Pediatric emergency care
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Central venous saturation (ScvO 2 ) can guide resuscitation of children with septic shock. The normal range of ScvO 2 is typically considered as 0.70-0.80, but has not been established in children with cancer. Children with cancer are particularly prone to develop sepsis due to their immunosuppressive therapy, and usually have a permanent central venous catheter, making ScvO 2 readily available. We aimed to investigate normal values of ScvO 2 in clinically stable children with cancer, and the association between ScvO 2 , hemoglobin, and lactate. ⋯ The study revealed that a substantial portion of clinically stable childhood cancer patients exhibited ScvO 2 levels below the typical reference value of 0.70, suggesting that these children may have inherently lower baseline ScvO 2 levels. This should be kept in mind when evaluating children with cancer for septic shock, emphasizing the importance of tailored assessments in this population. Further understanding of baseline ScvO 2 abnormalities may be helpful if ScvO 2 is used to guide resuscitation.
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Pediatric emergency care · Dec 2024
Case ReportsPoint-of-Care Ultrasound Evaluation of Pediatric Osteomyelitis in the Emergency Department: A Case Series.
Musculoskeletal and soft tissue complaints commonly present to the pediatric emergency department and literature supports the use point-of-care ultrasound (POCUS) in the diagnosis of these complaints. The diagnosis of osteomyelitis typically involves laboratory testing with inflammatory biomarkers, imaging with x-ray, and often magnetic resonance imaging with test results often not immediately available. We report a case series of children initially evaluated with POCUS for osteomyelitis. The POCUS may expedite diagnosis and treatment when used as the initial test in children with suspected osteomyelitis in the emergency department.
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Pediatric emergency care · Dec 2024
Hyperchloremia and Prolonged Acidosis During Treatment for Pediatric Diabetic Ketoacidosis.
Diabetic ketoacidosis (DKA) is characterized by metabolic acidosis with a high anion gap secondary to ketonemia. Intravenous hydration fluids used in treatment can cause chloride overload, leading to hyperchloremic metabolic acidosis (HMA). The development of HMA can lead to the persistence of acidosis despite the resolution of ketonemia. ⋯ During treatment of DKA, monitoring anion gap, blood ketones, and Cl - /Na + ratio or using regression equations in addition to routine acid-base parameters may help differentiate DKA from HMA and prevent prolonged intravenous treatment.
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Pediatric emergency care · Dec 2024
ReviewNeonatal Mastitis: Clinical Presentation and Approach to Evaluation and Management.
Mastitis is an uncommon but potentially serious infection in neonates. Characteristic findings include erythema, induration, and tenderness around the breast bud. Fluctuance and purulent drainage may be present with abscess formation. ⋯ Treatment of neonatal mastitis consists primarily of antibiotic administration. Surgical intervention, such as incision and drainage or intraoperative debridement, may be needed for frank abscesses. While antibiotics are typically administered intravenously, there may be a role for oral antibiotics in some lower risk infants with mastitis.
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Pediatric emergency care · Dec 2024
Investigating the Risk Factors Associated With Acute Neurologic Dysfunction in Pediatric Hyperglycemic Emergencies on Transport.
This study aims to identify key characteristics of hyperglycemic emergencies in pediatric patients and those at risk for acute neurologic dysfunction during transport. ⋯ Our findings reveal associations between acute neurologic dysfunction, younger age, severe acidosis, and elevated corrected sodium for glucose values in pediatric hyperglycemic emergencies during transport. Education and adherence to guidelines are recommended to improve outcomes in this population.