Pediatric emergency care
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Pediatric emergency care · Jun 1989
Case ReportsIntraosseous drug administration: successful resuscitation from asystole.
The case of a seven-month-old infant presenting in full cardiac arrest and resuscitated utilizing a right tibial intraosseous access line is presented. The child who presented in asystole appears to be the first reported case of the successful use of the intraosseous route as the sole source of drug administration. Flow time from tibia to clinical cardiac response was noted to be less than three minutes, similar to those in animal arrest models.
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Pediatric emergency care · Jun 1989
Case ReportsImmobilization hypercalcemia: unusual presentation with seizures.
Immobilization hypercalcemia usually causes mild neurologic symptoms. Seizures are a rare complication, appearing weeks after the appearance of other symptoms of hypercalcemia. ⋯ In this child, early diagnosis and therapy probably prevented the more complicated course described in previous cases. We wish to draw attention to this potentially life-threatening complication of immobilization.
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We retrospectively reviewed the emergency department records of 77 children and adolescents seen in an emergency department with the chief complaint of fainting. Upon careful review, 20 patients had not had any type of syncopal or near-syncopal episode. Of the remaining 57 patients, 40 experienced syncope, and 17 patients had near-syncope. ⋯ The most frequent diagnoses in the near-syncope group were lightheadedness (29%), seizure (18%), tension headache (12%), and migraine (6%). Seventeen and one half percent of syncopal patients had abnormalities of vital signs, orthostatic vital signs, glucose, hematocrit, or ECG; none of the near-syncopal patients had abnormalities. We conclude that initial evaluation of first-episode syncope should include orthostatic vital signs, glucose, hematocrit, and ECG with further studies performed as clinically indicated.