Pediatric emergency care
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Pediatric strokes lead to significant morbidity and mortality. To date, no systematic review has been available to guide the initial diagnostic approach to pediatric stroke. ⋯ In pediatric patients, the etiologies of stroke are varied and differ for children with ischemic stroke versus hemorrhagic stroke. With the present systematic review, a guide to the initial evaluation of stroke is presented.
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Pediatric emergency care · Sep 2014
Review Case ReportsPoint-of-Care Ultrasound in a Patient With Perforated Appendicitis.
We present the case of an 8-year-old girl with two emergency department visits for constipation and abdominal pain. Her medical history and physical examination noted by the emergency physician did not reveal a clear etiology of her symptoms until the second visit, when a point-of-care ultrasound was performed. ⋯ A computerized tomographic scan of the abdomen confirmed these findings in addition to two large abscesses in the lower pelvis, which subsequently required percutaneous drainage. This case illustrates the utility of point-of-care ultrasound in the evaluation of the pediatric patient with abdominal pain when appendicitis is a concern, as well as the ability of the emergency physician to use this technology to guide treatment and care of pediatric patients.
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Pediatric emergency care · Sep 2014
ReviewDamage control resuscitation: permissive hypotension and massive transfusion protocols.
Evidence for changes in adult trauma management often precedes evidence for changes in pediatric trauma management. Many adult trauma centers have adopted damage-control resuscitation management strategies, which target the metabolic syndrome of acidosis, coagulopathy, and hypothermia often found in severe uncontrolled hemorrhage. Two key components of damage-control resuscitation are permissive hypotension, which is a fluid management strategy that targets a subnormal blood pressure, and hemostatic resuscitation, which is a transfusion strategy that targets coagulopathy with early blood product administration. ⋯ There is no evidence to support permissive hypotension strategies in pediatrics. Evidence for hemostatic resuscitation in adult trauma management is more comprehensive, and there are limited data to support its use in pediatric trauma patients with severe hemorrhage. Additional studies on the management of children with severe uncontrolled hemorrhage are needed.
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Pediatric emergency care · Sep 2014
Case ReportsSplenic Infarction Caused by a Rare Coinfection of Epstein-Barr Virus, Cytomegalovirus, and Mycoplasma pneumoniae.
Epstein-Barr virus (EBV), cytomegalovirus (CMV), and Mycoplasma pneumoniae are common pathogens of respiratory infection among children and young adults. Although single infection of 1 of these pathogens is common enough, their coinfection has been rarely reported. A 19-year-old woman presented with severe upper abdominal pain for 5 hours as well as flu-like symptoms and jaundice for 2 to 3 weeks. ⋯ By hospital day 7, her fever and abdominal pain had subsided and her liver function became normal. This case exemplifies the challenges in the diagnosis of coinfection of multiple respiratory pathogens and its associated complications. Greater awareness among clinicians would ensure an earlier and more accurate diagnosis of coinfection of EBV/CMV with other respiratory pathogen(s).
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Pediatric emergency care · Sep 2014
Randomized Controlled Trial Comparative StudyImpact of Follow-up Calls From the Pediatric Emergency Department on Return Visits Within 72 Hours: A Randomized Controlled Trial.
We compare the rate of return to the emergency department (ED) within 72 hours between families of children receiving a follow-up telephone call by a non-health care provider asking about the child's well-being 12 hours after their visit to the ED and families not receiving a follow-up call. ⋯ Emergency departments practicing follow-up calls by non-health care providers should consider a forecasted increase in return rates.