Pediatric emergency care
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Lacerations are common in emergency departments. A review of pediatric patients was carried out to determine the infection rate. During a three-month period, from August to October, 415 patients were prospectively evaluated to determine the occurrence of infections in sutured lacerations. ⋯ Falls accounted for 61% of the injuries. The infection rate in children is less than that in adults. However, large lacerations in the lower extremities are at greater risk.
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A study was undertaken in order to identify factors correlated with the outcome of pediatric cardiopulmonary resuscitation (CPR). A total of 35 children who experienced a total of 41 cardiopulmonary arrests were included. Sixteen of 41 patients (39%) could not be resuscitated; 16/41 (39%) were resuscitated temporarily but did not survive to discharge; 9/41 (22%) survived to discharge. ⋯ A statistically significant difference in outcome was also demonstrated between patients with an initial arterial blood pH greater than 7.0 and those with an initial arterial blood pH less than 7.0 (P less than 0.05). We conclude that an initial arterial blood pH less than 7.0 predicts a poor outcome from cardiopulmonary arrest in children. Access to early basic CPR may improve the initial pH and the ability of the patient to be resuscitated.
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Intracranial hemorrhage secondary to head trauma is a major cause of morbidity and mortality in patients with bleeding disorders. Indications for head computerized tomographic scanning (CT scan) on patients with bleeding disorders who sustain head trauma are not well established. We retrospectively reviewed the medical records and head CT scan results of 21 patients with bleeding disorders. ⋯ In three of four patients with severe head trauma, the CT scan showed evidence of intracranial hemorrhage. In this series, all 17 patients with 24 episodes of moderate or minor head trauma had normal head CT scans. We conclude that a larger prospective study is needed to further evaluate the diagnostic value of head CT scan in hemophilia patients with minor or moderate head trauma, as defined in this study.
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Pediatric emergency care · Sep 1987
The effect of Medicaid criteria on pediatric emergency department visits.
The use of the emergency department by children on Medicaid was documented, and the effect of new adult Medicaid criteria on a pediatric emergency department was investigated. Eight percent of daytime visits by all patients were nonemergencies, compared to 15% by Medicaid patients. ⋯ Emergency department use by Medicaid patients was not decreased by the new criteria. Documentation of inappropriate denials of emergency care when criteria designed for adults were applied to pediatric patients was presented to state health officials and resulted in a change in the state Medicaid criteria for emergency care of children.