Pediatric emergency care
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Primary cardiac arrhythmias are much less common in children than adults. This study was performed to identify the characteristics of primary arrhythmias in pediatric patients in the Emergency Department (ED). ⋯ Primary arrhythmias are unusual ED presentations in children and atrial tachyarrhythmias are the most common rate and rhythm disturbance in this population.
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Pediatric emergency care · Apr 1999
Case ReportsPrehospital epinephrine overdose in a child resulting in ventricular dysrhythmias and myocardial ischemia.
Epinephrine overdoses in children have been associated with supraventricular tachycardia. Myocardial ischemia subsequent to epinephrine overdose has not been reported in pediatric patients. ⋯ There is no role for high-dose epinephrine in the treatment of allergic reactions or asthma. Careful epinephrine dosing, using mg/kg and verifying the volume, dilution, and route of administration is essential to prevent epinephrine toxicity.
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Pediatric emergency care · Apr 1999
Comparative StudyInpatient reports of suspected child abuse or neglect (SCAN): a question of missed opportunities in the acute care setting.
To determine reasons inpatient reports of suspected child abuse or neglect (SCAN) were not initiated at the time of evaluation in the acute care setting. ⋯ Inpatient reports are often the result of additional findings obtained after admission. A higher percentage of admissions from a GED than from a PED had inpatient reports of SCAN without additional findings. Patients who have an inpatient report filed for SCAN are often of high medical acuity, less likely to have physical findings, and may present with injuries or illnesses unrelated to the SCAN.
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Over the past 10 years the reported incidence of acute isoniazid (INH)-related poisonings has increased, with 507 cases reported in 1996. Parenteral pyridoxine is the antidote for INH-induced seizures, but 5-g aliquot recommended to treat an ingestion of unknown quantity of INH is not always readily available to emergency physicians. ⋯ Our results imply that between one third and one half of the respondents would be ill-equipped to treat acute INH neurotoxicity. Establishing regional distribution centers may alleviate this deficiency, specifically in urban areas with a high incidence or a positive percent increase in TB.
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Pediatric emergency care · Apr 1999
Review Case ReportsAtraumatic pneumocephalus: a case report and review of the literature.
Pneumocephalus or air within the cranial vault is usually associated with disruption of the skull caused by head trauma, neoplasms, or after craniofacial surgical interventions. We report a child who presented with headache and the pathognomonic "succussion splash" and was found to have atraumatic pneumocephalus from forceful valsalva maneuvers. Pneumocephalus forms, caused by either a ball-valve mechanism that allows air to enter but not exit the cranial vault, or cerebrospinal fluid (CSF) leaks, which create a negative pressure with subsequent air entry. We review the literature for traumatic and atraumatic causes of pneumocephalus, its complications, and therapy.