Pediatric emergency care
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Since minimal information exists regarding quality assurance in pediatric emergency departments, the experience of staff members of a pediatric emergency department who have recently established a quality assurance program is described. The steps of development are identified. The program is analyzed based upon initial results, and it is measured against theoretical approaches to quality assurance.
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During the period from July to November 1984, 265 consecutive febrile infants younger than one year of age were evaluated in a pediatric emergency department. None had a source of infection on physical examination, and all were admitted with the diagnosis of "rule out sepsis." During the month of July, all patients with positive urine culture results had their urine sample collected by bag. In no instance was there a clinical diagnosis of urinary tract infection because of the presence of contaminant bacteria. ⋯ The technique utilized for collecting urine for culture in infants has a major impact on the incidence of urinary tract infection. The absence of pyuria is not a reliable indicator of the absence of urinary tract infection. Infants with urinary tract infection may have a transient loss in urine concentrating ability early in the course of their infection.
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The epidemiology and management aspects of 212 consecutive cases of foreign bodies of the ears and nose in children presenting to an urban pediatric walk-in and emergency care facility were retrospectively reviewed. The items most commonly removed from children's external auditory canals were roaches, paper wads, toy parts, earring parts, hair beads, eraser tips, and food. ⋯ Those who required referral for otorhinolaryngologic intervention had more often failed at self or parental home foreign body removal attempts than those who were able to managed successfully by emergency department personnel. Parents should be cautioned against attempting to remove objects not readily visible or not capable of being grasped easily.
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After prevention, of all the elements in the care of the drowned child, none is more important than the early institution of respiration and appropriate resuscitation. Observation of the asymptomatic patient with any history of alteration of consciousness or respiration during a drowning accident for at least 12 to 24 hours is mandatory. ⋯ Transfer of these severely injured patients to a pediatric referral center where intracranial pressure monitoring and intensive support are available offers the best hope. Provisions for psychosocial support and follow-up for family members are essential.
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Pediatric emergency care · Mar 1987
Case ReportsEarly coma in intussusception: endogenous opioid induced?
A decreased level of consciousness with little abdominal pain or gastrointestinal symptoms is an uncommon, but well described, presentation of infantile intussusception. Its etiology is unclear. ⋯ We speculate that the coma and miosis were induced by an endogenous opioid which could also mask the abdominal pain, thus explaining this presentation of intussusception. If so, miosis would be a valuable clue for diagnosing such children.