Pediatric emergency care
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Pediatric emergency care · Nov 2005
Randomized Controlled TrialPediatric intravenous insertion in the emergency department: bevel up or bevel down?
Intravenous catheters are usually inserted with the bevel facing up. Bevel down may be superior in small and/or dehydrated children. We seek to determine whether there is a difference in the success rate of intravenous insertion using these 2 methods. ⋯ The bevel-up technique performed superior to bevel-down technique in this study. The bevel-down technique might be useful in small infants.
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Pediatric emergency care · Nov 2005
Case ReportsNegative-pressure pulmonary edema: a rare complication of upper airway obstruction in children.
Negative-pressure pulmonary edema is a rare but life-threatening complication of upper airway obstruction. Because negative-pressure pulmonary edema may occur in a large spectrum of pathologies associated with upper airway obstruction, awareness of this condition is crucial during daily clinical practice. We report a case of negative-pressure pulmonary edema during anesthetic recovery to highlight this condition. ⋯ A 2-year-old boy was scheduled for orchidopexy under general anesthesia. Shortly after an uneventful operation, the patient presented airway obstruction. Serious oxygen desaturation and bradycardia ensued, during inefficient attempts at positive-pressure ventilation. After emergency intubation, copious pink secretions emerged from the airway. Pulmonary edema was confirmed by clinical examination, pulse oximetry, and chest radiography. The finding of pulmonary edema was resolved within 24 hours after mechanical ventilation and positive end-expiratory pressure. The child suffered no sequelae. This report highlights the clinical features of negative-pressure pulmonary edema and serves as a reminder to the pediatrician who must be able to recognize and initiate treatment for conditions that are uncommon but life-threatening.
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Pediatric emergency care · Nov 2005
Case ReportsCongenital lobar emphysema: tube thoracostomy not the treatment.
A 23-month-old boy was transferred to our facility after being diagnosed with a right-sided pneumothorax in an outlying hospital emergency department. The patient's primary complaint was a nonproductive cough and runny nose. Vital signs were stable with 98% oxygen saturation by pulse oximetry. ⋯ Chest x-ray revealed a large lucency over the right lung field, yet an intact vascular pattern. Computed tomography scan of the chest revealed congenital lobar emphysema of the right upper lobe. The pathophysiology, clinical presentation, diagnostic evaluation, and management of congenital lobar emphysema are reviewed.
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Pediatric patients with dilated cardiomyopathy can initially be present for medical attention with non-specific and misleading signs and symptoms. We present the case of a 7-year-old girl with vague complaints of fever, vomiting, and abdominal pain and cardiac murmur on physical exam who progressed to congestive heart failure before her dilated cardiomyopathy was diagnosed. Clinicians should maintain a high index of suspicion for dilated cardiomyopathy in any patient with cardiac murmur and systematic symptoms.