Pediatric emergency care
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Pediatric emergency care · Sep 1988
Case ReportsAcute airway obstruction in a seven-month-old infant with epiglottitis.
A seven-month-old male infant with epiglottitis developed acute airway obstruction in the operating room during halothane induction. This case suggests that epiglottitis should be suspected in any child, regardless of age, who presents with stridor, respiratory distress, dysphagia, or "tripoding," and it reiterates the need for prompt airway management.
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Pediatric emergency care · Sep 1988
Pediatric sexual abuse management in a sample of children's hospitals.
Medical directors of pediatric emergency departments were surveyed by mail to determine the present role of their pediatric hospitals in general, and emergency departments in particular, in the evaluation and management of pediatric sexual assault and abuse. Seventy-four percent of the responses were from communities with an estimated yearly incidence of sexual abuse cases greater than 500. Sixty-eight percent of the communities had a designated pediatric sexual assault center. ⋯ Estimated physician time required for evaluations averaged less than 60 minutes in 52%, 60 to 90 minutes in 32%, and greater than 90 minutes in 16%. Other patients were felt to be always or frequently compromised in 34% and occasionally compromised in another 44%. The directors rated the abilities of their respective departments to evaluate and manage these patients as excellent in 33%, good in 33%, adequate in 29%, and inadequate in 4%.
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Differentiating acute appendicitis from other causes of acute abdominal pain in children frequently remains unsatisfactory. To determine whether initial historical and physical examination findings might predict final diagnoses, 246 patients with complaints of nontraumatic and nonrecurrent acute abdominal pain were studied. All were between three and 18 years of age and had presented to a hospital-based pediatric emergency department. ⋯ Nonruptured appendicitis was generally indistinguishable from ruptured appendicitis preoperatively, by both duration and symptoms. Boys were found more likely to have appendicitis (with or without rupture) than girls (18/118 or 15%, vs. 6/128 or 5%, P less than 0.05). In conclusion, fever and vomiting were noted at presentation more frequently in children with appendicitis than in children with other causes of acute abdominal pain.(ABSTRACT TRUNCATED AT 250 WORDS)
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Pediatric emergency care · Jun 1988
Why not your pediatrician's office? A study of weekday pediatric emergency department use for minor illness care in a community hospital.
To determine the rationale for using a community hospital's emergency department for minor illness care on weekdays, we surveyed 150 parents of children 15 years of age or younger. Fifty (33.3%) participants had no identified source of routine pediatric care, and 31 (20.7%) had pediatric providers not locally available. ⋯ The results of this study demonstrate that the utilization pattern and sociodemographic profile of children seen in our emergency department on weekdays is more characteristic of an inner-city hospital than of a non-metropolitan setting. There are a number of feasible measures which could improve access to routine pediatric care for low socioeconomic families and reduce unnecessary emergency department utilization.
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Pediatric emergency care · Jun 1988
Comparative StudyA comparison of four techniques to establish intraosseous infusion.
This study was designed to determine whether the success rate in establishing intraosseous infusion (IOI) varied with four different types of needles--standard hypodermic, spinal, bone marrow, and Turkel intraosseous infusion needle. Twenty-four second-year residents from various specialties, without prior training or experience in the technique, participated in the study. Each participant attempted to establish an intraosseous infusion in a randomly assigned limb of an anesthetized piglet, using each needle in a randomly assigned order. ⋯ Success ratios varied between needles: hypodermic 54%, spinal 75%, bone marrow 75%, and Turkel 67%. Utilizing Cochran's Q-test, there was no statistical difference in success rates between needle types. However, in cases where the resident was successful with all four needles, the average time to successful infusion was significantly less for bone marrow needles.