Pediatric emergency care
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Pediatric emergency care · Aug 2009
Ten-year retrospective study of delayed diagnosis of injury in pediatric trauma patients at a level II trauma center.
Published rates of delayed diagnosis of injury (DDI) in pediatric trauma vary from 1.0% to 18%. The purpose of this study was to determine the long-term trend of DDI over 10 years, to identify risk factors associated with DDI, and to elucidate patterns of DDI. ⋯ The rate of missed injuries remained relatively constant over the past 10 years at our institution. More severely injured patients are more likely to have missed injuries. Special attention to the lower extremities of the younger trauma patient may be warranted.
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Henoch-Schönlein purpura (HSP) is the most common form of vasculitis found in the pediatric population. The most common presenting complaint for children with HSP is a purpuric rash on the lower extremities. Many other organ systems beyond the skin can be involved for children with HSP. We report a case of a 7-year-old girl with HSP who presented with status epilepticus and onset of rash 2 weeks after her initial symptoms.
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Pediatric emergency care · Aug 2009
Risk of bacterial or herpes simplex virus meningitis/encephalitis in children with complex febrile seizures.
To estimate the rates of bacterial meningitis and herpes simplex virus (HSV) encephalitis in children presenting with complex febrile seizures. ⋯ Given the low rate of bacterial meningitis and HSV encephalitis in children presenting with complex febrile seizures, routine lumbar puncture in these patients may be unnecessary.
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Pediatric emergency medicine (PEM) is more than a quarter of a century old; yet, very little is known about the career longevity of its practitioners. The purpose of our survey was to examine different aspects of career longevity in the clinical practice of PEM. ⋯ Most senior PEM physicians participating in our survey continue to carry a significant clinical load and are concerned about their career longevity in clinical practice of PEM.
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Pediatric emergency care · Aug 2009
Case ReportsStevens-Johnson syndrome and toxic epidermal necrolysis: consequence of treatment of an emerging pathogen.
We report a case of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) secondary to trimethoprim-sulfamethoxazole (TMP-Sx) therapy for presumed community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection. Although the association between SJS/TEN and the sulfonamide class of antibiotics is well established, the increasing prevalence of CA-MRSA has left practitioners with limited regimens to effectively treat skin and soft tissue infections (SSTIs) in the outpatient setting. ⋯ Future investigations evaluating the efficacy of adjunctive antibiotics for purulent SSTIs and monitoring the incidence of SJS/TEN in the era of CA-MRSA are necessary to reduce unnecessary use of sulfonamide drugs. The potential development of SJS/TEN, a severe life-threatening illness, emphasizes the need for judicious use of TMP-Sx and close monitoring and follow-up for patients who were given TMP-Sx for SSTIs.