Usha Sethuraman
Wayne State University
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Featured researches published by Usha Sethuraman.
Pediatric Emergency Care | 2012
Bhawana Arora; Prashant Mahajan; Marwan Zidan; Usha Sethuraman
Background Heated, humidified, high-flow nasal cannula oxygen therapy (HHHFNC) has been used to improve ventilation in preterm infants. There are no data on airway pressures generated and efficacy in bronchiolitis. Objective The objective of this study was to determine nasopharyngeal (NP) pressures generated with HHHFNC therapy in bronchiolitis. Methods We conducted a prospective, observational study to measure NP pressures at varying flow rates of HHHFNC therapy in moderate to severe bronchiolitis. Vital signs, bronchiolitis severity scores, and oxygen saturation were also noted. Results Twenty-five patients were enrolled (mean, 78.1 [SD, 30.9] days; weight, 5.3 [SD, 1.1] kg). Nasopharyngeal pressures increased linearly with flow rates up to 6 L/min. Beyond 6 L/min, pressure increase was linear but less accelerated. On average, NP pressure increased by 0.45 cm H2O for each 1-L/min increase in flow rate. There were significant differences between pressures in open- and closed-mouth states for flow rates up to 6 L/min. At 6 L/min, the pressure in open-mouth state was 2.47 cm H2O and that in closed-mouth state was 2.74 cm H2O (P < 0.001). Linear regression analysis revealed that only flow (not weight or gender) had an effect on generated pressure. Bronchiolitis severity scores improved significantly with HHHFNC therapy (pre: 14.5 [SD, 1.4], post: 10.4 [SD, 1.2]; P < 0.001). Conclusions Increasing flow rates of HHHFNC therapy are associated with linear increases in NP pressures in bronchiolitis patients. Larger studies are needed to assess the clinical efficacy of HHHFNC therapy in bronchiolitis.
Pediatric Anesthesia | 2009
Nirupama Kannikeswaran; Prashant Mahajan; Usha Sethuraman; Anna Groebe; Xinguang Chen
Background: There are few studies on sedation medication requirements and sedation related adverse events in developmentally disabled children.
Clinical Pediatrics | 2009
Usha Sethuraman; Deepak Kamat
Important details in the history that should be elicited include the following: duration of symptoms, changes in vision, foreign body sensation in the eye, associated pain and photophobia, history of trauma, use of contact lenses, and any eye discharge. Any child with a history of wearing contact lenses (even if not wearing one at the time of the examination) should be referred to the ophthalmologist, as a primary physician cannot assess parameters such as lens fit. Besides, the risk of permanent scarring from infections is significantly increased, especially in soft lens wearers. The examination of the red eye should be performed after contact lenses or glasses (if the child is wearing any) are removed. During examination, care must be taken to obtain the following details: (1) Is the eye universally red, or is the redness restricted to any portion of it? (2) Is vision impaired? (3) Are the ocular movements restricted (movements are often restricted with orbital cellulitis)? (4) Are the eyelids intact and free of infections? (5) Are the pupils equal and reactive to light? and (6) Is the cornea clear? A flourescein stain and examination of the eye should be performed to rule out any corneal abrasions or tears, and when possible, a slit lamp examination should be performed. Some of the red flags for red eye include an immune-compromised host, persistent blurred vision, severe pain, ciliary flush, corneal opacification, proptosis, a pupil that does not react to direct light, reduced ocular movements, worsening signs, and no improvement despite therapy for 3 days. Some of the specific conditions that present with a red eye are discussed below.
Pediatric Emergency Care | 2010
Nirupama Kannikeswaran; Usha Sethuraman
Lunate and perilunate dislocations are uncommon, but devastating carpal injuries, which, if unrecognized in the emergency department and not treated promptly, lead to a high incidence chronic wrist pain and long-term functional disability. In this case report, we will review the wrist joint anatomy as pertaining to these injuries, mechanism of injury, signs and symptoms, radiological findings, and treatment of such injuries.
Pediatric Anesthesia | 2011
Nirupama Kannikeswaran; Xinguang Chen; Usha Sethuraman
Background: We have shown previously that children with developmental disabilities have three times higher incidence of sedation‐related hypoxia when compared with normal children.
American Journal of Emergency Medicine | 2009
Usha Sethuraman; Marjan Siadat; Cynthia A. Lepak-Hitch; Demetris Haritos
Pulmonary embolisms (PEs) are easily missed both in children and adults because of the varied presentations and subtle clinical findings. Abdominal pain as the presenting symptom of PE is extremely rare in children and only reported as occasional case reports in adults. We present a series of 2 cases of PE presenting as acute abdomen. Case 1 is a 14-year-old adolescent boy who presented to a pediatric emergency department with abdominal pain, whereas case 2 is a 22-year-old man who presented to the adult emergency department of the same institution with abdominal pain. There was a delay in diagnosis in both cases due to lack of recognition of the unusual presentation. Awareness of the unusual presentations of PE and the risk factors in both adults and children can assist the clinician toward an accurate diagnosis and timely therapeutic intervention.
Pediatric Emergency Care | 2011
Usha Sethuraman; Nirupama Kannikeswaran; Xinguang Chen; Prashant Mahajan
Objectives: Wait times and length of stay (LOS) measure efficiency of care in pediatric emergency departments (PEDs). Our hospital introduced a rapid assessment program (RAP) wherein patients will be seen by a physician within 29 minutes of arrival to the PED. Our primary objective was to evaluate the impact of this RAP on total LOS and compare it with the pre-RAP period. The secondary objective was to compare door-to-physician times and admission frequencies. Methods: We conducted an observational study of randomly selected visits before (in 2004) and after (in 2005) RAP in a PED. Data were acquired retrospectively from charts. We compared total LOS (time from arrival at triage to discharge), boarding time (time from the decision to admit to transfer to inpatient bed), door-to-physician time (arrival at triage to first evaluation by physician), and admission frequencies. Results: Data from 990 visits (in 2004) and 1010 visits (in 2005) indicated similar age, sex, seasonal distribution, and weekday distribution. The total median LOS decreased by 37 minutes with RAP (103 [interquartile range {IQR}, 57-187] minutes in 2005 vs 140 [IQR, 78-234] minutes in 2004, P < 0.001) but only among lower triage categories. Median door-to-physician time decreased by 20 minutes with RAP (15 [IQR, 7-29] minutes in 2005 vs 35 [IQR, 18-72] minutes in 2004, P < 0.001) among lower triage categories. The LOS was reduced both in admitted and discharged patients with no difference in the boarding times or admission frequencies. Conclusions: In our PED, a RAP reduced the total LOS of patients with lower acuity of illness.
Pediatric Emergency Care | 2012
Nirupama Kannikeswaran; Usha Sethuraman; Lalitha Sivaswamy; Xinguang Chen; Prashant Mahajan
Objective Our objective was to prospectively compare sedation medication requirements and adverse events related to sedation in children with and without developmental disabilities. Methods We conducted a prospective, observational, age-matched, 1:2 case-control study of children (3–10 years) sedated for brain magnetic resonance imaging at a tertiary-care children’s hospital. Developmental assessment was performed using the Vineland Adaptive Behavioral Scale and by a pediatric neurologist. Patients were sedated according to institutional sedation protocol. Patient demographics, type and dose of sedation medications, depth of sedation, and adverse events were collected. We defined hypoxia as oxygen saturation 90% or less for 30 seconds or longer and requiring airway maneuvers. Results Seventy children were designated as cases (DD) and 140 as controls (DN). DD had a significantly lower mean Vineland Adaptive Behavioral Scale score than did DN (DD: 62.34 ± 9.70, DN: 103.0 ± 13.71; P < 0.001). A combination of pentobarbital and fentanyl (DD: 32/70 [45.7%], DN: 60/140 [42.9%]) and combination of pentobarbital and midazolam (DD: 28/70 [40%], DN: 43/140 [30.7%]) were the most common sedatives used in both groups. There was no difference in the mean dose of pentobarbital (DD:4.68 ± 1.63 mg/kg, DN:4.67 ± 1.69 mg/kg; P = 0.9), fentanyl (DD: 0.61 ± 0.65 &mgr;g/kg, DN: 0.64 ± 0.65 &mgr;g/kg; P = 0.7), and midazolam (DD: 0.15 ± 0.17 mg/kg, DN: 0.11 ± 0.14 mg/kg; P = 0.1). There was no difference in the overall adverse events (DD: 30%, DN: 32.9%; P = 0.7) as well as hypoxia (DD: 10%; DN: 9.3%, P = 0.9). Conclusions When compared with DN children, DD children do not require a higher dose of sedatives and do not have a higher incidence of adverse events.
Pediatric Emergency Care | 2011
Nirupama Kannikeswaran; Usha Sethuraman; Seema Rao; Stephen R. Knazik; Xinguang Chen; Prashant Mahajan
Objectives: The issue of multiple family members presenting to the emergency department (ED) for care during a single visit is unique to pediatric EDs (PEDs). The epidemiology of such multiple-patient visits (MPVs) has not been well characterized. The aims of this study were to describe patient characteristics, Emergency Severity Index (ESI) triage categories, length of stay, ED disposition, and payer characteristics of such MPV and to compare these characteristics to that of the overall ED visits (OEVs). Methods: We conducted a retrospective chart review of MPVs to an inner-city PED from June to December 2006. We collected patient demographics, ESI triage categories, ED disposition, length of stay, and payer characteristics. Descriptive methods and comparative methods were used to summarize the sample characteristics and compare group differences, respectively. Results: Multiple-patient visit constituted 2.2% (1166/52,491) of the total ED visits with a total of 2511 patients. The majority (88%; 1025/1166) of such visits were with 2 patients in a family. Ninety-one percent (2285/2511) of patients presented for medical complaints. Compared with the OEV, MPV belonged significantly more to ESI triage category 5 (51.2% vs 28.6%) and less to ESI triage category 3 (10.0% vs 24.6%; &khgr;2 = 775.4; P < 0.01). A significantly higher percentage of MPV patients belonged to Medicaid Health Maintenance Organization compared with the OEV patients (72.4% vs 47.6%; P < 0.01). Only 3.3% of MPV patients required hospital admission. Conclusions: In our inner-city PED, most of the MPVs are for medical complaints, belong to a lower acuity, and have a low hospital admission rate.
Clinical Pediatrics | 2009
Amit Sarnaik; Usha Sethuraman; Eric T. Jones
A previously healthy 31⁄2-year-old Caucasian boy was evaluated in the emergency department (ED) for pain and weakness in the lower extremities. About 3 weeks prior to presentation, he had developed a fever of 1028F associated with slight upper respiratory symptoms, and the symptoms resolved in 48 hours without any treatment. He remained asymptomatic for about 8 days after which he started complaining of pain in the right knee and generalized pain in the left lower extremity. The pain was significant enough to cause loss of ambulation and inability to climb stairs. The pain was treated by the parent with ibuprofen for about 3 days, which provided minimal relief. When the pain awakened him at nights, the parents brought him to his primary care physician (PCP). He was found to have normal physical examination as well as normal laboratory investigations, which included a complete blood count, erythrocyte sedimentation rate, C-reactive protein, creatine phosphokinase, and an antinuclear antibody test. A diagnosis of myalgia was made by the PCP. However, persistence of symptoms led to a visit to the ED, where he was found to have normal physical examination except for a mild discomfort on internal and external rotation of bilateral hips. Radiographs of the hips were done and were interpreted as normal. He was discharged home with a presumptive diagnosis of synovitis. When the symptoms continued to persist beyond 2 weeks, he was referred to pediatric orthopedics by the PCP for evaluation. Here, he was noted to be ambulatory, with normal appearing hip, knee, and ankle joints. The child was, however, found to have significant difficulty in standing up from a sitting position, raising suspicion for proximal muscle weakness in the bilateral lower extremities. A plain radiograph to evaluate the child’s spine was obtained, which was inconclusive. Because the patient’s presentation and symptoms appeared to be of nonorthopedic etiology, he was transferred to the ED for a repeat evaluation of bilateral leg pain and possible muscle weakness. The mother denied any trauma, respiratory, or gastrointestinal complaints. There were no bowel or bladder complaints and no history of changes in mental status or cognition, although the mother gave a history of the child often requesting that his feet be ‘‘rubbed.’’ In the ED, his vital signs were normal with a temperature of 378C, pulse of 114 per minute, respirations of 16 per minute and a blood pressure of 82/56 mm Hg. He was alert and active with a normal sensorium but appeared slightly uncomfortable secondary to lower extremity pain. His cranial nerves were grossly intact. Motor examination was hard secondary to the child’s poor cooperation, but he still demonstrated normal gait. He was noted to have slightly diminished patellar reflexes. Upper extremity neurological exam was found to be within normal limits. An MRI of the spine was done and revealed enhancement of nerve roots in the lumbar, conal, and to some extent, even in the cervical region (Figure 1). These findings coupled with the background of the clinical exam, were considered to be highly suggestive of Guillain Barré; syndrome (GBS). He was subsequently admitted to the hospital for further evaluation and treatment. A spinal tap done on the following day revealed no red blood cells, 1 white blood cell, and normal glucose level of Clinical Pediatrics Volume 48 Number 4 May 2009 440-443