Pediatric emergency care
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Pediatric emergency care · Sep 2019
ReviewResurgence of Vaccine-Preventable Disease: Ethics in the Pediatric Emergency Department.
After a decades-long reduction in vaccine-preventable illnesses worldwide, there has been a reappearance of childhood illnesses once thought to be eradicated. This resurgence in illnesses such as polio and measles is a consequence of multifactorial events leading to decreased vaccination rates. ⋯ As providers in the pediatric emergency department, we are often the first to encounter children manifesting these diseases. It is imperative that we understand the circumstances leading to these encounters, so that we can have engaged conversations with families, gain an understanding of their motivations, dispel any misinformed beliefs, and encourage positive health behaviors for their children.
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Pediatric emergency care · Sep 2019
Quality Improvement Initiative to Improve Abuse Screening Among Infants With Extremity Fractures.
The aim of this study was to evaluate the effectiveness of clinical pathway implementation and quality improvement (QI) interventions to increase the percentage of infants with extremity fractures undergoing evaluation for suspected physical abuse, including skeletal survey (SS), and consultation with social work, and/or Child Protection Team. ⋯ Skeletal survey use pre- and postpathway averaged 40%, surpassing 60% on average during active QI and post-QI periods. Consultation performance averaged 46% pre- and postpathway, increasing to nearly 67% during active QI; consultation performance decreased during post-QI to 60%. A lack of trauma history and presence of femur or humerus fracture were associated with increased SS use and consultation (both P < 0.001). Overall 20% of SS revealed occult fractures.
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Pediatric emergency care · Sep 2019
Pediatric Dog Bite Prevention: Are We Barking Up the Wrong Tree or Just Not Barking Loud Enough?
The objectives of this study were (1) to evaluate dog bite-related injuries and associated medical documentation and (2) to compare these results with a study of dog bites from the same institution 10 years prior. ⋯ Pediatric dog bites continue to occur frequently, and the associated factors did not change over the 10-year period: young age of child, bites to the craniofacial region, and dogs familiar to the child. Although accurate medical documentation of dog bites is a prerequisite to develop effective prevention strategies, current medical documentation of dog bites may be misguided.
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Pediatric emergency care · Sep 2019
Case ReportsVentricular Tachycardia Induced by Propafenone Intoxication in a Pediatric Patient.
Unintentional poisonings are a global health problem frequently resulting in hospital admissions. Propafenone is a class 1C antiarrhythmic drug used in the second-line management of supraventricular and ventricular arrhythmias and, when unintentionally ingested, can lead to severe and life-threatening poisoning. ⋯ Two boli of intravenous hypertonic sodium bicarbonate (total amount of 3 mEq/kg), followed by 3-hours continuous infusion of 1 mEq kg h sodium bicarbonate, were able to restore the clinical conditions of the patient. With this case report, we aim to highlight the existing challenge in the therapeutic management of propafenone intoxication that finds intravenous hypertonic bicarbonate to be a useful tool also in pediatric population.
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Pediatric emergency care · Sep 2019
Epidemiologic Characteristics of Pediatric Trauma Patients Receiving Prehospital Care in Kigali, Rwanda.
Pediatric trauma is a significant public health problem in resource-constrained settings; however, the epidemiology of injuries is poorly defined in Rwanda. This study describes the characteristics of pediatric trauma patients transported to the emergency department (ED) of the Centre Hospitalier Universitaire de Kigali by emergency medical services in Kigali, Rwanda. ⋯ In this cohort of Rwandan pediatric trauma patients, injuries to the extremities and craniofacial regions were most common. Theses traumatic patterns were predominantly due to road traffic injury, suggesting that interventions addressing the prevention of this mechanism, and treatment of the associated injury patterns, may be beneficial in the Rwandan setting.