Pediatric emergency care
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Pediatric emergency care · Jan 2013
Anterior shoulder dislocations in pediatric patients: are routine prereduction radiographs necessary?
Fractures are reported to complicate anterior shoulder dislocations in up to 50% of adults. For this reason, prereduction and postreduction radiographs are recommended for the routine evaluation of shoulder dislocations in all patients. To date, few data have been reported as to the incidence of fractures or as to the value of prereduction x-rays in pediatric patients with anterior shoulder dislocations. ⋯ In our sample of pediatric patients with anterior shoulder dislocations due to low-energy injury mechanisms, plain radiography identified a lower incidence of fractures than those reported from adult studies. Pediatric patients with anterior shoulder dislocations clinically apparent after clinical evaluation may not benefit from prereduction radiographs. Forgoing prereduction x-rays might expedite definitive pain relief for patients, lower cost and radiation exposure, and decrease ED length of stay.
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Pediatric emergency care · Jan 2013
Case ReportsAcute myocardial infarction induced by concurrent use of adderall and alcohol in an adolescent.
Adderall (amphetamine, dextroamphetamine mixed salts), a widely prescribed stimulant for the treatment of attention-deficit/hyperactivity disorder in children and adolescents, is considered safe with due precautions. Nonmedical use of Adderall is prevalent and rising in high school and college students. ⋯ The sporadic use of Adderall with alcohol creates a potentially dangerous situation with serious cardiovascular adverse effects. We should have a high degree of suspicion for children and adolescents on stimulant therapy who present with chest pain and an abnormal electrocardiogram in the pediatric emergency department, and there is a need to evaluate them for myocardial ischemia and infarction.
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Pediatric emergency care · Jan 2013
Predictive value of initial Glasgow coma scale score in pediatric trauma patients.
The objective of this study was to determine the predictive value of the Glasgow coma scale (GCS) and the Glasgow motor component (GMC) for overall mortality, death on arrival, and major injury and the relationship between GCS and length of stay (LOS) in the emergency department (ED) and hospital. ⋯ For pediatric trauma victims, the GCS is predictive of mortality and injury outcomes, as well as both ED and hospital LOS, and has excellent prognostic accuracy. The GMC has predictive value for injury and mortality that is nearly equivalent to the full GCS.
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Pediatric emergency care · Jan 2013
Randomized Controlled TrialEfficacy of intravenous lidocaine to reduce pain and distress associated with propofol infusion in pediatric patients during procedural sedation.
Research suggests that young children experience an increased incidence and severity of discomfort during propofol infusion. Evaluations of varied interventions to reduce or eliminate this discomfort with adult subjects suggest that premedication with intravenously administered lidocaine (0.5 mg/kg) offers the best overall effectiveness. ⋯ Our data do not support using lidocaine pretreatment to alleviate pain/discomfort in pediatric patients during propofol infusion.
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Pediatric emergency care · Jan 2013
Review Case ReportsHypertension in severe pediatric diabetic ketoacidosis: case report and review of literature.
Dehydration from fluid loss secondary to glycosuria is the central pathogenesis of diabetic ketoacidosis (DKA). Decreased oral intake and increased insensible water loss are also common in DKA. ⋯ We present a case of DKA with severe dehydration and hypertension in contrast to expected hypotension. The aim of this article was to increase awareness that pediatric DKA could present with hypertension, and this should be looked at and included in DKA management protocols.