Pediatric emergency care
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Pediatric emergency care · Nov 2014
Case ReportsUntethering an unusual cause of kidney injury in a teenager with down syndrome.
Acute kidney injury (AKI) is characterized by the acute nature and the inability of kidneys to maintain fluid homeostasis as well as adequate electrolyte and acid-base balance, resulting in an accumulation of nitrogenous waste and elevation of serum blood urea nitrogen and creatinine values. Acute kidney injury may be a single isolated event, yet oftentimes, it results from an acute chronic kidney disease. It is critical to seek out the etiology of AKI and to promptly manage the underlying chronic kidney disease to prevent comorbidities and mortality that may ensue. ⋯ Foley catheter was successful in relieving the obstruction and improving her renal function. However, a magnetic resonance imaging was pursued in light of her chronic constipation and back pain, and it revealed a structural defect (tethered cord) that underlies a chronic process that was highly likely contributory to her AKI. She was managed accordingly with a guarded result and required long-term and close monitoring.
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Pediatric emergency care · Nov 2014
Case ReportsRapid response to treatment of heart failure resulting from hypocalcemic cardiomyopathy.
Hypocalcemia is a rare condition that causes dilated cardiomyopathy and can result in heart failure. Patients with hypocalcemia have been reported to recover in 3 to 12 months after calcium and vitamin D replacement therapy as well as treatment of heart failure. ⋯ After administration of anticongestive treatment, positive inotropic support, as well as vitamin D and calcium supplementation, cardiac function returned to normal in a week. Our case is the first report of such a rapid improvement in cardiac morphology and function in a patient with hypocalcemic dilated cardiomyopathy and heart failure.
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Myocarditis is an inflammatory disease of the heart that can cause devastating disease in otherwise healthy children. Inciting agents such as viral infection cause direct damage to the myocardial cells, which triggers an inflammatory response that enhances myocardial toxicity and associated morbidity. ⋯ Treatment is concentrated on hemodynamic stabilization with optimization of heart failure management, dysrhythmia protocol, and supportive therapy. The purpose of this review was to provide the emergency medicine practitioner a concise and current review of the basic pathophysiology as well as a functional and evidence-based approach to the diagnosis and treatment of myocarditis in the pediatric population.
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Pediatric emergency care · Nov 2014
Observational StudyPostpartum Depression Screening in the Pediatric Emergency Department.
This study aimed to determine the prevalence of and risk factors for postpartum depression (PPD) in mothers of young infants presenting to the pediatric emergency department (PED). ⋯ Postpartum depression affects a significant number of mothers of young infants who present to the PED for medical care. There are no clear demographic identifiers of these at-risk mothers, making universal screening an advisable approach. Capture of at-risk mothers during PED visits may accelerate connection with mental health resources. Anxiety seems to be a significant contributor. Mothers with PPD often characterize their infants to have a "fussy" temperament. The most appropriate referral for these women in this setting merits further investigation.