Pediatric emergency care
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Pediatric emergency care · Dec 1989
Case ReportsSurvival after emergency department thoracotomy in a child with blunt multisystem trauma.
A 14-year-old boy sustained severe blunt, multisystem trauma. On presentation, vital signs were present but disappeared despite maximal resuscitation. ⋯ Ultimately, the child survived with normal neurologic function and quality of life. This case illustrates the potential value of EDT in selected patients who present with detectable vital signs and deteriorate in the face of maximal conventional therapy.
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Pediatric emergency care · Dec 1989
Case ReportsTreatment of severe imipramine poisoning complicated by a negative history of drug ingestion.
The wide use of imipramine (Tofranil) for the treatment of nocturnal enuresis continues in spite of the unique dangers associated with this drug. Young children are particularly susceptible to the potentially lethal central nervous system and cardiovascular toxicities, yet the toxic potential of imipramine remains unrecognized by both parents and too many physicians. Management of severe imipramine intoxication can be difficult. This report describes a 12-month-old patient with severe imipramine intoxication whose treatment was complicated by a negative history at presentation.
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Pediatric emergency care · Dec 1989
Comparative StudyInfluence of topical anesthesia on the sedation of pediatric emergency department patients with lacerations.
Local anesthetic infiltration of wounds causes pain which distresses children. A painless topical anesthetic solution containing tetracaine, adrenaline, and cocaine (TAC) may reduce this distress. We hypothesized that the use of TAC for anesthesia may reduce the utilization of sedation for laceration repair. ⋯ However, there was a significant reduction in the percent of patients with lacerations receiving DPT during the experimental period, from 12% to 7.6% (P less than 0.05). There were no significant differences in laceration frequency (119/mo and 116/mo), length (2.7 and 2.7 cm), location (85% and 93% total for face and digits), or complexity (64% and 63%) for preTAC and TAC periods, respectively. We conclude that TAC used for local anesthesia may reduce the need for sedation in PED patients with lacerations that require suturing.
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Pediatric emergency care · Dec 1989
Case ReportsManagement strategy for penetrating oropharyngeal injury.
Direct force applied to an object held in the mouth may cause either superficial or penetrating injury within the oropharynx. The natural course for a majority of these injuries is spontaneous healing. ⋯ Violation of the retropharyngeal space may lead to dissecting emphysema or mediastinitis. Knowledge of these infrequent but serious sequelae complicates emergency department management decisions.
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Pediatric emergency care · Dec 1989
Should patients with normal cranial CT scans following minor head injury be hospitalized for observation?
The purpose of this study was to determine the incidence of complications in hospitalized patients with normal cranial computed tomographic (CT) scans following minor head injury (Glasgow Coma scale of 13-15). Seventy-three patients were included in the analysis, with 63 children being assigned a GCS score of 15 at presentation. Seventy-one percent of patients were male, and motor vehicle accidents accounted for 56% of the injuries. ⋯ GCS scores, history of LOC, vomiting, or seizures did not significantly influence length of hospitalization. None of the patients developed complications, and all were discharged in good condition. We conclude that a child with minor head injury, GCS score of 15, and a normal neurologic examination and cranial CT scan can be safely discharged to the care of a responsible adult and can be observed at home.