Pediatric emergency care
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Pediatric emergency care · Nov 2021
Improving Pediatric Diabetic Ketoacidosis Management in Community Emergency Departments Using a Simulation-Based Collaborative Improvement Program.
The majority of pediatric patients with diabetic ketoacidosis (DKA) present to community emergency departments (CEDs) that are less prepared to care for acutely ill children owing to low pediatric volume and limited pediatric resources and guidelines. This has impacted the quality of care provided to pediatric patients in CEDs. We hypothesized that a simulation-based collaborative program would improve the quality of the care provided to simulated pediatric DKA patients presenting to CEDs. ⋯ This study demonstrated a significant improvement in adherence to pediatric DKA guidelines in CEDs across the state after execution of an in situ simulation-based collaborative improvement program.
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Pediatric emergency care · Nov 2021
Attending-Provider Handoffs and Pediatric Emergency Department Revisits.
The objective of this study was to determine if intradepartment attending-provider transitions of care (handoffs) during a pediatric emergency department (ED) encounter were associated with return ED visits resulting in hospitalization. ⋯ Provider handoffs in a pediatric ED did not increase the risk of return ED visits or return ED visits with deficiencies in care after adjustment for demographic, clinical, and visit factors.
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Pediatric emergency care · Nov 2021
Clinical Indicators of Pediatric Shunt Malfunction: A Population-Based Study From the Nationwide Emergency Department Sample.
The majority of the previous literature on clinical predictors of shunt malfunction is from the neurosurgical data, looking at the symptoms of patients who had surgery. Because common childhood illnesses are filtered from these samples, the prevalence of shunt malfunction is markedly higher than it would be for the pediatrician's office or emergency department (ED). Clinical predictive values obtained from a representative population can better inform clinical judgment in these environments. ⋯ We identified peritonitis, papilledema, and oculomotor palsies as the strongest clinical indicators for shunt malfunction in pediatric ED visits with a CSF shunt. We found that patients presenting with headache, nausea/vomiting, convulsions, or fever were more likely to have an etiology other than shunt malfunction. Thus, after an appropriate shunt evaluation, other sources of symptoms should be investigated.
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Pediatric emergency care · Nov 2021
A Case Series of Life-Threatening Complications of Central Venous Catheter Insertion.
Central venous catheters are commonly used in emergency department and the intensive care units for the treatment of critically ill patients. Reports on the rate of mechanical complications of catheter insertion are around 1%. ⋯ Here, we report a case series of 4 patients who had life-threatening complications of central venous catheter insertion, including venous intimal injury leading to pleural effusion, kinked central venous catheter in the superior vena cava, knotted guidewire with the separation of coil and core, and a missed guidewire with their respective insertion history and imaging. Increasing the awareness of and developing strategies to prevent these rare but potentially fatal conditions may have impact on patient outcomes.
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Pediatric emergency care · Oct 2021
Hydrocarbon Intoxication in Children: Clinical and Sociodemographic Characteristics.
Hydrocarbon intoxication in children still occurs, although it is preventable. It may cause a variety of clinical manifestations, involving the respiratory system and the nervous system. Our goal was to investigate all cases of hydrocarbon poisoning in children hospitalized in the Hadassah-Hebrew university hospitals in Jerusalem due to exposure to hydrocarbon in 2 decades. ⋯ Hydrocarbon intoxication results in a variety of clinical manifestations and can be life-threatening. Most cases of poisoning could have been easily prevented if the substances were kept out of the reach of children.