Pediatric emergency care
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Pediatric emergency care · Jun 1997
ReviewComplications of Fleet enema administration and suggested guidelines for use in the pediatric emergency department.
Hypertonic sodium phosphate enema solutions are commonly used for the treatment of acute constipation in the pediatric emergency department. The potential for severe metabolic derangement and death in children with gastrointestinal and/or renal abnormalities and these reported as normal has been documented in the literature. ⋯ The guidelines provided will promote safe use of hypertonic sodium phosphate enema solutions for the treatment of acute constipation in children presenting to the emergency department.
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Pediatric emergency care · Jun 1997
Randomized Controlled Trial Clinical TrialThe value of end-tidal CO2 monitoring when comparing three methods of conscious sedation for children undergoing painful procedures in the emergency department.
Many studies have evaluated conscious sedation regimens commonly used in pediatric patients. Recent advances in capnography equipment now enable physicians to assess respiratory parameters, specifically end-tidal CO2 (et-CO2), more accurately in spontaneously breathing sedated children than was possible in the earlier studies. This study was designed to: 1) compare the safety and efficacy of intravenous fentanyl, intravenous fentanyl combined with midazolam, and intramuscular meperidine-promethazine-chlorpromazine (MPC) compound when used for painful emergency department (ED) procedures: and 2) to determine whether the addition of et-CO2 monitoring enabled earlier identification of respiratory depression in this population. ⋯ Fentanyl, fentanyl-midazolam, and MPC produced a high incidence of subclinical respiratory depression. End-tidal CO2 monitoring provided an earlier indication of respiratory depression than pulse oximetry and respiratory rate alone. MPC administration resulted in a significantly delayed discharge from the ED.
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Pediatric emergency care · Jun 1997
Comparative StudyTibial length following intraosseous infusion: a prospective, radiographic analysis.
Intraosseous infusion is a well accepted means of obtaining emergency intravascular access in children. Despite the low incidence of serious complications from intraosseous infusions, the potential exists for growth plate injury and subsequent growth disturbance following intraosseous infusion. ⋯ We found no significant difference in mean tibial length between the legs that had intraosseous infusions and the opposite legs, which served as controls. We conclude that intraosseous infusion does not appear to produce subsequent leg length discrepancy one year after infusion.
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Pediatric emergency care · Jun 1997
Skull fractures in infants and predictors of associated intracranial injury.
Emergency department (ED) management of skull fractures in children remains controversial. Because infants incurring head trauma have a high incidence of skull fracture, we chose to describe fractures in this subset of patients and to determine if there are clinical predictors of associated intracranial injury (ICI) that may have utility in developing more efficient management schemes in these patients. ⋯ This study reports a high prevalence of fracture characteristics often associated with inflicted injury in other studies when virtually all injuries in our sample were accidental. Several clinical characteristics were demonstrated to be potentially useful in predicting ICI associated with skull fracture; however, prospective study is recommended to validate these findings prior to clinical application.
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Pediatric emergency care · Jun 1997
Utility of toxicology screening in a pediatric emergency department.
To determine the types of patients who undergo toxicology screen testing (TS) and the clinical utility of the test in a pediatric emergency department. ⋯ A minority of patients have unexpected TS results. TS results rarely necessitate a change in medical management. Emergency physicians should reevaluate indications for TS testing in pediatric patients.