Clinical pediatrics
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Clinical pediatrics · Oct 2008
Randomized Controlled Trial Comparative StudyA comparison of oral dexamethasone with oral prednisone in pediatric asthma exacerbations treated in the emergency department.
The aim of this study was to determine if 2 doses of oral dexamethasone are as effective as a 5-day course of oral prednisone in preventing relapse for pediatric asthma exacerbations. Patients presenting to the emergency department with an asthma exacerbation were randomized to receive 0.6 mg/kg of dexamethasone or 2 mg/kg of prednisone in a prospective, double-blind study. The primary outcome was relapse within 10 days, and the secondary outcome was vomiting in the emergency department. ⋯ In all, 3 patients in the prednisone group (8%) and 8 patients in the dexamethasone group (16%) required an unscheduled follow-up visit (P = .27). In all, 7 patients in the prednisone group (18%) and 5 patients in the dexamethasone group (10%) had vomiting ( P = .24). No difference was found in the relapse rate or incidence of vomiting between patients given prednisone and dexamethasone for pediatric asthma exacerbations.
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Clinical pediatrics · Oct 2008
ReviewCutaneous mastocytosis: a review focusing on the pediatric population.
Cutaneous mastocytosis can be divided into 4 different clinical variants--urticaria pigmentosa, solitary mastocytoma, diffuse cutaneous mastocytosis, and telangiectasia macularis eruptiva perstans. Skin findings are often accompanied by symptoms secondary to mast cell release of mediators. ⋯ The majority of pediatric cases of cutaneous mastocytosis show a good prognosis with gradual resolution of both symptoms and skin lesions. This article will review each of the 4 clinical presentations focusing on pediatric-onset of disease while reviewing the literature.
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Clinical pediatrics · Oct 2008
Analgesia and sedation practices for incarcerated inguinal hernias in children.
In this study, the use of medications for analgesia and/or sedation for incarcerated inguinal hernia reductions in the emergency department was analyzed. A retrospective chart review was conducted for all patients presenting to a pediatric emergency department with incarcerated inguinal hernia from 2002 to 2005. A total of 99 children presented with incarcerated hernias during the study period. ⋯ Forty-five percent of children who received medication went through at least 1 hernia reduction attempt initially without medications. More than half the children with incarcerated inguinal hernias did not receive any medication for pain and/or sedation prior to hernia reduction. Guidelines for medication use for children with incarcerated inguinal hernias need to be developed.
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Clinical pediatrics · Oct 2008
Pediatric resident confidence in resuscitation skills relates to mock code experience.
To assess confidence in resuscitation skills among pediatric residents and its relationship to training and experience, all pediatric residents at one institution were surveyed regarding their confidence in technical and leadership resuscitation skills and their prior experience with real and mock codes. Respondents (61/82, 74%) reported participation in 4.9 +/- 3.6 mock and 3.9 +/- 5.0 real codes. Confidence score for all skills was 2.7 +/- 0.6 (scale 1-5). ⋯ Confidence correlated with mock codes (r = 0.52) and to a lesser degree with real codes attended (r = 0.36). Performance of active roles and debriefing occurred more commonly with mock than with real codes. The data indicate that pediatric residents have limited confidence in resuscitation skills and that mock code training with active participation and debriefing may be an effective educational tool.