Pediatric emergency care
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We studied 149 children aged seven months to 13 years (mean age 2.9 +/- 0.2 years) who had aspirated foreign bodies for age, sex, and type of foreign body. Symptoms, physical findings, chest x-ray, and fluoroscopy were compared with different sites of enlodgement. Positive history was obtained in 135 (91%). ⋯ Decreased breath sounds were significantly more common among children with lower airway enlodgement (P less than 0.001). A delay in diagnosis of longer than three weeks was associated with equivocal history of aspiration (P less than 0.05), and with significantly more wheezing (P less than 0.02) and atelectasis (P less than 0.01). Our study reemphasizes the importance of integrating various diagnostic tools in order to accurately evaluate and manage these children.
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Pediatric emergency care · Jun 1988
Why not your pediatrician's office? A study of weekday pediatric emergency department use for minor illness care in a community hospital.
To determine the rationale for using a community hospital's emergency department for minor illness care on weekdays, we surveyed 150 parents of children 15 years of age or younger. Fifty (33.3%) participants had no identified source of routine pediatric care, and 31 (20.7%) had pediatric providers not locally available. ⋯ The results of this study demonstrate that the utilization pattern and sociodemographic profile of children seen in our emergency department on weekdays is more characteristic of an inner-city hospital than of a non-metropolitan setting. There are a number of feasible measures which could improve access to routine pediatric care for low socioeconomic families and reduce unnecessary emergency department utilization.
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Pediatric emergency care · Mar 1988
Case ReportsTraumatic pneumoperitoneum following combined abdominal and thoracic injury.
Pneumoperitoneum following blunt abdominal trauma in the absence of other signs of severe intraabdominal injury is a rare finding. Although the vast majority of all cases of pneumoperitoneum are due to a ruptured intraabdominal hollow viscus, free abdominal air may result from significant barotrauma to the thorax. This type of secondary pneumoperitoneum can occur in the absence of chest x-ray evidence of a pneumothorax or pneumomediastinum. The complications associated with a missed visceral injury warrant an exploratory laparotomy, even if an extraabdominal source for the pneumoperitoneum is suspected.
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In disaster planning, the role of the specialist is often overlooked. That role, for the pediatrician, entails being familiar with hospital and community disaster plans and agreeing to take part in implementation of those plans by: (1) before a disaster, teaching special pediatric emergency techniques to emergency medical technicians and paramedics, being sure that pediatric supplies and equipment are available in ambulances, checking to see that pediatric needs have been considered in designated evacuation shelters, and, for disasters occurring in one's own hospital, being sure that evacuation routes are known and that means of notifying parents have been set up; (2) during a disaster, helping to determine which pediatric patients can be discharged from the hospital or transferred to another hospital if beds are needed for accident victims, and being available as needed according to the plans; and (3) after a disaster, counseling parents and children on how to cope with the stress and fear of having been involved in a disaster. The emergency pediatrician active in disaster planning has a responsibility to see that the services of pediatricians in general practice are incorporated into those plans.
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Pediatric emergency care · Mar 1988
Case ReportsAn unusual complication from a femoral venous catheter.
We report a case of a child with sickle cell disease and decreased intravascular volume secondary to splenic sequestration in whom a femoral venous catheter dislodged, infiltrated into the soft tissue of the anterior abdominal wall, and caused clinical signs of peritonitis. Inability to recognize this complication led to a delay in diagnosis of the problem and removal of the catheter. Central venous catheters utilized to resuscitate hypovolemic patients should be removed as soon as peripheral venous access is possible and will suffice to fill the medical needs of the patient. If a patient with a femoral venous catheter develops signs of peritonitis, diagnostic studies should be performed to delineate catheter location.