Pediatric emergency care
-
Pediatric emergency care · May 2020
Utility of Soft Tissue Lateral Neck Radiographs in the Emergency Department: The 5-Year Experience of a Large Tertiary Care Pediatric Hospital.
Although retropharyngeal infection (RPI) may present with voice change, drooling, fever, and a toxic appearance, diagnosis based on symptoms alone is unreliable. As incidence is increasing in children and drug-resistant bacterial strains such as methicillin-resistant Staphylococcus aureus are becoming more common, we decided to assess the clinical utility of lateral neck radiography. ⋯ Lateral neck radiography is useful for diagnosis of RPI in the ED with good sensitivity and specificity. Additional imaging is to be considered at the behest of physician's clinical judgment.
-
Pediatric emergency care · May 2020
Outpatient Parenteral Antimicrobial Therapy and Judicious Use of Pediatric Emergency Resources.
Pediatric returns to the emergency department (RTED) vary between 3% and 13% of the total ED volume of visits. However, the incidence and contribution of scheduled RTED on pediatric emergency department (PED) utilization is less clear. Antimicrobial stewardship programs on inpatient wards have been shown to improve judicious use of outpatient parenteral antimicrobial therapy (OPAT) in upon discharge. The implementation of such programs in PEDs has yet to be reported. The objectives of this study are to quantify the burden of scheduled RTED for OPAT on PED utilization and to examine how frequently OPAT use are supported by published practice standards for 3 common pediatric infections-cellulitis, pneumonia, and urinary tract infections. ⋯ Our findings suggest that OPAT poses a sizable burden on PED utilization, with a proportion of them potentially preventable.
-
Pediatric emergency care · May 2020
Case ReportsPerforated Meckel Diverticulum: A Rare Cause of Acute Abdomen in Children.
Meckel diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract and the most common cause of gastrointestinal bleeding in children. Although it usually follows the rule of 2's, exceptions to this rule are reported in the literature. Often asymptomatic, MD is commonly an incidental finding during surgical interventions. ⋯ Meckel diverticulum has been reported to mimic other abdominal pathologies like appendicitis, inflammatory bowel disease, and pancreatitis to name a few. We report a patient with acute abdomen in whom the more common causes of acute abdomen were ruled out and a diagnosis of MD was established on exploratory laparoscopy, only after he developed perforation. This report emphasizes the need for maintaining a high index of suspicion towards a possibility of a complicated MD in patients presenting with an acute abdomen, once other causes of acute abdomen are ruled out.
-
Pediatric emergency care · May 2020
Case ReportsTraumatic Pneumoperitoneum After Vaginal Intercourse.
Pneumoperitoneum with peritonitis, although uncommon, is a serious injury encountered in the pediatric emergency department. Although the patients may often appear ill or toxic, they can have normal vital signs at initial presentation. Patients with such injury can present with a variety of complaints because of the nature of referred pain. As a result, some patients may be more or less straightforward, thus illustrating the importance of obtaining a detailed history and performing a thorough physical examination. ⋯ Pneumoperitoneum resulting from vaginal intercourse in an otherwise healthy adolescent female is a rare cause of peritonitis. Although it has been described in the adult literature, this case illustrates the importance of considering sexual history as a contributory factor in pediatric patients presenting with an acute abdomen.