Pediatric emergency care
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Pediatric emergency care · Mar 2022
Case ReportsUse of POCUS in the Diagnosis of Paradoxical Vocal Cord Movement.
Point-of-care ultrasound has been instrumental in allowing providers to make prompt diagnoses at the bedside but has been historically underutilized for the diagnosis of upper airway processes, including paradoxical vocal fold motion (PVFM), also known as vocal cord dysfunction. PVFM is characterized by adduction of the vocal cords during inspiration, resulting in stridor and shortness of breath. This case report describes a teenage girl who presented to the pediatric emergency department (ED) with difficulty breathing. Point-of-care ultrasound diagnosed PVFM, which was confirmed with bedside flexible laryngoscopy by otorhinolaryngology (ENT) in the ED.
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Pediatric emergency care · Mar 2022
Applying the Ottawa Ankle Rules in a Pediatric Emergency Department.
Ankle and midfoot injuries constitute one of the most frequent reasons to visit the pediatric emergency department (ED). The aims of the study were (1) to determine the feasibility of the Ottawa Ankle Rules (OARs) in a pediatric ED and its reliability to safely manage ankle and midfoot injuries and (2) to verify the impact in reducing the number of radiographs, healthcare costs, and time spent in the ED. ⋯ The OARs are an important clinical instrument with a high sensitivity and negative predictive value, which allows clinicians to avoid unnecessary exposure to radiation without missing clinically relevant fractures.
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Pediatric emergency care · Mar 2022
Scalp Staples Placed in a Pediatric Emergency Department: Feasibility and Benefits of Home Removal.
Scalp lacerations are a common occurrence in the pediatric population. A preferred method of closure in a busy pediatric emergency department (PED) is skin staples, because of their ease of use and rapid application. However, using skin staples also demands that the child have a follow-up visit for their removal. This study examines whether caregivers can be taught how to safely remove their child's skin staples at home, obviating the need for a return clinic visit and its associated costs. ⋯ Caregivers who were taught how to remove their child's scalp staples in the PED before discharge were highly successful at home. Ninety-three percent of enrolled patients had their staples completely removed and no complications were reported. Benefits included avoiding lost wages, lost time attending a follow-up clinic, and lost time from school. Staple removal is a simple technique that can easily be taught to caregivers in a matter of minutes and lead to greater patient and parent satisfaction.
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Pediatric emergency care · Mar 2022
Initial Fluid Balance Associated Outcomes in Children With Severe Sepsis and Septic Shock.
Net fluid balance and its role in sepsis-related mortality is not clear; studies suggest that aggressive fluid resuscitation can help in treatment, whereas others consider it is associated with poor outcomes. This study aimed to clarify the possible association of initial 24 hours' fluid balance with poor outcomes in pediatric patients with sepsis. ⋯ Among children with sepsis and/or septic shock, there is significant association between mortality and initial high blood lactate levels and positive fluid balance at 24 hours from admission to the PICU.
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Pediatric emergency care · Mar 2022
Nonutility of Diagnostic Testing in Ambulatory Patients With Supraventricular Tachycardia.
Supraventricular tachycardia (SVT) is the most common arrhythmia in the pediatric population. Patients often present to the emergency department and undergo extensive diagnostic assessment. The objective of this study is to determine the frequency of diagnostic studies obtained in such patients and to assess clinical significance of these results. ⋯ Patients undergoing ED management of uncomplicated SVT are likely to undergo laboratory investigation and unlikely to have abnormal studies impacting their care. Given the associated risk of false-positive studies, the discomfort to the patient and parent, and cost of these studies, routine laboratory or radiographic investigation in this population may be unwarranted.