Pediatric emergency care
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Conscious sedation is used frequently to perform procedures that may be undertaken with or without minimal sedation. Fracture manipulation can be performed with minimal discomfort in the awake patient using various techniques-for example, intravenous regional anesthesia, nerve blocks, and hematoma blocks. These have been used for many years and are very safe. ⋯ Other novel approaches to topical anesthesia have seen the use of iontophoresis (again requires specific expensive equipment), jet injection of lidocaine, or "freeze sprays." Each has its own advantages and disadvantages. Femoral nerve block is a useful intervention for analgesia in patients with femoral fractures and can obviate the need for parenteral analgesia and allows excellent analgesia particularly during x-ray examination. Thus, it is important to remember that there are alternatives to conscious sedation which gives good analgesia during the procedure and allows the patient to be discharged sooner.
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Pediatric emergency care · Jun 2009
Sedation after intubation using etomidate and a long-acting neuromuscular blocker.
Etomidate is an imidazole hypnotic which is commonly used by emergency medicine physicians during rapid sequence intubation. Etomidate's duration of action is significantly shorter than that of commonly used long-acting paralytic medications (3-12 minutes vs 25-73 minutes). If additional sedative medications are not administered in the paralyzed patient before the conclusion of etomidate's duration of action, patients are at risk for experiencing paralysis without adequate sedation. ⋯ A significant proportion of pediatric patients receiving etomidate and rocuronium or vecuronium during endotracheal intubation are likely experiencing ongoing paralysis without adequate sedation. Emergency medicine physicians should be cognizant of this when using these medications for facilitating intubation.
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Pediatric emergency care · Jun 2009
Comparative StudyCharacteristics that distinguish adolescents who present to a children's hospital emergency department from those presenting to a general emergency department.
To identify characteristics of adolescents who access health care in a children's hospital emergency department (ED) compared with a general ED. ⋯ When a children's and general ED are in close proximity, there are unique characteristics of the adolescents at each site. Understanding the differences can assist clinicians to provide care tailored to meet the needs of each group.
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Pediatric emergency care · Jun 2009
Case ReportsHemorrhagic shock resulting from post-coital vaginal bleeding in an adolescent with Ehlers-Danlos type IV.
Multiple cases of obstetric-related vaginal bleeding exist in the medical literature pertaining to affected people with Ehlers-Danlos syndrome. We present a novel case of a 16-year-old female with vascular Ehlers-Danlos syndrome (formerly Ehlers-Danlos type IV) who was brought to the emergency department with brisk vaginal bleeding after her first episode of sexual intercourse.