Pediatric emergency care
-
Pediatric emergency care · Dec 2008
Review Case ReportsAtlantoaxial rotary subluxation after minor trauma.
We present a case of atlantoaxial rotary subluxation after a minor injury managed by manual reduction under sedation. Atlantoaxial rotary subluxation should be considered in a child with inability or unwillingness to turn their head when history and physical examination do not suggest torticollis of benign etiology. In our discussion, we review etiology, diagnosis, as well as pre- and in-hospital management.
-
Pediatric emergency care · Dec 2008
ReviewRetrospective review of unintentional female genital trauma at a pediatric referral center.
Unintentional female genital trauma is a complaint commonly seen and managed through the emergency department. The purpose of this study was to review all unintentional female genital trauma evaluated at The Hospital for Sick Children for 3.5 years to determine the factors associated with gynecologic consultation and need for operative repair. ⋯ Unintentional female pediatric genital traumas most commonly result from straddle injuries. Most injuries are minor, and in this cohort, only 48.57% received gynecologic consultation and 19.05% required operative management. Future prospective studies would be useful to better evaluate the efficacy of surgical choices.
-
Pediatric emergency care · Dec 2008
ReviewSearching for the Holy Grail: a review of markers of tissue perfusion in pediatric critical care.
Goal-directed therapy has become the key to resuscitating critically ill patients since 2001. However, the ideal marker to guide pediatric resuscitation has remained elusive. The ideal marker is specific, sensitive, easy to use, safe, validated, and cost-effective. ⋯ Sublingual capnometry may also prove to be useful, but no pediatric research has been published related to this device. Finally, near-infrared spectroscopy monitoring may be useful in highlighting changes in patient conditions, but its use in goal-directed therapy is limited by the wide interpatient variability. In summary, the search for the ideal marker of tissue perfusion continues, but there is promise on the horizon.
-
Pediatric emergency care · Dec 2008
Time- and fluid-sensitive resuscitation for hemodynamic support of children in septic shock: barriers to the implementation of the American College of Critical Care Medicine/Pediatric Advanced Life Support Guidelines in a pediatric intensive care unit in a developing world.
To analyze mortality rates of children with severe sepsis and septic shock in relation to time-sensitive fluid resuscitation and treatments received and to define barriers to the implementation of the American College of Critical Care Medicine/Pediatric Advanced Life Support guidelines in a pediatric intensive care unit in a developing country. ⋯ The mortality rate was higher for children older than 2 years, for those who received less than 40 mL/kg in the first hour, and for those whose treatment was not initiated in the first 30 minutes after the diagnosis of septic shock. The acknowledgment of existing barriers to a timely fluid administration and the establishment of objectives to overcome these barriers may lead to a more successful implementation of the American College of Critical Care Medicine guidelines and reduced mortality rates for children with septic shock in the developing world.
-
Pediatric emergency care · Dec 2008
Case ReportsFatal abusive head trauma cases: consequence of medical staff missing milder forms of physical abuse.
Missed diagnosis of child abuse may lead to chronic abuse with potential for death. This paper reports 3 such cases. ⋯ Physicians assessing children, especially infants, should be alert to indicators of abusive trauma to recognize abuse early on. Including abusive trauma in the differential diagnostic list and taking appropriate steps to rule out or confirm the diagnosis are of paramount importance in establishing child protective services and preventing further abuse and neglect that may at times be fatal.