Pediatric emergency care
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Pediatric emergency care · Jul 2010
ReviewPain management of musculoskeletal injuries in children: current state and future directions.
Pain is the most common reason for seeking health care in the Western world and is a contributing factor in up to 80% of all emergency department (ED) visits. In the pediatric emergency setting, musculoskeletal injuries are one of the most common painful presentations. Inadequate pain management during medical care, especially among very young children, can have numerous detrimental effects. No standard of care exists for the management of acute musculoskeletal injury-related pain in children. Within the ED setting, pain from such injuries has been repeatedly shown to be undertreated. ⋯ There is a need to optimize the measurement, documentation, and treatment of pain in children. There is growing evidence that nonpharmacological methods can be introduced to improve analgesia in the ED, and efforts to help parents implement these methods at home might be advantageous to optimize outpatient treatment plans. In pharmacotherapy, ibuprofen has emerged as an appropriate first-line choice for mild-moderate orthopedic pain. Other oral opioids (hydrocodone, oxycodone) are gaining popularity over codeine, because of the current understanding of the pharmacogenomics of such medications.
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Pediatric emergency care · Jul 2010
Multicenter StudyOccult pneumonia in infants with high fever without source: a prospective multicenter study.
The prevalence of pneumonia in infants with high fever without source (FWS; temperature, > or =39.0 degrees C) and a white blood cell (WBC) count greater than 20 x 10(9)/L (occult pneumonia) has been reported to be 20% before the introduction of the 7-valent pneumococcal conjugated vaccine (PCV7). This is the main reason for carrying out chest x-ray (CXR) on infants with high FWS. The aims of this study were to establish the prevalence of occult pneumonia in well-appearing infants with high FWS (temperature, > or =39.0 degrees C) and a WBC count greater than 20 x 10(9)/L in the era of PCV7 and to analyze the value of WBC, absolute neutrophil count (ANC), and C-reactive protein (CRP) level as predictors of the risk of occult pneumonia in these patients. ⋯ In the era of PCV7, the incidence of pneumonia in infants younger than 36 months with high FWS and WBC count greater than 20 x 10(9)/L seems to be lower than that previously reported. However, this is not a uniform group because the incidence of pneumonia increases in infants older than 12 months and with higher ANC and serum CRP level.
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Pediatric emergency care · Jul 2010
Case ReportsAcute ethanol poisoning in a 4-year-old as a result of ethanol-based hand-sanitizer ingestion.
Alcohol-based hand sanitizers have become widely available because of widespread usage in schools, hospitals, and workplaces and by consumers. We report what we believe is the first unintentional ingestion in a small child producing significant intoxication. A 4-year-old 14-kg girl was brought to the emergency department with altered mental status after a history of ingesting an alcohol-based hand sanitizer. ⋯ The child was intubated, placed on mechanical ventilation, and admitted for medical care. She recovered over the next day without sequelae. As with other potentially toxic products, we would recommend caution and direct supervision of use when this product is available to young children.