Pediatric emergency care
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To determine the incidence of renal symptoms associated with amoxicillin, a retrospective review of exposures to amoxicillin in children younger than 6 years as reported to the National Poison Data System was done. ⋯ Although renal toxicity may occur with amoxicillin ingestions, it is rare and does not seem to be dose related.
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Pediatric emergency care · May 2013
Comparative StudyComparison of clinicians to radiologists in assessment of abdominal radiographs for suspected intussusception.
The objectives of this study were to determine agreement of abdominal radiography (AXR) interpretation and to compare test characteristics, between pediatric emergency medicine (PEM) physicians and pediatric radiologists for evaluation of intussusception. ⋯ Agreement between PEM physicians and pediatric radiologists for evaluation of AXR in suspected intussusception is moderate. Sensitivity and negative predictive value of AXR alone are not sufficiently high overall to exclude intussusception; however, PEM physician interpretation of AXR may possess utility in determining need for abdominal ultrasound in low-risk patients given the high negative predictive value.
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Pediatric emergency care · May 2013
Acceptability of sexual health discussion and testing in the pediatric acute care setting.
The objective of this study was to determine acceptability of sexual health discussion and testing among adolescents, parents, and health care providers (HCPs). ⋯ In contrast to HCPs, adolescents and parents expressed broad support for sexual health discussion and testing, which may inform HCP practice to improve access to care.
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Pediatric emergency care · May 2013
Randomized Controlled Trial Comparative StudyA randomized controlled trial of cast versus splint for distal radial buckle fracture: an evaluation of satisfaction, convenience, and preference.
Buckle fractures are inherently stable and at low risk for displacement. These advantages allow for treatment options that may create confusion for the practitioner. Accepted immobilization methods include circumferential cast, plaster or prefabricated splint, and soft bandaging. Despite mounting evidence for splinting, the questions of pain, preference, satisfaction, and convenience offer a challenge to changing practice. The purposes of this study were (1) to compare cast versus splint for distal radial buckle fractures in terms of parental and patient satisfaction, convenience, and preference and (2) to compare pain reported for cast versus splint. ⋯ With the exception of pain reported in the emergency department being higher for the splinted group, all other measures, including convenience, satisfaction, and preference, showed a clear trend favoring splints at almost every time period in the study. This study provides additional evidence that splinting is preferable to casting for the treatment of distal radial buckle fractures.
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Pediatric emergency care · May 2013
Case ReportsSuccessful early management of a female patient with a metabolic stroke due to ornithine transcarbamylase deficiency.
Ornithine transcarbamylase deficiency (OTC-D) is a urea cycle disorder caused by dysfunction of ornithine transcarbamylase, which frequently leads to hyperammonemia. Hyperammonemia represents a medical emergency requiring prompt treatment to reduce plasma ammonia levels and prevent severe neurological damage, coma, and death, particularly in patients with acute decompensation-related coma. The clinical symptoms of OTC-D can manifest themselves either at an early stage, which is often associated with severe symptoms, or in later life (late-onset OTC-D), when symptoms may be less severe. There is currently little agreement over diagnostic signs of the condition or the most appropriate therapeutic approach. Hyperammonemia is usually treated with ammonia scavengers, continuous venovenous hemodialysis, and dietary changes. N-carbamylglutamate is approved for the treatment of hyperammonemia in N-acetylglutamate synthetase deficiency and may have efficacy in other urea cycle disorders. ⋯ This case demonstrates that clinical benefits can be obtained by beginning aggressive treatment of OTC-D within a few hours of the onset of severe neurological symptoms even in the absence of altered biochemical markers.