Pediatric emergency care
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Pediatric emergency care · Aug 1995
The relationship between grandmothers' involvement in child care and emergency department utilization.
This study examines the relationship between involvement of grandmothers in child care and poor urban mothers' use of the emergency department (ED) for nonurgent care. Mothers with an index child between one and two years old were interviewed in the waiting room of a pediatric continuity clinic. ⋯ Results showed that mothers who frequently used the ED for nonemergent pediatric care were more likely to have the child's grandmother or great-grandmother living in close proximity or involved in care of the child than infrequent users (80 vs 45%, P < 0.05). This study suggests that proximity and involvement of the grandmother may influence health care decisions.
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Pediatric emergency care · Jun 1995
Review Case ReportsAcute scrotal symptoms due to perforated appendix in children: case report and review of literature.
Acute appendicitis is rarely included in the differential diagnosis of acute scrotum. We report a case of an unusual presentation of acute appendicitis as acute left scrotal swelling. The relevant literature is reviewed.
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Pediatric emergency care · Jun 1995
Comparative Study Clinical TrialAdult respiratory distress syndrome and artificial surfactant replacement in the pediatric patient.
Adult respiratory distress syndrome (ARDS) frequently develops after near-drowning, smoke inhalation, burns, blunt trauma to chest, and overwhelming sepsis. Surfactant depletion, inactivation or destruction by the accumulation of proteinaceous material in the alveoli, and changes in the relative composition of phospholipids or protein component have been associated with ARDS. Artificial surfactant reverses these changes in experimental animals. ⋯ Mortality between these two groups was analyzed with Fisher's exact test. One of seven (14.2%) children treated with surfactant died of overwhelming infection, and 2/5 (40%) of the historical controls died of pulmonary causes (P = 0.523). Statistically, surfactant therapy did not improve survival in patients with ARDS; however, ARDS patients receiving surfactant improved in their pulmonary dynamic compliance and had a tendency to stabilize earlier in gas exchange, allowing us to decrease ventilatory support.
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Pediatric emergency care · Jun 1995
Telephone follow-up of patients discharged from the emergency department: how reliable?
As the result of the current emphasis on health care cost containment, outpatient management of entities previously in the domain of inpatient therapy is being proposed. The advocates of this approach stress the importance of telephone follow-up in patients chosen for outpatient therapy. Our objective was to determine the reliability of phone follow-up in patients discharged from the emergency department (ED). ⋯ A mean of 1.61 +/- 1.09 calls were needed to reach the guardians who were successfully contacted, and the mean time required was 3.14 +/- 7.25 hours. Medical indication for telephone follow-up, as determined by the managing physician, did not influence our ability to reach the study subjects. In view of our moderate success rate in reaching patients discharged from the ED, we advocate caution in the implementation of outpatient strategies in the management of febrile children who are at high risk for life-threatening complications.