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From Cradle to the Grave – ACEM Annual Scientific Meeting 2014


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This years Australasian College of Emergency Medicine Annual scientific meeting in Melbourne has attracted over 900 delegates from all over the world. With an overarching theme of “Back to the Future” a number of speakers have been looking back on the past year in emergency medicine literature and predicting what might be up and coming in the next five years.  Whilst there have been a number of wonderful speakers talking about all aspects of emergency medicine the second day had a number of sessions that would be of interest to those practicing paediatric emergency medicine as well as those clinicians working in mixed adult and paediatric departments.  Some of the talks have been recorded and will be available on the ACEM website in due course, but one of the talks, by Simon Craig of Monash Medical Centre, stood out.

Whilst top ten lists are always subjective Simon chose a number of key papers that he thought should reach a wider audience.  Some of them have already been covered here by the Don’t Forget the Bubbles crew.


1. Topical Lidocaine for mouth ulcers

As much as we like to think it makes a difference, this study suggests there is no difference in fluid intake over 60 minutes in children that had a flavoured gel placebo over those that used viscous lidocaine.


2. Analysis of intraosseous samples using a bedside i-STAT point-of-care analyser

Intraosseous access is often the only option in resuscitation of critically ill children.  This study asks if a popular handheld point-of-care device can be used to analyse samples that would normally cause consternation in the laboratory as bone spicules block up the machinery.  Clinically important biochemical variables such as glucose, sodium, ionised calcium, pH and base excess correlate well with venous sampling.


3. Ultrasound for hand fractures in children

Ultrasound offers a “no radiation” method of detecting metacarpal and phalangeal fractures in kids. Watch this space!


4. Lorazepam vs diazepam in the management of status epilepticus

Either are equally effective though not all are available worldwide.  Chris Partyka wrote about the management of status here.


5. Endotracheal intubation in the paediatric emergency department

The lead author, Elliot Long, of the Royal Children’s Hospital in Melbourne, presented some of the data from this audit of emergency intubations in the plenary session.  It is a rare event, even in a quaternary referral centre, and as such is a high risk procedure.


6. Oral midazolam plus oral ketamine for sedation for laceration repair

There was no difference in the pain assessment of local anaesthetic injection if midazolam and ketamine was used compared with oral midazolam alone though there was a lower need for intravenous sedation.


7. Traumatic brain injuries and vomiting in children

This secondary analysis of the PECARN head injury data suggests that clinically significant brain injury is very rare in the setting of children with a bump to the head and vomiting as an isolated symptom.  Read Anna Ings’ review of PECARN, CATCH and CHALICE here.


8. Pulse oximetry in bronchiolitis

Tessa wrote up this interesting paper here.


9. Hypertonic saline in bronchiolitis

As winter moves forward in the northern hemisphere it is worth considering that good supportive therapy is the mainstay of treatment. Mike South wrote about the SABRE trial here.


10. Duration of respiratory tract infections in infants

This important paper reminds us that we need to be honest with parents about how long simple respiratory illnesses actually last.  Earache lasts 7-8 days, sore throats between 2 and 7 days, acute cough can last around 25 days (!), and the common cold lasts about 2 weeks.




Hopper, Sandy M., et al. “Topical Lidocaine to Improve Oral Intake in Children With Painful Infectious Mouth Ulcers: A Blinded, Randomized, Placebo-Controlled Trial.” Annals of emergency medicine 63.3 (2014): 292-299.

Veldhoen, Esther S., et al. “Analysis of bloodgas, electrolytes and glucose from intraosseous samples using an i-STAT® point-of-care analyser.” Resuscitation 85.3 (2014): 359-363.

Neri, Elena, et al. “Diagnostic accuracy of ultrasonography for hand bony fractures in paediatric patients.” Archives of disease in childhood (2014): archdischild-2013.

Chamberlain, James M., et al. “Lorazepam vs Diazepam for Pediatric Status Epilepticus: A Randomized Clinical Trial.” JAMA 311.16 (2014): 1652-1660.

Long, Elliot, Stefan Sabato, and Franz E. Babl. “Endotracheal intubation in the pediatric emergency department.” Pediatric Anesthesia 24.12 (2014): 1204-1211.

Barkan, Shiri, et al. “A double-blind, randomised, placebo-controlled trial of oral midazolam plus oral ketamine for sedation of children during laceration repair.” Emergency Medicine Journal (2013): emermed-2012.

Dayan, Peter S., et al. “Association of Traumatic Brain Injuries With Vomiting in Children With Blunt Head Trauma.” Annals of emergency medicine 63.6 (2014): 657-665.

Schuh, Suzanne, et al. “Effect of oximetry on hospitalization in bronchiolitis: a randomized clinical trial.” JAMA 312.7 (2014): 712-718.

Everard, Mark L., et al. “SABRE: a multicentre randomised control trial of nebulised hypertonic saline in infants hospitalised with acute bronchiolitis.” Thorax 69.12 (2014): 1105-1112.

Thompson, Matthew, et al. “Duration of symptoms of respiratory tract infections in children: systematic review.” BMJ: British Medical Journal 347 (2013).



About the authors


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Chest compressions in traumatic cardiac arrest

Searching for sepsis

The missing link? Children and transmission of SARS-CoV-2

Don’t Forget the Brain Busters – Round 2

An evidence summary of Paediatric COVID-19 literature


The fidget spinner craze – the good, the bad and the ugly

Parenteral Nutrition

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