Pediatric emergency care
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Pediatric emergency care · May 2010
Case ReportsIsoniazid-induced status epilepticus in a pediatric patient after inadequate pyridoxine therapy.
Isoniazid (INH) is an effective treatment for tuberculosis and among the most common causes of drug-induced seizures in the United States. Isoniazid intoxication produces a characteristic clinical syndrome including seizures, metabolic acidosis, and, in severe cases, respiratory depression and coma. ⋯ As soon as possible after INH overdose is suspected or diagnosed, pyridoxine should be administered in a dose approximately equal to the estimated amount of INH ingested regardless of the age of the patient.
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Pediatric emergency care · May 2010
Comparative StudyPremature departure from the pediatric emergency department: a cohort analysis of process- and patient-related factors.
Previous literature suggests that process-related factors (eg, time of day, patient volume) and patient-related factors (eg, acuity, socioeconomic status) are associated with premature departure from emergency departments. We sought to evaluate the relationship of these and other factors with premature departure in a large, unselected cohort of pediatric emergency department patients. ⋯ Process-related factors and individual patient acuity have the strongest influence on premature departure from the pediatric emergency department. Health care organizations concerned with premature departure should focus efforts on improving pediatric emergency process flow.
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Pediatric emergency care · Apr 2010
Case ReportsTwo cases of upper-extremity swelling: Paget-Schroetter syndrome and non-Hodgkin lymphoma.
Two adolescents presented to our emergency department with isolated, acute onset upper-extremity swelling. In their initial emergency department evaluations, both patients were found to have a deep venous thrombosis. ⋯ After further evaluation, one patient was diagnosed with Paget-Schroetter syndrome and the other with non-Hodgkin lymphoma. These cases illustrate the importance of maintaining a broad differential diagnosis and using a multidisciplinary approach to patients with the unusual and potentially life-threatening presentation of upper-extremity swelling.
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Pediatric emergency care · Apr 2010
Case ReportsInfantile-onset Pompe disease: a diagnosis not to miss.
Pompe disease is a rare genetic disorder that affects glycogen and lysosome storage secondary to a deficiency in the enzyme that breaks down glycogen (acid alpha-glucosidase). With such deficiency, glycogen buildup occurs within lysosomes and cells, causing dysfunction of several organ systems (typically skeletal and respiratory muscles). Within this disease, the spectrum of severity is attributed to the differing amounts of enzyme deficiency. ⋯ Physical examination, however, revealed findings suggestive of an underlying neuromuscular disorder and after thorough evaluation led to the diagnosis of infantile-onset Pompe disease. This case emphasizes the need to maintain clinical vigilance when treating common pediatric illnesses. The recognition of Pompe disease in this infant resulted in the initiation of contemporary treatment strategies delaying disease-related morbidity and mortality.
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Pediatric emergency care · Apr 2010
"My child can't keep anything down!" Interviewing parents who bring their preschoolers to the emergency department for diarrhea, vomiting, and dehydration.
Viral gastroenteritis with dehydration is one of the most frequent reasons for visits to pediatric emergency departments (ED). Parental intervention before presentation to the ED can make a significant difference in the course of a child's illness. There is a discrepancy between medical knowledge of dehydration and parental fears and understanding. This project is part of a larger program of research developing an educational tool for parents of preschoolers with diarrhea, vomiting, and dehydration. The primary objective was to develop an interview guide. From initial data, the researchers explored parental motivations for bringing their children to the ED. ⋯ A framework is proposed, which outlines the most important factors our sample of parents reported when deciding whether to take their ill child to the ED. The interview guide developed will facilitate collection of further information.