Pediatric emergency care
-
Pediatric emergency care · Sep 2011
ReviewCerebral sinovenous thrombosis in children: diagnosis and treatment.
Cerebral sinovenous thrombosis (CSVT) is a pediatric stroke syndrome that occurs uncommonly in association with a number of common pediatric problems, most notably dehydration and infection-otitis media in older children, in particular. Cerebral sinovenous thrombosis involves considerable risk of morbidity and mortality. In the pediatric population, neonates are most commonly affected, but no age group is spared. ⋯ Anticoagulation is a controversial but generally recommended element of CSVT treatment. Prognosis is related to the extent of vessel and brain parenchymal involvement as well to timeliness of diagnosis and institution of therapy. Long-term follow-up should involve pediatric neurology and ophthalmology and, whenever indicated, rehabilitational therapy as well.
-
Pediatric emergency care · Sep 2011
Adolescent female with urinary symptoms: a diagnostic challenge for the pediatrician.
The objective of this study was to determine the accuracy with which physicians diagnose sexually transmitted infections (STIs) and urinary tract infections (UTIs) in adolescent females with urinary symptoms. Secondary aims were to determine the prevalence of STIs and UTIs in this subset of patients and to identify variables associated with a physician diagnosis of STI or UTI. ⋯ Pediatric emergency medicine physicians both underdiagnose and overdiagnose STIs and UTIs in patients with urinary symptoms. This diagnostic challenge necessitates that all adolescent patients presenting with urinary symptoms should be tested for STIs and UTIs and have adequate follow-up means established to ensure timely treatment.
-
Pediatric emergency care · Sep 2011
Hypoglycemia after accidental pediatric sulfonylurea ingestions.
Because the prevalence of type 2 diabetes increases annually, there has been an increase in pediatric exposures to sulfonylureas. These medications are associated with delayed and often prolonged hypoglycemia. As such, most authorities but not all recommend admission for all pediatric patients with an accidental sulfonylurea ingestion. ⋯ Hypoglycemia is common after accidental sulfonylurea exposures. The results of this study support mandatory admission to a monitored setting for at least 16 hours, with frequent glucose determinations.
-
Pediatric emergency care · Sep 2011
Physicians' perceptions of background noise in a pediatric emergency department.
The objectives of this study were to measure noise levels in a tertiary care pediatric emergency department (ED) and to identify attending staff physicians' and first-year residents' perceptions of background noise levels and its impact on communication and teaching. ⋯ The high background noise levels in a pediatric ED are perceived as stressful and interfering with communication and teaching. Noise levels in EDs should be measured, and noise reduction strategies should be implemented because physicians are not consistent in identifying excessive noise levels.
-
: Vasopressin and its analog, terlipressin (TP), are potent vasopressors that may be useful therapeutic agents in the treatment of cardiac arrest (CA), septic and catecholamine-resistant shock, and esophageal variceal hemorrhage. The American Heart Association 2000 guidelines recommend its use for adult ventricular fibrillation arrest, and the American Heart Association 2005 guidelines note that it may replace the first or second epinephrine dose. There is little reported experience with TP in cardiopulmonary resuscitation (CPR) of children. The purpose of this retrospective case series was to report successful return of spontaneous circulation after the rescue administration of vasopressin after prolonged CA and failure of conventional CPR, advanced life support, and epinephrine therapy in children. ⋯ : The combination of TP to epinephrine during CPR may have a beneficial effect in children with CA. However, the recommendations for its use in the pediatric literature are based on limited clinical data.