Pediatric emergency care
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Pediatric emergency care · Jun 1992
Case ReportsAn unsuspected alkaline battery foreign body presenting as malignant otitis externa.
We describe a case of an unsuspected button battery foreign body in the ear canal causing symptoms that mimic malignant otitis externa in a previously healthy 13 year old. Button batteries in the ear canal may cause extensive liquefactive necrosis of the surrounding tissue by leaking an alkaline electrolyte solution. Suspicion of a foreign body should be maintained in any child presenting with a complicated otitis externa. Prompt evaluation and removal of button batteries are necessary to prevent tissue destruction.
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Acute pancreatitis in childhood is not a rare condition, and it should be considered in all children presenting with acute abdominal complaints. A complete history should be obtained, with emphasis on recent trauma or infection, current medications, and the presence of any chronic diseases. ⋯ Appropriate aggressive treatment, instituted early, will help to reduce the associated morbidity and mortality. Most children with acute pancreatitis will recover with conservative management and suffer no significant long-term sequelae.
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We undertook a prospective study of 377 children (two to 16 years old) presenting with abdominal pain to determine: 1) common discharge diagnoses; 2) what signs and symptoms are associated with appendicitis; and 3) follow-up of patients discharged from the emergency department (ED). Nine diagnoses accounted for 86% of all diagnoses made. The most common final diagnosis was "abdominal pain" (36%). ⋯ Of the patients contacted within one week of the visit (237), 75% reported that the pain had resolved (mean contact time, 2.6 days). We conclude that 1) patients presenting to the ED with abdominal pain often leave with the diagnosis of abdominal pain; 2) of the patients contacted, the majority reported that their pain has resolved; and 3) a diagnosis of appendicitis should be considered in any patient with any two of the following signs or symptoms: vomiting, guarding, tenderness, or RLQ pain. Such patients should be evaluated and observed carefully for the possible diagnosis of appendicitis.
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Pediatric emergency care · Jun 1992
Comparative StudyHigh-flow sheaths for pediatric fluid resuscitation: a comparison of flow rates with standard pediatric catheters.
We evaluated high-flow intravenous devices designed specifically for fluid resuscitation of infants and children. Fluid flow rates with 4-, 5-, and 6-Fr high-flow sheaths and 18-, 20-, and 22-gauge catheters were measured and compared. Flow rate is significantly faster with the 4-Fr sheath (P less than 0.0001) than with the 18-, 20-, or 22-gauge catheter. The high flow rates possible with the sheaths make them ideal for use in patients who require rapid fluid resuscitation.
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Pediatric emergency care · Jun 1992
Can early bacterial complications of aspiration with respiratory failure be predicted?
We studied the early infectious complications of all children admitted for intensive care over a six-year period who were at high risk of having severe aspiration of gastric or pharyngeal secretions. Patients were only analyzed if they required mechanical ventilation for acute respiratory failure, had a blood culture obtained in the first 48 hours, and survived at least 24 hours. Infections were identified by positive blood cultures. ⋯ Infected patients tended to be older (P less than 0.05). No diagnostic features in the first two days of hospitalization reliably identified those who would develop early infections (P greater than 0.05). Since early life-threatening infection is common and cannot be reliably predicted by clinical signs, we recommend aggressive bacteriologic surveillance and the administration of IV antibiotics on admission to all patients in respiratory failure requiring mechanical ventilation after presumed aspiration of gastric or pharyngeal secretions.