Pediatric emergency care
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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.
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Pediatric emergency care · Apr 1995
Randomized Controlled Trial Clinical TrialEfficacy of oral ketamine for providing sedation and analgesia to children requiring laceration repair.
A prospective, double-blind, placebo-controlled, randomized clinical trial was conducted to study the efficacy of oral ketamine for providing sedation and analgesia to children during laceration repair. Thirty children between the ages of one and seven years with lacerations that required suturing were randomly assigned to receive either oral ketamine (10 mg/kg) or an identically flavored placebo syrup prior to suturing. Patients were assessed by means of a tolerance score reflecting behavioral correlates of perceived pain at the time of both lidocaine injection and suturing. ⋯ The ketamine-treated group also achieved a significantly greater degree of sedation (P = 0.012). No significant respiratory or circulatory adverse effects were seen in either group, although 26% of patients who received ketamine experienced minor, transient adverse effects. We conclude that oral ketamine in a dose of 10 mg/kg provides effective sedation and analgesia to young children undergoing wound repair.
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Pediatric emergency care · Dec 1994
Randomized Controlled Trial Comparative Study Clinical TrialA controlled trial of methylprednisolone in the early emergency department treatment of acute asthma in children.
Asthma continues to be a leading cause for pediatric hospitalizations. A study using high-dose intravenous (i.v.) steroids early in the emergency department (ED) care of adults with acute asthma reported a 60% reduction in hospitalization rate. Limited data are available for children. ⋯ No significant differences were found between the admission rates of the MP and P groups (41% MP vs 33% P, P = 0.44, chi 2, 95% CI for decrease in MP vs P groups -28 to +12%). The average hospital stay was shorter for those children treated with MP (79 hours vs 90 hours). We conclude that IV methylprednisolone given as an adjunct to routine ED care of children with acute asthma is unlikely to markedly reduce hospitalization rates.
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Pediatric emergency care · Dec 1992
Randomized Controlled Trial Comparative Study Clinical TrialThe role of abdominal x-rays in the diagnosis and management of intussusception.
The management of intussusception requires early diagnosis and reduction with either barium enema or surgical intervention. Supine and erect abdominal radiographs are often obtained prior to ordering a barium enema. In many pediatric centers, the critical, initial interpretation of these radiographs is made by nonradiologists and, in most instances, by pediatric emergency physicians. ⋯ These physicians then identified patients for whom they would proceed to barium enema. The mean sensitivity was 80.5% (range, 71-93%), and the mean specificity was 58% (range, 48-69%). This compares favorably to the sensitivity of signs and symptoms, and we conclude that plain and upright abdominal films are a useful adjunct for the clinician evaluating patients for suspected intussusception.
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Pediatric emergency care · Aug 1992
Randomized Controlled Trial Clinical TrialThe use of nebulized albuterol in wheezing infants.
Using a double-blind, placebo-controlled protocol, we evaluated the efficacy of nebulized albuterol in the treatment of infants aged 0 to 24 months who presented to the emergency department with wheezing. Twenty-five infants were randomly assigned to receive two identical treatments of either nebulized albuterol (0.15 mg/kg) or placebo (saline). Assessment after each treatment included a wheeze and retraction score, respiratory and heart rates, and pulse oximetry. ⋯ After one treatment, there was an initial decrease in oxygen saturation in the albuterol group, which improved after the second treatment. There were no significant differences between the two groups in heart rate or respiratory rate. This study supports the use of nebulized albuterol in the treatment of wheezing infants in the emergency department.