Pediatric emergency care
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Pediatric emergency care · Apr 2013
Review Case ReportsRectum perforation after broomstick impalement in a 17-year-old: case report and review.
Impalement injuries are uncommon, especially in the pediatric population. Because of the rarity of these injuries, physicians may have difficulty recognizing and treating impalement injuries appropriately. Clinical findings are sometimes innocuous, but can be life threatening. ⋯ We report a very rare case of rectum perforation after transanal introduction of a broomstick with almost no clinical findings. Impalement injuries are difficult to recognize, and severity may not be reflected by their external appearance. To diagnose these injuries in time, it is important to use a well-organized workup.
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Pediatric emergency care · Apr 2013
Review Case ReportsIdentification of unanticipated pelvic pathology on renal bedside ultrasound.
Bedside emergency ultrasound can be a useful initial test in children who present with abdominal pain. Our case describes a teenager who presented to the emergency department with back pain and right lower quadrant pain, suspicious for nephrolithiasis. The use of bedside ultrasound enabled timely diagnosis and management of an unanticipated condition.
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Pediatric emergency care · Apr 2013
Case ReportsTracheal foreign bodies: are radiographs misleading?
This study aimed to highlight the pitfalls of relying on radiographs in identifying potentially life-threatening upper airway foreign bodies in children. ⋯ Tracheal foreign bodies present a diagnostic challenge, and patients may fail to manifest radiographic abnormalities. In patients with a characteristic history and biphasic stridor, an endoscopic evaluation of the airway should be performed to avoid potentially devastating consequences.
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Pediatric emergency care · Apr 2013
Appendix not seen: the predictive value of secondary inflammatory sonographic signs.
Acute appendicitis is the most prevalent emergency surgical diagnosis in children. Although traditionally a clinical diagnosis, the diagnosis of acute appendicitis is uncertain in approximately 30% of pediatric patients. In attempts to avoid a misdiagnosis and facilitate earlier definitive care, imaging modalities such as ultrasonography have become important tools. In many pediatric studies, the absence of a visualized appendix with no secondary sonographic features has been reported as a negative study result, and a study where the appendix is not seen but demonstrates secondary features is often deemed equivocal. With ultrasound appendiceal detection rates reported at 60% to 89%, the dilemma of the nonvisualized appendix or equivocal study is frequently faced by clinicians. ⋯ Although uncommonly seen, large amounts of free fluid, phlegmon, and pericecal inflammatory fat changes were very specific signs of acute appendicitis. In the absence of a distinctly visualized appendix, the presence of multiple secondary inflammatory changes provides increasing support of a diagnosis of acute appendicitis.
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Pediatric emergency care · Apr 2013
Review Case ReportsTwist and shout! Pediatric ovarian torsion clinical update and case discussion.
Ovarian torsion (OT) in the pediatric patient is an uncommon event and a challenging diagnosis. Clinicians caring for children in the acute setting should be aware of the symptoms and the diagnostic findings of OT. All patients suspected to have OT require consultation with gynecology; however, there is some controversy regarding the best operative intervention. In this article, case discussions will serve as a platform for discussing the epidemiology and clinical manifestations of pediatric OT, as well as reviewing the latest evidence related to the diagnosis and treatment.