Pediatric emergency care
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Headache is a common presenting complaint in pediatric emergency departments. The goal of emergent evaluation is to identify those children with potentially life-threatening conditions. ⋯ Genetic testing eventually led to the diagnosis of SDHB-related hereditary paraganglioma-pheochromocytoma syndrome. Alarm features ("red flags") in children presenting with headache are reviewed, as well as the main features of paragangliomas and the indications for genetic testing.
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Pediatric emergency care · Mar 2014
ReviewThe use of alternate light sources in the clinical evaluation of child abuse and sexual assault.
Alternate light sources are devices that produce visible and invisible light at specific wavelengths to allow for enhanced visualization of fluorescent substances. These devices (which include Wood's lamp and blue light) are often used in forensics for evidence collection and can be quite useful to physicians in the medical evaluation of suspected physical or sexual assault. An understanding of the proper applications, as well as the limitations, of each alternate light source is imperative to correctly performing and interpreting medical evaluations in the emergency department. This review discusses the evidence from prospective trials in children and adults on the ability of specific alternate light sources to identify evidence of physical or sexual assault and also highlights some promising new technological adjuncts to alternate light sources that may allow for accurate dating of bruising.
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Pediatric emergency care · Mar 2014
Legislation in Québec for all-terrain vehicles: are we doing enough?
All-terrain vehicle (ATV) legislation in Québec is among the most restrictive in Canada. The purpose of our study was to characterize the pediatric ATV traumas in our center and determine the impact of legislation. ⋯ Despite implementation of ATV legislation regarding helmet use and minimal legal age, a lot of our patients did not obey these rules. This study demonstrates that strong legislation did not have a real impact on ATV morbidity in children. It is essential to develop strategies to enforce ATV users to respect legislation.
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Pediatric emergency care · Mar 2014
Mobile and web-based education: delivering emergency department discharge and aftercare instructions.
Prior research has identified deficiencies in the standard process of providing instructions for care at discharge from the emergency department (ED). Patients typically receive a brief verbal instruction, along with preformatted written discharge documents. Studies have found that understanding and retention of such information by families are very poor, leading to nonadherence in follow-up care, unnecessary return visit to the ED, and poor health outcomes. ⋯ Information can also be delivered both synchronously and asynchronously, enabling the health care providers to deliver health education to the patients electronically to their home, where health care occurs. Furthermore, the providers can track information access by patients, customize content to the individual patients, and reach other caregivers who may not be present during the ED visit. Further research is needed to develop the systems and best practices for incorporating mobile health in the ED setting.
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Pediatric emergency care · Mar 2014
Case ReportsUltrasound-Guided Intra-articular Lidocaine Block for Reduction of Anterior Shoulder Dislocation in the Pediatric Emergency Department.
We report a case of successful reduction of an anterior shoulder dislocation after ultrasound-guided intra-articular lidocaine (IAL) block with subsequent sonographic confirmation of reduction. Current literature suggests that IAL can provide similar levels of analgesia as intravenous sedation, and IAL block is associated with lower complication rates and shorter emergency department stays. However, these studies may be limited by uncertainty about the accuracy of landmark-based glenohumeral injections. The use of beside ultrasound may improve the effectiveness of IAL block for reduction of anterior shoulder dislocation and provide a mechanism for immediate postreduction evaluation of the placement of the humeral head.