Pediatric emergency care
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Pediatric emergency care · Apr 2020
Review Case ReportsBilateral Pulmonary Embolism With Right Heart Strain in a Patient With Immune Thrombocytopenia-A Case Report and Review of the Literature.
Patients with immune thrombocytopenia are at risk of both bleeding complications and venous thromboembolism. There is no standard to treating life-threatening pulmonary embolism in this population. This case illustrates the difficulty of treating significant thromboembolism in pediatric patients who have reduced clotting capacity. ⋯ The patient underwent thromboembolectomy by interventional radiology with subsequent administration of intravenous immunoglobulin, high-dose steroids, and enoxaparin therapy. There is no standard of care for patients with life-threatening pulmonary embolism in this population. Several authors suggest medical therapy options, but do not include patients with potential hemodynamic instability.
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Pediatric emergency care · Apr 2020
Review Case ReportsClosed Digital Artery Injury in Children: A Case Report and Review of the Literature.
Closed digital artery injury is a very rare phenomenon, even more so in children, with only 5 cases reported in the literature. We report a case of closed digital arterial interruption in a child after crush injury to the left hand. We further discuss possible etiologies and describe adequate management as found in the pertinent literature. Digital arterial injury should be suspected even in closed hand trauma because a delay in recognition may lead to devastating consequences.
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Pediatric emergency care · Apr 2020
ReviewEmergency Department Implementation of the Brain Trauma Foundation's Pediatric Severe Brain Injury Guideline Recommendations.
The "Guidelines for the Management of Pediatric Severe Traumatic Brain Injury, Third Edition: Update of the Brain Trauma Foundation Guidelines" published in Pediatric Critical Care Medicine in 2019 provides new and updated recommendations applicable to the emergency department management of children with severe traumatic brain injury. Practice-changing takeaways include specific recommendations for administration of 3% hypertonic saline, administration of seizure prophylaxis, and avoiding hyperventilation.
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Pediatric emergency care · Apr 2020
ReviewDiagnosis and Management of Neonatal Herpes Simplex Infection in the Emergency Department.
Neonatal herpes simplex virus infection (HSV) is rare in neonates, with an estimated global incidence of 10 per 100,000 live births. Neonatal HSV is challenging to diagnose due to often vague signs and symptoms. Untreated, the mortality of some HSV subtypes exceeds 80%. ⋯ In contrast, prompt evaluation and use of empiric antiviral therapy before the results of definitive testing can improve outcomes for infants with HSV. A wide degree of practice variation exists with respect to testing and treatment for neonatal HSV, and more research is required to safely risk-stratify this population. This review presents the epidemiology, risk factors, presenting features, and emergency department management of neonatal HSV infection.