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If a child had a history of a bladder augmentation, and they are unable to get a catheter into a catheterizable channel, a history of whether or not their urethra is open must be elicited Urology should be consulted, and a catheter either through the channel or urethra can be attempted If not, the bladder can be drained with a transabdominal needle The best location for this to be placed is at the scar from a previous suprapubic catheter—this will be the safest location Suggested Readings and Key References General Lambert SM Pediatric urological emergencies Pediatr Clin North Am 2012;59:965–976 Lao OB, Fitzgibbons RJ, Cusick RA Pediatric inguinal hernias, hydroceles and undescended testicles Surg Clin North Am 2012;92:487–504 Leslie JA, Cain MP Pediatric urological emergencies and urgencies Pediatr Clin of North Am 2006;53:513–527 Merriman LS, Herrel L, Kirsch AJ Inguinal and genital anomalies Pediatr Clin North Am 2012;59:769–781 Sung EK, Setty BN, Castro-Aragon I Sonography of the pediatric scrotum: emphasis on the Ts—torsion, trauma, and tumors AJR Am J Roentgenol 2012;198:996–1003 Penile Problems American Academy of Pediatrics Task Force on Circumcision Circumcision policy statement Pediatrics 2012;130:585–586 American Academy of Pediatrics Task Force on Circumcision Male circumcision Pediatrics 2012;130:e756–e785 Brown-Trask B, Van Sell S, Carter S, et al Circumcision care RN 2009;72:22– 28 Donaldson JF, Rees RW, Steinbrecher HA Response to commentary to priapism in children: a comprehensive review and clinical guideline J Pediatr Urol 2014;10:11–25 Rogers ZR Priapism in sickle cell disease Hematol Oncol Clin North Am 2005;19:917–928 Testicular Problems Barthold JS Undescended testis: current theories of etiology Curr Opin Urol 2008;18:395–400 Da Justa DG, Granberg CF, Villanueva C, et al Contemporary review of testicular torsion: new concepts, emerging technologies and potential therapeutics J Pediatr Urol 2013;9:723–730 Hutson JM, Clarke MC Current management of the undescended testicle Semin Pediatr Surg 2007;16:64–70 Main KM, Skakkebaek NE, Toppari J Cryptorchidism as part of the testicular dysgenesis syndrome: the environmental connection Endocr Dev 2009;14:167–173 Robinson SP, Hampton LJ, Koo HP Treatment strategy for the adolescent varicocele Urol Clin North Am 2010;37:269–278 Female Emergencies Van Eyk N, Allen L, Giesbrecht E, et al Pediatric vulvovaginal disorders: a diagnostic approach and review of the literature J Obstet Gynaecol Can 2009;31(9):850–862 Vunda A, Vandertuin L, Gervaix A Urethral prolapse: an overlooked diagnosis of urogenital bleeding in premenarcheal girls J Pediatr 2011;158:682–683 Nephrolithiasis Bowen DK, Tasian GE Pediatric stone disease Urol Clin N Am 2018;45:539– 550 Tasian GE, Copelovitch L Evaluation and medical management of kidney stones in children J Urol 2014;192:1329–1336 Tasian GE, Cost NG, Granberg CF, et al Tamsulosin and spontaneous passage of ureteral stones in children: a multi-institutional cohort study J Uro 2014;192:506–511 CHAPTER 120 ■ MINOR LESIONS SARAH C CAVALLARO, TODD W LYONS GOALS OF EMERGENCY CARE A variety of minor lesions in children may prompt an emergency department (ED) visit Most visits are the result of acute injury, infection, or a combination of the two mechanisms (e.g., hair tourniquet, felon, paronychia) Some formerly quiescent abnormalities (e.g., thyroglossal duct cyst, pyogenic granuloma) become clinically apparent after rapid enlargement secondary to infection or trauma Alternatively, asymptomatic minor lesions (e.g., lipoma, pilomatrixoma) may be noted during the evaluation of an unrelated complaint Regardless of the presentation, a systematic approach is necessary for proper diagnosis and subsequent management of these lesions Although most “lumps and bumps” in children have a benign cause, the clinician should recognize lesions requiring emergent management, and understand the possibilities of associated systemic illness and future complications RELATED CHAPTERS Signs and Symptoms Lymphadenopathy: Chapter 47 Neck Mass: Chapter 48 Medical, Surgical, and Trauma Emergencies Dermatologic Urgencies and Emergencies: Chapter 88 Endocrine Emergencies: Chapter 89 Gynecology Emergencies: Chapter 92 Infectious Disease Emergencies: Chapter 94 Hand Trauma: Chapter 109 ENT Emergencies: Chapter 118 Procedures: Chapter 130 The Children’s Hospital of Philadelphia Clinical Pathway ED Clinical Pathway for the Evaluation/Treatment of the Child With a Suspected Deep Neck Space Infection URL: https://www.chop.edu/clinical-pathway/neck-infection-clinicalpathway Authors: R Abaya, MD; M Joffe, MD; L Vella, MD; M Dunn, MD; S MacFarland, MD; M Rizzi, MD; K Shekdar, MD; R Bellah, MD; J Lavelle, MD Posted: February 2017, reviewed October 2019 HAND AND FOOT LESIONS CLINICAL PEARLS AND PITFALLS Herpetic whitlow involving a finger is sometimes mistaken for a paronychia Consider hair tourniquets in the crying infant Ganglion cysts should not be incised in the ED but may require outpatient excision if painful or cosmetically concerning Trephination is the treatment of choice for uncomplicated subungual hematomas with intact nail margins regardless of the size of the hematoma Eponychia and Paronychia Infections and/or minor trauma of the digits are the major causes of hand lesions presenting to the ED The most common infections of the digits involve the eponychium (cuticle) as a result of a breakdown of the epidermal border due to trauma, traumatized hangnail, manicuring, finger sucking, or nail biting In its initial stage, the infection consists of a superficial cellulitis that remains localized to the cuticle and is termed an eponychia Symptoms include erythema and localized pain at the nail margin With progression, pus collects in a single thinwalled pocket under the cuticle, forming an acute paronychia ( Fig 120.1 ) Patients typically present with localized tenderness and have an area of fluctuance and purulence at the nail margin This may progress, extending under the skin at the base of the nail, and along the nail fold Less commonly, the pus burrows beneath the proximal nail, forming an onychia or subungual abscess Causative organisms include Staphylococcus aureus (including methicillin-resistant ... 120 ■ MINOR LESIONS SARAH C CAVALLARO, TODD W LYONS GOALS OF EMERGENCY CARE A variety of minor lesions in children may prompt an emergency department (ED) visit Most visits are the result of... bleeding in premenarcheal girls J Pediatr 2011;158:682–683 Nephrolithiasis Bowen DK, Tasian GE Pediatric stone disease Urol Clin N Am 2018;45:539– 550 Tasian GE, Copelovitch L Evaluation and... varicocele Urol Clin North Am 2010;37:269–278 Female Emergencies Van Eyk N, Allen L, Giesbrecht E, et al Pediatric vulvovaginal disorders: a diagnostic approach and review of the literature J Obstet Gynaecol

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