Pediatric emergency care
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Pediatric emergency care · Dec 2008
Development of an emergency department triage tool to predict acidosis among children with gastroenteritis.
Design a triage assessment tool that predicts acidosis in children with vomiting, diarrhea, and dehydration. ⋯ The stepwise regression tree triage assessment tool dichotomizing patients based on age younger than 2 years, dry mucous membranes, and days of illness more than 2 days was able to predict acidosis with 90% sensitivity in patients presenting to the ED for evaluation of gastroenteritis. Identifying patients with acidosis early in their ED course allows the treating ED physician to focus more attention and resources toward rehydrating this at-risk population of patients with gastroenteritis.
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Anaphylaxis is a severe, life-threatening immunoglobulin E (IgE)-mediated hypersensitivity reaction. The key to successful management of anaphylaxis involves rapid diagnosis, assessment, and early initiation of therapy. ⋯ Although hospital course must be individualized to meet each patient's needs, a minimum of 4 to 6 hours of observation period after complete symptom resolution may be reasonable to monitor for recurrence of symptoms and biphasic reaction. Before discharge, every patient should receive patient education about anaphylaxis, a prescription for self-injectable epinephrine, and instructions for follow-up care.
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Pediatric emergency care · Dec 2008
Confirming nasogastric tube position in the emergency department: pH testing is reliable.
The aim of this study was to determine whether pH testing is an accurate method of confirming nasogastric tube (NGT) position in children with and without gastroenteritis in the emergency department. ⋯ Testing of gastric pH is a reliable way of confirming NGT position when the pH is 4 or lower. When the pH is higher than 4, a radiograph may be necessary.
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Pediatric emergency care · Dec 2008
Case ReportsEsophageal foreign body: a case of a neonate with stridor.
We present a case of a 7-week-old female with a 3-week history of progressively worsening stridor who was admitted to rule out a congenital anomaly in the airway or vasculature. After 3 different imaging modalities, we discovered an esophageal foreign body causing esophagitis and proximal airway compression. Young infants with symptoms of stridor, wheezing, or retractions will often have a common diagnosis such as a viral infectious etiology, or in rarer cases an anatomic anomaly. This case illustrates that the presence of a foreign body must still remain on the differential, even in this age group.
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Pediatric emergency care · Dec 2008
Review Comparative StudyUrgency classification methods for emergency department visits: do they measure up?
Across the United States, emergency departments (EDs) are plagued by overcrowding and its deleterious effects. Consequently, investigators have attempted to identify a subset of nonurgent patients who could potentially be managed in alternative settings to help alleviate the burden of overcrowding. ⋯ Accurate identification of nonurgent ED visits is necessary to compare nonurgent populations across health care settings and design safe, effective interventions aimed at reducing ED overcrowding. In this paper, we review the currently used methods for the classification of ED visit urgency, discuss the implications of measurement of ED urgency for health care stakeholders, and suggest future directions for the feasible, practical measurement of ED urgency.