Pediatric emergency care
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Pediatric emergency care · Feb 2009
ReviewCerebrospinal fluid pleocytosis in children in the era of bacterial conjugate vaccines: distinguishing the child with bacterial and aseptic meningitis.
Although bacterial meningitis remains an important cause of childhood morbidity and mortality, the incidence of bacterial meningitis has greatly decreased with the advent of polysaccharide-protein conjugate vaccines in the past 2 decades. Most children with cerebrospinal fluid pleocytosis have aseptic rather than bacterial meningitis, raising the possibility that some patients may be managed as outpatients. In this article, we review the changing epidemiology of bacterial meningitis as well as the available clinical decision rules that may assist the clinician in distinguishing aseptic from bacterial meningitis in patients with cerebrospinal fluid pleocytosis.
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Pediatric emergency care · Feb 2009
Comparative StudyClinician judgment versus a decision rule for identifying children at risk of traumatic brain injury on computed tomography after blunt head trauma.
To compare a decision rule with clinician judgment for identifying children at risk of traumatic brain injury (TBI) after blunt head trauma. ⋯ A decision rule trended toward greater sensitivity than clinician judgment for identifying children with TBI on CT after blunt head trauma but was less specific. Because decisions to order cranial CT did not strictly follow clinician judgment, however, use of the decision rule would have resulted in less frequent use of CT.
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Our objective was to describe young children injured through the use of infant carrier car seats, comparing them with children injured through other fall mechanisms. ⋯ Falls from infant carriers are common, often involve children unbuckled in their car seats, and represent a significant source of morbidity. Injury prevention measures such as education and manufacture labeling may be effective strategies.
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Pediatric emergency care · Feb 2009
Review Case ReportsAccidental methadone ingestion in an infant: case report and review of the literature.
We discuss accidental methadone intoxication in an 11-month-old female infant, review the literature, and stress the potential for child abuse among methadone-maintained caregivers. ⋯ Methadone intoxication should be considered in children presenting with lethargy, miosis, and respiratory depression. Seventy-two percent of reported methadone poisoning patients are symptomatic, and unintentional poisoning is a real danger to children because small amounts can be fatal. There are also several case reports where the cause of intoxication was homicide by the parents. Initial management consists of establishing an airway, and naloxone may be indicated, before urine toxicology results are obtained, to help establish the diagnosis. However, if 2 doses do not reverse the child's symptoms, the diagnosis should be questioned. When repeated bolus doses of naloxone are indicated, a continuous infusion may be preferable.
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Pediatric emergency care · Feb 2009
Multicenter StudyEmergency management of pediatric convulsive status epilepticus: a multicenter study of 542 patients.
To perform a multicenter study examining the presentations and emergency management of children with convulsive status epilepticus (CSE) to sites within the Paediatric Research in Emergency Departments International Collaborative. ⋯ Convulsive status epilepticus is an important neurological emergency, with many children experiencing prolonged seizures in both the prehospital and hospital phases. Persistent seizure activity beyond 40 minutes contrasts with current published guidelines. There is a need to adopt a widely accepted approach to the management of children who fail to respond to standard anticonvulsant therapy.