Pediatric emergency care
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Pediatric emergency care · Feb 2010
Case ReportsOrbital trauma, bradycardia, and vomiting: trapdoor fracture and the oculocardiac reflex: a case report.
The presentation of vomiting and bradycardia after closed head trauma should invariably prompt concern for significant intracranial injury, yet other less common causes for the clinical picture do exist. This case reports one such scenario in which fracture to the patient's inferior orbital wall resulted in the rare though potentially life-threatening oculocardiac reflex, a vagally mediated phenomenon with possible respiratory, cardiovascular, and gastric motility effects.
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Pediatric emergency care · Feb 2010
Anaphylaxis management in the pediatric emergency department: opportunities for improvement.
To determine the rate, immediate treatment, and outpatient management for anaphylaxis in patients receiving care in a pediatric emergency department (ED). ⋯ This study is the first to describe the management of anaphylaxis in a pediatric ED. The results revealed opportunities for improvement. Although our ED treatment and outpatient management of patients with anaphylaxis did not meet the recommended standards of care with regard to administration of intramuscular epinephrine, prescribing autoinjection epinephrine, or referral to an allergist for all patients who had a diagnosis of anaphylaxis, we do report a higher concordance with published recommendations than those reported in previous studies performed in adults.
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Pediatric emergency care · Feb 2010
Case ReportsPneumomediastinum and subcutaneous emphysema in a child with ulcerative colitis.
We discuss the case of a young adolescent boy with ulcerative colitis who developed pneumomediastinum and subcutaneous emphysema in the neck and surrounding cervical soft tissues secondary to a probable retroperitoneal perforation of the colon. To our knowledge, this is the first reported case of this complication in the pediatric literature. Our experience provides insight into this unusual complication, how it may present, and its clinical significance in young patients with ulcerative colitis. The literature on this complication is also discussed.
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Pediatric emergency care · Feb 2010
Case ReportsA 7-year-old boy with acute onset of breathing difficulty.
Group A streptococcus (GAS) is a major bacterial pathogen affecting children globally. Approximately 15% of school-age children experience a symptomatic episode of GAS culture-positive pharyngitis each year. Although the incidence of invasive GAS disease under these circumstances is low (0.5%-2%), an increasing number of invasive GAS cases have been reported over the last 2 decades. This report describes a 7-year-old boy who, after being treated for GAS pharyngitis, developed a fatal streptococcal toxic shock syndrome.
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Pediatric emergency care · Jan 2010
Multicenter Study Comparative StudyPotential impact of peripheral intravenous catheter placement on resource use in the pediatric emergency department.
In an era of pediatric emergency department (PED) overcrowding and diminishing health care resources, routine peripheral intravenous (PIV) catheter placement in the pediatric population requires evaluation because it might directly impact PED efficiency. This study aims to determine the utility of routine PIV catheter placement during phlebotomy. ⋯ Nearly half of the PIV catheters placed in the PED were unused. Unused PIV catheters represent an inefficient use of limited resources that could be redistributed to improve ED efficiency, flow, and resource use.