Body piercing has become a fashionable trend in western culture. High ear piercing is common among the adolescent population and comlications from this procedure although uncommon can be permanently disfiguring. We describe a case of perichondritis after high ear piercing in an adolescent male. A review of the history of body piercing, complications, risk factors, and treatment is presented.

Objective A prospective blinded, randomized controlled trial was undertaken to compare the initial response of albuterol nebulized in heliox or control in the treatment of moderately severe asthma in children presenting to a pediatric ED. Methods Patients were randomized to receive heliox (n = 20) or control (n = 21). The primary outcome was to compare a modified dyspnea index score at 10 and 20 minutes after randomization. Secondary outcomes were to determine if heliox decreased admission rates or endotracheal intubation. Results There was no statistically significant difference found at 10 or 20 minutes after randomization with heliox (P = .169 and P = .062, respectively). No statistical difference in admission rate was found, and no patients required endotracheal intubation in either group. Conclusions Our results demonstrate that albuterol nebulized with heliox offered no clinical benefit over standard therapy in the initial treatment of moderately severe asthma in the ED.

Objective: A prospective blinded, randomized controlled trial was undertaken to compare the initial response of albuterol nebulized in heliox or control in the treatment of moderately severe asthma in children presenting to a pediatric ED. Methods: Patients were randomized to receive heliox (n=20) or control (n=21). The primary outcome was to compare a modified dyspnea index score at 10 and 20 minutes after randomization. Secondary outcomes were to determine if heliox decreased admission rates or endotracheal intubation. Results: There was no stastically significant difference found at 10 or 20 minutes after randomization with heliox (p = .169 and p = .62, respectively). No statistical difference in admission rate was found and no patients required endotracheal intubation in either group. Conclusions: Our results demonstrate that albuterol nebulized with heliox offered no clinical benefit over standard therapy in the initial treatment of moderately severe asthma in the ED.

Pediatric patients with CSF shunts frequently present to the ED for evaluation of possible shunt malfunction. Most shunt studies appear in the neurosurgical literature. To our knowlecge, none have reviewed presenting sighs and symptoms of shunt malfunction in patients who present to the PEM department. The study objective was to evaluate the medical record of children with cerebrospinal fluid shunts who presented to a pediatric emergency department in order to determine if any signs and/or symptoms were predictive of shunt malfunction. A retrospective chart review was conducted on peds patients 0-18 years who presented to the PED between 1/1/1998 - 12/31/2002 with signs and/or syptoms that prompted an evaluation for possible shunt malfunction. 352 patients were enrolled and of these 86 had a malfunction. Of all signs and symptoms evaluated, lethargy and shunt site swelling were significantly predictive of shunt malfunction (p

A prospective blinded, randomized controlled trial was undertaken to compare the initial response of albuterol nebulized in heliox or control in the treatment of moderately severe asthma in children presenting to a pediatric ED. METHODS: patients were randomized to receive heliox (n = 20) or control (n = 21). The primary outcome was to compare a modified dyspnea index score at 10 and 20 minutes after randomization. Secondary outcomes were to determine if heliox decreased admission rates or endotracheal intubation. Results There was no statistically significant difference found at 10 or 20 minutes after randomization with heliox (p=.169 and p=.062 respectivelyl). No statistical difference in admission rate was found and no patients required endotracheal intubation in either group. Conclusions: Our results demonstrate that albuterol nebulized w heliox offered no clinical benefit over standard therapy in the initial treatmen of moderately severe asthma in the ED.

Abstract: Body piercing has become a fashionable trend in Western culture. High ear piercing is common amongst the adolescent population and complications from this procedure although uncommon can be permanently disfiguring. We describe a case of perichondritis after high ear piercing in an adolescent male who presented to the emergency department. A discussion of the history of body piercing, complications, risk factors, and treatment are discussed.

Objectives: Many parents of children with ventriculoperitoneal shunts present to the emergency department for evaluation of a possible shunt malfunction. No study to date has evaluated their ability to predict a shunt malfunction. Our study objective was to evaluate parents? accuracy for predicting a shunt malfunction in their child. We hypothesized that parents, more experienced with prior shunt malfunctions are better able to predict subsequent malfunctions in their child. Methods: We conducted a prospective, descriptive study on children aged < 18 years presenting to our tertiary care pediatric emergency department with a possible ventriculoperitoneal shunt malfunction. Parents rated the likelihood of a shunt malfunction using an unmarked 100 mm visual analog scale (VAS) marked ?definitely malfunctioning? at the high end. An experienced parent was defined as one who had previously experienced at least 3 shunt malfunctions in their child. Results: We enrolled 85 parent-child dyads in our study. Twenty-four children were diagnosed with a malfunction. The best combination of sensitivity and specificity among the inexperienced parents was found at a VAS score of ≥ 53 (sensitivity 53.3%, specificity 58.3%) vs. ≥ 76 (sensitivity 77.8%, specificity 81.1%) in the experienced parents.. Experienced parents showed an area under the curve of 0.7928 [95% CI (0.6037, 0.9819)] and inexperienced parents 0.5611 [95% CI (0.3646, 0.7576)], p = 0.096. Conclusions: Experienced parents are better able to predict a shunt malfunction in their child.