Pediatric emergency care
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Pediatric emergency care · Jul 2011
Review Case ReportsRenal stones: evolving epidemiology and management.
The incidence of renal stones in adults has increased significantly over time. Although published evidence is somewhat limited, during the last 10 years, there have been reports of 4-fold increase in the number of children evaluated for nephrolithiasis, and of those, a 7-fold increase in diagnosis of stone disease. ⋯ It was our goal in this review of the literature on pediatric renal stone disease to further highlight the changing epidemiology and etiology as well as provide a framework for appropriate clinical evaluation and use of diagnostic tools when approaching a patient with suspected renal stone disease. We also provide guidance regarding treatment and prevention of renal stone disease in children.
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Pediatric emergency care · Jul 2011
Case ReportsNontraumatic spontaneous acute subdural hematoma in identical teenage twins 1 year apart.
Acute subdural hematoma (ASDH) is a life-threatening injury with a high mortality rate. Most ASDH cases are a result of trauma; nontraumatic causes are relatively rare with an incidence rate of 3% to 5%. We report an unusual series of 2 patients, identical twins, who had nontraumatic subdural hematomas 1 year apart, one at age 15 and the other at age 16. METHODS (CASE PRESENTATIONS): Identical twin brothers presented 1 year and 10 days apart to an academic medical center after incurring confusion, decreased mental functioning, and a subsequent comatose state. The injuries occurred while the patients were playing football, but there was no evidence of traumatic blow to the head in either brother. ⋯ Acute spontaneous subdural hematoma is an emergent medical condition that may result in rapid neurological decline and must be addressed in a timely fashion. After evacuation of the hematoma, intracranial pressure decreases and cerebral perfusion pressure increases, which may allow normal perfusion of the brain. Consequently, prompt recognition and evacuation of an ASDH can drastically improve prognosis. Rarely, subdural hematoma can occur without head injury and should be in the differential diagnosis of athletes who rapidly become comatose.
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Pediatric emergency care · Jul 2011
The acceptability of mental health screening in a pediatric emergency department.
The purposes of the study were (1) to assess the acceptability of mental health screening in the pediatric emergency department (ED) for children and their parents; (2) to measure providers' perceptions on whether screening has an impact on patient care; and (3) to determine the impact of screening status on acceptability. ⋯ Overall, mental health screening appears to be acceptable in the pediatric ED.
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Pediatric emergency care · Jul 2011
Procedural restraint use in preverbal and early-verbal children.
Children frequently undergo diagnostic and therapeutic procedures while in hospital. To conduct these procedures safely, preverbal and early-verbal children in particular are often restrained. However, the literature on procedural restraint use is very limited. We set out to describe the extent of restraint use in 4 common procedures. ⋯ Procedural restraint use in preverbal and early-verbal children is extensive, and significant amounts of force are used, which vary by procedure. Restraint use diminishes with age. A scoring system for restraint use is suggested based on the number of body parts restrained.
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Pediatric emergency care · Jul 2011
Case ReportsPerforated appendicitis and appendicolith in a child presenting as intussusception: a case report.
Simultaneous diagnoses of intussusception and appendicitis in the same patient have rarely been described in the pediatric literature. A case of a 30-month-old boy is presented with an initial diagnosis of intussusception that was successfully reduced by air contrast enema. ⋯ The patient's hospitalization and surgical course is described along with a discussion of the intermingling of intussusception and appendicitis in a young child. This case illustrates the need to consider alternative diagnoses when a patient's course takes an unexpected and confusing turn.