Pediatric emergency care
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Pediatric emergency care · Oct 1995
Randomized Controlled Trial Comparative Study Clinical TrialCircumferential pressure as a rapid method to assess intraosseous needle placement.
This study was done to determine whether the application of circumferential pressure about an intraosseous (IO) site can be used as a rapid method to detect incorrect placement of an IO needle. We used a prospective, randomized, controlled canine tibial IO model. According to random assignment, IO needles were placed either intramedullary (correct placement) or extramedullary (incorrect placement) in the anteromedial tibias of 12 euthanized mongrel dogs. ⋯ Following inflation of the blood pressure cuffs, the mean percent decrease in flow was 48% for the correctly placed IO needles, and 95% for the incorrectly placed IO needles. A two-way repeated measure of analysis of variance was significant between groups (P = 0.006), and a significant interaction was found between groups and flow rates over time (P = 0.043). We conclude that circumferential pressure about an IO infusion site can be used as a rapid method to detect incorrect placement of the IO needle.
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Pediatric emergency care · Aug 1995
ReviewUrethral prolapse: an often misdiagnosed cause of urogenital bleeding in girls.
Urethral prolapse is an uncommon disorder in girls, usually presenting as "vaginal" bleeding. This retrospective chart review focuses on the high rate of misdiagnosis of urethral prolapse and describes treatment modalities based on 24 patients seen at a major children's hospital during an 11-year span. Their mean age was 4.9 years. ⋯ Of these, five showed no improvement and underwent surgical repair. Although most children eventually require resection of the prolapsed urethral mucosa, nonoperative treatment is appropriate for asymptomatic girls with a mild degree of urethral prolapse. Increased physician awareness of urethral prolapse is desirable to enhance early recognition and to avoid unnecessary examinations and parental concern.
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With increasing emergency department (ED) violence, security in pediatric EDs is an important concern. The objective of this study was to document current security measures taken in pediatric EDs in the United States. A telephone survey of the security director or designee in the 42 children's hospitals in the United States with over 150 beds was performed. ⋯ No ED reported universal metal detector screening. Fourteen directors (35%) reported having had a firearm-related incident in their ED in the past year. In spite of the relatively common nature of ED violence, security measures in pediatric EDs are varied, with most EDs not using all measures recommended by the American College of Emergency Physicians.