Pediatric emergency care
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Pediatric emergency care · Dec 1992
Review Case ReportsAnomalous left coronary artery masquerading as infantile bronchiolitis.
Four infants less than six months of age with anomalous left coronary artery from the pulmonary artery who present with symptoms of wheezing are described. All had cardiomegaly on chest radiographs and because of wheezing received beta-agonist agents (albuterol alone or with epinephrine). ⋯ The literature is reviewed for utility of chest radiographs in infants presenting with wheezing and for the efficacy of beta-adrenergic agents in infants less than six months of age. The authors suggest that physicians have a low threshold for obtaining a chest radiograph prior to treating a first-time wheezing infant less than six months of age with a beta-agonist agent.
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Pediatric emergency care · Dec 1992
Case ReportsGrunting respirations: chest or abdominal pathology?
A large percentage of misdiagnosed appendicitis cases occur during childhood. Misdiagnosed patients have increased morbidity and mortality from the diagnostic delay. ⋯ The patients with misdiagnosed appendicitis are young and likely to have atypical signs and symptoms. Grunting respirations incorrectly attributed to respiratory infection may serve as a pathway for a misdiagnosed case of appendicitis.
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Pediatric emergency care · Dec 1992
Aeromedical transport services accepting pediatric patients and their abidance by published guidelines.
The number of aeromedical transport services accepting pediatric patients (ATSP) in the United States has increased greatly over the past decade. Most aeromedical transport services are primarily designed for adults but will also transport children. ⋯ This survey of 65 ATSP and their abidance by the major AAP guidelines showed that two thirds of the ATSP were based at facilities with pediatric tertiary care capabilities; most ATSP were not directed by pediatric critical care (PCC) or pediatric emergency care (PEC) specialists; most transport team personnel were not trained in PCC or PEC; most ATSP had specific protocols for different clinical situations; most ATSP had separate equipment appropriate for pediatric patients; and there was little variation in transport team composition based on different clinical situations. In summary, all ATS surveyed transported children, but few were aware of the AAP guidelines, and only one in 65 was in complete abidance with the recommendations.
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Pediatric emergency care · Dec 1992
Randomized Controlled Trial Comparative Study Clinical TrialThe role of abdominal x-rays in the diagnosis and management of intussusception.
The management of intussusception requires early diagnosis and reduction with either barium enema or surgical intervention. Supine and erect abdominal radiographs are often obtained prior to ordering a barium enema. In many pediatric centers, the critical, initial interpretation of these radiographs is made by nonradiologists and, in most instances, by pediatric emergency physicians. ⋯ These physicians then identified patients for whom they would proceed to barium enema. The mean sensitivity was 80.5% (range, 71-93%), and the mean specificity was 58% (range, 48-69%). This compares favorably to the sensitivity of signs and symptoms, and we conclude that plain and upright abdominal films are a useful adjunct for the clinician evaluating patients for suspected intussusception.