Pediatric emergency care
-
Pediatric emergency care · Apr 1999
Review Case ReportsAtraumatic pneumocephalus: a case report and review of the literature.
Pneumocephalus or air within the cranial vault is usually associated with disruption of the skull caused by head trauma, neoplasms, or after craniofacial surgical interventions. We report a child who presented with headache and the pathognomonic "succussion splash" and was found to have atraumatic pneumocephalus from forceful valsalva maneuvers. Pneumocephalus forms, caused by either a ball-valve mechanism that allows air to enter but not exit the cranial vault, or cerebrospinal fluid (CSF) leaks, which create a negative pressure with subsequent air entry. We review the literature for traumatic and atraumatic causes of pneumocephalus, its complications, and therapy.
-
Status epilepticus (SE) is a common pediatric emergency encountered in the prehospital situations and in the emergency administration of anticonvulsants, which will cause the seizures to cease. Although prognosis is primarily determined by the etiology, the duration of SE and therapy administered have unequivocal impact. If the seizures last longer than 1 hour, homeostatic mechanisms may start to fail. ⋯ The input of the pediatric intensive care physician is critical and assumes a major role if the patient fails to respond to first-line therapy. The treatment of refractory status epilepticus requires labor-intensive hemodynamic support and suppression of central nervous system, with either an anesthetic agent or a barbiturate. There is an urgent need to formulate guidelines for management of refractory status epilepticus.
-
Primary cardiac arrhythmias are much less common in children than adults. This study was performed to identify the characteristics of primary arrhythmias in pediatric patients in the Emergency Department (ED). ⋯ Primary arrhythmias are unusual ED presentations in children and atrial tachyarrhythmias are the most common rate and rhythm disturbance in this population.
-
Pediatric emergency care · Apr 1999
Comparative StudyInpatient reports of suspected child abuse or neglect (SCAN): a question of missed opportunities in the acute care setting.
To determine reasons inpatient reports of suspected child abuse or neglect (SCAN) were not initiated at the time of evaluation in the acute care setting. ⋯ Inpatient reports are often the result of additional findings obtained after admission. A higher percentage of admissions from a GED than from a PED had inpatient reports of SCAN without additional findings. Patients who have an inpatient report filed for SCAN are often of high medical acuity, less likely to have physical findings, and may present with injuries or illnesses unrelated to the SCAN.