Archive for March 2018

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5 Things You Should Know About Concussions

This is a post authored by J. Forrest Bennett, ARNP who works in the rehabilitation department and on the concussion team led by Dr Samuel Browd (@DrBrowd), medical director of Seattle Children’s Sports Concussion Program. Forrest has had the unique experience to care for children after concussions in the immediate time after injury and in weeks to months thereafter when symptoms are prolonged. His wisdom can help us all understand the opportunity we have to improve children’s recovery after a head injury. In this post he explains what happens to the brain cells during a concussion, what constitutes risk for concussions, and the 5 things all of us need to know about concussions. I certainly know more after reading this and suspect you will too. Please leave comments or questions if you have them. Click here to read the first post in this series. 

Soccer is the highest risk sport for school-age girls.

Soccer is the highest risk sport for school-age girls.

What Happens During A Concussion?

A concussion is a complex process affecting the brain, brought on by biomechanical forces (like a blow to the head, car crash, etc.) The force is transmitted to the head and can result in usually short-lived symptoms such as headaches, brief loss of consciousness, nausea, and/or dizziness. These symptoms are believed to be due to a temporary shift in the neurotransmitters (chemicals that allow cells to communicate) in the brain. This helps explain the symptoms associated with a time-limited injury such as a concussion.

This also explains why diagnosing and managing concussions can be frustrating for families and medical providers. Unlike a broken bone, we do not have imagining or blood tests that enable definitive diagnosis of concussion. Medical providers will sometimes order head CTs or brain MRIs to make sure that there is not a more severe injury, but the scans cannot diagnosis concussion.

Diagnosing concussion currently relies on a detailed history and physical exam. If an injury occurs when a child is playing in an organized sport, a sideline assessment should be performed to look for common post-concussive symptoms. In 2017, the guideline for sideline assessment for concussion was updated. Depending on the severity of the initial presentation, one may need to be evaluated in an emergency department to help rule out a more severe injury.
The goal is to prevent injuries, screen for potential head injuries when appropriate, and to diagnose injuries so that we can treat the symptoms and limit the impact.

How To Prevent Head Injuries

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Sore Throat Versus Strep Throat

When you or your child has a sore throat, it can be hard to tell if it might be something that needs medical intervention, like Strep throat. Strep throat is an infection caused by group A Streptococcus (GAS). When you confirm (by throat swab in the lab) that GAS is present, your child needs 10 days of antibiotics. If the test is negative, it’s unlikely you need any Rx medical treatment! More below:

  • Sore Throat
    • Tonsillitis refers to tonsils that are inflamed. Inflamed tonsils (and even when they have white stuff on them) doesn’t necessarily mean your child needs antibiotics. If enlarged tonsils make it hard to swallow or changes the sounds when your child breaths, they need to see a pediatrician.
    • Pharyngitis refers to an inflamed throat. Most episodes of pharyngitis are caused by infections from viruses. Some are caused by other bacteria that live in the throat that aren’t as problematic as GAS and don’t require antibiotic treatment.
    • Viruses, bacteria, allergens, environmental irritants (such as cigarette smoke), and chronic postnasal drip can all cause a sore throat. Most tonsillitis & pharyngitis will typically resolve on their own without prescription treatment.
    • Try acetaminophen or ibuprofen for pain, throat lozenges, warm beverages, gargling salt water and get lots of rest. In time, sore throats typically improve in a few days.
  • Strep throat is an infection caused by a specific type of bacteria, Streptococcus. Infections from the bacteria can be minor or severe. When your child has Strep throat, their tonsils are usually very inflamed, they likely have a fever and swollen lymph nodes in the front of the neck, a BAD sore throat, and sometimes a headache. Many children complain of lots of pain with swallowing. Strep throat symptoms typically come in isolation from other “cold symptoms.” With typical strep, most children do not have cough, runny nose or hoarseness (changes in your voice that makes it sound breathy, raspy, or strained). No one can diagnose strep throat just by looking at your throat. Instead, healthcare professionals use two tests to see if group A Strep bacteria are causing a sore throat. A “rapid strep test” involves swabbing your throat and gives results quickly, usually in about 15-20 minutes. The test is accurate about 95% of the time meaning only 1 in 20 people (5%) who have a negative test actually may have the infection. If the rapid test is positive, your doctor or provider will prescribe antibiotics. If the test is negative, your healthcare professional may likely send the swab for a full throat culture (to catch the 5% that falsely didn’t show an infection). A throat culture involves sending a throat swab to a lab for 1-2 days to see if bacteria grow from the sample. If it turns positive, then your child should be treated with an antibiotic for 10 days.

Great information from the American Academy of Pediatrics on the differences between a sore throat and strep.

E-cigarette Studies In Teens Bust Safety Myths

Two new studies out today on e-cigarettes showed e-cigs remain a significant concern for teen users. E-cigs were found to pass along carcinogens (cancer-causing chemicals) to those who used them and are associated with future tobacco cigarette smoking in teens. Data out today in Pediatrics finds that teens who used e-cigarettes had up to three times greater amounts of five volatile organic compounds (carcinogens) in their urine compared to teens who did not use e-cigarettes at all. Teens using fruit flavored e-cigarette products, often the preferred choices for teens, produced significantly higher levels of acrylonitrile (a volatile organic compound, known to be toxic). Teens who used both e-cigs and tobacco cigs had even higher levels of the carcinogens overall.

Let’s be clear, e-cigarettes are not “safe” nor do they provide health benefits for teens. It’s our obligation to help teens and parents everywhere understand that…the data keeps accumulating as more and more teens use e-cigs across the country. E-cigs tend to increase smoking of traditional tobacco cigarettes, too. My worry is many teens believe e-cigs are safe to use. More and more, I’m certain they are not.

Relevant E-Cigarette Statistics:

  • About 95% of adult tobacco users started using before they turned 21 years of age. In the study out today, E-cigs were positively and independently associated with progression to being a regular, established smoker. Researchers conclude, “data suggest that e-cigarettes do not divert from, and may encourage, cigarette smoking” in teen population. Especially in those who have a tried a few cigs but not yet established a smoking habit. Rather than being a “safer” choice e-cigs enhance the choice to smoke traditional cigs in teens.
  • Use of e-cigarettes rose 900% between 2011 and 2015. And between 2014 and 2016, US middle and HS students used e-cigs more than any other tobacco product.
  • 85% of e-cigarette users ages 12-17 use flavors. In the study out today, carcinogens and toxic substances were increased in teens’ urine in those who used e-cigs compared with those who didn’t. Added risks may be in fruit-flavored e-cigs preferred by teens; even higher levels of a specific toxin (acrylonitrile) was detected.

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