Pediatric emergency care
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Pediatric emergency care · Sep 1987
The effect of Medicaid criteria on pediatric emergency department visits.
The use of the emergency department by children on Medicaid was documented, and the effect of new adult Medicaid criteria on a pediatric emergency department was investigated. Eight percent of daytime visits by all patients were nonemergencies, compared to 15% by Medicaid patients. ⋯ Emergency department use by Medicaid patients was not decreased by the new criteria. Documentation of inappropriate denials of emergency care when criteria designed for adults were applied to pediatric patients was presented to state health officials and resulted in a change in the state Medicaid criteria for emergency care of children.
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Since minimal information exists regarding quality assurance in pediatric emergency departments, the experience of staff members of a pediatric emergency department who have recently established a quality assurance program is described. The steps of development are identified. The program is analyzed based upon initial results, and it is measured against theoretical approaches to quality assurance.
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During the period from July to November 1984, 265 consecutive febrile infants younger than one year of age were evaluated in a pediatric emergency department. None had a source of infection on physical examination, and all were admitted with the diagnosis of "rule out sepsis." During the month of July, all patients with positive urine culture results had their urine sample collected by bag. In no instance was there a clinical diagnosis of urinary tract infection because of the presence of contaminant bacteria. ⋯ The technique utilized for collecting urine for culture in infants has a major impact on the incidence of urinary tract infection. The absence of pyuria is not a reliable indicator of the absence of urinary tract infection. Infants with urinary tract infection may have a transient loss in urine concentrating ability early in the course of their infection.
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Pediatric emergency care · Jun 1987
Case ReportsCardiac injuries caused by blunt chest trauma in children.
Two illustrative cases with different features of cardiac injury caused by blunt chest trauma are described. The first patient had mild and obscure symptoms, detected on physical examination, and required observation only. ⋯ We present the different medical procedures that should be taken into consideration in management of such cases, although continuous monitoring, repeated physical examination, electrocardiograms, chest x-rays, and echocardiography proved sufficient in managing our two children. It is important that physicians who provide care to children suffering from blunt chest trauma have increased awareness of possible cardiac injuries.