Pediatric emergency care
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Pediatric emergency care · Nov 2019
Observational StudyDiagnostic Practices for Suspected Community-Acquired Central Nervous System Infection in the Post-Conjugate Vaccine Era.
The aim of this study was to evaluate diagnostic practices for suspected community-acquired central nervous system (CNS) infection in an urban pediatric population. ⋯ Bacterial studies were performed more frequently than viral and other studies. Cerebrospinal fluid bacterial culture was nearly 5 times more likely to yield a contaminant than a pathogen. The frequency of viral infection was likely underestimated as only 20% were tested, mainly by culture, which is suboptimal. These data suggest diagnostic practices for the evaluation of suspected community-acquired CNS infections in children need to be modified to reflect current epidemiology and highlight the need for greater accessibility to polymerase chain reaction for viral diagnostics. Furthermore, NMDAR ab-mediated encephalitis should be considered early in children presenting with suggestive symptoms.
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Pediatric emergency care · Nov 2019
A Call to Restore Your Calling: Self-Care of the Emergency Physician in the Face of Life-Changing Stress-Part 4 of 6: Physician Helplessness and Moral Injury.
Many aspects of our health care system in the United States can lead to physicians feeling helpless-an inability to save a dying child, an inability to protect an immunocompromised child from a vaccine-preventable illness because of waning herd immunity, and a burdensome new electronic medical record system that your employer insists you must use. The cumulative effect of these experiences can lead to moral distress and ultimately moral injury. We discuss helplessness, moral distress, and moral injury in the setting of today's practice of emergency medicine and provide concrete recommendations to help providers cope with their own reactions to distressing clinical situations.
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Pediatric emergency care · Nov 2019
Case ReportsEarly Reduction of Pediatric Traumatic Posterior Hip Dislocation Is Much More Important Than the Treatment Procedure.
Traumatic hip dislocations are very rare in the pediatric population, and they are real emergent cases that can occur with minimal trauma. If they are not diagnosed immediately and reduction is not performed as soon as possible, they may cause problems such as avascular necrosis and degenerative arthritis. ⋯ We aim to present the functional outcomes and radiographic results of 2 pediatric traumatic hip dislocation cases with 36 months of follow-up who were treated with abduction orthosis after the reduction. We want to emphasize the importance of reduction time in the outcome of posterior traumatic hip dislocations followed with abduction orthesis even if there is a trend and suggestion to treat these patients with spica cast with the review of the recent literature.