Pediatric emergency care
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Pediatric emergency care · Jun 1997
Randomized Controlled Trial Clinical TrialThe value of end-tidal CO2 monitoring when comparing three methods of conscious sedation for children undergoing painful procedures in the emergency department.
Many studies have evaluated conscious sedation regimens commonly used in pediatric patients. Recent advances in capnography equipment now enable physicians to assess respiratory parameters, specifically end-tidal CO2 (et-CO2), more accurately in spontaneously breathing sedated children than was possible in the earlier studies. This study was designed to: 1) compare the safety and efficacy of intravenous fentanyl, intravenous fentanyl combined with midazolam, and intramuscular meperidine-promethazine-chlorpromazine (MPC) compound when used for painful emergency department (ED) procedures: and 2) to determine whether the addition of et-CO2 monitoring enabled earlier identification of respiratory depression in this population. ⋯ Fentanyl, fentanyl-midazolam, and MPC produced a high incidence of subclinical respiratory depression. End-tidal CO2 monitoring provided an earlier indication of respiratory depression than pulse oximetry and respiratory rate alone. MPC administration resulted in a significantly delayed discharge from the ED.
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Pediatric emergency care · Apr 1997
Randomized Controlled Trial Clinical TrialA prospective, randomized study comparing intramuscular midazolam with intravenous diazepam for the treatment of seizures in children.
To compare treatment of ongoing seizures using intramuscular (IM) midazolam versus intravenous (IV) diazepam. ⋯ IM midazolam is an effective anticonvulsant for children with motor seizures. Compared to IV diazepam, IM midazolam results in more rapid cessation of seizures because of more rapid administration. The IM route of administration may be particularly useful in physicians' offices, in the prehospital setting, and for children with difficult IV access.
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Pediatric emergency care · Aug 1996
Randomized Controlled Trial Clinical TrialDelivery of albuterol in a pediatric emergency department.
To determine if albuterol delivery by the combination of a metered-dose inhaler (MDI) with a spacer is equal in effectiveness to nebulization in a pediatric emergency department setting. ⋯ In a pediatric emergency department setting, aerosolized albuterol delivered by MDI-spacer was equal in effectiveness to nebulization in the acute asthma management of children > or = six years of age.
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Pediatric emergency care · Apr 1996
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of interventions to improve clinic follow-up compliance after a pediatric emergency department visit.
A randomized prospective study was made to compare two interventions to improve compliance with follow-up appointments (FA) after a pediatric emergency department (ED) visit. The study population was 253 patients and families seen during daytime hours at a large pediatric ED and who required follow-up for their diagnosed condition. A control group of patients were told to call the clinic for FA, an appointment group of patients were given a FA in the ED prior to discharge and written reminder, and an intense group of patients were given a FA in the ED prior to discharge, a written reminder; they were offered a work excuse, child care, and transportation assistance; they were sent mailed reminders and had attempts at telephone reminders. ⋯ If telephone contact is successful, telephone reminders also improve compliance. If follow-up is recommended, the majority of patients do not make their own appointments. A one-time intervention does not result in a long-term behavioral change in use of clinics or the ED.
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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.