Pediatric emergency care
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Pediatric emergency care · Jun 1989
Case ReportsImmobilization hypercalcemia: unusual presentation with seizures.
Immobilization hypercalcemia usually causes mild neurologic symptoms. Seizures are a rare complication, appearing weeks after the appearance of other symptoms of hypercalcemia. ⋯ In this child, early diagnosis and therapy probably prevented the more complicated course described in previous cases. We wish to draw attention to this potentially life-threatening complication of immobilization.
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We retrospectively reviewed the emergency department records of 77 children and adolescents seen in an emergency department with the chief complaint of fainting. Upon careful review, 20 patients had not had any type of syncopal or near-syncopal episode. Of the remaining 57 patients, 40 experienced syncope, and 17 patients had near-syncope. ⋯ The most frequent diagnoses in the near-syncope group were lightheadedness (29%), seizure (18%), tension headache (12%), and migraine (6%). Seventeen and one half percent of syncopal patients had abnormalities of vital signs, orthostatic vital signs, glucose, hematocrit, or ECG; none of the near-syncopal patients had abnormalities. We conclude that initial evaluation of first-episode syncope should include orthostatic vital signs, glucose, hematocrit, and ECG with further studies performed as clinically indicated.
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Vascular access in young children frequently proves difficult in the prehospital setting. To assess the feasibility of training paramedics in the placement of intraosseous (IO) lines as an alternative to intravenous (IV) access, this pilot project studied a training program and treatment protocol for prehospital IO use. Paramedics underwent a training program in IO placement. ⋯ Although no patients achieved long-term survival, three were initially resuscitated from arrest. Paramedics can be trained in IO placement, and IO infusion can be used in prehospital pediatric care. Training methods, limitations, and implications for future use are discussed.
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Pediatric emergency care · Mar 1989
Prospective evaluation of selective criteria for imaging among children with suspected blunt renal trauma.
The evaluation of children with suspected blunt renal injury relies mainly on clinical assessment, urinalysis, and imaging studies. Because imaging studies rarely influence management, yet entail both risk and expense, we investigated a protocol to define their appropriate use. During a one-year period, children seen in the emergency department underwent a mandated radiographic evaluation for renal injury only if they had (a) severe injuries or (b) a urinalysis with greater than 20 RBC/hpf. ⋯ All children with abnormal imaging studies had greater than 20 RBC on urinalysis. None of the 16 children who were not studied radiographically developed complications related to renal trauma during short-term follow-up. Our findings support earlier recommendations for limiting the use of imaging for suspected blunt renal trauma in children with minor to moderate injuries and hematuria of less than or equal to 20 RBC/hpf.
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Pediatric emergency care · Mar 1989
Case ReportsNear-miss asphyxiation from a toy ball: a small parts failure.
The case report of a near-fatal asphyxiation of an 11-month-old child by a 26 mm (diameter) toy ball is presented. The lack of compliance with existing Consumer Product Safety Commission standards for small parts is discussed, and a recommendation is made regarding the coloring of ingestible objects.