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Background: Greater attention to and management of anxiety and pain in pediatric patients signifies a healthy evolution in the care of children in emergency departments (EDs). Interventions to address such distress may involve unanticipated adverse effects. Midazolam, a benzodiazepine commonly administered to children for anxiolysis, may precipitate paradoxical agitation and delirium, a rare but alarming effect that warrants prompt identification and treatment., Case Report: The case presented is that of a 4-year-old girl who received oral midazolam and developed a paradoxical reaction, which was reversed successfully with flumazenil. This is the first such case report in an ED involving a child. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians must stay abreast of the adverse and unintended effects of the treatments provided. The literature on benzodiazepine-induced paradoxical reactions is reviewed, and flumazenil as well as other treatment options and anxiolytic alternatives are presented., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Skin and soft-tissue infections (SSTIs) are common disease presentations to the emergency department (ED), with the majority of the infections attributed to community-acquired methicillin-resistant Staphylococcus aureus. Rapid and accurate identification of potentially serious SSTIs is critical. Clinician-performed ultrasonography (CPUS) is increasingly common in the ED, and assists in rapid and accurate identification of a variety of disease processes., Case Report: A 21-year-old female presented to the ED with chin swelling and "boils." Although her visual examination was benign, CPUS of her facial swelling quickly established a more concerning disease process, which was eventually confirmed by aspiration and bone biopsy to be mandibular osteomyelitis. The causative organism, Serratia odorifera, is rarely associated with infections, and we are aware of no previously reported cases of osteomyelitis due to this species. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In this case of mandibular osteomyelitis, CPUS rapidly and accurately identified abnormal bony cortex of the mandible and an associated fluid collection. CPUS of an otherwise benign presentation of a facial infection led to a maxillofacial computed tomography scan, aspiration and biopsy, and then elective debridement of the bone infection. Emergency physicians should be aware of the utility of CPUS and the need to carefully investigate SSTIs presenting to the ED., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Aspirated or swallowed coins are a common phenomenon resulting in a pediatric patient presenting to the Emergency Department. The location of the coin (trachea vs. esophagus) is commonly determined by the alignment of the coin on radiographic studies. We present a child who had an esophageal coin but radiographic findings that supported a coin located in the trachea. Our case illustrates the importance of performing radiographic studies that include both anteroposterior and lateral neck/chest views in patients who aspirate or swallow coins.

A study was done to estimate the prevalence of hypoglycemia among children with dehydration due to acute gastroenteritis, and to identify clinical variables associated with hypoglycemia in these children. A retrospective case series of children older than 1 month of age and younger than 5 years of age who presented to an urban children's hospital Emergency Department with acute gastroenteritis and dehydration was performed. Medical records were reviewed; demographic and clinical data, including pretreatment serum glucose concentrations, were recorded. There were 196 children comprising the study population. Eighteen children (9.2%) were hypoglycemic. The duration of vomiting was longer for the children with hypoglycemia (2.6 days, SD +/- 1.5) than for those without hypoglycemia (1.6, SD +/- 1.8), 95% CI 0.13 to 1.88. Hypoglycemia may complicate dehydration due to acute gastroenteritis in young children. Clinicians should examine the serum glucose concentration in these children.

Two pediatric patients with life-threatening intra-abdominal injuries associated with Superman play are presented. The cases illustrate the importance of knowing the mechanism of injury in the assessment of children with blunt abdominal trauma. The diagnostic value of liver enzymes and the controversies surrounding the radiographic assessment of pediatric blunt abdominal trauma are presented.