Pediatric emergency care
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Pediatric emergency care · Jun 2014
Use of Adenosine in the Treatment of Supraventricular Tachycardia in a Pediatric Emergency Department.
Supraventricular tachycardia (SVT) is the most frequent arrhythmia requiring treatment in childhood, with an estimated incidence of 1/100 to 1/250 children. The treatment of choice of the acute event is intravenous adenosine. This study aimed to determine if doses of adenosine higher than previously described are needed to successfully revert SVT in children. ⋯ Most of the patients with SVT episodes require treatment with more than 1 dose of adenosine. Doses higher than the usually described in the guidelines are necessary to revert SVT. Most patients can be discharged home from the emergency department, without the need of hospital admission.
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Pediatric emergency care · Jun 2014
Project CAPE: A High-Fidelity, In Situ Simulation Program to Increase Critical Access Hospital Emergency Department Provider Comfort With Seriously Ill Pediatric Patients.
Variation exists between the qualities of emergency department (ED) care provided to urban versus rural pediatric patients. We implemented a pediatric simulation program in the Critical Access Hospital (CAH) ED setting and evaluated whether this training would increase provider comfort with seriously ill children. ⋯ An in situ pediatric simulation program can be implemented effectively in CAH EDs and results in increased comfort with pediatric patients. Such a program could be used as the core feature of a CAH education program aimed at improving the quality of pediatric emergency services provided at these safety net institutions.
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Pediatric emergency care · Jun 2014
Risk Factors Leading to Failed Procedural Sedation in Children Outside the Operating Room.
Deep sedation enables effective performance of imaging or procedures in children, but failed sedation still occurs. We desired to determine the factors that were associated with failed sedation in children receiving deep sedation by a dedicated nonanesthesia sedation service and hypothesized that the presence of an upper respiratory infection (URI) and/or other risk factors would increase the probability of failing sedation. ⋯ Presence of a URI, a history of OSA/snoring, ASA class III, obesity, and older age are associated with increased probability of failed sedation. A prospective, multicenter observational study would allow for the robust modeling of comorbidities to guide pediatric sedation management.
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Pediatric emergency care · Jun 2014
Case ReportsA rare case of penetrating brain injury by crossbow in a 22-month-old child.
Nonmissile penetrating brain injuries are exceedingly uncommon among civilian population and are most often associated with inflicted injury. They show specific characteristics different from that of missile wounds. ⋯ We document neuroimaging studies and review the management concerning this pathology. To our knowledge, this is the youngest survived case of penetrating brain injury by a crossbow with such radiological findings reported in the literature.
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Pediatric emergency care · Jun 2014
Case ReportsLife-threatening pneumonitis complicating low-dose methotrexate treatment for juvenile idiopathic arthritis in a child.
Methotrexate, a drug commonly used to treat juvenile idiopathic arthritis (JIA), has been reported to cause interstitial pneumonitis as a rare complication in adults with rheumatoid arthritis. Only 1 suspicious case of methotrexate pneumonitis in a child with JIA has been reported in 1998, though with no histopathologic proof. Given its rarity and nonspecific presenting symptoms, diagnosis may be challenging, and a life-threatening illness can occur without a high index of suspicion, as illustrated by this report of a 13-year-old girl with JIA who developed fever, nonproductive cough, and dyspnea as presenting features of interstitial pneumonitis after 1 year of methotrexate therapy. ⋯ A restrictive ventilatory defect with decreased diffusion capacity on pulmonary function testing persisted until 20 months after methotrexate withdrawal. There is no single pathognomic feature for methotrexate pneumonitis; rather, diagnosis relies on a constellation of clinical, radiologic, and pathologic findings. This report highlights the necessity for pediatricians to be continuously vigilant for interstitial pneumonitis in children receiving methotrexate who develop new unexplained pulmonary symptoms.