Pediatric emergency care
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Pediatric emergency care · Mar 2009
Randomized Controlled Trial Multicenter Study Comparative StudyEffect of high-fidelity simulation on Pediatric Advanced Life Support training in pediatric house staff: a randomized trial.
To assess the effect of high-fidelity simulation (SIM) on cognitive performance after a training session involving several mock resuscitations designed to teach and reinforce Pediatric Advanced Life Support (PALS) algorithms. ⋯ The use of high-fidelity simulation in a PALS training session resulted in improved cognitive performance by pediatric house staff. Future studies should address skill and knowledge decays and team dynamics, and clearly defined and reproducible outcome measures should be sought.
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Pediatric emergency care · Mar 2009
Case ReportsCerebral sinovenous thrombosis masquerading as migraine: a case report.
Headaches are common during childhood and a common pediatric presentation to emergency departments (EDs). The most common diagnoses for acute headache in the pediatric ED are viral upper respiratory tract infection with fever, sinusitis, and migraine, accounting for 70% to 75% of presentations; serious neurologic diagnoses are rare. Most literature recommends against neuroimaging for uncomplicated headache given the absence of any other signs or symptoms associated with causes of intracranial pathology and the presence of a normal physical examination. ⋯ Pediatric CSVT has yet to be presented in the emergency medicine literature. We report the case of a child who presented to the pediatric ED with headache, which was complicated by background difficulties with aggression and other behavioral issues. This case illustrates an extremely rare ED presentation of CSVT masquerading as migraine headache and discusses the diagnostic dilemma of neuroimaging.
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Pediatric emergency care · Mar 2009
Randomized Controlled Trial Comparative StudyRandomized controlled trial of ultrasound-guided peripheral intravenous catheter placement versus traditional techniques in difficult-access pediatric patients.
We hypothesized that the use of ultrasound guidance would improve the success rate of peripheral intravenous catheter placement in pediatric patients with difficult access in a pediatric emergency department (ED). Our secondary hypotheses were that ultrasound guidance would reduce the number of attempts, the number of needle redirections, and the overall time to catheter placement. ⋯ In a sample of pediatric ED patients with difficult access, ultrasound-guided intravenous cannulation required less overall time, fewer attempts, and fewer needle redirections than traditional approaches.
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Pediatric emergency care · Mar 2009
ReviewNewer agents for rapid sequence intubation: etomidate and rocuronium.
The emergency airway management of children and adolescents with critical illnesses may necessitate rapid sequence intubation with a sedating and a neuromuscular blocking agent. Etomidate and rocuronium have become increasingly popular for the sedation and paralysis, respectively, of pediatric patients in rapid sequence intubation, and there are many advantages to the use of both agents. ⋯ Rocuronium can produce optimal intubating conditions without the serious complications that can accompany succinylcholine. The available evidence supports the safety of etomidate and rocuronium in rapid sequence intubation but also suggests that more prospective studies are needed in pediatric patients.
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Pediatric emergency care · Mar 2009
Comparative StudyEffect of volume resuscitation on regional perfusion in dehydrated pediatric patients as measured by two-site near-infrared spectroscopy.
The aim of this study was to measure the change of cerebral and somatic regional oxygen saturation (rSO2) using near-infrared spectroscopic (NIRS) monitoring during volume resuscitation of dehydrated children. ⋯ In children with acute dehydration, cerebral rSO2 is preserved in moderate dehydration. Somatic tissue beds show an increase in rSO2 by NIRS oximetry with rehydration. Two-site NIRS monitoring is a continuous, noninvasive quantitative method for early detection of regional hypoperfusion in dehydrated children.