Pediatric emergency care
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Pediatric emergency care · Apr 2013
Review Case ReportsRectum perforation after broomstick impalement in a 17-year-old: case report and review.
Impalement injuries are uncommon, especially in the pediatric population. Because of the rarity of these injuries, physicians may have difficulty recognizing and treating impalement injuries appropriately. Clinical findings are sometimes innocuous, but can be life threatening. ⋯ We report a very rare case of rectum perforation after transanal introduction of a broomstick with almost no clinical findings. Impalement injuries are difficult to recognize, and severity may not be reflected by their external appearance. To diagnose these injuries in time, it is important to use a well-organized workup.
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Pediatric emergency care · Apr 2013
Review Case ReportsIntestinal obstruction in children: could it be congenital abdominal bands?
Chronic abdominal pain is the most commonly seen condition in the pediatric population. Many causes can be successfully managed by conservative treatment; nevertheless, surgical intervention is sometimes inevitable. ⋯ The cause of chronic abdominal pain as well as the intestinal obstruction was revealed during the operation: 2 congenital abdominal bands, trapping the gut convolutes. To our knowledge, this is the first report of 2 bands in a single patient.
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Pediatric emergency care · Apr 2013
Review Case ReportsIdentification of unanticipated pelvic pathology on renal bedside ultrasound.
Bedside emergency ultrasound can be a useful initial test in children who present with abdominal pain. Our case describes a teenager who presented to the emergency department with back pain and right lower quadrant pain, suspicious for nephrolithiasis. The use of bedside ultrasound enabled timely diagnosis and management of an unanticipated condition.
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Pediatric emergency care · Apr 2013
Pediatric parapneumonic empyema: risk factors, clinical characteristics, microbiology, and management.
Pediatric empyema is increasing in incidence and continues to be a source of morbidity in children. Our objective was to determine the risk factors, clinical characteristics, distribution of the pathogens, and outcome of pediatric empyema in 2 Israeli pediatric medical centers. ⋯ The most prevalent pathogen in children with CAP with and without empyema is S. pneumoniae. Children with empyema experience significantly more morbidity than did patients with CAP alone. In our experience, VATS apparently does not shorten the duration of hospitalization compared with conventional treatment. Immunization may affect the incidence of pediatric empyema and should be studied prospectively.
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Pediatric emergency care · Apr 2013
Appendix not seen: the predictive value of secondary inflammatory sonographic signs.
Acute appendicitis is the most prevalent emergency surgical diagnosis in children. Although traditionally a clinical diagnosis, the diagnosis of acute appendicitis is uncertain in approximately 30% of pediatric patients. In attempts to avoid a misdiagnosis and facilitate earlier definitive care, imaging modalities such as ultrasonography have become important tools. In many pediatric studies, the absence of a visualized appendix with no secondary sonographic features has been reported as a negative study result, and a study where the appendix is not seen but demonstrates secondary features is often deemed equivocal. With ultrasound appendiceal detection rates reported at 60% to 89%, the dilemma of the nonvisualized appendix or equivocal study is frequently faced by clinicians. ⋯ Although uncommonly seen, large amounts of free fluid, phlegmon, and pericecal inflammatory fat changes were very specific signs of acute appendicitis. In the absence of a distinctly visualized appendix, the presence of multiple secondary inflammatory changes provides increasing support of a diagnosis of acute appendicitis.