Pediatric emergency care
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Pediatric emergency care · Dec 1989
Case ReportsManagement strategy for penetrating oropharyngeal injury.
Direct force applied to an object held in the mouth may cause either superficial or penetrating injury within the oropharynx. The natural course for a majority of these injuries is spontaneous healing. ⋯ Violation of the retropharyngeal space may lead to dissecting emphysema or mediastinitis. Knowledge of these infrequent but serious sequelae complicates emergency department management decisions.
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Pediatric emergency care · Dec 1989
Should patients with normal cranial CT scans following minor head injury be hospitalized for observation?
The purpose of this study was to determine the incidence of complications in hospitalized patients with normal cranial computed tomographic (CT) scans following minor head injury (Glasgow Coma scale of 13-15). Seventy-three patients were included in the analysis, with 63 children being assigned a GCS score of 15 at presentation. Seventy-one percent of patients were male, and motor vehicle accidents accounted for 56% of the injuries. ⋯ GCS scores, history of LOC, vomiting, or seizures did not significantly influence length of hospitalization. None of the patients developed complications, and all were discharged in good condition. We conclude that a child with minor head injury, GCS score of 15, and a normal neurologic examination and cranial CT scan can be safely discharged to the care of a responsible adult and can be observed at home.
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This study was conducted to determine the frequency of suspected abuse/neglect in pediatric patients with burns presenting to an emergency department. Criteria were established for the suspicion of abuse/neglect. During a 12-month period, 431 patients were evaluated. ⋯ We conclude that abuse or neglect is a significant factor in pediatric burn patients and that the child's previous medical record must be reviewed. Other associated factors include a single parent family or the child with greater than two burn sites. The actual incidence of abuse/neglect could not be determined, owing to laws regarding confidentiality.
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Pediatric emergency care · Dec 1989
Case ReportsTreatment of severe imipramine poisoning complicated by a negative history of drug ingestion.
The wide use of imipramine (Tofranil) for the treatment of nocturnal enuresis continues in spite of the unique dangers associated with this drug. Young children are particularly susceptible to the potentially lethal central nervous system and cardiovascular toxicities, yet the toxic potential of imipramine remains unrecognized by both parents and too many physicians. Management of severe imipramine intoxication can be difficult. This report describes a 12-month-old patient with severe imipramine intoxication whose treatment was complicated by a negative history at presentation.