Pediatric emergency care
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Pediatric emergency care · Mar 2012
ReviewDexmedetomidine sedation: uses in pediatric procedural sedation outside the operating room.
As the field of pediatric procedural sedation continues to expand, so does the exploration of medications that have a role in such invasive and noninvasive procedures. One such medication that has emerged during the last decade is dexmedetomidine, a drug approved for use in the adult intensive care setting. Its role in pediatrics has varied in its use from sedation in ventilated children in the intensive care unit to treatment for emergence reactions from general anesthesia and in sedation needed for radiographic imaging studies, electroencephalography, and invasive procedures. This review article presents the pediatric studies that have been published thus far regarding dexmedetomidate in the nonventilated, spontaneously breathing patient and identifies those patients where the use of this agent may not be indicated.
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The objective of this study was to assess charting errors by junior trainees in the emergency department at the beginning of the academic year and to evaluate the effect of audits and reminders in reducing charting errors in July. ⋯ There is a significant increase in charting errors by new trainees in July compared with June. A simple intervention of reminders and alerts significantly reduced charting errors in July.
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Pediatric emergency care · Mar 2012
Case ReportsAltered mental status and hematemesis in a child with hypercalcemia.
Altered mental status in a child is a potentially life-threatening condition with a broad differential including vascular, toxin-mediated, infectious, metabolic, and traumatic causes. Hypercalcemia is a rare cause of altered mental status in children. ⋯ Familial hypocalciuric hypercalcemia is a rare cause of hypercalcemia that usually presents with asymptomatic hypercalcemia. This case illustrates the presentation of severe hypercalcemia and reviews the initial management and evaluation of hypercalcemia in children.
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Pediatric emergency care · Mar 2012
Concomitant hypercalcemia and hyperammonemia associated with distal renal tubular acidosis.
We describe an infant with concomitant hypercalcemia and hyperammonemia associated with nonanion gap metabolic acidosis secondary to distal renal tubular acidosis (dRTA). The levels of both serum calcium and ammonia rapidly normalized with the correction of dehydration and metabolic acidosis. To the best of our knowledge, there has been only one previous case report of concomitant hypercalcemia and hyperammonemia associated with dRTA that has been reported in the literature. We describe the causes and emergent management of hypercalcemia and review the possible mechanisms of this rare association with dRTA.
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Pediatric emergency care · Mar 2012
Review Case ReportsPrimary amebic meningoencephalitis: a case report and literature review.
Primary amebic meningoencephalitis (PAM) is a rare but nearly always fatal disease caused by infection with Naegleria fowleri, a thermophilic, free-living ameba found in freshwater environments. Cases of N. fowleri infection have been reported from many of the southern-tier states in the United States, with Florida and Texas disproportionately represented among them. ⋯ Pediatric acute care practitioners in emergency departments, general pediatric wards, and critical care units, especially those practicing in the southern United States, should be familiar with the risk factors for acquisition of PAM, its clinical presentation, and the fact that common empiric treatment of bacterial meningitis will not treat N. fowleri. Herein, we present the case of an adolescent who died of PAM and review the (a) epidemiology, (b) pathophysiology, (c) available diagnostic modalities, (d) treatment options, and (e) outcomes of patients treated for N. fowleri infection of the central nervous system.