Pediatric emergency care
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Pediatric emergency care · Sep 2014
Randomized Controlled Trial Comparative StudyImpact of Follow-up Calls From the Pediatric Emergency Department on Return Visits Within 72 Hours: A Randomized Controlled Trial.
We compare the rate of return to the emergency department (ED) within 72 hours between families of children receiving a follow-up telephone call by a non-health care provider asking about the child's well-being 12 hours after their visit to the ED and families not receiving a follow-up call. ⋯ Emergency departments practicing follow-up calls by non-health care providers should consider a forecasted increase in return rates.
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Pediatric emergency care · Sep 2014
ReviewDamage control resuscitation: permissive hypotension and massive transfusion protocols.
Evidence for changes in adult trauma management often precedes evidence for changes in pediatric trauma management. Many adult trauma centers have adopted damage-control resuscitation management strategies, which target the metabolic syndrome of acidosis, coagulopathy, and hypothermia often found in severe uncontrolled hemorrhage. Two key components of damage-control resuscitation are permissive hypotension, which is a fluid management strategy that targets a subnormal blood pressure, and hemostatic resuscitation, which is a transfusion strategy that targets coagulopathy with early blood product administration. ⋯ There is no evidence to support permissive hypotension strategies in pediatrics. Evidence for hemostatic resuscitation in adult trauma management is more comprehensive, and there are limited data to support its use in pediatric trauma patients with severe hemorrhage. Additional studies on the management of children with severe uncontrolled hemorrhage are needed.
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Pediatric emergency care · Sep 2014
Case ReportsSplenic Infarction Caused by a Rare Coinfection of Epstein-Barr Virus, Cytomegalovirus, and Mycoplasma pneumoniae.
Epstein-Barr virus (EBV), cytomegalovirus (CMV), and Mycoplasma pneumoniae are common pathogens of respiratory infection among children and young adults. Although single infection of 1 of these pathogens is common enough, their coinfection has been rarely reported. A 19-year-old woman presented with severe upper abdominal pain for 5 hours as well as flu-like symptoms and jaundice for 2 to 3 weeks. ⋯ By hospital day 7, her fever and abdominal pain had subsided and her liver function became normal. This case exemplifies the challenges in the diagnosis of coinfection of multiple respiratory pathogens and its associated complications. Greater awareness among clinicians would ensure an earlier and more accurate diagnosis of coinfection of EBV/CMV with other respiratory pathogen(s).
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Propofol mixed with racemic ketamine (or "ketofol") is popular for short procedural sedation and analgesia, yet the optimal combination is unknown. We aimed to determine a ketofol dosing regimen for short procedural sedation and analgesia of 5- to 20-minute duration in healthy patients (2-20 y). ⋯ We suggest an optimal ratio of racemic ketamine to propofol of 1:3 for boluses during short procedures (5-20 minutes). A short ketofol infusion, ratio 1:4, is a suitable alternative to intermittent boluses. Ratios greater than 1:3 result in delayed recovery after 20 minutes.
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Pediatric emergency care · Sep 2014
A Computerized Child Passenger Safety Screening Program in the Emergency Department.
The emergency department (ED) can be an effective site for pediatric injury prevention initiatives, including child passenger safety. The objectives of this study were to evaluate the implementation of an ED child passenger safety program and to analyze the effectiveness of a computerized screening tool to identify car seat-related needs for children younger than 8 years. ⋯ A child passenger safety program can be successfully implemented in the ED. A computerized nursing screening tool increases compliance with screening and providing needed car seats.