Pediatric emergency care
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Pediatric emergency care · Feb 2013
Subconjunctival hemorrhages in infants and children: a sign of nonaccidental trauma.
Subconjunctival hemorrhages in infants and children can be a finding after nonaccidental trauma. We describe 14 children with subconjunctival hemorrhages on physical examination, who were subsequently diagnosed by a child protection team with physical abuse. Although infrequent, subconjunctival hemorrhage may be related to abuse. Nonaccidental trauma should be on the differential diagnosis of subconjunctival hemorrhage in children, and consultation with a child abuse pediatrics specialist should be considered.
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Pediatric emergency care · Feb 2013
Factors associated with prolonged stay in a pediatric emergency observation unit of an urban tertiary children's hospital in China.
This study aimed to examine the factors associated with increased length of stay (LOS > 24 hours) in the pediatric emergency observation unit (OU) of an urban tertiary children's hospital in China. ⋯ We identified some risk factors for prolonged stay in an OU. These factors are the starting points in understanding issues related to prolonged stay and are needed to assess efficiency and quality of care in pediatric emergency department and OU. Our results have provided information basis for making improvements in the system and may be important considerations for similar institutions, which encounter similar challenges.
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Encephalitis is a serious and potentially treatable infection of the central nervous system. A pathogen is identified in less than 50% of cases. ⋯ Emergent investigations include blood work, cerebrospinal fluid analysis, and neuroimaging. Empiric acyclovir and antibiotics should be started immediately to maximize the child's chance of neurologic recovery.
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Pediatric emergency care · Feb 2013
ReviewApplications of nitrous oxide for procedural sedation in the pediatric population.
The objective of this review was to provide a general descriptive account of the physical properties, end-organ effects, therapeutic applications, and delivery techniques of nitrous oxide (N2O) as used in the arena of procedural sedation. ⋯ In general, N2O is a useful adjunct for procedural sedation. Given the variety of procedures performed in the pediatric patient, ongoing research is required to identify the most appropriate and effective use of this agent. This may be particularly relevant when evaluating its use for procedures associated with significant pain. In these scenarios, the combination of N2O with other agents needs to be evaluated. Given the potential for adverse effects, strict adherence to published guidelines regarding procedural sedation and monitoring is suggested.
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Pediatric emergency care · Feb 2013
Case ReportsMassive hemoptysis in a post-Fontan procedure patient.
Aortopulmonary collateral vessels (AP collaterals) are frequently seen in patients with cyanotic heart disease. However, massive hemoptysis leading to life-threatening hemorrhage is rare. In this case, we present a 7-year-old girl who presented to the pediatric emergency department with massive hemoptysis secondary to AP collateral hemorrhage. We were able to control her hemoptysis initially through calming techniques, but the patient eventually went on to have 2 cardiac catherization procedures, during which coiling of many AP collateral vessels was performed.