Pediatric emergency care
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Pediatric emergency care · Dec 2024
Streamlining Telecommunications Center and Interfacility Patient Throughput to a Pediatric Emergency Department by Utilizing an Electronic Handoff: A Quality Improvement Initiative.
Effective handoffs are critical for patient safety and high-quality care. The pediatric emergency department serves as the initial reception for patients where optimal communication is crucial. The complexities of interfacility handoffs can result in information loss due to lack of standardization. The aim of our project was a 50% reduction in monthly calls routed through the communication center from 157 to 78, for interfacility transfers to the emergency department from outpatient sites within our organization over a 1-year period, through utilization of an electronic handoff activity. ⋯ Our initiative facilitated the safe and efficient transfer of patients and streamlined workflows without sacrificing quality of patient care. Our telecommunications center has been freed up for other tasks with fewer interruptions during patient throughput. Next steps will analyze the encounters of transferred patients to further optimize patient flow at our organization.
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There is a paucity of data describing the frequency and complications of body piercing injuries (BPI) in the United States. ⋯ BPI is a common problem in children, adolescents, and youth. Age and body piercing location significantly impact rates of BPI, infection, and hospitalization/transfer. Further study should identify the total number of annual body piercings in the United States. This could generate targeted counseling and risk reduction interventions aimed at specific groups, especially older children who appear to be at increased risk.
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Pediatric emergency care · Dec 2024
Case ReportsPoint-of-Care Ultrasound Evaluation of Pediatric Osteomyelitis in the Emergency Department: A Case Series.
Musculoskeletal and soft tissue complaints commonly present to the pediatric emergency department and literature supports the use point-of-care ultrasound (POCUS) in the diagnosis of these complaints. The diagnosis of osteomyelitis typically involves laboratory testing with inflammatory biomarkers, imaging with x-ray, and often magnetic resonance imaging with test results often not immediately available. We report a case series of children initially evaluated with POCUS for osteomyelitis. The POCUS may expedite diagnosis and treatment when used as the initial test in children with suspected osteomyelitis in the emergency department.
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Central venous saturation (ScvO 2 ) can guide resuscitation of children with septic shock. The normal range of ScvO 2 is typically considered as 0.70-0.80, but has not been established in children with cancer. Children with cancer are particularly prone to develop sepsis due to their immunosuppressive therapy, and usually have a permanent central venous catheter, making ScvO 2 readily available. We aimed to investigate normal values of ScvO 2 in clinically stable children with cancer, and the association between ScvO 2 , hemoglobin, and lactate. ⋯ The study revealed that a substantial portion of clinically stable childhood cancer patients exhibited ScvO 2 levels below the typical reference value of 0.70, suggesting that these children may have inherently lower baseline ScvO 2 levels. This should be kept in mind when evaluating children with cancer for septic shock, emphasizing the importance of tailored assessments in this population. Further understanding of baseline ScvO 2 abnormalities may be helpful if ScvO 2 is used to guide resuscitation.
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Pediatric emergency care · Dec 2024
Hyperchloremia and Prolonged Acidosis During Treatment for Pediatric Diabetic Ketoacidosis.
Diabetic ketoacidosis (DKA) is characterized by metabolic acidosis with a high anion gap secondary to ketonemia. Intravenous hydration fluids used in treatment can cause chloride overload, leading to hyperchloremic metabolic acidosis (HMA). The development of HMA can lead to the persistence of acidosis despite the resolution of ketonemia. ⋯ During treatment of DKA, monitoring anion gap, blood ketones, and Cl - /Na + ratio or using regression equations in addition to routine acid-base parameters may help differentiate DKA from HMA and prevent prolonged intravenous treatment.