The 2019 coronavirus disease has not appeared to affect children as severely as adults. However, approximately 1 month after the COVID-19 peak in New York City in April 2020, cases of children with prolonged fevers abruptly developing inflammatory shock-like states have been reported in Western Europe and the United States. This case series describes four previously healthy children with COVID-19 infection confirmed by serologic antibody testing, but negative by nasopharyngeal RT-PCR swab, presenting to the Pediatric Emergency Department (PED) with prolonged fever (5 or more days) and abrupt onset of hemodynamic instability with elevated serologic inflammatory markers and cytokine levels (IL-6, IL-8 and TNF-α). Emergency physicians must maintain a high clinical suspicion for this COVID-19 associated post-infectious cytokine release syndrome, with features that overlap with Kawasaki Disease (KD) and Toxic Shock Syndrome (TSS) in children with recent or current COVID-19 infection, as patients can decompensate quickly.

ClinicalTrials.gov; No.: NCT01654887; URL: www.clinicaltrials.gov.

Background. Healthcare simulations are used at most academic facilities to improve knowledge and performance on critical and key concepts and can also be used to enhance competency and teamwork. Group simulation scenarios often have individual team leaders, but these scenarios require a team to work together to efficiently care for the patient. Escape rooms can be utilized in healthcare as a fun educational activity to encourage teams to work together and think creatively to solve puzzles and challenges. One advantage of this type of activity in a healthcare setting is to dissolve any hierarchy amongst the team and build the confidence of novice or more passive participants. Escape rooms in a healthcare setting do not have to be medically themed to be effective, and rooms can be set up with minimal equipment. Aim. This article addresses the detailed steps required to set up a healthcare themed escape room that has been shown to work well. It is applicable to healthcare professionals and can be adapted for non-healthcare workers. Method. Based on the Escape Room video games and social activity phenomenon, teams compete to solve content-specific challenges to attain pieces of the final puzzle set forth by the instructors. Traditional quiz-type exercises, pictograms, and procedural based activities comprise the puzzles of the game. The first team to obtain all pieces of the final clue and put them together in the correct order in the shortest amount of time is deemed the winner. Gameplay is designed to conclude in approximately 20 minutes. Results and Conclusion. This game mimics interdisciplinary teamwork environments. Participating in interactive collaborative learning environments enhances the overall learning experience, allowing learners to apply knowledge.

Unintentional injuries are the leading cause of death in the United States among children older than 1 year of age, adolescents, and young adults. Each year, nearly 9 million pediatric patients are treated in emergency departments for unintentional injuries, and more than 9,000 die from their injuries, amounting to approximately 25 children each day. Common causes of fatal and nonfatal unintentional injury include motor vehicle collisions, drownings, fires, falls, and sports-related injuries. Aside from their morbidity and mortality, these injuries and their treatment result in significant financial burdens for families and society.Children and adolescents are particularly vulnerable to injury because of their size, immature development, natural curiosity, and inexperience. Males have a higher risk of injury compared to females, and the male death rate from injury is twice that of females. A number of social factors suggestive of family stress and disorganization are associated with greater childhood injury, including lower socioeconomic status, lower maternal age, lower maternal education, and an increased number of people living in one household. Injury rates also vary based on geographic location. Fire and burn-related injuries and deaths are greatest in the southern states, while trafficrelated injuries are greatest in the Great Plains states and the South. Motor vehicle crashes are a leading cause of preventable deaths across all age groups.Patient visits to the office or the emergency department provide physicians with the opportunity to educate parents and children on safety and injury prevention. The specific anticipatory guidance provided to families should depend on the age of the child because the risk and type of injury vary with age. Promoting safety and preventing injury during a child's first year after birth can be difficult because infants are rapidly developing during this time. Families often underestimate infants' motor skills and overestimate their cognitive skills. Suffocation and motor vehicle crashes are the most common causes of injury and death. Parents must pay special attention to restricting infants' exposure to choking and suffocation hazards such as small toys, balloons, and plastic bags. Infants and toddlers should ride in rear-facing safety seats until they reach the age of 2 years or the highest height and weight allowed by the car seat manufacturer.

Escape room games have gained in popularity in both entertainment and education venues over the past several year. The global health pandemic put an abrupt end to in-person escape room programs due to the enclosed space in which they take place. In an attempt to continue to utilize the escape room concept we set about to create a virtual escape room using commonly available software and assessed its usability and participant feelings about the experience. The results indicated that the participants thought the escape room was engaging (88%), that they had to work as a team (95%), and that they overall enjoyed the experience (85%). Virtual experiences cannot completely replace in-person experiences, but there are ways to introduce important teamwork and communication concepts to participants and make online meetings and conferences more engaging.

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Objectives: To evaluate whether ultrasound can differentiate between cellulitis and angioedema from insect bites in pediatric patients.Methods: A prospective, pre-post study in an urban pediatric emergency department of patients younger than 21 years with soft tissue swelling from insect bites without abscesses were enrolled. Treating physician's pretest opinions regarding the diagnosis and need for antibiotics were determined. Ultrasound of the affected areas was performed, and effects on management were recorded. Further imaging, medications, and disposition were at the discretion of the enrolling physician. Phone call follow-ups were made within a week of presentation.Results: Among 103 patients enrolled with soft tissue swelling secondary to insect bites, ultrasound changed the management in 27 (26%) patients (95% confidence interval [CI], 18-35%). Of the patients who were indeterminate or believed to require antibiotics, ultrasound changed management in 6 (23%) of 26 patients (95% CI, 6%-40%). In those patients who were believed not to require antibiotics, ultrasound changed management in 12 (16%) 77 patients (95% CI, 7%-24%). Patients with diagnosis of local angioedema achieved symptom resolution 1.4 days sooner than patients diagnosed with cellulitis (mean, −1.389; 95% CI, −2.087 to −0.690; P < 0.001).No patient who was initially diagnosed as local angioedema received antibiotics upon patient follow-up.Conclusions: Point-of-care ultrasound changed physician management in 1 of 4 patients in the pediatric emergency department with soft tissue swelling secondary to insect bites. Ultrasound may guide the management in these patients and lead to improved antibiotic stewardship in conjunction with history and physical examination.

Enterobius vermicularis is a parasite that inhabits the human digestive tract. We present two pediatric patients with symptoms mimicking acute appendicitis who were found to have E. vermicularis infection. The first case is a 5-year-old female who presented with flank and abdominal pain associated with low-grade fever and anorexia. She had localized tenderness in the right lower quadrant and a leukocytosis with left shift. Intraoperative findings included a normal-appearing appendix, but ex vivo examination revealed Enterobius vermicularis. The second case is a 7-year-old female who presented with periumbilical abdominal pain, anorexia, and emesis. She had tenderness at McBurney's point, and ultrasound revealed a small echogenic focus within the appendix. Intraoperatively, the distal tip of the appendix appeared inflamed. Again, ex vivo examination revealed E. vermicularis. Enterobius vermicularis infection of the appendix can present with a clinical picture similar to acute appendicitis. In at-risk populations, it should be included in the differential diagnosis for children with right lower quadrant abdominal pain. Complete therapy requires treatment with mebendazole.