ABSTRACT
BACKGROUND: An examination of invasive procedure cancellations found that the lack of pre-procedural oral screening was a preventable cause, for children with congenital heart disease. The purpose of this study was to implement an oral screening tool within the paediatric cardiology clinic, with referral to paediatric dental providers for positive screens. The target population were children aged ≥6 months to <18 years old, being referred for cardiac procedures. METHODS: The quality implementation framework method was used for this study design. The multi-modal intervention included education, audit and feedback, screening guidelines, environmental support, and interdisciplinary collaboration. Baseline rates for oral screenings were determined by retrospective chart audit from January 2018 to January 2019 (n = 211). Provider adherence to the oral screening tool was the outcome measure. Positive oral screens, resulting in referral to the paediatric dental clinic, were measured as a secondary outcome. Provider adherence rates were used as a process measure. RESULTS: Data collected over 14 weeks showed a 29% increase in documentation of oral screenings prior to referral, as compared to the retrospective chart audit. During the study period, 13% of completed screenings were positive (n = 5). Provider compliance for the period was averaged at 70% adherence. CONCLUSION: A substantial increase in pre-procedural oral screenings by paediatric cardiologists was achieved using the quality implementation framework and targeted interventions.
Subject(s)
Cardiologists , Heart Defects, Congenital , Child , Heart Defects, Congenital/diagnosis , Humans , Infant , Pediatricians , Referral and Consultation , Retrospective StudiesSubject(s)
Electric Countershock/adverse effects , Tachycardia, Ectopic Junctional/therapy , Ventricular Fibrillation/etiology , Amiodarone/administration & dosage , Anti-Arrhythmia Agents/administration & dosage , Female , Humans , Infant , Ventricular Fibrillation/diagnosis , Ventricular Fibrillation/drug therapyABSTRACT
Traumatic injuries that involve the dentition and maxillofacial region may occur as isolated events in pediatric patients but are often associated with multisystem injuries and traumatic brain injuries. The primary trauma survey serves to identify and treat life-threatening injuries. The secondary trauma survey is a complete examination of the patient after the stabilization of physiological parameters. Frequent neurologic and physical assessments of the injured child are crucial to preventing deterioration. The role of the dental professional is to identify and refer for medical evaluation patients who present with concerning neurologic signs and symptoms after traumatic injuries to the maxillofacial region.
Subject(s)
Maxillofacial Injuries/diagnosis , Neurologic Examination , Physical Examination , Accidents, Traffic , Airway Management/methods , Brain Injuries/diagnosis , Brain Injuries/therapy , Cervical Vertebrae/pathology , Child, Preschool , Glasgow Coma Scale , Hemodynamics/physiology , Humans , Male , Multiple Trauma/diagnosis , Multiple Trauma/therapy , Protective Devices , Shock/diagnosis , Spleen/injuries , Trauma Severity IndicesABSTRACT
Traumatic injuries that involve the dentition and maxillofacial region may occur as isolated events in pediatric patients but are often associated with multisystem injuries and traumatic brain injuries. The primary trauma survey serves to identify and treat life-threatening injuries. The secondary trauma survey is a complete examination of the patient after the stabilization of physiological parameters. Frequent neurologic and physical assessments of the injured child are crucial to preventing deterioration. The role of the dental professional is to identify and refer for medical evaluation patients who present with concerning neurologic signs and symptoms after traumatic injuries to the maxillofacial region.
Subject(s)
Maxillofacial Injuries/diagnostic imaging , Physical Examination , Abdominal Injuries/diagnostic imaging , Brain Injuries/diagnostic imaging , Child, Preschool , Humans , Male , Neurologic Examination , Spleen/injuries , Tomography, X-Ray Computed , Trauma Severity IndicesABSTRACT
Children with prosthetic cardiac valves and other invasive mechanical devices that direct blood flow require anticoagulant medication for prevention of thrombosis. Dental surgery for these children has historically consisted of decreasing and/or discontinuing the oral anticoagulant and instituting heparin therapy prior to the planned dental procedure, which can result in thromboembolism and increased morbidity and mortality. This case report demonstrates that oral anticoagulation need not be decreased or discontinued prior to extraction of multiple carious primary teeth in a child at risk for thromboembolism.
Subject(s)
Dental Care for Children , Dental Care for Chronically Ill , Heart Valve Prosthesis/adverse effects , Stents/adverse effects , Thromboembolism/prevention & control , Tooth Extraction/methods , Anticoagulants/therapeutic use , Child , Dental Caries/surgery , Heparin/therapeutic use , Humans , Male , Pulmonary Artery , Tooth Extraction/adverse effects , Warfarin/therapeutic useABSTRACT
This report provides a description and discussion of a 19-year-old, 65-kg male, with a large mediastinal mass, right pleural effusion, and pericardial effusion, requiring urine alkalinization during a propofol infusion. The patient required NaHCO3 boluses, urine pH, electrolyte, arterial blood gas and lactate monitoring, and discontinuation of the propofol. The authors suggest that caution be used when prescribing a propofol infusion for patients who are at risk of tumor lysis syndrome and the need for urine alkalinization.
Subject(s)
Mediastinal Neoplasms/urine , Pericardial Effusion/urine , Pleural Effusion, Malignant/urine , Tumor Lysis Syndrome/urine , Adult , Anesthetics, Intravenous/administration & dosage , Humans , Hydrogen-Ion Concentration , Male , Mediastinal Neoplasms/therapy , Pericardial Effusion/therapy , Pleural Effusion, Malignant/therapy , Propofol/administration & dosage , Sodium Bicarbonate/administration & dosage , Tumor Lysis Syndrome/therapyABSTRACT
As professionals who care for the sickest children, we want to provide the best evidence-based care available. While there are questions still to be answered, it is clear that when propofol is administered to children, it should be done in a manner that is intentional, well planned, and consistent with national guidelines and regulatory groups. Haphazard administration of propofol will place children at risk.
Subject(s)
Conscious Sedation/nursing , Critical Care/organization & administration , Hypnotics and Sedatives/therapeutic use , Pediatric Nursing/organization & administration , Propofol/therapeutic use , Child , Conscious Sedation/adverse effects , Conscious Sedation/methods , Drug Approval , Drug Monitoring , Humans , Hypnotics and Sedatives/adverse effects , Intensive Care Units, Pediatric , Nurse's Role , Patient Care Planning/organization & administration , Patient Selection , Practice Guidelines as Topic , Propofol/adverse effects , Safety Management/organization & administration , United States , United States Food and Drug AdministrationABSTRACT
BACKGROUND: Subcutaneous emphysema is a rare occurrence in the dental setting. When it does occur, the entity may be mistaken for an anaphylactic reaction to a local anaesthetic agent or other medications used in dental surgery. CASE REPORT: During restorative treatment of a left second primary molar air was introduced under an operculum. Communication with submandibular and sublingual spaces to the mediastinum was established. CONCLUSION: Therapy for subcutaneous emphysema involves, correct diagnosis and antibiotic coverage. Subcutaneous air will resolve over time so observation is indicated.
Subject(s)
Dental Restoration, Permanent/adverse effects , Face , Neck/pathology , Subcutaneous Emphysema/etiology , Child, Preschool , Dental Caries/therapy , Dental Restoration, Permanent/instrumentation , Female , Humans , Mediastinal Emphysema/etiology , Molar/pathology , Tooth, Deciduous/pathologySubject(s)
Airway Obstruction/etiology , Airway Obstruction/therapy , Mucus , Positive-Pressure Respiration , Humans , Infant , MaleABSTRACT
It was previously shown that children with congenital heart disease (CHD) harbored Hemophilus, Actinobacillus, Cardiobacter, Eikenella, and Kingella (HACEK) microbes to a greater extent and had more severe gingival inflammation than a normal group of children. The purpose of this study was to determine if HACEK microbes are more prevalent in children with CHD than in normal children when there is no difference in gingival inflammation. Two groups of 12 children were matched with respect to gingival inflammation. Each child had a gingival index recorded as described by Massler. The experimental group consisted of 12 children with CHD 2.5-10 years old (average 5.5) and the control group consisted of 12 healthy children 2-13 years old (average 5.6). Subgingival samples were obtained and cultured for HACEK microbes. Fischer's exact test was performed with the significance level defined at P<0.05. The average gingival indices for the experimental and control groups were 6.5 and 6.4, respectively (N.S.). Nine of 12 children with CHD had Eikenella corrodens (E.c.) compared to 3/12 control patients ( P<0.05). Three of 12 CHD patients but no control patient had Actinobacillus actinomycetemcomitans (A.a.) (N.S.). There were no significant differences in E.c. or A.a. presence between cyanotic and acyanotic CHD patients. This study found that the greater extent of specific HACEK microbes harbored by children with CHD is not associated with cyanosis or the degree of gingival inflammation. Further study is needed to delineate fully the medical significance of this observation.
Subject(s)
Gingivitis/microbiology , Heart Defects, Congenital/microbiology , Aggregatibacter actinomycetemcomitans/isolation & purification , Case-Control Studies , Child , Child, Preschool , Cyanosis/etiology , Eikenella corrodens/isolation & purification , Gingivitis/complications , Gram-Negative Facultatively Anaerobic Rods/isolation & purification , Haemophilus/isolation & purification , Heart Defects, Congenital/complications , Humans , Kingella/isolation & purification , Periodontal IndexABSTRACT
OBJECTIVE: To optimize CO2 removal in a child with a single ventricle. DESIGN: Case report. SETTING: A ten-bed pediatric intensive care unit in a university-affiliated hospital. PATIENT: A 6-yr-old boy with a single ventricle who underwent a Fontan procedure. INTERVENTIONS: Addition of a membrane oxygenator to a venovenous hemodialysis circuit. MEASUREMENTS: Patient respiratory variables were measured. MAIN RESULTS: A clinically significant improvement in CO2 removal was achieved. CONCLUSIONS: Addition of a membrane oxygenator to a dialysis circuit facilitates CO2 removal.