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054 and 0.075 L/h) and with data reported in the literature (0.04-0.06 L/h). CONCLUSIONS Our case reports presented preliminary evidence that dalbavancin can be considered a therapeutic option for necrotizing fasciitis in intensive care unit patients. The role of hypoalbuminemia during dalbavancin exposure merits further investigation.In this study, the authors report the case of a patient diagnosed with hepatitis C virus who was treated with sofosbuvir-velpatasvir (400/100 mg). As the patient was unable to swallow whole tablets, therapeutic drug monitoring was performed to evaluate the effect of crushing sofosbuvir-velpatasvir tablets on drug absorption and global exposure.OBJECTIVES Patients with immune thrombocytopenia are at risk of both bleeding complications and venous thromboembolism. There is no standard to treating life-threatening pulmonary embolism in this population. This case illustrates the difficulty of treating significant thromboembolism in pediatric patients who have reduced clotting capacity. CASE This case focuses on a 16-year-old pediatric patient with a history of immune thrombocytopenia presenting with mild chest discomfort and dyspnea on exertion. The d-dimer was mildly elevated, and the subsequent computed tomography angiogram revealed bilateral pulmonary embolisms with right ventricular strain. CONCLUSIONS The patient underwent thromboembolectomy by interventional radiology with subsequent administration of intravenous immunoglobulin, high-dose steroids, and enoxaparin therapy. There is no standard of care for patients with life-threatening pulmonary embolism in this population. Several authors suggest medical therapy options, but do not include patients with potential hemodynamic instability.OBJECTIVE Cerebral ventricular shunt failure is common and presents with symptoms that range from headaches to death. The combination of Diamox (acetazolamide), Decadron (dexamethasone), and Zantac (ranitidine) (DDZ) is used at our institution to medically stabilize pediatric patients presenting with symptomatic shunt failure before shunt revision. We describe our experience of this drug combination as a temporizing measure to decrease symptoms associated with shunt failure. METHODS We performed a single-center retrospective chart review of patients younger than 18 years with ventricular shunt failure who underwent a shunt revision between January 2015 to October 2017 and received DDZ before surgery. The outcome variables evaluated included pre-DDZ and post-DDZ clinical symptoms, pain scores, and vital signs. RESULTS There were 112 cases that received DDZ before shunt revision. The 4 most commonly reported symptoms were analyzed. Headache was observed in 42 cases pre-DDZ, and post-DDZ there was a 71% reduction in headache (P less then 0.0001); emesis was reported pre-DDZ in 76 cases, and post-DDZ there was an 83% reduction (P less then 0.0001); irritability was noted pre-DDZ in 30 cases, and post-DDZ there was a 77% reduction (P = 0.0003); lethargy pre-DDZ was observed in 60 cases, and post-DDZ 73% demonstrated improvement (P less then 0.0001). Maximum pain scores significantly decreased post-DDZ (P less then 0.0001). Heart rate, systolic, and diastolic blood pressures significantly decreased post-DDZ (P less then 0.0001, P less then 0.0001, P = 0.0002, respectively). CONCLUSIONS The combination of Decadron, Diamox, and Zantac is a novel treatment for ventricular shunt failure that may temporarily improve symptoms in patients awaiting shunt revision. Future studies could compare efficacy with other medical treatments.PURPOSE To show the efficacy of cartoon as a distraction technique in suturing a child patient in the emergency room. METHODS We studied children aged 2 to 8 years who had sustained a facial laceration 3 cm or less that required suturing from September 2015 to November 2016. [https://www.selleckchem.com/products/chroman-1.html Chroman 1 chemical structure] We used local anesthesia and attempted to place the sutures without sedation while showing the children cartoons instead. If the first attempt failed, 1 more attempt was made. The patients were divided into 3 groups success, success on second attempt, and failure. Age, location and size of the wound, and scores on the FACES Pain Rating Scale (FPS) before and after local anesthesia were recorded. RESULTS The study included 106 children. Cartoon distraction was most effective for those aged 3 to 6 years (4.6 ± 1.9 years). The second-attempt group tended to be older, whereas the failure group was much younger (mean age, 7.4 ± 1.0 vs 2.7 ± 1.8 years). The FPS-R score differed widely among the groups. The success group tended to have a low score before and after local anesthetic injection (4.1 ± 2.0 and 3.1 ± 1.3), whereas the second-attempt and failure groups had much higher scores after injection (8.0 ± 1.7 and 8.8 ± 0.8; 5.2 ± 2.6 and 9.3 ± 0.8). CONCLUSIONS Cartoon distraction techniques can reduce the treatment duration and number of assistants, which also makes it appropriate for the emergency room. In addition, our results indicate that the pre-/post-local injection FPS score is a good predictor of success.We report a case of a 20-year-old man presenting to our pediatric emergency department with an anterior shoulder dislocation. Point-of-care ultrasound demonstrated a Hill-Sachs deformity. The potential role of ultrasound and the clinical importance of identifying patients with Hill-Sachs deformities are discussed.Shortness of breath and wheezing are common presenting signs for children in the emergency department. In adolescence, it is often due to asthma or lower respiratory tract infections. We present a rare pediatric case of an adolescent with biphasic stridor and progressive exercise-induced shortness of breath who was found to have severe idiopathic subglottic stenosis.Point-of-care ultrasound (POCUS) is being used for clinical decision making with increasing frequency across a broad range of indications in pediatric emergency medicine (PEM). We present a series of 4 patients in whom POCUS was used to facilitate a diagnosis of perforated appendicitis.The differential diagnosis for facial swelling is broad and can be a diagnostic challenge in the pediatric emergency department. We describe the first pediatric case of acute parotitis with sialolithiasis where the diagnosis was facilitated by point-of-care ultrasound.