Pediatric emergency care
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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.
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Pediatric emergency care · Mar 1987
Case ReportsEarly coma in intussusception: endogenous opioid induced?
A decreased level of consciousness with little abdominal pain or gastrointestinal symptoms is an uncommon, but well described, presentation of infantile intussusception. Its etiology is unclear. ⋯ We speculate that the coma and miosis were induced by an endogenous opioid which could also mask the abdominal pain, thus explaining this presentation of intussusception. If so, miosis would be a valuable clue for diagnosing such children.
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A model was constructed to predict pediatric asthmatic wheezing visits to the emergency department. All wheezing visits to the Children's Hospital of Philadelphia Emergency Department were analyzed for 1982 and 1983, for ages two to 18. Nine thousand four hundred twenty-five visits fit the study requirements, 27% of the total number of emergency department visits for all causes. ⋯ Carbon monoxide, barometric pressure, and relative humidity were also statistically significant predictors but were clinically insignificant, explaining only a few percentage points of the total variation. By taking advantage of the seasonal pattern of wheezing through the use of temperature velocity, predictive models for asthmatic wheezing can be greatly improved. They may also aid in planning emergency department staffing, and even help prevent emergency department visits by premedication or lifestyle change during high-risk periods.