Pediatric emergency care
-
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.
-
Pediatric emergency care · Apr 1999
Comparative StudyUtilization analysis of an observation unit for children with asthma.
Short-stay observation unit (OU) care for children with asthma has the potential to reduce hospitalization rates for this common pediatric condition. In the effort to increase the efficiency of such a unit, knowledge of predictive factors for successful discharge is important. ⋯ No clinical predictive factors determined at the time of arrival to the ED were identified for children with asthma who were successfully discharged from the OU except for a lesser need of oxygen supplementation. The patients observed in the OU had similar management in the initial 3 hours of arrival and similar length of stay in the OU, regardless of their disposition outcome. Maximal OU efficiency remains limited by the lack of clear predictive factors for successful discharge. Further study in this area is indicated.
-
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.
-
Status epilepticus (SE) is a common pediatric emergency encountered in the prehospital situations and in the emergency administration of anticonvulsants, which will cause the seizures to cease. Although prognosis is primarily determined by the etiology, the duration of SE and therapy administered have unequivocal impact. If the seizures last longer than 1 hour, homeostatic mechanisms may start to fail. ⋯ The input of the pediatric intensive care physician is critical and assumes a major role if the patient fails to respond to first-line therapy. The treatment of refractory status epilepticus requires labor-intensive hemodynamic support and suppression of central nervous system, with either an anesthetic agent or a barbiturate. There is an urgent need to formulate guidelines for management of refractory status epilepticus.