The American journal of emergency medicine
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Altered state of consciousness and lethargy could be early and cardinal complaints in diseases that actually originate within the abdomen. Thirteen children were seen at our departments in whom impairment of the individual's mental state preceded the appearance of common gastrointestinal symptoms. Whereas in infants with intussusception of childhood neurological signs and symptoms have been rarely mentioned, references to an altered state of consciousness and lethargy in volvulus, strangulation or bowel incarceration have not been previously reported. Recognition of this possibility, however, should be taken into account in the diagnostic work-up of children presenting with inexplicable alterations of their mental state.
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This is the first report of which we are aware that describes the use of procedural sedation for the emergency department management of ear and nose foreign bodies in children < 18 years of age. During a 5.5-year period, we identified 312 cases of children with a foreign body in a single orifice (174 ear, 138 nose). ⋯ Procedural sedation had a positive effect on the success rate as more than half of the sedation cases had undergone failed attempts without sedation by the same physician. Emergency physicians should have familiarity with this indication for procedural sedation.