Pediatric emergency care
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Pediatric emergency care · Apr 2014
Multicenter StudyListeria and Enterococcal Infections in Neonates 28 Days of Age and Younger: Is Empiric Parenteral Ampicillin Still Indicated?
Empiric parenteral ampicillin has traditionally been used to treat listeria and enterococcal serious bacterial infections (SBI) in neonates 28 days of age or younger. Anecdotal experience suggests that these infections are rare. Existing data suggest an increasing resistance to ampicillin. Guidelines advocating the routine use of empiric ampicillin may need to be revisited. ⋯ Listeria is an uncommon cause of neonatal SBI in febrile neonates who presented to the ED. Empiric use of ampicillin may need to be reconsidered if national data confirm very low listeria and enterococcal prevalence and high ampicillin resistance patterns.
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Pediatric emergency care · Apr 2014
Review Case ReportsAcute disseminated encephalomyelitis following meningoencephalitis: case report and literature review.
Meningoencephalitis and acute disseminated encephalomyelitis (ADEM) are both neurological disease processes, but there have been few cases of meningoencephalitis progressing to ADEM in the pediatric population. A case of a 4-year-old girl with an initial diagnosis of meningoencephalitis is presented here, whose initial presentation was manifested by prolonged fever, gray matter signal abnormality on brain magnetic resonance imaging, cerebrospinal fluid pleocytosis, and a markedly irritable mental status. ⋯ Her symptoms and imaging findings completely resolved with a course of methylprednisolone. Based on the literature and this current case, it is our recommendation to consider ADEM as a diagnosis if meningoencephalitis is not improving.
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Pediatric emergency care · Apr 2014
Trends in Prescription Opioid Use in Pediatric Emergency Department Patients.
In recent years, there has been increased emphasis on treating pain in emergency departments (EDs), coinciding with mounting concerns regarding the abuse potential of prescription opioids. In this study, we describe trends in opioid prescribing in pediatric patients in the US EDs over the past decade. ⋯ Opioid use for pain-related pediatric ED visits has increased significantly from 2001 to 2010, particularly among adolescents. Emergency department providers must be vigilant in balancing pain relief with minimizing the adverse effects of opioid analgesics.
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Pediatric emergency care · Apr 2014
Multicenter StudyPrevalence of Electrocardiogram Use in Infants With Apparent Life-Threatening Events: A Multicenter Database Study.
An apparent life-threatening event (ALTE) is a common diagnosis in pediatrics, but there is no standardized method to evaluate these patients. We sought to determine the prevalence of electrocardiogram (ECG) use in patients presenting to children's hospitals with an ALTE. ⋯ Electrocardiograms are performed in fewer than half of patients with ALTE presenting to children's hospitals. There is wide variation in the prevalence of ECG use as a diagnostic tool for infants presenting with an ALTE.
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Pediatric emergency care · Apr 2014
Case ReportsBedside hip ultrasonography in the pediatric emergency department: a tool to guide management in patients presenting with limp.
We present a case of a 3-year-old girl brought to the emergency department for evaluation of limp after falling off the monkey bars 1 day prior. X-rays of the entire left lower extremity were normal with no evidence of fracture, dislocation, or effusion. Point-of-care ultrasound of the left hip demonstrated a hip effusion, which prompted further imaging, ultimately revealing an occult fracture of the left proximal femoral metaphysis. This case demonstrates the ability of point-of-care ultrasound to guide the management of patients presenting to the pediatric emergency department with musculoskeletal complaints.