Pediatric emergency care
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Pediatric emergency care · Apr 2019
ReviewCurrent Approach to the Management of Forearm and Elbow Dislocations in Children.
Pediatric orthopedic injuries are a common reason for presentation to the emergency department. This article sequentially discusses 2 important upper extremity injuries that require prompt management in the emergency department. Radial head subluxations are discussed with a focus on current evidence for imaging, reduction techniques, and follow-up. Elbow dislocations, although less common than radial head subluxations, are also addressed, highlighting imaging, reduction, immobilization, and follow-up recommendations.
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Pediatric emergency care · Apr 2019
Review Case ReportsParoxysmal Tonic Upgaze in Children: Three Case Reports and a Review of the Literature.
In clinical practice, nonepileptic paroxysmal events during infancy and childhood are common reasons for parents and caregivers to seek for medical advice. These events are mostly unrecognized and considered as an epileptic seizure because of the clinical features resembling an epileptic seizure. Paroxysmal tonic upgaze, which consists of recurrent episodes of sustained upward deviation of the eyes and incomplete downward saccades, and normal horizontal eye movements without impairment of consciousness, is a diagnostic challenge for the pediatrician and pediatric neurologist. In general, the entity was defined as an apparently benign phenomenon with normal investigations and eventual complete resolution of the symptoms, although some authors reported on patients with associated neurologic signs, such as ataxia, developmental delay, and abnormal brain magnetic resonance imaging finding. ⋯ In conclusion, paroxysmal tonic upgaze is an apparently benign phenomenon with unclear pathophysiology of various proposed mechanisms such as genetic predisposition, immaturity of the brain stem, neurotransmitter depletion, or immune dysregulation. It is important to recognize the clinical presentation of paroxysmal tonic upgaze and distinguish the disorders from epilepsy for deciding the treatment and prognosis of the patients.
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Pediatric emergency care · Apr 2019
Review Case ReportsFocused Cardiac Ultrasound in Pediatric Pulmonary Hypertension.
We present 2 cases of pediatric pulmonary hypertension presenting with respiratory distress. Focused cardiac ultrasound revealed findings consistent with right ventricular dilatation and elevated right ventricular pressure. These findings, in conjunction with the clinical presentation, allowed for early identification and rapid evaluation of a pathologic process that can often go unidentified. In this report, we review the relevant aspects of focused cardiac ultrasound in the setting of pulmonary hypertension.
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Pediatric emergency care · Apr 2019
Review Case ReportsCompartment Syndrome Secondary to Group A Streptococcus Infection in the Presence of a Congenital Hemangioma.
Nontraumatic compartment syndrome is frequently difficult to diagnose but this is especially troublesome in infants. Pain is the most sensitive sign and is characteristically severe and refractory to routine analgesia. Failure to diagnose and treat can lead to disability, multiorgan failure, and death. Surgical intervention is crucial and includes emergent fasciotomy, debridement, nerve decompression, and later skin grafting. Streptococcal myositis causing compartment syndrome is more likely in the immunocompromised patient.Congenital hemangiomas are rare, benign vascular tumors that present fully grown at birth. ⋯ This case report details a healthy child, with a resolving congenital hemangioma of the forearm, presenting with toxic shock syndrome and a streptococcal myositis creating a compartment syndrome in the same forearm after an upper respiratory tract infection. The child underwent an emergent fasciotomy and debridement of the arm. Profound systemic effects necessitated transfer to intensive care unit and continuing postoperative mechanical ventilation, inotropic support, intravenous antibiotics, and immunoglobulin administration. Postoperatively, blood cultures and wound biopsies were all positive for Beta Hemolytic Group A Streptococci. Several days later, after a course of antibiotics, the volar forearm was closed with meshed split thickness skin grafts with good graft take. In our patient, we concluded that the hemangioma may have acted as a locus to attract the hematogenous spread of the streptococcal infection from the throat and caused a soft tissue infection that led to massive edema of the limb and consequently to compartment syndrome.
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Pediatric emergency care · Apr 2019
ReviewManagement of Isolated Skull Fractures in Pediatric Patients: A Systematic Review.
Isolated skull fractures (ISFs) in children are one of the most common emergency department injuries. Recent studies suggest these children may be safely discharged following ED evaluation with little risk of delayed neurological compromise. The aim of this study was to propose an evidence-based protocol for the management of ISF in children in an effort to reduce medically unnecessary hospital admissions. ⋯ Pediatric ISF patients with a presenting Glasgow Coma Scale score of 15 who are neurologically intact and tolerating feeds without concern for nonaccidental trauma or an unstable social environment can safely be discharged following ED evaluation to a responsible caregiver.