Pediatric emergency care
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Pediatric emergency care · Jan 2021
Centralization of Prehospital Triage Improves Triage of Pediatric Trauma Patients.
This study describes the experience at a level 1 pediatric trauma center before and after the centralization of prehospital trauma triage, focusing on the rate of undertriage of trauma patients. Before centralization, emergency physicians were responsible for triaging these patients with mainly physiology-based criteria; after centralization, paramedics in a communication center performed this function using the same criteria. ⋯ Centralization of prehospital trauma triage at a level 1 pediatric trauma facility significantly reduced undertriage rates. Trauma centers should consider similar processes to improve prehospital triage.
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Pediatric emergency care · Jan 2021
The Impact of a Displayed Checklist on Simulated Pediatric Trauma Resuscitations.
Advanced Trauma Life Support resuscitation follows a strict protocolized approach to the initial trauma evaluation. Despite this structure, elements of the primary and secondary assessments can still be omitted. The aim of this study is to determine if a cognitive aid checklist reduces omissions and speeds the time to assessment completion. We additionally investigated if a displayed checklist improved performance further. ⋯ Despite a structured approach to trauma resuscitations, omissions still occur. The use of a displayed checklist improves performance and reduces omissions without delaying assessment. Better compliance with Advanced Trauma Life Support protocols may improve patient outcomes.
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Pediatric emergency care · Jan 2021
Case ReportsAn Unusual Pediatric Case of Seronegative Systemic Lupus Erythematosus Presented With Acute Abdominal Pain and Gross Hematuria.
A child with acute abdomen with gross hematuria occasionally visits the emergency department (ED). Usually, such a condition is subject to differential diagnosis for stones, injuries, or sometimes malignancies in the urinary tract. Here we introduce an unusual case of a 9-year-old girl who presented to ED with acute lower abdominal pain and gross hematuria. ⋯ Later at follow-up, however, she had a recurrent episode of renal vein thrombosis. A kidney biopsy was performed to reveal histology of membranous lupus nephropathy. The case emphasizes the importance for both ED physicians and pediatricians to have a clinical suspicion of autoimmune diseases in cases with major vessel thrombosis, even when the patient is seronegative.
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Pediatric emergency care · Jan 2021
Pediatric Prehospital Intraosseous Access During Combat Operations in Iraq and Afghanistan.
Vascular access in critically ill pediatric patients can be challenging with delays potentially leading to worse outcomes. Intraosseous (IO) access has a low rate of complications and can be utilized to administer lifesaving medications. Combat medics are trained to treat adults but may also be required to treat children in the deployed setting. Vascular access in children can be challenging, especially in a hypovolemic state. There are limited data on prehospital lifesaving interventions in children in the combat setting. We sought to characterize the use of IO access in pediatric patients who sustained trauma in the combat setting. ⋯ Pediatric IO placement in the prehospital setting occurred infrequently. Pediatric subjects receiving an IO had higher injury severity scores and higher mortality rates compared with those who received an IV only. Intraosseous use appears to be used more often in critically ill pediatric subjects.
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Pediatric emergency care · Jan 2021
Trends in Pediatric Poisoning-Related Emergency Department Visits: 2001-2011.
We sought to understand the burden of pediatric poisonings on the health care system by characterizing poisoning-related emergency department (ED) visits among children on a national level. ⋯ Poisoning-related ED visits among children have remained stable, with significant increase in intentional ingestions from 2001 to 2011. Poisoned children, and particularly those with intentional poisonings, require more health care resources than children with other health concerns. More study is needed on circumstances leading to pediatric poisonings, so that preventive efforts can be targeted appropriately.