Pediatric emergency care
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Pediatric emergency care · Apr 1997
Review Case ReportsVentricular fibrillation following blunt chest trauma from a baseball.
Baseball injuries account for a significant number of sports-related fatalities in children. We present a case of a 12-year-old male who died after being struck in the chest by a high velocity baseball propelled from a pitching machine. We examine the pathophysiology of blunt chest trauma, discuss possible explanations for the development of arrhythmias, review baseball-related fatalities, and suggest injury prevention strategies. ⋯ Blunt trauma to either the chest or head accounts for the majority of baseball-related deaths. This case was similar to other reports of cardiac arrest following blunt chest trauma from a baseball. The patient had no prior medical problems, collapsed immediately, had no pathological findings on direct visualization, remained unresponsive despite rapid and maximal treatment, and died. Direct blows to the chest can stimulate inherently excitable cardiac tissue producing arrhythmias, particularly ventricular fibrillation, that are difficult to treat. A child's unique anatomy provides minimal protection to the underlying thoracic organs. The key to reducing the risk of injury lies in always complying with accepted safety rules, and in developing appropriate chest protection and safer baseballs.
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Since the 1980s, violence has emerged as a leading public health concern in the United States. Recent studies have begun to address the impact of interpersonal violence specifically on young children. The purpose of this study was to describe the epidemiology of violence-related injuries (VRI) in an urban pediatric emergency department (ED). ⋯ The vast majority of patients with VRI are discharged from the ED. Females and young children were frequently evaluated for VRI in the pediatric ED. Identification of these patients can be used to initiate service protocols directed at violence prevention.
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To review recent acute pain management care issues in a pediatric emergency department (ED) in order to identify opportunities for a performance improvement program. ⋯ These data from 1994 document suboptimal analgesic use and home analgesic instruction for children in our ED with burns and fractures. Other opportunities in our ED for acute pain management improvement include optimizing initial analgesic doses, shortening the time elapsed to initial analgesic administration, and documenting the response to pain management.
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Pediatric emergency care · Apr 1997
Failure of aggressive therapy to alter outcome in pediatric near-drowning.
To identify predictors of outcome in pediatric near-drowning victims, and to measure the effectiveness of therapy in pediatric near-drowning victims by assessing clinical outcome as a function of injury severity at presentation and therapeutic interventions during hospitalization. ⋯ Severity of illness measured by GCS and PRISM score in the ICU can be useful in predicting outcome. For patients cared for in a Pediatric Intensive Care Unit, those with asystole on arrival at the ED had uniformly poor outcome. Currently available therapies do not alter outcome.