Pediatric emergency care
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Pediatric emergency care · May 2008
ReviewTreatment of children with migraine in the emergency department: a qualitative systematic review.
To evaluate which treatment could be effective in the emergency department (ED) for children with migraine and status migrainosus, we carried out a qualitative systematic review of randomized controlled trials (RCTs) that evaluated treatment that could be used for those conditions. ⋯ There is a lack of studies addressing the question of treatment in the ED for children experiencing migraine. Although other treatments were found effective in children with migraine, none was evaluated in the ED except prochlorperazine and ketorolac.
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Noninvasive ventilation (NIV) refers to the delivery of ventilatory support using techniques that do not require an endotracheal airway. Noninvasive ventilation is being used with increased frequency in a variety of clinical situations in the emergency department, intensive care unit, and prehospital environment. This article reviews the history of NIV, the rationale for its use, and the evidence of efficacy in both the adult and pediatric literature. This article also describes equipment and techniques currently available for administration of NIV as well as new trends in noninvasive respiratory support.
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Many children are brought to the emergency department because of respiratory symptoms including wheezing. Asthma is the most common but not the only cause of wheezing in children. There are many conditions, both pulmonary and extrapulmonary, which may cause recurrent wheezing. ⋯ The late presentation of congenital diaphragmatic hernia poses a considerable diagnostic challenge. We report an 18-month-old child with congenital diaphragmatic hernia who presented with recurrent respiratory symptoms and localized physical findings. This case underscores the need to consider alternative diagnoses including congenital diaphragmatic hernia in the evaluation of recurrent respiratory symptoms; this is especially true if the presentation is not consistent with asthma or there are asymmetric findings on auscultation.
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Pediatric emergency care · May 2008
Tracheal intubation practice and maintaining skill competency: survey of pediatric emergency department medical directors.
One of the most critical resuscitation skills in pediatric emergency medicine is establishing and maintaining a patent airway. This often requires tracheal intubation (TI). The purpose of this survey study was to determine the practice of TI in pediatric emergency departments (PEDs) and the methods used by PED medical directors to maintain TI competency among PED physicians. ⋯ Most PED TI for both nontrauma and trauma patients were performed by PED physicians. Most of these were rapid sequence intubations. The number of TI per PED had a large range. Most PED medical directors judged this number to be inadequate to maintain TI competency. Didactic activities to maintain TI skills were most common, but many other activities were used.
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Pediatric emergency care · May 2008
Case ReportsAn unusual case of button battery-induced traumatic tracheoesophageal fistula.
Much of pediatric medicine is focused on prevention of disease and injury. Although accidental ingestions of various household chemicals and medicines are well described and the treatment is supported by local poison control hotlines, the ingestion of button batteries by children is less publicized, and the dangers are less understood by both parents and health care providers. ⋯ Esophageal button battery impaction places the patient at high risk for full-thickness damage to the esophagus and tracheal structures with fistula formation in as little as a few hours. The key to successful therapy is prompt diagnosis and removal, but in nonverbal pediatric patients, this often is not achievable. Because of the complications associated with this disease (tracheoesophageal fistula) and subsequent difficulties associated with oxygenation and ventilation, these patients should be managed at an institution with the skilled capability of providing cardiopulmonary bypass quickly as a potentially lifesaving therapy.