Annals of emergency medicine
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Sedation and analgesia are essential components of the ED management of pediatric patients. Used appropriately, there are a number of medications and techniques that can be used safely in the emergency care of infants and children. Emergency physicians should be competent in the use of multiple sedatives and analgesics. Adequate equipment and monitoring, staff training, discharge instructions and continuous quality management should be an integral part of the ED use of these agents.
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Time series analysis can provide accurate predictions of emergency department volume, length of stay, and acuity. ⋯ Time series analysis can provide powerful, accurate short-range forecasts of future ED volume. Simpler models performed best in this study. Time series forecasts of length of stay and patient acuity are not likely to contribute additional useful information for staffing and resource allocation decisions.
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We report two cases of severe complications from intraosseous infusions. One child was a sudden infant death syndrome patient who developed severe tissue necrosis after intraosseous placement. ⋯ Intraosseous infusion remains an important resuscitation modality, but great care must be taken to avoid these results. Strategies for avoiding extravasation are discussed.
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To determine whether a set of published triage guidelines identifies patients who can safely be refused emergency department care. ⋯ When tested in our patient population, the triage guidelines were not sufficiently sensitive to identify patients who needed ED care. Broad application of these guidelines may jeopardize the health of some patients.
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Comparative Study
Rectal diazepam for prehospital pediatric status epilepticus.
To compare the feasibility, effectiveness, and safety of rectal diazepam and intravenous diazepam in the treatment of pediatric prehospital status epilepticus. ⋯ Rectal diazepam is a simple, effective, and safe method of prehospital management of pediatric status epilepticus. Compared with IV diazepam, rectal diazepam is easier to administer, especially in infants and toddlers; is equally efficacious; and is less likely to produce respiratory depression. Although respiratory depression is rare with rectal diazepam, prehospital personnel must be prepared to provide definitive respiratory support. Short duration of action is an important limitation of both treatments.