Pediatric emergency care
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Intrathecal baclofen (ITB) therapy is being used increasingly to treat medically intractable spasticity in children with cerebral palsy and spinal cord injuries. Baclofen overdose and withdrawal are potentially life-threatening complications of pump and spinal catheter system malfunction. We report a case of a 12-year-old boy, on long-term ITB therapy, who presents to our emergency department with an overdose of ITB, which is followed by withdrawal symptoms. ⋯ The pump was found to be disconnected and was revised. The patient was discharged home without permanent sequelae. With increased use of ITB, emergency medicine physicians must be aware of the mechanics of these pumps and the management of baclofen toxicity and withdrawal.
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Pediatric emergency care · Apr 2006
Case ReportsRecurrent episodes of intractable laryngospasm during dissociative sedation with intramuscular ketamine.
We report 2 cases of dissociative sedation with intramuscular ketamine with recurrent episodes of laryngospasm that we were unable to ventilate with bag-mask ventilation, in 1 case leading to endotracheal intubation to protect the airway. Supplemental oxygen was given throughout the sedations, and ventilatory status was noninvasively monitored on a continuous basis, providing detailed and objective documentation of the patients' clinical status throughout the sedations. We were, therefore, able to rapidly assess and confirm apnea, laryngospasm, and airway dysfunction.
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Pediatric emergency care · Apr 2006
Cardiac troponin I as a predictor of mortality for pediatric submersion injuries requiring out-of-hospital cardiopulmonary resuscitation.
It is difficult to predict ultimate survivors to hospital discharge in children who are successfully resuscitated after a cardiorespiratory arrest associated with a submersion injury. Serum measurements of organ injury or dysfunction may serve as a surrogate marker of the degree of hypoxic injury. We designed a prospective study whose purpose was to assess the predictive value for outcome of serum cardiac troponin I measurements after submersion injury and cardiorespiratory arrest. ⋯ Nine patients were admitted, and 2 patients (22%) survived to hospital discharge. The area under the receiver operating characteristic curve is 0.786 (95% confidence interval, 0.481-1.0). This suggests that cardiac troponin I has a moderate degree of discriminatory power in selecting children who did not survive to hospital discharge.
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Pediatric emergency care · Apr 2006
Case ReportsCase report: esophageal foreign body mistaken for impacted button battery.
Foreign body ingestion is a common complaint in the pediatric emergency department. Here, we report an interesting case of a coin ingestion in which the radiographic findings were alarming and inconsistent with the history provided by our patient. A brief review of the diagnosis and management of gastrointestinal foreign bodies is presented, with particular focus on ingested coins and button batteries.