Pediatric emergency care
-
Pediatric emergency care · Feb 1996
Efficacy and safety of continuous albuterol nebulization in children with severe status asthmaticus.
We prospectively examined the efficacy and safety of continuous albuterol nebulization (CAN) therapy for children diagnosed with impending respiratory failure and status asthmaticus. Serum creatine phosphokinase (CPK) levels were measured, and other factors associated with cardiotoxicity were monitored. Seventeen patients (20 months to 17 years old) were enrolled in the study. ⋯ An elevation of total serum CPK was found in three patients; however, only one of these patients had an elevated (positive) CPK-MB isoenzyme fraction. We feel that CAN is safe for use in children diagnosed with status asthmaticus. Monitoring of serum CPK enzymes during CAN therapy is warranted until further studies have determined the significance of elevated CPK-MB isoenzymes in otherwise asymptomatic children treated for severe status asthmaticus.
-
Pediatric emergency care · Feb 1996
Technical skills experiences in pediatric emergency medicine fellowship programs.
Guidelines for Pediatric Emergency Medicine (PEM) fellowship programs were published by the Curriculum Subcommittee, Section of Emergency Medicine, American Academy of Pediatrics in February 1993. The guideline listed 120 technical skills that the subcommittee felt all fellows should be able to perform at the completion of their training. The purpose of this study was to measure the experience of PEM fellows in performing skills recommended by the subcommittee and to determine if documentation lists were being maintained. ⋯ Large emergency department volumes did not influence number of procedure completions. Our data indicate that graduating PEM fellows have limited experience in performing many common as well as several life- and limb-saving skills. Documentation lists of technical skills are not being maintained by most fellows.
-
Pediatric emergency care · Dec 1995
Review Comparative StudyPediatric emergency medicine fellow clinical work requirements.
A wide range of clinical requirements exists among PEM fellowship programs. Programs are equally split concerning the question of whether fellows should work with supervision or independently in the first year; a significant number of fellowship programs require continued supervision of fellows in subsequent years. ⋯ Programs in which first-year fellows worked independently had fewer attendings and were less likely to provide 24-hour coverage. Fellows appear to work a similar or less demanding schedule than PEM attendings in most fellowship programs, and most fellowship directors feel that their fellows should continue with their current schedule.
-
Pediatric emergency care · Dec 1995
Comparative StudyCharacteristics of frequent pediatric emergency department users.
The purpose of this study was to examine the medical and demographic characteristics of patients who frequently seek emergency care at a pediatric emergency department (ED). Registration information of ED visits during the study period from 11/1/87 to 5/31/92 (4.6 years) was stored in a data base. Patients with 10 or more ED visits during this study period were considered to be "frequent" ED users. ⋯ We conclude that cultural differences appeared to be an important factor associated with frequent ED use by healthy persons. Medical care resources as measured by immunizations, insurance, and identification of a primary care physician did not appear to be deficient in this cohort of frequent ED users. Since recurrent wheezing is a dominant chronic condition among frequent ED users, pediatric emergency medicine training programs may consider the inclusion of the chronic management of wheezing in their curriculum.