Pediatric emergency care
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Pediatric emergency care · Feb 2021
Case ReportsExtracorporeal Life Support as a Treatment of Supraventricular Tachycardia in a Newborn.
Supraventricular tachycardia (SVT) is the most common symptomatic tachyarrhythmia in children and requires medical treatment. Thus far, there have been few reports of the use of extracorporeal life support (ECLS) to provide cardiac support in children with low cardiac output resulting from arrhythmia. We present a case of a newborn in whom ECLS was used to provide support for cardiogenic shock secondary to intractable SVT. ⋯ The patient then reverted to a sinus rhythm with a rate of 180 beats per minute. There was considerable improvement of the heart function within 2 days of starting ECLS; the patient was weaned from ECLS support, and the blood access catheters were decannulated on day 3. After weaning from ECLS support, cardiac function returned to normal.
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Pediatric emergency care · Feb 2021
Communication Between Primary Care Pediatricians and the Pediatric Emergency Department.
This study aimed to measure the quality of communication from primary care pediatricians (PCPs) to the pediatric emergency department (ED). We also sought to determine whether the quality of this communication affected patient outcomes. ⋯ Our study demonstrates a lack of documented communication between PCPs and a pediatric ED, albeit with no statistically significant impact on patient outcomes. Practices to increase the quality of PCP-ED communication could include standardizing interfacility referrals, maximizing shared electronic health record use between clinical environments, and increased collaboration between ED physicians and PCPs. Further research to investigate subjective outcomes, such as patient expectations or satisfaction associated with PCP-ED communication, may reveal other consequences of incomplete communication.
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Pediatric emergency care · Feb 2021
Point-of-Care Ultrasound Used to Diagnose Sternal Fractures Missed by Conventional Imaging.
Sternal fractures have often been associated with high-impact thoracic trauma. In children, this is not always the case. ⋯ The following 2 cases describe sternal fractures that were missed by traditional imaging modalities, including a fracture missed by chest computed tomography. They also highlight other potential causative mechanisms for sternal fractures in children, including hyperflexion injuries and low-mechanism motor vehicle accidents.
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Fundamental to the practice of pediatric emergency medicine is making timely and accurate diagnoses. However, studies have shown errors in this process are common. A number of factors in the emergency department environment as well as identifiable errant patterns of thinking can contribute to such challenges. ⋯ Reviewing how these 2 styles of thinking are applied in clinical practice provides a framework for understanding specific cognitive errors. This article uses illustrative examples to introduce many of these common errors, providing context for how and why they occur. In addition, a practical approach to reducing the risk of such errors is offered.