Pediatric emergency care
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Pediatric emergency care · Aug 2017
Case ReportsLeukemoid Reaction in a Pediatric Patient With Diabetic Ketoacidosis.
Herein, we report a case of a 12-year-old girl who presented with diabetic ketoacidosis and a leukemoid reaction. Although this association has been described in a few adult patients, pediatric cases have not been reported. A leukemoid reaction is commonly defined as an elevation in the white blood cell count greater than 50,000/μL in response to severe illness or stress other than hematologic malignancy; it is considered to be mediated by various hormones, cytokines, and factors that are released in response to inciting triggers, such as acidosis. As highlighted in our report, distinguishing a benign leukemoid reaction from a hematologic malignancy and even tumor lysis syndrome, particularly in a setting of diabetic ketoacidosis, is crucial to ensuring safe and efficacious therapeutic interventions.
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Pediatric emergency care · Aug 2017
Case ReportsSevere Infant Rash Resistant to Therapy Due to Zinc Deficiency: A Case Report.
Pediatric skin diseases are a common presenting complaint to emergency medicine physicians but often pose a significant diagnostic challenge. Skin eruptions that are unusually severe for the diagnosis in question, lasting beyond the typical time of resolution, or not responding to conventional therapy should raise concern of a misdiagnosis. We present the case of a severe rash not responding to conventional atopic dermatitis therapy that led to a diagnosis of transient neonatal zinc deficiency. Clinicians caring for children should be aware of zinc deficiency and its corresponding clinical presentation, because it is readily treatable and may lead to the avoidance of unnecessary treatments and prevention of serious complications.
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Pediatric emergency care · Aug 2017
Observational StudyAfebrile Infants Evaluated in the Emergency Department for Serious Bacterial Infection.
Afebrile infants 0 to 60 days of age are sometimes evaluated for serious bacterial infection (SBI). Our objective was to describe the clinical and laboratory findings in this population and compare them to their febrile counterparts. ⋯ Afebrile infants make up a significant percentage of SBI evaluations in the emergency department. Respiratory symptoms, vomiting, and seizure-like activity are common presentations. Although rates of bacteremia and urinary tract infection are higher in the febrile group, this did not reach statistical significance, and therefore afebrile infants should still be considered at risk for SBI.
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Pediatric emergency care · Aug 2017
A New Paradigm for the Management of Thoracolumbar Pediatric Spine Traumas.
The transient breath holding sign (TBHS) is a clinical sign often associated with magnetic resonance imaging (MRI) spine traumatic lesions. The aims of this study were to prospectively evaluate the TBHS in the detection of thoracolumbar lesions in a large cohort of children and to establish a comprehensive strategy on the use of MRI in spine traumas in children. ⋯ This study confirms that the TBHS is a relevant clinical tool that should be added in the routine questionnaire after any trauma at admission. Magnetic resonance imaging should be restricted to patients with a TBHS positive at admission. A single T2 Short T1 Inversion Recovery (STIR) sagittal sequence seems sufficient to make the diagnosis and could replace the use of standard x-rays in pediatric spine traumas.
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Pediatric emergency care · Aug 2017
Missed Fractures in Infants Presenting to the Emergency Department With Fussiness.
The aim of this study was to evaluate incidence of prior fussy emergency visits in infants with subsequently diagnosed fractures suggestive of abuse. ⋯ Fractures concerning for child abuse are an important cause of unexplained fussiness in infants presenting to the pediatric ED. A high index of suspicion is essential for prompt diagnosis and likely prevention of other abuse.