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Daily Dose

No Need for Stitches?

1.45 to read

OUCH!! This week, I was heading out to grab some lunch when a patient of mine, who happens to have 3 young sons (brings back memories) walked in with her youngest son who had been jumping on the bed and bumped his head!

As you can see by the picture, there was a nice little laceration right in the middle of his forehead. This was the perfect wound that would have previously required a stitch or two, but can now be closed with a liquid adhesive called Dermabond.

Fortunately, this experienced mother of 3 boys had already become a fan of Dermabond and instead of going to the ER; she came by the office for a fairly easy procedure to close the wound.  Smart Mom!

When Dermabond was released in the early 2000’s it took me awhile to get used to how easy this made wound closure.  Dermabond is a liquid skin adhesive that holds wound edges together. The best thing is that it is painless and can be used on small superficial lacerations. Even for a wiggly toddler in most cases the laceration can be closed even while the parent is holding a child still. This is certainly not the case when having to suture!

Dermabond forms a polymer which causes adhesion of the wound edges so it is perfect for “clean, straight, small” lacerations that I often see among my patients.  The classic ones are on the edge of the eye, the chin, the forehead or even the scalp. In studies the cosmetic outcome was comparable to suturing, and in my opinion for those small lacerations it is preferable.

So, we cleaned the wound up, laid him right down (he was perfectly still too) and within 5 minutes the head wound was closed and a happy 2 year waltzed out of the office. Not a tear to be found, but I did have a little residual glue on my finger!

The Dermabond will wear off on its own in 5 – 10 days. Once the adhesive comes off I always remind parents to use sunscreen on the area, which also helps to prevent scarring.

Happily this little guy left while singing “Dr. Sue said, no more little boys jumping on the bed!”

That’s your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

Dealing With Dog Bites

What should you do if your child is bitten by a dog? I received an email via our iPhone App from a mom who was very worried after her daughter had been bitten by a friend's dog.  This is a common concern/query to the pediatrician.  In fact, one of my own children was severely bitten by a friend's dog, but I had somehow forgotten that experience and the 20 stitches to his face!

Tincture of time is the best remedy for many things. At any rate, I looked at the CDC's website to find that there are over 5 million dog bites a year and about 800,000 require medical attention. No wonder the health care system is overflowing! This mother was concerned as to what was the appropriate treatment. Her daughter's bite was on the face (very common for a child) but small. It did break the skin. The first thing a parent should do is to stop the bleeding by applying pressure. Then, clean the area with warm water and soap. Dogs, like humans, have dirty mouths, so you want to wash and rinse well and even flush out the wound if it is deep. If the bite wound is small, it is usually not sutured, as this may increase the risk for infection. On the other hand, facial wounds, and larger bites have to be well cleansed and irrigated, and may require suturing. The sooner this can be accomplished the better. For a child with a dog bite that has broken the skin, most pediatricians would recommend a 7-day course of an antibiotic, typically Augmentin (unless the child is penicillin allergic). Rabies is usually not a risk in dogs that are family pets and in homes. If the dog is not known or their rabies status is unclear and you cannot find the dog, check with your pediatrician about rabies prophylaxis. Lastly, you want to ensure minimal scarring by using a topical vitamin E cream on the healed skin and sunscreen. The less the sun exposure, the less scarring, especially if the face is involved.  That really goes for all cuts and scars. That's your daily dose, we'll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

How to Treat Hyperventilation

It is not uncommon for someone to hyperventilate when they are in pain.I saw a child today who had been injured in a soccer match when he was accidentally kicked in the chest. He had shortness of breath and then became uncomfortable and started to breath rapidly and get upset about "feeling light headed" and anxious. Because he had a history of asthma his Mom brought him straight to the office for fear that he was having an asthma attack.

But he was not having any real respiratory distress and his oxygen levels were normal and his lungs were clear. The problem was that he was hyperventilating. It is not uncommon for someone to hyperventilate when they are in pain. When you hyperventilate and disturb your CO2 and O2 levels, you will have a feeling of lightheadedness, and often tingling in your arms and hands. That seems even scarier, so you then breathe faster and faster and the cycle continues. The best thing to do if you think someone is hyper-ventilating, have them re- breathe into a paper bag. By re-breathing your CO2 it will slow down your breathing and within several minutes they will be feeling much better, less anxious and light headed. If you don't happen to have a paper bag, have them follow your lead as you slow their breathing down and reassure them that their symptoms are going to improve as they take slow deep breathes. A bit of TLC for the little guy today, slow breathing exercises, a Sprite and a note for school sent him on his way! That's your daily dose, we'll chat again soon!

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Daily Dose

Poison Control in Your Home

1:15 tow atch

Our office gets many calls from parents who are worried that their child may have swallowed a stray pill, or a berry or plant leaf.  The list is endless. Despite every parents efforts at childproofing their home (childproofing cabinets, electrical outlets etc, should begin as your your-baby starts to crawl) at times a toddler finds something stray and the first place it goes is in their mouth.

The phone number that needs to be at every parent's fingertips is the number to the Poison Control Center. That number is 1-800-222-1222 and should be on your speed dial or on a sticker on your phone.

The poison control center is the national source for information on poisoning and I have been so impressed with their professional, yet compassionate manner and their knowledge base. If your child does accidentally ingest a household cleanser, or a drug have the bottle handy when you call them so that you can read them the label. It is much easier for them to help you decide what to do for the ingestion with complete information. Telling them that it was a small white pill leaves millions of possibilities; so make sure that you do keep all medications, whether over the counter or prescription, in their appropriate bottle. Fortunately, many ingestions may be benign and require no treatment, but do not assume this until you have spoken with Poison Control. The use of syrup of ipecac, to induce vomiting after ingestion is no longer recommended. Thank goodness!

That's your daily dose, we'll chat again tomorrow.

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Your Teen

Hand Sanitizer Hangover?

1.45 to read

From the “Really?” file, another way for kids to get high and sick has emerged. This one is not a national trend … yet. And because it requires drinking something that you might normally spread on your hands after going into a public restroom, maybe it won’t catch on.

But, forewarned is forearmed. And with the Internet able to spread “challenges” at the speed of light it’s probably a good idea that parents are aware of this one.

Some teens are drinking hand-sanitizer to get high. Not surprisingly they are ending up in the emergency room incredibly drunk and sick.

Recently, six teens from the Los Angeles area were hospitalized with alcohol poisoning after downing the germ killing agent.  

The Los Angeles Times reported some of the teenagers used salt to separate the alcohol from the sanitizer using instructions found online. If a liquid hand sanitizer contains 62 percent ethyl alcohol, that means a "drink" can be as high as 120 proof, whereas a shot of hard liquor such as whiskey or vodka is typically 80 proof.

"All it takes is just a few swallows and you have a drunk teenager," Dr. Cyrus Rangan, director of the toxicology bureau for the county public health department and a medical toxicology consultant for Children's Hospital Los Angeles, told the Los Angeles Times. "There is no question that it is dangerous."

The teens showed symptoms of slurred speech and a burning sensation in the stomach. Some of them were so drunk they had to be monitored in the emergency room.

Los Angeles emergency rooms had not reported any other cases before this sudden spurt of ER visits. The teens did not come in all together but as separate incidents. 

It’s not only Los Angeles that has seen this situation pop up in its emergency rooms. Dr. Robert Glatter, an emergency medicine physician at Lenox Hill Hospital in New York City, said he has taken care of some teens who had ingested hand sanitizers at school as a "dare," only to come to the ER drunk with dizziness, nausea and vomiting.

"They denied drinking any 'alcohol', had no smell of alcohol on their breath, but when their blood alcohol was quite elevated, they later admitted to drinking the hand sanitizer," Glatter told HealthPop.

Doctors told the L.A. Times that parents should purchase foam hand sanitizers since they're harder to extract alcohol from compared with gel-based products, and they should monitor hand sanitizer bottles around the house as if they are liquor or medicine bottles.

"Over the years, they have ingested all sorts of things," Helen Arbogast, injury prevention coordinator in the trauma program at Children's Hospital Los Angeles, told the Times. "Cough syrup had reached a very sexy point where young people were using it.... We want to be sure this doesn't take on the same trend."

Apparently there is no limit to what some teens will do to get a buzz on, hopefully this venture will end quickly. The yuck factor alone should help.

Source: http://www.cbsnews.com/8301-504763_162-57420106-10391704/drinking-hand-s...

Daily Dose

No Need for Stitches?

1.45 to read

OUCH!! I was just heading out to grab some lunch when a patient of mine, who happens to have 3 young sons (brings back memories) walked in with her youngest son who had been jumping on the bed and bumped his head!

As you can see by the picture, there was a nice little laceration right in the middle of his forehead. This was the perfect wound that would have previously required a stitch or two, but can now be closed with a liquid adhesive called Dermabond.

Fortunately, this experienced mother of 3 boys had already become a fan of Dermabond and instead of going to the ER; she came by the office for a fairly easy procedure to close the wound.  Smart Mom!

When Dermabond was released in the early 2000’s it took me awhile to get used to how easy this made wound closure.  Dermabond is a liquid skin adhesive that holds wound edges together. The best thing is that it is painless and can be used on small superficial lacerations. Even for a wiggly toddler in most cases the laceration can be closed even while the parent is holding a child still. This is certainly not the case when having to suture!

Dermabond forms a polymer which causes adhesion of the wound edges so it is perfect for “clean, straight, small” lacerations that I often see among my patients.  The classic ones are on the edge of the eye, the chin, the forehead or even the scalp. In studies the cosmetic outcome was comparable to suturing, and in my opinion for those small lacerations it is preferable.

So, we cleaned the wound up, laid him right down (he was perfectly still too) and within 5 minutes the head wound was closed and a happy 2 year waltzed out of the office. Not a tear to be found, but I did have a little residual glue on my finger!

The Dermabond will wear off on its own in 5 – 10 days. Once the adhesive comes off I always remind parents to use sunscreen on the area, which also helps to prevent scarring.

Happily this little guy left while singing “Dr. Sue said, no more little boys jumping on the bed!”

That’s your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

Sudden Cardiac Deaths in Young Athletes

2.00 to read

I have received several questions via our iPhone App about recent discussions in both the media and in the medical community surrounding sudden cardiac death (SCD) in young athletes.

Each year between 10–12 million kids in the U.S. participate in sports.  The tragedy of a sudden death in an otherwise  “presumably healthy” child causes not only sadness, but concern as to how the death might have been prevented. Doctors are often asked, “isn’t there a test or something to prevent this? “.

Depending on the studies I have read, the sudden cardiac death of a child or adolescent accounts for about 100 deaths a year in the U.S.  The prevalence rate for sudden cardiac death is 1:100,000- 200,000 and is higher among males than females.  Statistics show that 90% of these sudden deaths occur immediately post training or competition with football and basketball having the highest incidence.

In 2007 the American Heart Association came out with guidelines to evaluate athletes who may be at risk for sudden cardiac death. The most important screening mechanism has been found to be the “gold standard” in medicine, a thorough history and physical exam.

The history that should be taken on any athlete who is being screened for sports participation should include a history of any unexplained or sudden death in a family member. Are there any family members with unexplained fainting episodes or seizures? Are there family members who had unexplained deaths (drowning or single car accidents)?   Are there any family members with a known genetic disorder that predisposes to sudden cardiac death?  The history should also ask about any fainting (syncope) in the athlete.

After a good history is taken (which should be updated yearly), the child/adolescent needs a complete and thorough physical exam. This exam should include blood pressure measurements, and a careful cardiac exam looking for new murmurs.  Symptoms such as palpitations during exercise, visual changes, fainting while exercising or immediately after exercise, and chest pain should all warrant further evaluation.

Studies show that about half of pediatric patients who succumb to sudden cardiac death had experienced a warning sign.  There are about 20 causes for SCD, with the most common causes being hypertrophic cardiomyopathy, anomalous coronary artery, and myocarditis.

While some may advocate routine EKG screening and echocardiograms on athletes (this is done in Italy), many studies have been done which show that it would take the screening of 200,000 student athletes to prevent 1 death.   At the same time you will certainly identify some children with clear risk factors for SCD, but for every positive finding there may be 10–20 athletes who have “borderline” or questionable findings that would require even more expensive follow up.

These pediatric patients might also be told they cannot participate in sports during the evaluation time and some might be told that they cannot participate even if they were not found to have disease, but were excluded just due to liability concerns.  There does not seem to be one right answer to this issue.

If your child is going to begin competitive sports make sure to see your pediatrician for a complete physical exam including a good family history.  Also advocate that your school have automatic external defibrillators viable at all times and personnel that know how to use them.

That’s your daily dose for today.  We’ll chat again tomorrow.

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DR SUE'S DAILY DOSE

A few life lessons & fun with Elf on the Shelf!

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