Pediatric emergency care
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Antibiotic administration within 1 hour of hypotension has been shown to reduce mortality. It is unknown whether antibiotics before hypotension in children who eventually meet criteria for septic shock improves outcomes. This study assesses whether antibiotic timing from the time of meeting criteria for sepsis in children with septic shock impacts morbidity and mortality. ⋯ Children with criteria for sepsis who subsequently progressed to septic shock who received antibiotics within 1 hour of meeting sepsis criteria had increased mortality, length of stay, and organ dysfunction.
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Pediatric emergency care · Oct 2020
Case ReportsPoint-of-Care Ultrasound Diagnosis of Ureteropelvic Junction Obstruction in a Child With Recurrent Abdominal Pain and Vomiting.
A case is described of a 4 year-old girl who presented with chronic episodic abdominal pain with vomiting. Physical examination was unremarkable aside from hypertension. Point-of-care renal ultrasound showed hydronephrosis, leading to a diagnosis of ureteropelvic junction obstruction presenting with Dietl crisis (episodic abdominal pain secondary to urinary tract obstruction). The clinical utility of point-of-care renal ultrasound in the evaluation of abdominal pain and ultrasound findings of ureteropelvic junction obstruction are highlighted.
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Point-of-care (POC) urine dipstick is a highly used test in the pediatric emergency department (PED) owing to its fast turn-around time and inexpensive cost. Past studies have shown hand-held urine dipsticks and automated urinalysis in children younger than 48 months to be sensitive predictors for urinary tract infection (UTI). It is hypothesized that POC dip testing is as accurate as laboratory urinalysis in the diagnosis of UTI. ⋯ Point-of-care dips are as sensitive in detecting UTI as the lab UA. A prospective study could allow for further demographic evaluation of POC dip diagnosed UTI.
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Pediatric emergency care · Oct 2020
Case ReportsA Mixed Presentation of Serotonin Syndrome vs Neuroleptic Malignant Syndrome in a 12-Year-Old Boy.
Neuroleptic malignant syndrome (NMS) and serotonin syndrome (SS) are serious medical conditions associated with commonly prescribed psychiatric medications. Although the mechanisms differ, they can be clinically difficult to distinguish. We report a case of a pediatric patient with complicated psychiatric history that developed features of both syndromes in the setting of polypharmacy. ⋯ The use of antipsychotic medications for young children with behavioral problems has risen dramatically in the last decade, increasing their risk for developing SS or NMS.
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Pediatric emergency care · Oct 2020
Case ReportsCrohn Disease Presenting as the Cutaneous Rash of Pyoderma Gangrenosum.
Pyoderma gangrenosum (PG) is a rare pediatric diagnosis, occurring in 3 to 10 patients per million per year, and most commonly seen in individuals between ages 20 and 50 years. This severe ulcerating skin rash is typically associated with an underlying systemic inflammatory condition. The appearance of PG often coincides with exacerbation of the underlying disease. ⋯ The disease's visual similarity to soft tissue infections, which have dramatically increased in recent years (Ann Emerg Med. 2008;51,3:291-98), makes isolated dermatologic presentations particularly problematic. We present a case of Crohn disease presenting as the inflammatory rash of PG in the absence of significant bowel symptoms. This case highlights the importance of keeping PG in the differential for inflammatory lesions presenting to the emergency department.