Pediatric emergency care
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Nail bed injuries are the commonest pediatric hand injuries presenting to the emergency department. If managed correctly, the patient recovers quickly and complications are rare. However, failure to appreciate the complex anatomy of the perionychium and the importance of exploration, washout, and repair can result in devastating complications. ⋯ The case of a 6-year-old boy with a flexor sheath infection and devitalized fingertip 1 week after injury is presented. Emphasis is placed on the soft tissue and underlying bony injury that was overlooked at initial presentation, and how this led to serious infection requiring amputation. Thorough assessment of these common injuries and a high index of suspicion are essential.
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Pediatric emergency care · Apr 2012
Case ReportsAcute onset altered mental status in a previously healthy teenager.
Evans syndrome is a rare disease characterized by autoimmune hemolytic anemia and thrombocytopenia. Its initial presentation with intracranial hemorrhage is rare. We report a case of a 12-year-old girl who presented to the emergency department with altered mental status secondary to an intracranial hemorrhage and later diagnosed to have Evans syndrome.
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Pediatric emergency care · Apr 2012
Case ReportsVenezuelan equine encephalitis in a teenager visiting Central America.
Stupor, coma, and other alterations of consciousness are among the most serious life-threatening emergencies faced by the emergency department physician. When a patient arrives with altered mentation from Central or South America, the usual causes that occur in the United States must be considered; however, other unusual tropical disease must be excluded, such as Venezuelan equine encephalitis (VEE). ⋯ Venezuelan equine encephalitis is an acute viral disease that causes acute illness in equines and humans, with symptoms ranging from a mild, flu-like syndrome to encephalitis or death. Laboratory abnormalities are common and include elevated hepatic transaminases, lymphocytosis, eosinophilia, and thrombocytopenia. Treatment is supportive, and complete recovery is expected within several weeks in most patients.