Pediatric emergency care
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Coarctation of the aorta is a congenital cardiac abnormality that can lead to congestive heart failure in early infancy or can go undetected for many years. We discuss the case of an infant who presented to our emergency department with epistaxis and was found to have this lesion based on the physical examination. ⋯ A cardiac murmur and differential blood pressure between upper and lower extremities are the most reliable physical findings for identifying patients with coarctation of the aorta. Absent femoral pulses are a hallmark of this lesion, but not a dependable finding.
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Pediatric emergency care · Jun 1998
Case ReportsAcute valproate ingestion induces symptomatic methemoglobinemia.
A wide variety of clinical outcomes have been described after acute valproate ingestion. We report for the first time the development of symptomatic methemoglobinemia after an acute ingestion of divalproex sodium (Depakote), resulting in serum concentrations 10 times greater than the therapeutic range. ⋯ Valproate elimination was enhanced by the continuous infusion of activated charcoal. The patient recovered without permanent sequelae.
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Pediatric emergency care · Jun 1998
Use of Emergency Medical Service transport system in medical patients up to 36 months of age.
To determine the frequency of inappropriate transport by Emergency Medical Service (EMS). ⋯ EMS is utilized for inappropriate transportation in approximately 37% of our pediatric patients less than 36 months of age with medical complaints. In addition, 28% of these same patients utilized the EMS system on more than one occasion. It would appear that education of care providers in the appropriate use of EMS and use of alternate means of transportation would make the system more efficient and productive.
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Pediatric emergency care · Jun 1998
Clinical criteria for using radiography for children with acute knee injuries.
To evaluate clinical criteria for selective radiography for knee injuries in children. ⋯ Point tenderness was not a good predictor of knee fracture in children. Using the clinical criteria to select patients requiring knee radiography may greatly reduce the number of unnecessary x-rays.
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Pediatric emergency care · Jun 1998
Comparative StudyChest radiograph in the evaluation of first time wheezing episodes: review of current clinical practice and efficacy.
To evaluate the current clinical use and utility of chest radiographs (CXR) in the workup of pediatric patients with first time wheezing (FTW) episodes. ⋯ Clinicians in this setting do not routinely obtain a CXR in patients with FTW episodes. Retrospective examination of clinician practice revealed several clinical characteristics that were associated with increased use of CXR in FTW. Increased utility of the CXR was associated with patients having elevated temperature, an absence of a family history of asthma, and localized wheezes or rales by ausculatory examination.