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
Case ReportsEncephalopathy from unintentional donepezil and memantine ingestion.
Donepezil and memantine are commonly prescribed antidementia drugs. There is a paucity of literature concerning pediatric ingestions of these drugs. We describe a case of a 2-year-old child who developed encephalopathy after an unintentional ingestion of donepezil and memantine. ⋯ She recovered with supportive care for 72 hours. Serum concentrations of donepezil and memantine measured on arrival were 470 ng/mL (therapeutic range, 25-50 ng/mL) and 32 ng/mL (therapeutic range, 70-150 ng/mL), respectively. This case demonstrates that unintentional ingestions of memantine and donepezil can potentially cause significant and prolonged neurological symptoms in pediatric patients.
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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
Case ReportsCentral cord syndrome in a 7-year-old boy secondary to standing high jump.
Acute traumatic central cord syndrome is commonly associated with major trauma such as falling and motor vehicle crash, but minor or nontraumatic causes are very rare in children. As a consequence, most physicians frequently overlook children presenting with complaints of arm weakness when history of any definite major trauma does not exist, especially in the emergency department. We present the case of a 7-year-old boy who was experiencing weakness in both arms after a standing high jump with tilting his head back in school. ⋯ Magnetic resonance imaging of the cervical spine revealed observable swelling with increased signal intensity at C1 to 4 levels. This case showed a spinal cord injury caused by standing high jump with neck extension alone. Therefore, the physicians have to consider the possibility of spinal cord injury even without any history of major trauma.
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Pediatric emergency care · Sep 2014
Outpatient Management of Young Febrile Infants With Urinary Tract Infections.
Controversy exists regarding the disposition of young febrile infants who present to emergency departments (EDs) with urinary tract infections (UTIs). In a large multicenter cohort of such patients, we aimed to determine the variation in patient disposition and clinical factors independently associated with outpatient management. ⋯ There is substantial practice variation regarding the disposition of febrile infants 29 to 60 days of age with UTIs. Institutional practice is the strongest predictor of outpatient management. Further evidence is needed to guide the management of non-toxic-appearing young febrile infants with UTIs.