Pediatric emergency care
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This study aimed to determine the incidence of missed opportunities to diagnose abuse in a cohort of children with healing abusive fractures and to identify patterns present during previous medical visits, which could lead to an earlier diagnosis of abuse. ⋯ One-third of young children with healing abusive fractures had previous medical visits where the diagnosis of abuse was not recognized. These children most commonly had signs of trauma on physical examination at the previous visits.
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Pediatric emergency care · Nov 2014
Adult Patients in the Pediatric Emergency Department: Presentation and Disposition.
Pediatric emergency departments (PEDs) are intended to care for acutely ill and injured children. Adult patients sometimes present to these facilities as well. Some of these are young adults still under the care of pediatric specialists, but older adults and those not under the care of specialists may seek care and may challenge pediatric care providers. Understanding the spectrum of adult illness encountered in the PED may help ensure optimum care for this patient population. ⋯ Adult patients in PEDs are rare but have relatively high acuity and often require transfer. Pediatric emergency department clinicians should have adequate, ongoing training to capably assess and stabilize adult patients across a spectrum of illness presentation.
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Pediatric emergency care · Nov 2014
Case ReportsHemodialysis for near-fatal sodium phosphate toxicity in a child receiving sodium phosphate enemas.
This study aimed to demonstrate the importance of considering hemodialysis as a treatment option in the management of sodium phosphate toxicity. ⋯ Hemodialysis can safely be used as an adjunctive therapy in sodium phosphate toxicity to rapidly reduce serum phosphate levels and increase serum calcium levels in children not responding to conventional management.
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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.