Pediatric emergency care
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Wooden foreign bodies in the extremities are frequently not suspected at initial presentation. Most often, these foreign bodies are not visualized radiographically. ⋯ In our case, a truly radiolucent wooden foreign body was well visualized on plain radiographs. The atypical appearance resulted in misinterpretation, and proper diagnosis and treatment were delayed.
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Pediatric emergency care · Jun 1991
Difficulties encountered in transport of the critically ill child.
A prospective survey of difficulties encountered in 100 pediatric emergency interhospital transfers was undertaken to identify needs for education of referring doctors and of transport service staff, as well as weaknesses in the organization of a pediatric emergency transport service (PETS). Such obstacles to smooth retrieval included administrative difficulties, mistakes in management, and unresolved acute severe physiologic derangements in the child. ⋯ Difficulties owing to conditions of transport (eg. vibration, dysbarism, and air turbulence) were uncommon (five percent of patients). Regular reviews of performance of all PET services, combined with measures to educate referring doctors, can improve patient outcome.
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Pediatric emergency care · Jun 1991
Complaints and compliments in the pediatric emergency department.
We conducted an analysis of all communications received from patients or their families by the director of a pediatric emergency department over a three-year period, during which approximately 150,000 visits occurred. Communications were characterized as complaint or compliment and subclassified by type: waiting time, staff attitude, quality of medical care, and billing. ⋯ The problems that we identified might be addressed by providing families improved access to non-emergency department care sources, education regarding the role of an emergency department, and better explanation of billing procedures during the registration process. Additionally, our findings serve as a reminder that many parents appreciate the care given to their children, particularly for life-threatening emergencies.
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Pediatric emergency care · Jun 1991
Toxic exposures and ingestions in Honolulu: I. A prospective pediatric ED cohort; II. A prospective poison center cohort.
Poisonings and toxic exposures are a frequent cause of preventable morbidity in children requiring emergency care. Ingestions and toxic substance exposures were studied in two prospective cohorts in Hawaii to examine the epidemiology of these events in this community in order to assess the effectiveness of current poison prevention practices and to identify additional measures to further prevent and reduce morbidity and mortality. During a 12-month period ending on 11/30/88, data were collected on 286 pediatric patients visiting a pediatric ED with an ingestion or a toxic substance exposure. ⋯ Although ipecac is widely recommended as a pre-hospital intervention, it use is limited owing to unavailability in the home and the short period of time during which it must be given. Since the dispensing of pharmaceuticals in limited quantities and in childproof containers began, it appears that other measures to further reduce morbidity and mortality owing to poisonings have had less additional effect. It appears that serious morbidity and mortality from poisonings in this cohort were uncommon.
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Pediatric emergency care · Jun 1991
Case ReportsLung injury resulting from a nonaccidental crush injury to the chest.
A six-week-old infant presented with rib trauma and a lung contusion from a nonaccidental compressive chest injury. He developed an illness consistent with diffuse alveolar damage, which worsened over 26 hours. ⋯ The value of isotope bone scanning in addition to x-rays is discussed. Nonaccidental injury should be considered in the differential diagnosis of a pulmonary contusion.