Pediatric emergency care
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Pediatric emergency care · May 2017
ReviewPediatric Spontaneous Pneumomediastinum: Narrative Literature Review.
Described since 1939 in the adult population, spontaneous pneumomediastinum is less known in children. Because of its symptoms and a generally benign evolution, it is probably an underestimated diagnosis. However, it has to be considered in the differential diagnosis of acute thoracic pain. ⋯ Spontaneous pneumomediastinum is uncommon in children but must be considered in pediatric patients with acute chest and/or neck pain. History taking, physical examination, and standard chest x-ray are most often diagnostic, and there is rarely a need for other investigation.Hospitalization is not always indispensable; ambulatory management can be considered. Outcome is good, and follow-up can be clinical, therefore avoiding further x-rays.
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Pediatric emergency care · May 2017
Case ReportsFemale Adolescent Presenting With Abdominal Pain: Accidental Wire Bristle Ingestion Leading to Colonic Perforation.
Abdominal pain in female adolescents is a common presentation to both the emergency department and the outpatient pediatric clinic. The broad differential diagnosis for abdominal pain requires a high index of suspicion to make an accurate diagnosis of foreign body ingestion as the etiology. Foreign body ingestion occurs in all age groups, but sequelae of gastrointestinal tract perforation in children are rare. Treatment for perforation requires consultation of the pediatric general surgeon. Clinicians should take care to not overlook subtle imaging findings or dietary/exposure history, even in the context of a patient with known history of abdominal pain. ⋯ Reports of unintended ingestion of wire bristles have been increasingly reported in the literature; however, most focus on injury to the upper airway or upper digestive tract and subsequent endoscopic or laryngoscopic removal. Most reports detail injury in adult patients, pediatric case reports with digestive tract injury are uncommon, and foreign body removal after lower digestive tract injury in children from a wire bristle has not been reported. We caution pediatric emergency medicine and ambulatory providers to consider such an ingestion and perforation in the differential diagnosis of acute-onset, focal, and localizable abdominal pain in children.
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Pediatric emergency care · May 2017
Consideration of Cost of Care in Pediatric Emergency Transfer-An Opportunity for Improvement.
Pediatric interhospital transfers are an economic burden to the health care, especially when deemed unnecessary. Physicians may be unaware of the cost implications of pediatric emergency transfers. A cost analysis may be relevant to reduce cost. ⋯ Significant number of transfers was discharged 12 hours or less without any additional intervention in PED. Fixed charges contribute to majority of total charges. Cost saving can be achieved by preventing unnecessary transfer.
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Pediatric emergency care · May 2017
Predictive Variables for Abnormal Comprehensive Metabolic Panel Testing and Potential Cost Savings in Children Receiving Pediatric Emergency Department Care.
The aim of this study was to determine variables predictive of abnormal comprehensive metabolic panel (CMP) results in pediatric emergency department (PED) patients and the potential cost savings of a basic metabolic panel (BMP) versus a CMP. ⋯ Limiting testing to a BMP for patients with none of the 12 clinical variables has the potential annual cost savings of $7125.
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Pediatric emergency care · May 2017
Case ReportsAcute-Onset Chest Pain in a 17-Year-Old Female Adolescent With Systemic Lupus Erythematosus.
We report the case of a 17-year-old adolescent girl with systemic lupus erythematosus with disseminated pneumococcal infection leading to purulent pericarditis with cardiac tamponade. Although pericarditis is not an uncommon entity in autoimmune diseases such as systemic lupus erythematosus, purulent pericarditis is a rare cause (<1%) of this presentation.