Annals of emergency medicine
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To determine whether a set of published triage guidelines identifies patients who can safely be refused emergency department care. ⋯ When tested in our patient population, the triage guidelines were not sufficiently sensitive to identify patients who needed ED care. Broad application of these guidelines may jeopardize the health of some patients.
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Comparative Study
Rectal diazepam for prehospital pediatric status epilepticus.
To compare the feasibility, effectiveness, and safety of rectal diazepam and intravenous diazepam in the treatment of pediatric prehospital status epilepticus. ⋯ Rectal diazepam is a simple, effective, and safe method of prehospital management of pediatric status epilepticus. Compared with IV diazepam, rectal diazepam is easier to administer, especially in infants and toddlers; is equally efficacious; and is less likely to produce respiratory depression. Although respiratory depression is rare with rectal diazepam, prehospital personnel must be prepared to provide definitive respiratory support. Short duration of action is an important limitation of both treatments.
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To determine the height of back elevation required to place the cervical spine of children less than 8 years old in neutral position and whether agreement on the height required for neutral position could be reached by two independent observers. ⋯ Children less than 8 years old require back elevation to achieve neutral position while lying supine on a backboard. Also, independent observers can agree on what constitutes neutral position in most children.
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We report two cases of severe complications from intraosseous infusions. One child was a sudden infant death syndrome patient who developed severe tissue necrosis after intraosseous placement. ⋯ Intraosseous infusion remains an important resuscitation modality, but great care must be taken to avoid these results. Strategies for avoiding extravasation are discussed.
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Randomized Controlled Trial Comparative Study Clinical Trial
Suprapubic bladder aspiration versus urethral catheterization in ill infants: success, efficiency and complication rates.
To compare success rates, complications, and efficiency of suprapubic bladder aspiration with urethral catheterization in ill infants. ⋯ Both suprapubic bladder aspiration and urethral catheterization afford the emergency physician low-risk access to uncontaminated urine in ill infants. Suprapubic bladder aspiration is less efficient in that it requires physician participation and failure rates are higher. These data suggest that successful suprapubic bladder aspiration is primarily dependent on the volume of urine in the bladder; thus, in the ill or febrile ED infant who may be dehydrated, the likelihood of success decreases. The authors recommend that ED nursing and physician staff become comfortable with performing urethral catheterization on infants.