Pediatric emergency care
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Pediatric emergency care · Nov 2004
Case ReportsAn adolescent with chest pain-sequela of Kawasaki disease.
Kawasaki disease, is an acute vasculitis of unknown etiology characterized by mucocutaneous involvement occurring in infants and young children, predominantly younger than 5 years of age. We present a case of a 19-year-old female with a prior history of Kawasaki disease as an infant who was seen in the emergency department with chest pain in the midsternal region lasting for 20 minutes with radiation to the left arm. ⋯ There was a 90% eccentric and calcified single discrete stenosis of the proximal segment of the left anterior descending artery, and the patient underwent a successful percutaneous transluminal coronary angioplasty with stent insertion. Physicians working in the emergency department setting should remain cognescent of the rarer but significant cardiac causes of chest pain while evaluating children, adolescents, and young adults.
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Pediatric emergency care · Nov 2004
Case ReportsWood's lamp employed as a provocative technique to identify pseudoseizures.
We present a case of a 12-year-old female who presented to the emergency department with ictal phenomena suggestive of pseudoseizures. A Wood's lamp was successfully employed to induce the stereotypic phenomena and thereby identify the ictal events as nonepileptiform. Use of the Wood's lamp has not previously been reported as a provocative stimulus to induce pseudoseizures. Given its noninvasive nature and ready availability, the Wood's lamp should be considered for identification of pseudoseizures.
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Pediatric emergency care · Nov 2004
Letter Case ReportsEvaluation of pediatric bladder reservoir trauma.
We present a case where computed tomographic cystography of the bladder failed to identify a bladder rupture in a girl with an Indiana pouch after falling from her bicycle. Despite the normal cystogram, surgery was performed because of unresolving abdominal pain and free fluid identified on abdominal computed tomography. Upon exploration, 2 intraperitoneal ruptures were identified. While computed tomographic cystography is accurate for the evaluation of trauma in a normal bladder, emergency room physicians should be aware of its potential inaccuracy in patients with bladder reservoirs.
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Pediatric emergency care · Nov 2004
Comparative StudyComparison of the temporal artery and rectal thermometry in children in the emergency department.
Rectal thermometry, the criterion standard of temperature measurement in young children, has numerous disadvantages. This study examined the agreement between rectal versus a new temporal artery professional model (TAPM) thermometer and rectal versus a home device temporal artery consumer model (TACM) thermometer, investigated if the TAPM can safely screen for rectal fever, and determined if parents can detect rectal fever using the TACM. DESIGN, OUTCOME MEASURES, AND SUBJECTS: In this cross-sectional agreement emergency department study, 327 children <24 months of age had their temperature measured rectally and by the TAPM and TACM by a single nurse and using the TACM by the parents. Agreements were analyzed by the Bland Altman plots. Temperature cutoff to detect rectal fever > or =38.0 degrees C and > or =38.3 degrees C with sensitivities of > or =90% and > or =95%, respectively, was determined for the TAPM. ⋯ The TAPM thermometer cannot replace the rectal. However, TAPM temperature of <37.7 degrees C can be safely used as a screen to exclude rectal fever > or =38.3 degrees C in infants 3 to 24 months of age. The TACM home device has insufficient ability to detect rectal fever. A multicenter trial is needed to validate these results across multiple emergency departments and numerous observers.