Pediatric emergency care
-
Pediatric emergency care · Aug 1995
ReviewUrethral prolapse: an often misdiagnosed cause of urogenital bleeding in girls.
Urethral prolapse is an uncommon disorder in girls, usually presenting as "vaginal" bleeding. This retrospective chart review focuses on the high rate of misdiagnosis of urethral prolapse and describes treatment modalities based on 24 patients seen at a major children's hospital during an 11-year span. Their mean age was 4.9 years. ⋯ Of these, five showed no improvement and underwent surgical repair. Although most children eventually require resection of the prolapsed urethral mucosa, nonoperative treatment is appropriate for asymptomatic girls with a mild degree of urethral prolapse. Increased physician awareness of urethral prolapse is desirable to enhance early recognition and to avoid unnecessary examinations and parental concern.
-
With increasing emergency department (ED) violence, security in pediatric EDs is an important concern. The objective of this study was to document current security measures taken in pediatric EDs in the United States. A telephone survey of the security director or designee in the 42 children's hospitals in the United States with over 150 beds was performed. ⋯ No ED reported universal metal detector screening. Fourteen directors (35%) reported having had a firearm-related incident in their ED in the past year. In spite of the relatively common nature of ED violence, security measures in pediatric EDs are varied, with most EDs not using all measures recommended by the American College of Emergency Physicians.
-
Pediatric emergency care · Aug 1995
Comparative StudyTeaching emergency medicine to pediatric residents: a national survey and proposed model.
To assess how emergency medicine is taught to pediatric residents, a cross-sectional survey was performed using a written questionnaire distributed to the chief residents of accredited pediatric residency programs throughout the continental United States. Information requested included the demographics of the training program, the structure of the emergency department (ED) rotation, and the chief residents' perceptions of the quality of precepting in the ED. Eighty three percent of 149 institutions responded. ⋯ Twenty-two percent of the chief residents consider their pediatric ED rotation as "average" when compared with the case-by-case precepting delivered in other hospital rotations; 39% consider the ED rotation as "above average," and 33% as "below average." Programs with core lecture series, skills workshops, and formal orientation and evaluation procedures are more likely to be regarded as "above average." Pediatric emergency medicine rotations provide ample opportunity for case-by-case precepting. Programs with an established curriculum and pediatric attending presence are more likely to be successful in this regard. The full potential of the ED rotation can be realized through faculty training in precepting and evaluation methods.
-
Pediatric emergency care · Aug 1995
Comparative StudyPrehospital management of pediatric asthma requiring hospitalization.
Our objective was to evaluate the quality of prehospital assessment and management in pediatric asthma requiring hospitalization via a retrospective chart review. Charts were obtained from a pediatric emergency department (ED) with 24,000 annual visits. Included in the study were 27 patients less than 18 years of age with asthma requiring hospitalization, transported to the Boston City Hospital Pediatric ED by Boston Emergency Medicine Services (EMS). ⋯ Thirty percent of cases (8/27) were hypoxic at ED presentation. None of the hypoxic patients had received albuterol in the field, and one did not receive O2. We conclude that further study of the prehospital assessment and management of pediatric asthma is warranted.