is new to our Western culture, but not to children worldwide. Terrorism, violence, and disaster have involved children in the form of naturally occurring events; transportation accidents; exposure to war; social, ethnic and religious conflict; and as collateral damage in adult mass casualty incidents. Throughout childhood and adolescence, children are physically less capable and emotionally more vulnerable to the effects of terrorism. This fact may make children likely primary targets for terrorism in the future. Children are unique from the perspective of their anatomy, physiology, emotional development, and response to specific physical and psychological insults. These unique needs of children have rarely been considered in disaster planning. Civilian emergency physicians and Emergency Medical Services (EMS) systems have learned about mass casualty incidents through military models, focused on the needs of adult victims; consequently, they have limited personal clinical experience with pediatric disaster medicine. A terrorist attack with predominately pediatric casualties would have a tremendous and far-reaching impact on all child survivors, family members, and the community at large. All facets of the EMS system must be aware of this potential and be prepared to meet the special and divergent needs of children in the setting of a chemical, biological, radiation, or explosive event that involves large numbers of children. A paradigm shift that deals with unaddressed issues of treatment, equipment, triage, and training is a critical step in preparing to address the needs of children in the midst of terrorism

Coccygeal fracture, constipation, convulsion, and confusion: a case report of malignant hypertension in a child

Malignant hypertension is an unusual but well described cause of seizures in pediatrics. It is a medical emergency that must be recognized and emergently treated to prevent morbidity and mortality. In contrast to adults, hypertension in children is usually secondary to an underlying disease process. We present a complex case of hypertensive encephalopathy with seizures as the initial presentation of a pelvic mass, describe the initial work-up and stabilization and present an overview of the literature. Review of the medical literature described only one similar presentation (1). Interestingly, acute symptoms in this patient may have been precipitated by use of an over-the-counter medication

Injury and Violence

Injury is the leading cause of death for persons 1–44 years and the 4th leading cause of death overall. Regardless of whether intentional or unintentional, injury is both predictable and preventable

Status epilepticus in a child secondary to ingestion of skin-lightening cream

The popularity of the Internet and online media has led to the increased availability of prescription-strength, skin-lightening products contributing to a rise in their use among people with various skin pigment disorders. These products may contain a wide variety of active ingredients such as heavy metals, hydroquinone, and corticosteroids that can be highly toxic, especially after prolonged application. For decades, there have been case reports of both corticosteroid and heavy metal toxicity related to skin-lightening cream use. We report a case of a child who developed status epilepticus after ingesting a skin-lightening solution containing 2% hydroquinone. The toxicodynamics of hydroquinone and its effects on the central nervous system are discussed

A prospective evaluation of the 1-hour decision point for admission versus discharge in acute asthma

Study objectives were to evaluate the 1-hour decision point for discharge or admission for acute asthma; to compare this decision point to the admission recommendations of the Expert Panel Report 2 (EPR-2) guidelines; to develop a model for predicting need for admission in acute asthma. The design used was a prospective preinterventional and postinterventional comparison. The setting was a university hospital emergency department. Participants included 50 patients seeking care for acute asthma. Patients received standard therapy and were randomized to receive albuterol by nebulizer or metered-dose inhaler with spacer every 20 minutes up to 2 hours. Symptoms, physical examination, spirometry, pulsus paradoxus, medication use, and outcome were evaluated. Based on clinical judgment, the attending physician decided to admit or discharge after 1 hour of therapy. Outcome was compared to the EPR-2 guidelines. Post hoc statistical analyses examined predictors of the need for admission from which a prediction model was developed. Maximal accuracy of the admit versus discharge decision occurred at 1 hour of therapy. Using FEV(1) alone as an outcome predictor yielded suboptimal performance. FEV(1) at 1 hour plus ability to lie flat without dyspnea were the best indicators of response and outcome. A model predictive of the need for admission was developed. It performed better (P =.0054) than the admission algorithm of the EPR-2 guidelines. The decision to admit or discharge acute asthmatics from the ED can be made at 1 hour of therapy. No absolute value of peak flow or FEV(1) reliably predicts need for hospital admission. The EPR-2 guideline thresholds for admission are barely adequate as outcome predictors. A clinical model is proposed that may allow more accurate outcome prediction