Stiff Neck and Drooling in a Young Girl.

A 3-year-old girl was brought to the emergency department 4 days after she was playing with a button battery and subsequently had a choking episode. The patient was seen immediately at a different emergency department and was discharged home after a normal chest x-ray finding and able to tolerate an oral challenge with liquids. She was later evaluated by her primary care physician and started on amoxicillin for possible pharyngitis. On examination in our emergency department, the patient had pooling of secretions and was unwilling to range her neck due to pain. Soft tissue neck x-ray confirmed a 20-mm button battery in the esophagus with air lucencies in the prevertebral soft tissues.

Corticosteroid use in management of pediatric emergency conditions.

Corticosteroids have been used for over half a century to treat various inflammatory disorders; however, their use in many pediatric conditions remains controversial. This issue reviews evidence on corticosteroid treatment in acute asthma exacerbations, croup, acute pharyngitis, anaphylaxis, acute spinal injury, and bacterial meningitis. While corticosteroids are clearly indicated for management of asthma exacerbations and croup, they are not universally recommended for potential spinal cord injury. Due to insufficient data or conflicting data, corticosteroids may be considered in children with acute pharyngitis, anaphylaxis, and bacterial meningitis.

Ultrasound evaluation of urachal abscess in a young infant.

The urachus is a tubular structure extending from the dome of the bladder to the umbilicus. Normally, this allantoic and cloacal remnant obliterates into a fibrous band by late fetal development. Urachal abnormalities include a patent urachus, urachal cyst, umbilical urachal sinus, and a vesicourachal diverticulum. These abnormalities are most often asymptomatic and only come to clinical attention when associated with infection. A 2-month-old male infant presented to our tertiary pediatric hospital with several days of intermittent fevers and a focal region of swelling and erythema over the umbilicus. On physical examination, a tender mass was palpated in the umbilical region. Ultrasound revealed a long tubular structure coursing from the dome of the bladder anteriorly and superiorly to the subumbilical region. This tubular structure was fluid filled with internal echoes suggestive of infection with abscess formation. The urachal abscess was drained surgically, at which time a patent urachus was also excised. This case demonstrates the importance of having a thorough understanding of urachal anomalies when evaluating infants presenting with umbilical pathology.

Pediatric major trauma: an approach to evaluation and management.

Trauma is the leading cause of death in children nationwide. Proper management of the pediatric trauma patient involves many of the components contained within standard trauma protocols. By paying strict attention to the anatomical and physiological differences in the pediatric population, clinicians will be assured the best possible outcomes. This article outlines the fundamentals of proper management of pediatric trauma patients.