J Emerg Med
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Observational Study
Hourly Rounding in the Pediatric Emergency Department: Patient and Family Safety and Satisfaction Rounds.
Methods of increasing patient and family involvement in and understanding of their medical care are plentiful, and hourly rounding specifically has shown benefit in several clinical settings. Although the approach has shown a variety of advantages in other areas, its use in urgent care pediatric settings is not well described. ⋯ This model of hourly rounding shows no measurable improvement in patient satisfaction or provider-patient communication using call bell data, family discharge opinion surveys, or vendor-collected patient satisfaction data. Further studies may be indicated to identify different methods of analyzing the effects of this method, and to examine alternative methods of improving these outcomes in the pediatric ED setting.
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Case Reports
Transient Cardiac Effects in a Child with Acute Cholinergic Syndrome Due to Rivastigmine Poisoning.
We report a case of rivastigmine poisoning resulting in a full cholinergic syndrome with nicotinic, muscarinic, and central effects requiring supportive or intensive care in a pediatric patient. ⋯ Poisoning with rivastigmine can be a life-threatening condition. Timely identification and appropriate management of the toxic effects of this drug are essential and often life-saving. This is particularly true in cases of cholinergic syndrome subsequent to drug poisoning. Patients with cholinergic syndrome should also be assessed for possible cardiac complications such as dysrhythmias. The main factors predisposing to the development of such complications are autonomic disorder, hypoxemia, acidosis, and electrolyte imbalance.
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Appendicitis is a common pediatric condition requiring urgent surgical intervention to prevent complications. Pelvic ultrasound (US) as a diagnostic aid has become increasingly common. Despite its advantages, evidence suggests US can lead to delayed definitive management. ⋯ Female pediatric patients and those presenting after hours that undergo an US have a significantly increased time to appendectomy compared with those who do not undergo diagnostic imaging.
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Presentation of congenital megaureter in adult life is rare; patients usually become symptomatic in childhood. ⋯ We report an unusual case of congenital megaureter, identified by point-of-care ultrasound performed to evaluate hypotension. Clinicians performing limited ultrasound examinations must be attentive to incidental findings that will require follow-up.