Pediatric emergency care
-
Pediatric emergency care · Jul 2014
Point-of-Care Ultrasonography for the Identification of 2 Children With Optic Disc Drusen Mimicking Papilledema.
We present 2 cases of asymptomatic patients who were found to have raised and blurred optic discs on physical examination, suggestive of papilledema. Evaluation in the emergency department revealed 2 well-appearing children with normal vital signs and neurologic evaluation results, without symptoms of increased intracranial pressure. ⋯ Optic disc drusen is caused by the deposition of calcified axonal debris and is often buried within the optic disc in pediatric patients. It can cause some changes in visual acuity and visual fields, but patients who are otherwise asymptomatic can be easily diagnosed through point-of-care ultrasound, thereby sparing patients an aggressive workup if their clinical picture is otherwise reassuring.
-
Pediatric emergency care · Jul 2014
Case ReportsChest pain in two athletic male adolescents mimicking myocardial infarction.
Acute chest pain with elevated troponin and CK-MB levels and focal ST elevation on electrocardiogram is considered to be myocardial infarction unless proven otherwise. The cardiac enzymes can be elevated in other etiologies of chest pain including myopericarditis, pulmonary embolism, acute rheumatic fever, and trauma. Therefore, patients presenting with chest pain and elevated cardiac enzymes should be carefully evaluated for other etiologies after ruling out acute coronary process. We report 2 male adolescents with myopericarditis who presented to the emergency department with chest pain and elevated cardiac enzymes.
-
Pediatric emergency care · Jul 2014
Randomized Controlled TrialEvaluating the Hematoma Block as an Adjunct to Procedural Sedation for Closed Reduction of Distal Forearm Fractures.
Although procedural sedation using intravenous agents is highly effective for forearm fracture reduction, the process is both resource and time intensive. Our objective was to determine whether the use of a hematoma block as an adjunct to procedural sedation with ketamine and midazolam reduces (1) pain during the procedure (scored using the Observational Score for Behavioral Distress-Revised score) or (2) the excess sedation time, defined by the time between procedure completion and discharge from sedation. Our secondary outcome measure was total ketamine dose administered during the procedure. ⋯ The use of a hematoma block as an adjunct to procedural sedation with ketamine and midazolam for forearm fracture reduction conferred no additional benefit and did not decrease observed pain scores, excess sedation time, or total ketamine dose administered.
-
Intranasal medication administration in the emergency care of children has been reported for at least 20 years and is gaining popularity because of ease of administration, rapid onset of action, and relatively little pain to the patient. The ability to avoid a needle stick is often attractive to practitioners, in addition to children and their parents. ⋯ This article reviews the use of intranasal medications in the emergency care of children. Particular attention will be paid to anatomy and its impact on drug delivery, pharmacodynamics, medications currently administered by this route, delivery devices available, tips for use, and future directions.