Pediatric emergency care
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Pediatric emergency care · Aug 2021
Case ReportsForeign Body Reaction Due to a Forgotten Rubber Band on the Neck of a Toddler Girl.
In the presence of an unhealed granulation tissue-like wound, a possibility of abuse and neglect along with a foreign body should come to mind. However, it may be difficult to recognize a foreign body in patients with atypical clinical presentations. We demonstrated delayed diagnosis of a rubber band embedded into subcutaneous tissue in a 2½-year-old girl who presented with a circumferential scar with 2 granulation tissue-like wounds on her neck due to a foreign body reaction developed over years. With this rare case presentation, we remind the possibility of abuse/neglect along with foreign bodies in neck lesions of children.
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Pediatric emergency care · Aug 2021
Point-of-Care Ultrasound-Guided Versus Conventional Bladder Catheterization for Urine Sampling in Children Aged 0 to 24 Months.
It can be difficult to obtain urine samples, especially in children aged 0 to 24 months who have not yet completed toilet training. Bladder catheterization is a common method for urine sampling in this age group. However, if the bladder is not adequately filled, this process fails and repeat catheterization is necessary. Point-of-care ultrasonography (POCUS) is often used to assist invasive procedures in the pediatric emergency department. This study aimed to compare success rates of bladder catheterization in patients with and without POCUS to guide the timing of the procedure. ⋯ The use of POCUS during bladder catheterization in children was found to be effective and successful. In addition, the detection of any amount of urine in the bladder using POCUS increases the success rate of bladder catheterization.
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Pediatric emergency care · Aug 2021
ReviewPharmacologic Management of Acute Agitation in Youth in the Emergency Department.
When youth in the emergency department become acutely agitated, it can be dangerous and distressing to patients, families, and clinicians. Timely, effective, and patient-centered management is key to reducing the potential for patient and staff injury while preserving patient dignity. We review the definition of agitation and pharmacologic management for youth with acute agitation, including common classes of medications, indications for use, and adverse effects. We also discuss the need to integrate the use of medications into a comprehensive strategy for agitation management that begins with proactive prevention of aggressive behavior, creation of a therapeutic treatment environment, and verbal de-escalation strategies.
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Pediatric emergency care · Aug 2021
Case ReportsSubacute Gummy Vitamin Overdose as a Rare Manifestation of Child Neglect.
We present a case of a 20-month-old girl who presented to the emergency department with anorexia, progressive weakness, and lethargy who was found to have severe hypercalcemia (20.7 mg/dL) and vitamin D hypervitaminosis. Further questioning revealed that this was secondary to a subacute toxic ingestion of "L'il Critters" calcium and vitamin D3 gummy vitamins that were being administered by the patient's mother multiple times a day for several weeks or even months. This occurred in the setting of child neglect due to the mother's mental illness. ⋯ Our patient had the highest calcium level we are aware of in a toddler and is the only case we know of that occurred as a result of a prolonged, intentional exposure in the setting of child neglect and a complex social situation. This case reviews the causes and management of hypercalcemia and vitamin D intoxication. It also highlights the need for a comprehensive social history and exposes the vulnerabilities of children living in homes afflicted by parental depression and severe mental illness.
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Pediatric emergency care · Aug 2021
Case ReportsSmall Bowel Obstruction in an Adolescent Boy With No Apparent Risk Factors: A Rare Case of Superior Mesenteric Artery Syndrome.
Superior mesenteric artery syndrome (SMAS) is an uncommon condition that can lead to upper gastrointestinal obstruction. Although SMAS is a rare diagnosis, our patient, a 13-year-old adolescent boy with no relevant medical or surgical history, had a classical presentation of the disorder. In this article, we discuss the risk factors, common presentation, and treatment options of SMAS, and why it is important to consider in the differential diagnosis of a pediatric patient presenting with bilious emesis and no other risk factors for intestinal obstruction.