Pediatric emergency care
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Pediatric emergency care · Oct 2001
Pediatric appendicitis in "real-time": the value of sonography in diagnosis and treatment.
To determine the accuracy of sonography in the diagnosis of clinically equivocal appendicitis, and to identify the factors leading to an inaccurate ultrasound diagnosis. The impact of sonographic findings on clinical management and outcome of children with appendicitis is examined. ⋯ Ultrasound is a useful for the evaluation of acute abdominal pain in children. However, in the setting of a pediatric hospital ED, the accuracy of ultrasound and its ability to improve early hospital triage may be reduced. Repeated clinical review is still essential and in selected cases, appendiceal CT scan may be required to guide therapeutic decision making.
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Pediatric emergency care · Oct 2001
Comparative StudyCoagulation testing in pediatric blunt trauma patients.
To determine the prevalence of abnormal coagulation studies and to identify variables associated with markedly elevated coagulation studies in children with blunt trauma. ⋯ Hospitalized pediatric blunt trauma patients frequently have minor elevations in ED coagulation studies. Marked elevations occur infrequently and are independently associated with a GCS < or =13, low systolic blood pressure, open/multiple bony fractures, and major tissue wounds.
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Pediatric emergency care · Oct 2001
Use of an observation unit by a pediatric emergency department for common pediatric illnesses.
To describe the use of a pediatric observation unit (OU), including relapse rates for common pediatric illnesses, and to assess effectiveness of OU utilization. ⋯ Admissions to the observation unit comprised over one third of all admissions from a pediatric ED. Certain pediatric illnesses appear to be well suited for admission to the observation unit, with low likelihood of the need for subsequent admission to the inpatient unit. Given the current trends in third-party payer reimbursements for short (<24 hours) admissions, observation unit use provides a more attractive alternative to inpatient admission for many pediatric patients.
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Pediatric emergency care · Oct 2001
A pediatric emergency department follow-up system: completing the cycle of care.
Prior to 1993, the follow-up program for our pediatric emergency department (ED) was the responsibility of the rotating senior pediatric resident. There were inherent problems with this system, as a consequence of inconsistent personnel. The residents' revolving schedules and the fact that they were accountable to other clinical areas decreased their availability for follow-up. Also, it was difficult for the clerical staff to identify the person responsible for answering parent calls. The medical director of the ED made the decision to turn the core responsibility for the follow-up program to the nurse practitioners in addition to their direct care provider role. The nurse practitioner group is a consistent member of the treatment team who has the critical thinking skills necessary to handle the majority of issues that require follow-up. The emergency attending physicians are available for consultation whenever questions arise. ⋯ The next step in further reviewing this program is the development of a satisfaction questionnaire for patient/ families and community providers to quantify their level of satisfaction with the program. A retrospective chart review of the patients who received a follow-up phone call after discharge, and the return visit rate would be another avenue to pursue to validate our antidotal information.
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Pediatric emergency care · Oct 2001
Case ReportsIatrogenic cardiopulmonary arrest during pediatric sedation with meperidine, promethazine, and chlorpromazine.
The pediatric sedative combination of meperidine, promethazine, and chlorpromazine (MPC) has been widely used for more than 40 years. Despite its relatively poor efficacy and questionable safety profile, many emergency departments (EDs) continue to stock specially formulated mixtures of these three agents. ⋯ Subsequently, we have removed MPC entirely from our ED and instituted a policy restricting ED procedural sedation privileges to emergency physicians. We urge other EDs to do likewise.