Pediatric emergency care
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Pediatric emergency care · May 2011
Comparative StudyAdherence of families to a group a streptococcal pharyngitis protocol used in a pediatric emergency department.
In an effort to limit inappropriate antibiotic use for children with pharyngitis, our pediatric emergency department (PED) has implemented a strep throat protocol using preprinted prescriptions given to families pending pharyngeal swab results. We sought to determine the rate of adherence of families managed with this protocol and to identify whether clinical features are associated with adherence. ⋯ Most families are adherent to our GAS pharyngitis protocol. Very few families filled prescriptions when the swab result was negative. Age was the only factor influencing adherence. Our current GAS pharyngitis protocol is an effective management strategy for children presenting with pharyngitis to the PED.
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Pediatric emergency care · May 2011
Case ReportsArm pain and fever as an unusual presentation of lobar pneumonia in a 3-year-old girl: case report.
Children with pneumonia presenting with extrathoracic pain, such as abdominal pain, have been previously described. In this report, we describe a 3-year-old girl with fever and right arm pain who was found to have an apical lobar pneumonia.
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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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Pediatric emergency care · May 2011
Case ReportsElastic bands on the wrist: a not so "silly" complication.
The recent popularity of elastic bands on the wrist may put children at risk for acute compartment syndrome. Acute compartment syndrome is a limb-threatening condition characterized by elevated interstitial pressure in a confined fascial compartment. ⋯ We report a case of a 2½-year-old girl with history of a rubber band around her wrist, who presented to the emergency department with a swollen, blue hand suggestive of an impending compartment syndrome. Although this patient ultimately was not diagnosed with acute compartment syndrome, we discuss the importance of prevention, early diagnosis, and prompt treatment of compartment syndrome to prevent permanent disability.