Pediatric emergency care
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Sudden cardiac deaths in previously healthy children are frequently due to undiagnosed cardiovascular diseases, either congenital or acquired. In an uncommon clinical entity known as commotio cordis, sudden death from cardiac arrest can occur in young athletes after a blunt blow to the chest, in the absence of preexisting cardiovascular disease. We present a case in which the clinician's high index of suspicion leads to the diagnosis of acute myocarditis in a patient whose sudden cardiac deterioration was initially attributed to the result of recent blunt chest trauma. ⋯ Although acute myocarditis, commotio cordis, and myocardial contusion can all present with malignant ventricular arrhythmia, other clinical features and approaches to management of each disease are very different. This case illustrates the importance of having a broad differential diagnosis in mind when presented with a previously healthy child in sudden cardiogenic shock.
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Pediatric emergency care · Nov 2005
Randomized Controlled Trial Comparative StudyA randomized controlled trial of sport helmet interventions in a pediatric emergency department.
To evaluate the effectiveness of 3 competing pediatric emergency department (ED) interventions aiming to increase sport helmet use in a state without helmet legislation. ⋯ Directly receiving a free helmet in the pediatric ED appears to be an effective hospital-based strategy to increase pediatric helmet use.
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Pediatric emergency care · Nov 2005
Practice GuidelineReport of the National Consensus Conference on Family Presence During Pediatric Cardiopulmonary Resuscitation and Procedures.
Representatives from 18 national organizations were convened for a conference to develop recommendations regarding family presence (FP) during pediatric procedures and cardiopulmonary resuscitation. Before the conference, invitees were given a questionnaire and provided with current literature regarding FP. A modified Delphi process was used to develop consensus, including use of multiple questionnaires and breakouts for discussion of specific issues. ⋯ Results of the conference were circulated to participants for review and revision. Consensus recommendations include (1) consider FP as an option for families during pediatric procedures and cardiopulmonary resuscitation, (2) offer FP as an option after assessing factors that could adversely affect the interaction, (3) if family is not offered the option for FP, document the reasons why, (4) always consider the safety of the health care team, (5) develop in-hospital transport and transfer policies and procedures for FP, such as family member definition, preparation of the family, handling disagreements, and providing support for the staff, (6) obtain legal review of policies, (7) include education in FP in all core curricula and orientation for health care providers, (8) promote research into best methods for education; effects of FP on patients, family, and staff; best practices for FP; and legal issues regarding FP, among others. These recommendations were approved in concept by the American Academy of Pediatrics and the Ambulatory Pediatrics Association.
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The purpose of this investigation was to determine the incidence and character of pediatric emergencies on a US-based commercial airline and to evaluate current in-flight medical kits. ⋯ The most common in-flight pediatric emergencies involved infectious diseases and neurological and respiratory tract problems. Emergency medical kits should be expanded to include pediatric medications.