Pediatric emergency care
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Pediatric emergency care · Aug 2021
Case ReportsDiagnosis of Posterior Urethral Valves in an Infant Using Point-of-Care Ultrasound.
This case describes a 7-week-old male infant presenting with vomiting and decreased urine output. Initial point-of-care ultrasound (POCUS) demonstrated a normal pylorus; however, assessment of bladder volume revealed the problem. The bladder was distended with a thickened, trabeculated wall and there was bilateral hydroureter, consistent with bladder outlet obstruction. ⋯ A voiding cystourethrogram confirmed the diagnosis of posterior urethral valves which were eventually ablated by urology. To our knowledge, this is the first case report of POCUS leading to a diagnosis of posterior urethral valves in an infant. This case highlights how POCUS can expedite evaluation of decreased urine output.
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Pediatric emergency care · Aug 2021
Randomized Controlled TrialDo Parents of Discharged Pediatric Emergency Department Patients Read Discharge Instructions?
The percentage of discharged emergency department (ED) patients who read discharge instructions (DCIs) is unknown. In this study of parents of pediatric ED patients, we attempt to quantify the DCI readership rate and identify variables associated with readership. We hypothesized that few families would read their child's DCIs. ⋯ A minority of parents of patients discharged from the pediatric ED appear to read through their child's DCIs, with Hispanic families and those without private insurance least likely to read. Future research can explore how best to reach these particularly vulnerable families.
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Pediatric emergency care · Aug 2021
Randomized Controlled TrialA Cost Analysis of Pulse Oximetry as a Determinant in the Decision to Admit Infants With Mild to Moderate Bronchiolitis.
A previous randomized controlled trial showed that artificially elevating the pulse oximetry display resulted in fewer hospitalizations with no worse outcomes. This suggests that management decisions based mainly on pulse oximetry may unnecessarily increase health care costs. This study assessed the incremental cost of altered relative to true oximetry in infants with mild to moderate bronchiolitis. ⋯ Reliance on oximetry as a major determinant in the decision to hospitalize infants with mild to moderate bronchiolitis is associated with significantly greater costs.
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Pediatric emergency care · Aug 2021
Medical Disimpaction for Children With Organic Esophageal Foreign Body in the Era of Eosinophilic Esophagitis.
Esophageal foreign body impaction (EFBI) is a common presentation in pediatric emergency medicine. Interventions (medical or endoscopic) are often required because of the severity of symptoms and risk of complications. Use of medical disimpaction (MD) such as glucagon injections and effervescent agents (eg, carbonated beverages) has been well described in adults; however, there are limited data in the pediatric literature. Eosinophilic esophagitis (EoE) is a relatively "new" clinicopathological entity that may present with EFBI mostly due to food with histological findings of EoE. Our study aim was to determine the efficacy of MD for organic EFBI in the pediatric population especially in children with EoE. ⋯ Medical disimpaction was ineffective in children with EoE but may be of help with symptom resolution in approximately 70% of children without EoE.
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Pediatric emergency care · Aug 2021
Case ReportsFlorid Scurvy in an Autistic Child on a Ketogenic Diet.
Ketogenic diets used for treating various neurological disorders can have potentially serious adverse effects. Among these is scurvy, a rarely reported, yet potentially fatal adverse effect of the ketogenic diet caused by vitamin C deficiency. ⋯ We have also reviewed the clinical indications and adverse effects of ketogenic diets with special reference to scurvy. This case emphasizes the importance of vitamin supplements in patients consuming a special diet.