Sunday, April 23, 2017

Pediatric Breath Holding Spells

This post was peer reviewed.
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Author: Christine Au
Western University of Health Sciences, College of Osteopathic Medicine of the Pacific

In the world of emergency medicine, it is prudent to be trained and adept at handling the worse case scenario. Breath holding spells are a pediatric phenomenon that affects 5% of children from six months to four years where an involuntary pause in breathing occurs. This may lead to a patient becoming unconscious; however, these routine episodes are far from life-threatening.[1] Breath holding spells can be a result of various situations, such as a frightening or painful event, or can be linked to excessive anger in a child. Goldman defined this as a “benign paroxysmal non-epileptic disorder occurring in healthy children 6 to 48 months of age”.[2] There are two main types of spells: cyanotic and pallid. Cyanotic is much more common compared to the pallid type. These spells are a result of a decrease in heart rate, low oxygen, and high carbon dioxide in the system that may precipitate a loss of consciousness.

Thursday, April 20, 2017

Scapulothoracic Disassociation: A Rare and Devastating Injury

This post was peer reviewed.
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Image Credit: Emergency Medicine: Open Access











The Case
Trauma Activation: A 25-year-old motorcyclist traveling approximately 75 miles per hour lost control and the motorcycle slid from underneath him. His entire right side made primary contact with the road. Upon arrival, he was awake and able to participate in his examination. His left upper extremity was pulseless with a complete loss of motor function and sensation. 

Diagnosis
Left Scapulothoracic Dissociation - a traumatic disruption of the scapulothoracic articulation often associated with:
  • other orthopedic injuries including those to the acromioclavicular joint, clavicle, scapula, and sternoclavicular joint,
  • vascular injuries particular to the subclavian and axillary arteries,
  • neurologic injuries especially to the ipsilateral brachial plexus.[1,2]