Pediatric emergency care
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Many children are brought to the emergency department because of respiratory symptoms including wheezing. Asthma is the most common but not the only cause of wheezing in children. There are many conditions, both pulmonary and extrapulmonary, which may cause recurrent wheezing. ⋯ The late presentation of congenital diaphragmatic hernia poses a considerable diagnostic challenge. We report an 18-month-old child with congenital diaphragmatic hernia who presented with recurrent respiratory symptoms and localized physical findings. This case underscores the need to consider alternative diagnoses including congenital diaphragmatic hernia in the evaluation of recurrent respiratory symptoms; this is especially true if the presentation is not consistent with asthma or there are asymmetric findings on auscultation.
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Pediatric emergency care · May 2008
Predictors of cerebrospinal fluid pleocytosis in febrile infants aged 0 to 90 days.
Young infants with fever routinely undergo laboratory evaluation, and many are treated with empirical antibiotics even when the infant seems well. The requirement of a lumbar puncture (LP) as part of a routine evaluation is debated; however, administration of antibiotics without an LP can cause concerns for partially treated bacterial meningitis and make subsequent evaluation of the cerebrospinal fluid (CSF) confusing. The ability to predict which febrile infants have a CSF pleocytosis would assist in the decision to perform LP in febrile infants. ⋯ A significant number of well-appearing febrile infants will have a CSF pleocytosis. A simple decision tree based on objective clinical information can help identify those at greatest risk for CSF pleocytosis.
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Pediatric emergency care · May 2008
Predictors for admission of children with periorbital cellulitis presenting to the pediatric emergency department.
To identify demographic and clinical characteristics associated with admission because of periorbital cellulitis (PC) in children. ⋯ Combination of local ocular symptoms and body temperature are positively associated with admission from the ED. Future research should concentrate on evaluating the suggested score we used in this cohort to validate it and evaluate its generalizability. Devising such scoring can help clinicians determine guidelines for admission of children with PC.