Pediatric emergency care
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Pediatric emergency care · Jul 2007
Case ReportsAn unusual case of a central nervous system tumor presenting as a chief complaint of depression.
Patients presenting to the emergency department with a psychiatric chief complaint often undergo a medical clearance examination. There is much debate in the literature as to the value of routine laboratory and other diagnostic studies in the initial evaluation of these patients. We report on a patient presenting to the pediatric emergency department with a chief complaint of depression who ultimately was found to have diabetes insipidus and a primary intracranial germ cell tumor. Although a rare outcome to a relatively common scenario in the emergency department, this case underscores the value of a detailed history, careful physical examination, and consideration of laboratory and other diagnostic studies in patients presenting to the emergency department for psychiatric evaluation.
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Spontaneous esophageal rupture (Boerhaave syndrome) is uncommon in children. Delayed or missed diagnosis can lead to poor outcomes in terms of morbidity and mortality. To highlight the importance of early recognition and management of spontaneous esophageal rupture in children, we report a case of a 16-year-old boy who presented in the emergency department with acute chest pain after episodes of vomiting.
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Pediatric emergency care · Jul 2007
Prospective study of sudden-onset asthma exacerbations in children.
Sudden-onset asthma exacerbations among adults have more rapid treatment responses than do slower-onset exacerbations. We hypothesized that a similar pattern would be evident in children presenting to the emergency department (ED) with an asthma exacerbation. ⋯ Patients with sudden-onset exacerbations had similar acute asthma severity as those with slower-onset exacerbations but had shorter ED length of stay and were less likely to be admitted to the hospital, suggesting a more rapid response to treatment.
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Etizolam (ETZ) is an antidepressive thienodiazepine drug that is used worldwide. The most frequent adverse effects in adults are drowsiness and muscle weakness, and this can rarely cause paradoxical excitation; however, no information exists on intoxication in children. ⋯ We present a case of a child who accidentally took a single dose of ETZ, approximately the same as a therapeutic dose for adults, and who showed paradoxical excitation and muscle weakness. The case presented here suggests that pediatricians and emergency physicians should be aware of the possible adverse effects in children and therapeutic approaches in intoxication of ETZ and the necessity of further investigations on a specific therapeutic guideline for overdose management especially in children.
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Pediatric emergency care · Jul 2007
Case ReportsSpontaneous pneumothorax, pneumomediastinum, and epidural emphysema presenting as neck pain suspicious for meningitis.
Pneumomediastinum and epidural pneumatosis are rare findings. Simultaneous occurrence of spontaneous pneumothorax, pneumomediastinum, pneumopericardium, and epidural emphysema is particularly rare. These findings are even more unusual when there is no history of trauma, underlying pathology, or history of asthma. ⋯ It is important to recognize the clinical signs and symptoms of air trapping in various tissues and investigate appropriately. This may prevent potentially life-threatening complications. Subcutaneous emphysema, pneumomediastinum, and epidural emphysema associated with spontaneous bilateral pneumothoraces represents an extremely rare presentation.