Pediatric emergency care
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Pediatric emergency care · Jul 2014
Randomized Controlled TrialEvaluating the Hematoma Block as an Adjunct to Procedural Sedation for Closed Reduction of Distal Forearm Fractures.
Although procedural sedation using intravenous agents is highly effective for forearm fracture reduction, the process is both resource and time intensive. Our objective was to determine whether the use of a hematoma block as an adjunct to procedural sedation with ketamine and midazolam reduces (1) pain during the procedure (scored using the Observational Score for Behavioral Distress-Revised score) or (2) the excess sedation time, defined by the time between procedure completion and discharge from sedation. Our secondary outcome measure was total ketamine dose administered during the procedure. ⋯ The use of a hematoma block as an adjunct to procedural sedation with ketamine and midazolam for forearm fracture reduction conferred no additional benefit and did not decrease observed pain scores, excess sedation time, or total ketamine dose administered.
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Intranasal medication administration in the emergency care of children has been reported for at least 20 years and is gaining popularity because of ease of administration, rapid onset of action, and relatively little pain to the patient. The ability to avoid a needle stick is often attractive to practitioners, in addition to children and their parents. ⋯ This article reviews the use of intranasal medications in the emergency care of children. Particular attention will be paid to anatomy and its impact on drug delivery, pharmacodynamics, medications currently administered by this route, delivery devices available, tips for use, and future directions.
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Pediatric emergency care · Jul 2014
Case ReportsHyperosmolar hyperglycemic state without ketosis in a toddler with type 1 diabetes.
We present a thin toddler whose initial presentation with type 1 diabetes was hyperglycemic hyperosmolar syndrome without diabetic ketoacidosis after ingestion of copious quantities of high-sugar beverages. Increasing consumption of high-sugar beverages may make this presentation of type 1 diabetes mellitus more common. Emergency care physicians must be aware of this potential clinical constellation in the very young, as management differs significantly from that accepted for diabetic ketoacidosis in children.
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Pediatric emergency care · Jul 2014
Case ReportsNasal disc battery removal: a novel technique using a magnetic device.
Disc batteries as foreign bodies present challenges in both diagnosis and management and carry a high risk for complications. We describe a novel device for disc battery removal using a magnet and basic medical supplies readily available in the emergency department setting. We also review diagnosis, complications, and management recommendations for disc batteries as foreign bodies.