Pediatric emergency care
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Pediatric emergency care · Dec 2021
Minimizing Ionizing Radiation in Evaluating Suspected Appendicitis in Children Before and After the Release of the ACEP Clinical Policy.
The aim of this study was to examine the impact of the ACEP (American College of Emergency Physicians) clinical policy regarding diagnosis of suspected appendicitis on changing practice in the pediatric emergency department (ED) in the absence of a formal departmental protocol. ⋯ After the release of the clinical policy, CT utilization decreased significantly suggesting possible effectiveness of the policy in bringing about change in practice. Subsequently, there was an increase in the definitiveness in the ultrasound results. Physicians also evolved in their response to indeterminate ultrasound results, with fewer CTs ordered reflexively after indeterminate results.
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Pediatric emergency care · Dec 2021
Role of Salivary Biomarkers in Predicting Significant Traumatic Brain Injury: An Exploratory Study.
The highest rates of traumatic brain injury (TBI)-related morbidity and mortality occur in young children and adolescents. The objective of this study was to describe the levels of 3 biomarkers (S100B, glial fibrillary acidic protein, neuron-specific enolase) in saliva of children with TBI requiring inpatient admission at a pediatric trauma center and compare these levels in children without TBI. ⋯ S100B levels in saliva were higher in children with TBI and may be predictive of SBI identified by presence of computed tomography abnormalities. Larger studies are needed to replicate our findings in using a noninvasive diagnostic measure for children with TBI and SBI.
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Pediatric emergency care · Dec 2021
Leaving Without Being Seen From a Pediatric Emergency Department: Identifying Caregivers' Perspectives Using Q-methodology.
National rates of left (or leaving) without being seen (LWBS) in pediatric emergency departments (PED) are higher than general emergency departments. We investigated coexisting perspectives on LWBS. ⋯ Elements that factor into caregivers' decision to LWBS from a PED include lack of reassessments, lack of updates on queue position, and lack of information about the triage process. Quality improvement interventions for decreasing LWBS rates should account for diverse coexisting perspectives such as these.
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Pediatric emergency care · Dec 2021
Case ReportsSildenafil Citrate Overdose in a 3-Month Postterm Premature Infant With Pulmonary Artery Hypertension.
We aimed to describe a case of prematurely born infant with accidental sildenafil overdose. ⋯ Sildenafil overdose can cause serious symptoms such as hypotension. However, in our case, the sildenafil overdose was well tolerated, even by a young patient with underlying heart and lung disease. We show that choices in the management of sildenafil intoxication can be made based on the knowledge of sildenafil pharmacokinetics in young children.
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Pediatric emergency care · Dec 2021
Decadron, Diamox, and Zantac: A Novel Combination for Ventricular Shunt Failure in Pediatric Neurosurgical Patients.
Cerebral ventricular shunt failure is common and presents with symptoms that range from headaches to death. The combination of Diamox (acetazolamide), Decadron (dexamethasone), and Zantac (ranitidine) (DDZ) is used at our institution to medically stabilize pediatric patients presenting with symptomatic shunt failure before shunt revision. We describe our experience of this drug combination as a temporizing measure to decrease symptoms associated with shunt failure. ⋯ The combination of Decadron, Diamox, and Zantac is a novel treatment for ventricular shunt failure that may temporarily improve symptoms in patients awaiting shunt revision. Future studies could compare efficacy with other medical treatments.