Illicit drug use continues to be a common problem among pediatric patients. Daily marijuana use among high school seniors is currently at a 30-year high. Marijuana use in adults has rarely been associated with cardiovascular adverse effects, including hypertension, tachycardia, arrhythmia, and myocardial infarction. Recently, abuse of synthetic cannabinoids, such as the incense "K2" or "Spice," has been increasingly reported in the lay press and medical literature. Overdose and chronic use of these substances may cause adverse effects including altered mental status, tachycardia, and loss of consciousness. Overdoses in adult patients have been described; however, limited reports in the pediatric population have been documented. A recent case series describes myocardial infarctions in pediatric patients, associated with synthetic cannabinoid use. In this report, we describe two adolescent patients admitted after they inhaled "K2," resulting in loss of consciousness, tachycardia, and diffuse pain.

Background: Pediatric seizures are commonly encountered in emergency medical services (EMS). Evidence is accumulating that the rate of hypoglycemia in this setting is low, challenging the concept of routine prehospital glucose measurement.Objective: We studied factors associated with EMS protocol compliance for glucose testing in children < 18 years of age with a 9-1-1 call for seizure as well as rates of hypoglycemia in the prehospital setting. Methods:We performed a retrospective analysis of data from the North Carolina EMS registry from 2013 to 2014. North Carolina EMS protocols require glucose measurement prior to seizure treatment. Scene calls for patients ≤ 17 years with a complaint of seizure were included. We calculated incidence of testing, hypoglycemia, and the relative risk of compliance with glucose measurement.Results: There were 13,182 calls for seizure, of which 6,262 (47.5%, 95% confidence interval [CI] = 46.6% to 48.3%) had a glucose obtained. Hypoglycemia (glucose < 60 mg/dL) was present in 78 of 6,262 (1.25%, 95% CI = 0.97% to 1.5%) patients. Glucose was supplemented in 61 patients (median glucose 61 mg/dL, interquartile range = 51 to 67 mg/dL). Testing rates increased with age (relative risk [RR] = 1.04 per year, 95% CI = 1.03-1.04 per year), emergency medical technician-paramedic (EMT-P) presence (RR = 1.2, 95% CI = 1.1-1.3) and with antiepileptic medication use (RR = 1.24, 95% CI = 1.1 to 1.2). Testing was less likely in nonwhite patients (RR = 0.95, 95% CI = 0.92 to 0.98). Conclusions:Compliance is suboptimal, varying with patient age, race, and EMT-P presence. Testing increases when antiepileptic drugs are used. Hypoglycemia in tested patients was infrequent; however, proper treatment for hypoglycemic seizures will not be delivered if testing does not occur. It is worthwhile examining the utility of routine testing in this setting; however, until such time as protocols are revised, regional EMS administration should focus on education and uniform compliance with state protocols.From the

Blunt abdominal trauma is the number three cause of traumatic death in children over 1 year of age in the United States and the most common unrecognized fatal injury. Vague symptoms and nonverbal pediatric patients make effective triage difficult in this population. In addition, there is limited utility in abdominal ultrasound, and early laboratory results may be misleading in the diagnostic assessment. Often, this leads to unnecessary computed tomography (CT) imaging, which results in radiation exposure, cancer risk, and excessive cost to the family. It is important to risk-stratify the stable patients using a proven algorithm to guide clinical decision-making. This chapter discusses the diagnosis, management, and disposition of both stable and unstable pediatric patients presenting with blunt abdominal trauma.

Background Pediatric patients with cancer commonly seek emergency department (ED) care, yet there is limited evidence on ED utilization patterns and disposition outcomes among these patients. Methods Retrospective analysis of the Healthcare Cost and Utilization Project State Emergency Department Databases and State Inpatient Databases for Maryland and New York from 2013 to 2017. We compared ED visits and disposition outcomes for 5.8 million pediatric patients (<18 years old) with and without cancer, and used multivariable regressions to estimate associations between the number of ED visits, hospital (inpatient) admissions through the ED, and ED or inpatient mortality and sociodemographic and clinical factors within the cancer cohort. Results Pediatric patients with cancer had more ED visits per year on average (2.4 vs. 1.5, p < .001), higher shares of admissions (56.8% vs. 6.6%, p < .001) and mortality (1.2% vs. 0.1%, p < .001) compared to those without cancer. Among patients with cancer, uninsured pediatric patients had fewer ED visits and lower risk of admission to a hospital through the ED compared to those with Medicaid coverage (total visits: incidence rate ratio [IRR]: 0.82, 95% confidence intervals [CI]: 0.75–0.90; admission: IRR: 0.75, 95% CI: 0.65–0.86). Mortality risks were higher for pediatric patients with cancer residing in areas with the lowest median household income, and with no health insurance coverage (IRR: 2.81, 95% CI: 1.21–6.51) compared to Medicaid. Conclusions Our findings emphasize the importance of enhancing health insurance coverage policies and social services for pediatric patients with cancer and their families to address clinical and nonclinical needs.