Pediatric emergency care
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Pediatric emergency care · May 2011
Case ReportsDiagnosis of an intraventricular hemorrhage by a pediatric emergency medicine attending using point-of-care ultrasound: a case report.
For the past 2 decades, point-of-care ultrasound (POCU) has been increasingly performed in adult emergency medicine for a variety of indications. However, the incorporation of POCU into pediatric emergency medicine has been much slower. Cranial ultrasound is an integral part in neonatology and is routinely used to diagnose intraventricular hemorrhage (IVH). ⋯ We report a case of a 16-day-old male that presented to the pediatric ED with fussiness and found to be anemic. An IVH was diagnosed for the first time using POCU by a pediatric ED attending. Sonographic characteristics of an IVH may be helpful in the prompt diagnosis of this condition, thereby reducing morbidity and mortality and improving the final outcome.
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Pediatric emergency care · May 2011
Case ReportsDeep vein thrombosis: rare cases of diagnoses in a pediatric emergency department.
Deep vein thrombosis (DVT) has an estimated annual incidence of 0.07/10,000 children. Early diagnosis suspicion in the emergency department is important because it is a serious disease that, if untreated, can lead to a postthrombotic disease or a pulmonary thromboembolism. We report 2 cases of DVT whose diagnosis was made in the pediatric emergency department. ⋯ The evolution was favorable after beginning treatment with low molecular weight heparin. Although DVT is rare in children, early detection is important, requiring a detailed case history in the presence of edematous, painful, and hot limbs that are keys to the diagnostic suspicion. The imaging test and the laboratory tests will confirm the diagnosis, and anticoagulant treatment will prevent complications.
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Pediatric emergency care · May 2011
Comparative StudyEndotracheal tube and laryngeal mask airway cuff pressures can exceed critical values during ascent to higher altitude.
Tracheal mucosal perfusion is compromised at an endotracheal tube (ETT) cuff pressure of 30 cm H(2)O, and blood flow is obstructed at a pressure of 50 cm H(2)O. ⋯ This model indicates that ETT cuffs inflated before air transport are likely to exceed critical pressure levels rapidly during flight. In addition, there will be loss of ETT cuff pressure, with loss of a good seal, during descent if a cuff is initially inflated at peak altitudes. Therefore, we suggest ETT cuff pressures should be monitored and adjusted continuously during ascent and decent.
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Surveys conveniently acquire and summarize valuable information from a target population. The specific aims, design, target sample, mode of distribution, data analysis, and inherent limitations of the survey methodology should be carefully considered to maximize the validity of the results. This review provides guidance on the methods and standards necessary to complete sound survey science.
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Pediatric emergency care · May 2011
Randomized Controlled Trial Comparative StudyA randomized comparison of the GlideScope videolaryngoscope to the standard laryngoscopy for intubation by pediatric residents in simulated easy and difficult infant airway scenarios.
Videolaryngoscopy has been developed mainly to assist difficult airway intubation. However, there is a lack of studies demonstrating the real efficacy of its use in children. In this study, we tested the hypothesis that GlideScope (Verathon Inc, Bothell, Wash) videolaryngoscope improves tracheal intubation when used by pediatric residents in an advanced patient simulation model. ⋯ In simulated scenarios of infant NA and difficult airway, when used by pediatric residents, GlideScope did not improve intubation performance when compared with the standard laryngoscope. Nevertheless, GlideScope may be safer for upper jaw injury and could have advantages in the management of complicated airway. Further studies are needed to assess if specific training will improve GlideScope intubation performance and whether the "in simulator" results translate into clinical practice.