Pediatric emergency care
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Atlanto-axial subluxation is a rare but potentially serious complication after otolaryngological procedures. We are describing a case of a 4-year-old child who developed atlanto-axial subluxation of the cervical spine after adenoidectomy. Our patient underwent adenoidectomy and, 18 days later, presented to the emergency department with her neck tilted to the left in a cock-robin position and complaining of neck pain persisting since the surgery. ⋯ She was managed conservatively with the application of a cervical collar, anti-inflammatory medication, and manual reduction under anesthesia later in the course because of persistence of her symptoms. It is important to consider this diagnosis in any child who undergoes ENT surgical procedures complaining of neck pain subsequent to surgery or holding the head in a fixed position persistently after surgery. Early diagnosis is important to reduce the time between the onset of symptoms and reduction to reduce the risk or need for surgical intervention.
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Pediatric emergency care · Jun 2017
Randomized Controlled TrialImpact of an Offline Pain Management Protocol on Prehospital Provider Self-efficacy: A Randomized Trial.
Pain in children is inadequately treated in the prehospital setting despite the reported recognition by prehospital providers (PHPs) of pain treatment as an important part of patient care. The impact of pediatric pain management protocol (PPP) implementation on PHP self-efficacy (SE), a measure congruent with performance, is unknown. ⋯ After a pain management protocol was introduced, SE scores among PHPs increased immediately and remained elevated for some individual actions involved in pain management, most notably pain assessment. Prehospital provider pain assessment SE scores declined 13 months after protocol introduction for adults, but remained elevated compared with baseline for the pediatric age groups.
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Pediatric emergency care · Jun 2017
Case ReportsEmergency Point-of-Care Ultrasound Diagnosis of Retained Soft Tissue Foreign Bodies in the Pediatric Emergency Department.
The presence of a foreign body (FB), its depth and size, is often indeterminate by clinical examination. Conventional imaging such as a radiograph can fail to visualize soft tissue FBs. We present 2 cases where point-of-care ultrasound was used to detect previously unidentified FBs.
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Many indications justifiably drive the pediatrician to request a urine sample in order to assess the health status of the incontinent baby or infant. Urine collection by means of an adhesive perineal bag is the most widely used in children who do not control urine emission, despite its inaccurate reflection of bacteriuria. We suggest a novel technique to immediately visualize the micturition event upon occurrence, in attempt to shorten waiting times and exhausting checking and rechecking opaque diapers in order to determine whether the desired sample has finally been delivered. ⋯ Widespread adoption of the diaper slit technique seems a promising procedure enhancing comfort and facilitating the process of obtaining a urine sample in the incontinent child. Assumptions that this procedure actually shortens waiting times and raises the success rates of sample retrieval remain to be proven by formal comparative trials.
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Pediatric emergency care · Jun 2017
Parental Language and Return Visits to the Emergency Department After Discharge.
Return visits to the emergency department (ED) are used as a marker of quality of care. Limited English proficiency, along with other demographic and disease-specific factors, has been associated with increased risk of return visit, but the relationship between language, short-term return visits, and overall ED use has not been well characterized. ⋯ Spanish-speaking parents are at an increased risk of 72-hour return ED visit but do not seem to be at increased risk of ED use during the year after their ED visit.