Pediatric emergency care
-
Pediatric emergency care · Oct 1992
Follow-up of patients with occult bacteremia in pediatric emergency departments.
Blood cultures are frequently obtained in pediatric emergency departments (EDs) from febrile young children at risk for bacteremia and subsequent development of serious bacterial infections. This study of 105 children with occult bacteremia treated in two large urban pediatric EDs describes the follow-up of these patients and the impact that positive blood culture results have on the detection of serious illness. Seventy-seven percent of patients had a follow-up visit in the ED, 8% had follow-up by telephone alone, and 15% were not contacted. ⋯ Ten children (9.6%), five of whom had been notified of the positive blood culture, returned with serious illnesses. Patients whose diagnosis of serious illness was facilitated by blood culture results had shorter delay in identifying cultures as positive than did patients notified of positive results who did not develop serious illness (16.2 vs 31.6 hours; P < 0.05). The delay in follow-up of children with occult bacteremia limits the usefulness of blood cultures in the early detection of serious illness.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Pediatric emergency care · Oct 1992
The usefulness of pulse oximetry in evaluating acutely ill asthmatics.
To examine the usefulness of pulse oximetry in determining the severity of acute asthma, the arterial oxygen saturation (SaO2) of 196 acutely ill asthmatic children was measured while the children were being treated in the emergency department (ED). The measure of severity used was the disposition from the ED--discharge or hospitalization--after receiving standard ED care. ⋯ The sensitivity of an SaO2 < or = 93% was 35%, and the specificity was 92%. We conclude that SaO2 lacks the sensitivity to differentiate the child who will respond to ED therapy from the child who will require further inpatient care.
-
Pediatric emergency care · Aug 1992
Comparative StudyBlood culture results as determinants in the organism identification of bacterial meningitis.
The diagnosis of bacterial meningitis depends on a lumbar puncture (LP). Sometimes, antibiotics are administered before a LP that is delayed owing to prior need for computerized tomography (CT) scan, technical problems, inability to obtain consent, or an unstable patient. We examined the accuracy of blood culture, cerebrospinal fluid (CSF) Gram's stain, and antigen detection by latex for organism identification of meningitis. ⋯ Blood culture identified the bacteria in 94% of those patients with Haemophilus influenzae meningitis, and this yield increased to 100% when patients who had been pretreated with antibiotics were excluded. The combination of blood culture, CSF Gram's stain, and/or latex agglutination identified the causative bacteria in 92% of patients with meningitis. Blood culture, CSF Gram's stain, and latex agglutination are useful in identifying the organism causing pediatric meningitis.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Pediatric emergency care · Aug 1992
Case ReportsUvulitis in three children: etiology and respiratory distress.
Uvulitis is an uncommonly reported disorder with the potential for significant morbidity. We describe three cases of uvulitis seen within a six month period in our emergency department. ⋯ The third case was associated with group A streptococcus tonsillitis and no respiratory compromise. Atypical presentations of upper airway infection with H. influenzae may be increasingly common.