The change in legal status of cannabis (the botanical species Cannabis sativa, commonly known as marijuana) in the United States has had significant impact on pediatric drug exposures. In states with decriminalization of recreational and medicinal use of cannabis, emergency department visits and poison control center calls for unintentional pediatric cannabis intoxication are on the rise in the last few decades. Exploratory or unintentional ingestions of cannabis-containing products (as opposed to those derived from synthetic cannabinoids, which may mimic the structure and/or function of cannabis, but are not the focus of this article) can lead to significant pediatric toxicity, including encephalopathy, coma, and respiratory depression. With the increasing magnitude of the public health implications of widespread cannabis use, clinicians who care for pediatric patients routinely must be adept in the recognition, evaluation, management, and counseling of unintentional cannabis exposure.
Background: Burnout is a common phenomenon among health care providers known to adversely affect their mental health and clinical acumen. As mindfulness has been shown to diminish burnout with large-scale interventions, our aim was to assess whether smaller, on-shift activities aimed at increasing mindfulness could decrease burnout among staff in a pediatric emergency department (PED). Methods: Prior to the implementation of a series of mindfulness-based activities, a diverse cohort of PED staff including nurses, physicians, nurse practitioners, technicians, and administrative personnel completed electronic preintervention surveys about their demographics, personal mindfulness engagement, and individual baseline burnout level using the Maslach Burnout Inventory (MBI). Trained nurses and physicians served as champions who coordinated on-shift mindfulness activities, and burnout levels were subsequently reassessed using a postintervention survey. Findings: Among 83 eligible staff, 75 completed the preintervention and 69 completed the postintervention survey. For the MBI, the majority of staff had moderate to high burnout levels at baseline. Few staff engaged in personal mindfulness activities outside of work. Although 82% of staff participated in the on-shift interventions, no significant differences were found in scores before and after the intervention for emotional exhaustion (20.1 vs. 20, p = .93), depersonalization (7.6 vs. 7.3, p = .97), and personal accomplishment (36.1 vs. 34.8, p = .11). Conclusion/Application to Practice: While mindfulness effectively combats burnout, few PED providers regularly practice mindfulness activities. Brief, on-shift mindfulness activities were insufficient to significantly reduce burnout levels. Hospital leadership should consider dedicating resources to more intensive mindfulness activities to combat amplified burnout levels among emergency department staff.
The sleeping arrangements of young children may depend on factors such as socioeconomic limitations and cultural beliefs. Approximately 3,700 infants die annually in the United States from sudden unexpected infant deaths (SUID), including sudden infant death syndrome (SIDS), accidental suffocation and less frequently reported, strangulation of the neck because of hair tourniquet syndrome when a young child co-sleeps with family members who have long hair. This case report describes a 13-month old male who was brought to the pediatric emergency department after he was found entangled with his mother's hair around his neck. The mother was awoken by her son's movement, struggling to breathe in bed. Given the unusual nature of the event, presentation of the child with diffuse facial petechiae and circumferential ligature mark that extended around his neck, the child was admitted to the general pediatric ward for observation and further investigation of possible non-accidental trauma. To the best of our knowledge, only two previous case reports of such strangulation from human hair were reported within the last 2 decades. The aim of this case report is to increase physician and parental awareness of the potential danger in accidental strangulation during cosleeping, and promote safe sleep environments.
Pediatric bilateral facial nerve paralysis (FNP) is a rare condition, representing less than 2% of all cases of FNP. The differential diagnosis of FNP is extensive (ranging from infectious, traumatic, neurologic, to idiopathic) and often can present as a diagnostic challenge. In contrast to unilateral presentation, bilateral FNP presents as a manifestation of serious systemic conditions, including meningitis (infectious and neoplastic), brain stem encephalitis, Guillain-Barre syndrome, sarcoidosis, Lyme disease, human immunodeficiency virus infection, leukemia, and vasculitis. In the evaluation of a child who presents with bilateral FNP, history plays the utmost role in the diagnosis. A history of rash consistent with erythema chronicum migrans, recent tick exposure, or travel to a Lyme disease–endemic area is highly suggestive that the facial paralysis is a result of Lyme disease. It is also important to recognize that Lyme disease is emerging as the most common infectious etiology of bilateral FNP in the pediatric population. In this case report, we describe a 16-year-old boy who presented to the emergency department with complaints of headache and bilateral FNP, an unusual presentation of Lyme disease.
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