Pediatric emergency care
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Pediatric emergency care · Aug 2014
The Role of Medical Home in Emergency Department Use for Children With Developmental Disabilities in the United States.
Children with developmental disabilities (DDs) have higher rates of emergency department use (EDU) than their typically developing peers do. This study sought to elucidate the relationship between EDU frequency and access to a comprehensive medical home for children with DD. ⋯ The study suggests that children with DD reporting 3 or more EDU per year would likely reduce their EDU by having access to usual source of primary care services and to clinicians with skills in building meaningful partnership with the parents. The inclusion of these medical home attributes in the adoption of patient-centered medical homes with the implementation of the Affordable Care Act presents a mechanism to improve care at lower cost as well as facilitate chronic disease management and coordination between emergency medicine and primary care physicians that may lead to reductions in EDU and unnecessary hospitalization.
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Pediatric emergency care · Aug 2014
Case ReportsNeurologic deterioration in a child undergoing treatment for tuberculosis meningitis.
Clinical deterioration while receiving antituberculosis (anti-TB) therapy can be due to a number of etiologies, including drug resistance, disease progression despite effective therapy, or alternative diagnoses. We present the case of a 22-month-old girl diagnosed with TB meningitis 4 months prior to presentation. At time of her initial diagnosis, computed tomography showed hydrocephalus and basilar meningitis with some evidence of ischemic damage. ⋯ Differential diagnosis included shunt malfunction and/or shunt infection. Magnetic resonance imaging of the brain showed interval development of tuberculomas. Symptomatic and radiographic improvement was seen after initiation of corticosteroids for immune reconstitution inflammatory syndrome, which can be seen in immunocompetent children, with onset weeks to months after starting antituberculous therapy.
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Pediatric emergency care · Aug 2014
Case ReportsUnusual sequela from a pencil stab wound reveals a retained graphite foreign body.
Penetrating pencil-tip injuries are common among children and usually resolve without long-term sequelae. However, failure to detect and remove embedded pencil fragments can result in increased morbidity or misdiagnoses of other, more serious, conditions. ⋯ Following suture removal, the patient returned to the emergency department (with bright-purple drainage from the wound site). Radiographic evaluation led to the discovery of an embedded foreign body requiring surgical removal.
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Pediatric emergency care · Aug 2014
Case ReportsTumor lysis syndrome: risk factors, diagnosis, and management.
Tumor lysis syndrome (TLS) is a potentially fatal complication of induction therapy for several types of malignancies. Electrolyte derangements and even downstream complications may also occur prior to the initial presentation to a medical provider, before an oncologic diagnosis has been established. ⋯ Careful evaluation of serum electrolytes, uric acid, and renal function must occur. Patients at risk for TLS and those who already exhibit laboratory or clinical evidence of TLS require close monitoring, aggressive hydration, and appropriate medical treatment.
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Pediatric emergency care · Aug 2014
Epidemiology of Hospital-Based Emergency Department Visits Due to Sports Injuries.
Sports-related injuries in adolescents incur a significant amount of hospital resources. Sports-related injuries are not an uncommon cause of ED visit; however, national estimates of such injuries in teenagers are unknown. ⋯ Sports injuries account for a substantial number of 2008 teenage ED visits in the United States. Patient- and hospital-level characteristics were analyzed and highlighted.