Pediatric emergency care
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Pediatric emergency care · Nov 2020
Case ReportsSpinal Epidural Abscess in an Infant Presenting as Fever and Respiratory Distress.
A 9-month-old healthy female presented during winter to the emergency department with a chief complaint of fever and prominent respiratory symptoms. She was discharged on oseltamivir with a presumptive diagnosis of influenza. She returned to the emergency department 2 days later with continued fever and more upper respiratory symptoms. ⋯ When her high fevers continued, bloodwork that was concerning for leukocytosis, elevated inflammatory markers, and elevated alkaline phosphatase was obtained. During her workup for fever, a full body magnetic resonance imaging was performed, which revealed the diagnosis of a C3 to L5 spinal epidural abscess. This case demonstrates the difficulty of making this important diagnosis in a preverbal child presenting with a concurrent virus during winter viral season.
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Much has been learned about hemorrhage control using tourniquets from wartime experiences, and recent mass casualty events. The use of tourniquets for extremity hemorrhage is a lifesaving skill for all providers to learn.
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Pediatric emergency care · Oct 2020
Case ReportsTwo Cases Illustrating the Diagnostic Challenge of Pediatric Blastomycosis Presenting as Osteomyelitis.
Blastomyces dermatitidis is a dimorphic fungus endemic to the United States and Canada. Although both Histoplasma and Blastomyces are found in similar geographic regions, Blastomyces is many times more likely to cause dissemination in the immunocompetent host, frequently involving the bone. ⋯ We review 2 pediatric cases that initially presented with isolated orthopedic symptoms without documented fever or pulmonary complaints, although both had signs of pulmonary infection on imaging. These cases demonstrate the importance of a high level of suspicion as well as appropriate diagnostic workup, including surgical pathology with fungal stains, when evaluating osteomyelitis in patients exposed to a Blastomyces-endemic region.
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Pediatric emergency care · Oct 2020
Clinical Factors Associated With Pediatric Brain Neoplasms Versus Primary Headache: A Case-Control Analysis.
Pediatric headaches are a common presentation to emergency departments accounting for almost half a million annual visits. Providers are left with the difficult task of deciding who has a secondary headache etiology that warrants neuroimaging. ⋯ This study identified clinical factors associated with pediatric brain neoplasms that may guide acute neuroimaging decisions. This study also provides insight into potential clinical factors to be studied prospectively to derive a clinical decision rule.
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Pediatric emergency care · Oct 2020
The Effect of an Observation Unit on Pediatric Minor Head Injury.
The aim of this study was to evaluate the effect of an observation unit (OU) in an emergency department on reducing unnecessary use of computed tomography (CT) for minor blunt head trauma. ⋯ The rate of CT use decreased by 30% as a result of OU institution. The OU was an effective means of avoiding an unnecessary head CT for pediatric minor head injuries.