Pediatric emergency care
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Pediatric emergency care · Nov 2019
Case ReportsProlonged QRS Widening After Aripiprazole Overdose.
Aripiprazole is an atypical antipsychotic with a long half-life. Overdose can result in protracted somnolence and cardiac disturbances, particularly QT interval prolongation. ⋯ This case suggests that aripiprazole toxicity may possibly be associated with QRS prolongation without associated dysrhythmias or cardiovascular compromise. In addition, toxicity may be prolonged in patients who are CYP2D6 poor metabolizers.
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Pediatric emergency care · Nov 2019
Improving Bronchiolitis Care in Outpatient Settings Across a Health Care System.
This study aimed (1) to reduce use of ineffective testing and therapies in children with bronchiolitis across outpatient settings in a large pediatric health care system and (2) to assess the cost impact and sustainability of these initiatives. ⋯ A system-wide quality improvement project involving multiple outpatient care settings reduced the use of ineffective therapies and interventions in patients with bronchiolitis and resulted in significant cost savings. Improvements in care were sustained for 3 bronchiolitis seasons.
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Pediatric emergency care · Nov 2019
Case ReportsMedian Nerve Entrapment in the Ulna in a Both-Bone Pediatric Forearm Fracture: Case Report and Review of the Literature.
This case report presents entrapment with subsequent complete disruption of the median nerve in the distal ulna in a both-bone fracture of the forearm in a 9-year-old girl. Closed fractures of the radius and ulna commonly occur in pediatric populations. Postinjury nerve dysfunction is often seen. ⋯ Features seen on examination and the radiographs supported possible nerve entrapment. Although uncommon, nerve entrapment or transection should be considered in all forearm fractures with sensory or motor nerve dysfunction. If suspicions are high, an early diagnosis of nerve entrapment may be obtained with magnetic resonance imaging evaluation.
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Pediatric emergency care · Nov 2019
Isolated Increased Intracranial Pressure and Unilateral Papilledema in an Infant With Traumatic Brain Injury and Nondepressed Basilar Skull Fracture.
Traumatic brain injury is one of the most common pediatric injuries; totaling more than 500,000 emergency department visits per year. When the injury involves a skull fracture, sinus venous thrombosis and the risk of resultant increased intracranial pressure (ICP) are a concern. We describe a previously healthy 11-month-old female infant with nondepressed skull fracture who developed increased ICP in the absence of intracranial changes on imaging. ⋯ Trauma alone can lead to increased ICP secondary to several processes, although this is expected in moderate to severe head trauma. Our case demonstrates that increased ICP can be present in infants with mild traumatic brain injury in the absence of intracranial pathology. This should be considered in patients who present with persistent vomiting that is refractory to antiemetics.