Pediatric Emergency Care • Volume 32, Number 10, October 2016
Magnetic Foreign Body Ingestions
CME EXAM INSTRUCTIONS FOR OBTAINING AMA PRA CATEGORY 1 CREDITSTM Pediatric Emergency Care includes CME-certified content that is designed to meet the educational needs of its readers. An annual total of 12 AMA PRA Category 1 CreditsTM is available through the twelve 2016 issues of Pediatric Emergency Care. This activity is available for credit through September 30, 2017. The CME activity is now available online. Please visit http://CME.LWW.com for more information about this educational offering and to complete the CME activity.
CME EXAMINATION October 2016 Please mark your answers on the ANSWER SHEET. Magnetic Foreign Body Ingestions, Alfonzo and Baum 1. A 24-month-old boy presents to the pediatric emergency department with bilious vomiting and abdominal pain 1 day after returning from his grandparents’ home for the weekend. He has had no sick contacts. Upon arrival, he is afebrile, tachycardic, and hypotensive. He is poorly cooperative with the exam, but his abdomen seems firm, distended, and diffusely tender to palpation with voluntary guarding. Which of the following initial clinical steps would be best? a. Consult pediatric surgery b. Obtain abdominal ultrasound STAT c. Obtain AP chest and abdominal radiographs STAT d. Obtain IV access and administer 20 mL/kg normal saline bolus 2. Which of the following patients are at increased risk for magnetic foreign body ingestion? a. 2-year-old female whose father possesses Buckyballs b. 9-month-old male whose older sister has a Polly Pocket Playset c. 13-year-old male touting a magnetic tongue “piercing” d. All of the above 3. A 5-year-old patient reports ingestion of multiple high-powered magnets approximately 4 hours ago and radiographs have identified multiple small spherical radio-opaque objects in the stomach, linked in a ring. His vital signs are within normal limits and his abdominal exam is benign. Your next clinical step should be: a. Consult pediatric gastrointestinal specialist for emergent endoscopic removal b. Place nasogastric tube for PEG 3350 administration and admit for serial abdominal radiographs
c. Obtain STAT abdominal CT scan with oral and IV contrast d. Discharge home and screen stool for evidence of passage 4. A 15-month-old girl presents to the pediatric emergency department accompanied by parents who report that several of their Zen Magnets have gone missing. She is asymptomatic. Your next clinical step should be: a. Consult pediatric gastroenterology b. Obtain AP chest and abdominal radiographs STAT c. Obtain STAT abdominal CT scan with oral and IV contrast d. Place nasogastric tube for PEG 3350 administration and admit for serial abdominal radiographs 5. As a patient-advocate, which of the following ways can a clinician enhance home safety for children? a. Discourage adolescents from using magnetic facial or oral piercings b. Encourage parents to remove high-powered magnets from the home c. Report any known cases of magnet ingestion to the CPSC at www.SaferProducts.gov d. All of the above
© 2016 Wolters Kluwer Health, Inc. All rights reserved.
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
www.pec-online.com
703
Pediatric Emergency Care • Volume 32, Number 10, October 2016
Alfonzo and Baum
ANSWER SHEET FOR THE PEDIATRIC EMERGENCY CARE CME PROGRAM EXAM October 2016 Please answer the questions on page 703 by filling in the appropriate circles on the answer sheet below. Please mark the one best answer and fill in the circle until the letter is no longer visible. To process your exam, you must also provide the following information: Name (please print): ___________________________________________________________________________________________ Street Address _______________________________________________________________________________________________ City/State/Zip _______________________________________________________________________________________________ Daytime Phone ______________________________________________________________________________________________ Specialty ___________________________________________________________________________________________________
1. 2. 3. 4. 5.
A
B
C
D
E
A
B
C
D
E
A
B
C
D
E
A
B
C
D
E
A
B
C
D
E
Your completion of this activity includes evaluating them. Please respond to the following questions below. Please rate this activity (1 - minimally, 5 - completely) Was effective in meeting the educational objectives Was appropriately evidence-based Was relevant to my practice Please rate your ability to achieve the following objectives, both before this activity and after it: 1 (minimally) to 5 (completely) Pre
1 2 3 4 5
1 2 3 4 5
1. Summarize the background and mechanism of injury of magnetic foreign body ingestions. 2. Report the epidemiology of magnetic foreign body ingestions in the United States. 3. Discuss the management of magnetic foreign body ingestions in children.
Post 1 2 3 4 5
How many of your patients are likely to be impacted by what you learned from these activities? ○ 80% Do you expect that these activities will help you improve your skill or judgment 1 2 3 4 5 within the next 6 months? (1 - definitely will not change, 5 - definitely will change)
How will you apply what you learned from these activities (mark all that apply): In making treatment decisions ○ In diagnosing patients ○ As a foundation to learn more ○ In monitoring patients ○ In educating patients and their caregivers ○ In educating students and colleagues ○ To confirm current practice ○ As part of a quality or peformance improvement project ○ For maintenance of licensure ○ For maintenance of board certification ○ To consider enrolling patients in clinical trials ○ Other ______________________________________________________________________________________________________ Please list at least one strategy you learned from this activity that you will apply in practice: 1 2 3 4 5 How committed are you to applying these activities to your practice in the ways you indicated above? (1 - minimally, 5 - completely)
Did you perceive any bias for or against any commercial products or devices? Yes No
If yes, please explain: How long did it take you to complete these activities? _______ hours _______ minutes What are your biggest clinical challenges related to pediatric emergency care? [ ] Yes! I am interested in receiving future CME programs from Lippincott CME Institute! (Please place a check mark in the box )
Mail by September 30, 2017 to Lippincott CME Institute, Inc. Wolters Kluwer Health Two Commerce Square 2001 Market Street, 3rd Floor Philadelphia, PA 19103
704
www.pec-online.com
© 2016 Wolters Kluwer Health, Inc. All rights reserved.
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
Magnetic Foreign Body Ingestions
CME EXAM INSTRUCTIONS FOR OBTAINING AMA PRA CATEGORY 1 CREDITSTM Pediatric Emergency Care includes CME-certified content that is designed to meet the educational needs of its readers. An annual total of 12 AMA PRA Category 1 CreditsTM is available through the twelve 2016 issues of Pediatric Emergency Care. This activity is available for credit through September 30, 2017. The CME activity is now available online. Please visit http://CME.LWW.com for more information about this educational offering and to complete the CME activity.
CME EXAMINATION October 2016 Please mark your answers on the ANSWER SHEET. Magnetic Foreign Body Ingestions, Alfonzo and Baum 1. A 24-month-old boy presents to the pediatric emergency department with bilious vomiting and abdominal pain 1 day after returning from his grandparents’ home for the weekend. He has had no sick contacts. Upon arrival, he is afebrile, tachycardic, and hypotensive. He is poorly cooperative with the exam, but his abdomen seems firm, distended, and diffusely tender to palpation with voluntary guarding. Which of the following initial clinical steps would be best? a. Consult pediatric surgery b. Obtain abdominal ultrasound STAT c. Obtain AP chest and abdominal radiographs STAT d. Obtain IV access and administer 20 mL/kg normal saline bolus 2. Which of the following patients are at increased risk for magnetic foreign body ingestion? a. 2-year-old female whose father possesses Buckyballs b. 9-month-old male whose older sister has a Polly Pocket Playset c. 13-year-old male touting a magnetic tongue “piercing” d. All of the above 3. A 5-year-old patient reports ingestion of multiple high-powered magnets approximately 4 hours ago and radiographs have identified multiple small spherical radio-opaque objects in the stomach, linked in a ring. His vital signs are within normal limits and his abdominal exam is benign. Your next clinical step should be: a. Consult pediatric gastrointestinal specialist for emergent endoscopic removal b. Place nasogastric tube for PEG 3350 administration and admit for serial abdominal radiographs
c. Obtain STAT abdominal CT scan with oral and IV contrast d. Discharge home and screen stool for evidence of passage 4. A 15-month-old girl presents to the pediatric emergency department accompanied by parents who report that several of their Zen Magnets have gone missing. She is asymptomatic. Your next clinical step should be: a. Consult pediatric gastroenterology b. Obtain AP chest and abdominal radiographs STAT c. Obtain STAT abdominal CT scan with oral and IV contrast d. Place nasogastric tube for PEG 3350 administration and admit for serial abdominal radiographs 5. As a patient-advocate, which of the following ways can a clinician enhance home safety for children? a. Discourage adolescents from using magnetic facial or oral piercings b. Encourage parents to remove high-powered magnets from the home c. Report any known cases of magnet ingestion to the CPSC at www.SaferProducts.gov d. All of the above
© 2016 Wolters Kluwer Health, Inc. All rights reserved.
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
www.pec-online.com
703
Pediatric Emergency Care • Volume 32, Number 10, October 2016
Alfonzo and Baum
ANSWER SHEET FOR THE PEDIATRIC EMERGENCY CARE CME PROGRAM EXAM October 2016 Please answer the questions on page 703 by filling in the appropriate circles on the answer sheet below. Please mark the one best answer and fill in the circle until the letter is no longer visible. To process your exam, you must also provide the following information: Name (please print): ___________________________________________________________________________________________ Street Address _______________________________________________________________________________________________ City/State/Zip _______________________________________________________________________________________________ Daytime Phone ______________________________________________________________________________________________ Specialty ___________________________________________________________________________________________________
1. 2. 3. 4. 5.
A
B
C
D
E
A
B
C
D
E
A
B
C
D
E
A
B
C
D
E
A
B
C
D
E
Your completion of this activity includes evaluating them. Please respond to the following questions below. Please rate this activity (1 - minimally, 5 - completely) Was effective in meeting the educational objectives Was appropriately evidence-based Was relevant to my practice Please rate your ability to achieve the following objectives, both before this activity and after it: 1 (minimally) to 5 (completely) Pre
1 2 3 4 5
1 2 3 4 5
1. Summarize the background and mechanism of injury of magnetic foreign body ingestions. 2. Report the epidemiology of magnetic foreign body ingestions in the United States. 3. Discuss the management of magnetic foreign body ingestions in children.
Post 1 2 3 4 5
How many of your patients are likely to be impacted by what you learned from these activities? ○ 80% Do you expect that these activities will help you improve your skill or judgment 1 2 3 4 5 within the next 6 months? (1 - definitely will not change, 5 - definitely will change)
How will you apply what you learned from these activities (mark all that apply): In making treatment decisions ○ In diagnosing patients ○ As a foundation to learn more ○ In monitoring patients ○ In educating patients and their caregivers ○ In educating students and colleagues ○ To confirm current practice ○ As part of a quality or peformance improvement project ○ For maintenance of licensure ○ For maintenance of board certification ○ To consider enrolling patients in clinical trials ○ Other ______________________________________________________________________________________________________ Please list at least one strategy you learned from this activity that you will apply in practice: 1 2 3 4 5 How committed are you to applying these activities to your practice in the ways you indicated above? (1 - minimally, 5 - completely)
Did you perceive any bias for or against any commercial products or devices? Yes No
If yes, please explain: How long did it take you to complete these activities? _______ hours _______ minutes What are your biggest clinical challenges related to pediatric emergency care? [ ] Yes! I am interested in receiving future CME programs from Lippincott CME Institute! (Please place a check mark in the box )
Mail by September 30, 2017 to Lippincott CME Institute, Inc. Wolters Kluwer Health Two Commerce Square 2001 Market Street, 3rd Floor Philadelphia, PA 19103
704
www.pec-online.com
© 2016 Wolters Kluwer Health, Inc. All rights reserved.
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
