Journals RSS : Gourt

Primary Survey

The Strategic Health Authorities' Emergency Services Review

The service concept: the missing link in our specialty's development?

Performance of influenza rapid antigen testing in influenza in emergency department patients

Background: The use of rapid antigen tests to triage specimens for polymerase chain reaction (PCR) testing from emergency department patients with influenza-like illness during surveillance for novel influenza viruses has been suggested. Objective: To measure the observed sensitivity and specificity for a widely used rapid antigen test (Binax) using a PCR-based assay (Medical Diagnostic Laboratories). Methods: Nasopharyngeal samples were taken with flocked swabs (Copan Diagnostics) from patients presenting to the emergency department of a community hospital. Samples were analysed using a rapid antigen and a PCR-based test. PCR testing was used as the criterion reference. Sensitivity and specificity were calculated for influenza and influenza A. Positive predictive values were calculated over a range of possible prevalence. Results: Samples from 566 unique patients were tested using both methods. Sensitivity was 69.1% (95% CI 58.9% to 78.1%) and specificity was 97.7% (95% CI 95.8% to 98.8%) for the detection of any influenza and 75.3% (95% CI 64.7% to 84.0%) and 97.8% (95% CI 95.9% to 98.9%), respectively, for influenza A only. The resultant positive predictive value ranges from 23% to 77% when the prevalence ranges from 1% to 10%. Conclusion: When planning early outbreak surveillance, provision of adequate PCR testing capacity rather than triaging specimens using rapid antigen testing for influenza is advisable.

Sustained manual abdominal compression during cardiopulmonary resuscitation in a pig model: a preliminary investigation

Objectives: The present study was undertaken to determine whether sustained manual abdominal compression (SMAC) using left paramedian compression technique can improve coronary perfusion pressure (CPP) during cardiopulmonary resuscitation (CPR) and resuscitation outcomes without causing liver laceration. Methods: Ventricular fibrillation was induced in 14 pigs, and circulatory arrest was maintained for 6 min. Animals were resuscitated either by standard CPR (control group) or by standard CPR with SMAC (SMAC-CPR group). Results: Mean blood pressure, aortic diastolic pressure and right atrial diastolic pressure in the SMAC-CPR group were significantly greater than in the control group throughout simulated basic life support. However, since the increases in aortic and right atrial diastolic pressures were similar, no significant intergroup difference was found in terms of CPP. Return of spontaneous circulation (ROSC) was attained in four of seven animals in the control group and in six of seven animals in the SMAC-CPR group (p = 0.55). Three animals in the control group and four in the SMAC-CPR group survived 24 h after ROSC (p = 1.00). Two of the seven animals in the SMAC-CPR group had a ruptured liver, but no such injury occurred in the control group. Conclusions: SMAC using left paramedian compression technique failed to improve CPP during CPR and resuscitation outcomes. Furthermore, this method could not avoid liver laceration.

Comparison of four manikins and fresh frozen cadaver models for direct laryngoscopic orotracheal intubation training

Objective: To compare the acceptability and preference between manikin models and fresh frozen cadaver (FFC) for direct laryngoscopic orotracheal intubation training. Methods: In this prospective crossover trial, participants in the airway workshop performed direct laryngoscopic orotracheal intubation on four airway training manikins: Airway Management Trainer (Ambu, St Ives, UK), Airway Trainer (Laerdal, Medical, Stavanger, Norway), Airsim (Trucorp, Belfast, Northern Ireland) and "Bill 1" (VBM, Sulz, Germany), and FFC. Participants were asked to access the following: reality of jaw mobility, difficulty with mouth opening, reality of neck flexibility, difficulty with intubation, overall model reality and model preference for each model using a visual analogue scale (VAS) of 0–10 cm. The VAS scores for each model were compared. Results: Fifty-six participants were included in the study. The FFC had a highest VAS score for reality of jaw mobility, overall reality and preference of model. Trucorp manikin and Laerdal manikin followed cadaver. There were no significant statistical differences between Trucorp manikin and Laerdal manikin. In difficulty with mouth opening and difficulty with intubation, Trucorp manikin had the lowest VAS score. Conclusion: The FFC is a more realistic and preferred model for direct laryngoscopic orotracheal intubation training. Trucorp and Laerdal manikin can be used as alternative models.

An intervention trial increases the evidence-based use of bupivacaine in hand injuries

Aim: Published evidence indicates that bupivacaine is the superior local anaesthetic for digital nerve blocks and where long-lasting analgesia is desirable. We aimed to develop and evaluate a multifaceted education initiative designed to improve the evidence-based use of bupivacaine in hand injuries. Methods: This was a pre- and post-intervention trial undertaken in a single emergency department (ED). All physicians working in the ED were included. The intervention comprised a specifically designed "e-learning module" supplemented by in-service training, reminder techniques and improved accessibility to bupivacaine. The primary end point was the proportion of patients with hand injuries administered bupivacaine in whom bupivacaine was the most appropriate local anaesthetic. Data were collected by explicit chart review of consecutive cases. Results: Both pre- and post-intervention periods were of 5 months’ duration. The charts of 107 pre-intervention and 111 post-intervention cases were reviewed. In the post-intervention period, the appropriate use of bupivacaine increased from 14.3% to 49.4% (difference 35.2%, 95% CI 20.9 to 49.4, p<0.001); the appropriate use of lignocaine and bupivacaine increased from 38.3% to 59.5% (difference 21.1%, 95% CI 7.3 to 35.0, p = 0.003); the total number of bupivacaine ampoules issued rose by 308% (from 60 to 245); the total number of lignocaine ampoules issued decreased by 6.7% (from 2008 to 1873); and the number of files with adequate documentation increased from 56.3% to 63.4% (difference 7.1%, 95% CI –3.5 to 17.7, p = 0.20). Conclusion: The education initiative resulted in significant improvements in the evidence-based use of bupivacaine, and its adoption by others is recommended.

Emergency Medicine Questions (EMQs): Theme: Vascular access

How have changes to out-of-hours primary care services since 2004 affected emergency department attendances at a UK District General Hospital? A longitudinal study

Background: The delivery of out-of-hours primary medical care in the United Kingdom has changed substantially since 2004, and there has been little examination of the effect that this has on secondary care. Aim: The authors aimed to quantify the change in patient type presenting to our emergency department. Methods: In this study, routinely collected coding data before, during and after the changes were analysed. Each September and October between 1999 and 2006 were included. Results: There was a steady increase in all attendances at our emergency department. The number and proportions of patients with non-traumatic conditions rose steadily throughout the study period. The number of patients presenting with traumatic conditions stayed the same. The number of patients presenting with non-traumatic conditions out-of-hours rose after the changes were implemented. Interpretation: The changes to the provision of out-of-hours primary care have been associated with an increase in patients with non-traumatic attendances presenting to our emergency department. This effect is most marked outside of office hours.

Emergency department attendance by children at risk of abuse

Background: Frequency of emergency department (ED) attendance has long been thought to be a risk factor for child abuse. The aim of this study was to test this assumption by comparing the ED attendances of at-risk children (before being placed on a child protection register) with the attendances of an age-matched control group (before an index attendance) Method: A group of 220 children (aged 0–12 years inclusive) were identified from the two child protection registers in the Shropshire area in 2006. The ED attendances of these children in the 2 years before registration were identified using the computer records of the two local EDs. A control group of 150 children for each year of age (0–12 years inclusive) was then identified from ED attendances between October and December 2006. The attendances of these children in the 2 years before this index attendance were obtained. The data for these two groups of children were then compared. Results: The at-risk children did not attend the EDs more frequently than did the children in the control group. Conclusion: The identification of children who attend EDs frequently may be useful for other reasons but is unlikely to be an effective way to detect child abuse.

Oesophagography and oesophagoscopy are not necessary in patients with spontaneous pneumomediastinum

Background: Because the condition is rare, the proper assessment of spontaneous pneumomediastinum (SPM) remains controversial. The purpose of this study was to determine whether additional oesophageal investigations beyond chest x ray and chest computed tomography (CT) scan are necessary for the diagnosis of SPM. Methods: The medical records of 25 patients diagnosed and treated for SPM from March 1986 to December 2007 were retrospectively reviewed. Results: There were 22 men and 3 women, with a median age of 19 years (range 15–57 years). All patients received chest x rays, which revealed air shadows within the mediastinum or subcutaneous emphysema in 24 patients. Twenty-two patients underwent chest CT scans, which showed pneumomediastinum in all cases. Oesophagography was performed in 14 patients and oesophagoscopy in three. All oesophagographies and oesophagoscopies were clear. Despite conservative treatment, no patients developed mediastinitis or complications associated with oesophageal injury. Conclusions: Chest x ray and CT scan are sufficient to diagnose SPM. Additional diagnostic assessments such as oesophagography and oesophagoscopy are not necessary in patients without evidence of mediastinitis or a history of oesophageal injury.

Evaluation of morning report in an emergency medicine department

Background: Morning report is considered as an important educational tool in different branches of medicine. The purpose of the present study was to examine the method of case selection, the leadership, the participant’s satisfaction and the educational value of morning report held in our centre. Method: In September 2007, a formal feedback about the morning report was provided by questionnaire surveys. The data on the method of case selection, the leadership, the participant’s satisfaction and the educational value of the sessions were collected from the residents, medical students and the academic staff in emergency medicine department. Each questionnaire also contained an open-ended question, asking for the responders’ suggestions for improving these sessions. Results: 73.2% of the responders were satisfied with the current model of the conference hall. The data showed that 46.3% of the participants believed these sessions are held for giving the medical team the required information and 65.9% for solving the patient’s problems. The data showed that the participants had evaluated the presentation strategy to be good; however, the presentation pattern was reported to be traditional and based on differential diagnosis in 53.7% of the cases and modern problem oriented in only 39%. Conclusion: Most participants considered morning report sessions held in our hospital to be effective in the way it is; however, issues such as communication skill, emergency department management, critical thinking, ethics, professionalism and evidence-based medicine should also be added to the sessions.

Evaluation of a bedside immunotest to predict individual anti-tetanus seroprotection: a prospective concordance study of 1018 adults in an emergency department

Background: Unscheduled tetanus prophylaxis (UTP) used in the emergency room (ER) in patients with wounds who are unaware of their vaccination history is erroneous in 40% of cases. Evaluation of bedside tetanus immunity with the Tétanos Quick Stick (TQS) test may improve UTP. Objectives: To show that (1) a positive TQS result reflects immunity to tetanus; and (2) TQS is reproducible by ER workers. Methods: In a prospective concordance study, immunity to tetanus of patients with wounds was assessed by two techniques: (1) TQS at the bedside, which detects specific tetanus antitoxins at concentrations >=0.2 IU/ml in whole blood or >=0.1 IU/ml in serum; (2) ELISA in the laboratory (threshold >0.1 IU/ml). The study comprised three groups: (A) healthcare personnel self-tested with the two techniques to determine the effect of training; (B) selected patients with wounds were double-tested with TQS by two healthcare providers whose readings were compared to test reproducibility; and (C) all patients with wounds aged >=15 years were consecutively included. Results: Of 1018 individuals included, 60 were in group A, 50 were in group B and 908 were in group C. 403 patients who were not included were similar to those included for age, vaccination history and types of wounds. The reproducibility of the test was 98%. TQS sensitivity was 83.0%, specificity 97.5%, positive predictive value 99.6% and negative predictive value 42.9%. Conclusions: TQS reliably predicts tetanus immunity and is reproducible by healthcare providers. Although it may not accurately discriminate between patients with ongoing and declining immunity, it is currently the most sensitive and specific tool for guiding tetanus prophylaxis and should be included in current guidelines on UTP.

Inappropriate use and interpretation of D-dimer testing in the emergency department: an unexpected adverse effect of meeting the "4-h target"

Introduction: D-dimer tests were inappropriately overused in our emergency department as a result of bloods being taken before clinical assessment to help meet the "4-hour target". We introduced a multifaceted intervention to reduce the number of inappropriate D-dimer tests. The secondary aim was to improve the diagnostic workup of suspected pulmonary embolism (PE). Method: Rate of D-dimer test and ventilation/perfusion scan requests were compared before, during and after a staggered intervention at two hospitals in one National Health Service Trust. Audits before and after the intervention were done to determine whether test use was appropriate and whether the diagnostic workup was complete. Results: At hospital 1, D-dimer testing after the intervention was almost halved: ratio 0.59 (95% CI 0.55 to 0.63) (p<0.0001). There was also a small reduction at hospital 2 (control): rate 0.88 (95% CI 0.78 to 0.99) (p = 0.03). After the formal introduction of change at hospital 2, there was a further reduction in tests: ratio 0.67 (95% CI 0.58 to 0.76) (p<0.0001). In hospital 1, pretest probability assessment improved by 42% (p = 0.0004) and D-dimer test use was reduced by 12.5% (p = 0.04) between audits. Improvement in the use of D-dimer test according to the pathway was not significant (32.5%, p = 0.11), and there was no change in the proportion of patients with completion of their diagnostic workup for PE: 47.6% (95% CI 38.3% to 56%) before and 45.6% (95% CI 38.3% to 53.1%) after the intervention. Conclusion: Implementation of a multifaceted change program reduced the number of D-dimer test requests in both hospitals and may have improved the diagnostic workup for PE at hospital 1. Processes that speed patient transit through the emergency department may impact negatively on other aspects of patient care. This should be the subject of further studies.

The impact of a temporary ice rink on a local emergency department service

Ice skating is becoming more popular throughout the UK, with temporary ice rinks opening in many city centres during holiday periods, especially during Christmas. Data were collected from patients who presented to the local emergency department with injuries sustained on a nearby city-centre temporary ice rink. Injuries related to ice rinks accounted for 0.76% of all emergency department attendances and represented 0.29% of ice rink participants (2.9 per 1000). Women in the older age range sustained the most significant injuries. Our study has shown that the rate of injuries per 1000 ice rink participants is comparable with data recorded when a new ice rink is opened.

Google governance: increasing the effectiveness of critical care physicians through the use of an online usergroup

Aims: The aim of this study was to describe the use of an online usergroup to enhance communication and productivity by critical care specialists. Methods: In this article, we provide a description of the first 6 months of use of an online usergroup by senior retrieval physicians. Results: Initially developed as a communication and online discussion tool, our online usergroup evolved to include a number of other utilities that support clinical governance. These included a repository for useful files, educational presentations, online rostering and "portfolio pages", updating aspects of an individual specialist’s non-clinical activity. Its applications continue to evolve in number and utility. Participating physicians perceive an increase in organisational efficiency. Conclusions: An online usergroup such as Google Groups may provide powerful support to an organisation’s clinical governance. We recommend this tool to other services with limited administrative personnel.

Frenal injury in children is not pathognomic of non-accidental injury

Upper labial frenal tear in infants is classically taught as having associations with non-accidental injury. Collection of data for a 12-month period in our paediatric facial injury study revealed that this injury pattern is common in ambulant children and was associated with other facial trauma. In assessing the possibility of this injury being due to abuse, the importance of the mobility of the child and the mechanism of the injury are paramount.

Towards evidence based emergency medicine: Best BETs from the Manchester Royal Infirmary

BET 1: Blood component therapy in trauma patients requiring massive transfusion

BET 2: Potato peel dressings for burn wounds

BET 3: Chlordiazepoxide, the management of alcohol withdrawal and the kindling effect

BET 4: ACE inhibitors in addition to standard treatments in acute heart failure

Chest compression first aid for respiratory arrest due to acute asphyxic asthma

This report demonstrates the importance of including external chest compression as a method of resuscitation in first aid for cases of life-threatening asphyxic asthma. Chest compression may be the only way that death of such patients may be avoided. Three such patients, two with respiratory arrest, were successfully treated by external chest compression. During the 1960s, there was an increase in asthma deaths, 81% of which occurred unexpectedly, outside the hospital. This coincided with the abandonment of the trusted methods of chest compression and the introduction of mouth-to-mouth resuscitation. Acute asphyxic asthma was the most common cause of death. In acute asphyxic asthma, the chest wall does not deflate spontaneously. The trapped air must be expelled by external compression. Mouth-to-mouth resuscitation may not work because air is being blown in while none escapes.

Back pain after wild mushroom consumption

Defining a standard medication kit for prehospital and retrieval physicians: a comprehensive review

Background: There is little consolidated evidence for which prehospital and retrieval drugs a given service should carry. Objectives: To suggest a core group of drugs based on the best evidence currently available. Methods: This paper has reviewed documents from recognised evidence-based sources and put together an initial skeleton for an evidence-based drug pack. Results: The resultant list of drugs is divided up into core agents with suggestions for regional variations. This may be of particular interest to de novo services. Conclusions: This review offers a starting point for services based on the evidence currently available. It is hoped that prehospital and retrieval clinicians will start to look analytically at what they carry and, through a process of audit, aim to improve the evidence in this area. Future reviews and comparisons of worldwide prehospital and retrieval databases are suggested.

Delayed presentation following accidental inhalation of a pushpin

A previously fit and well 18-year-old woman presented to the accident and emergency department following referral by her general practitioner with a provisional diagnosis of appendicitis. The history obtained from the patient revealed the presence of a bitemporal headache with associated neck stiffness, photophobia and vomiting for approximately 1.5 weeks. The patient complained of abdominal pain localised to her right iliac fossa and anorexia for approximately 1 week. She also noted the presence of a cough productive of green sputum for 3 weeks. A chest radiograph was obtained which showed a large area of consolidation in the right lower lobe consistent with infection and a linear density in keeping with a metallic foreign body. Following review of the chest radiograph, the patient was interviewed further and recalled having inhaled a pushpin approximately 1 year before her presentation. Aspiration of foreign bodies is relatively common in children and is often associated with delayed diagnosis and high morbidity. To prevent delayed diagnosis, characteristic symptoms and clinical and radiological signs of foreign body aspiration should be checked in all suspected cases and a low index of suspicion for ordering additional imaging or using bronchoscopy for diagnostic purposes should be employed.

Possible interaction between pomegranate juice and warfarin

Pomegranate juice is growing in popularity in the UK. We report a potential interaction between pomegranate juice and warfarin. Laboratory studies have shown that pomegranate juice inhibits cytochrome P450 enzymes involved in warfarin metabolism. As with previous reports of interactions between food and warfarin, this case does not definitively prove the association between pomegranate juice consumption and increased warfarin bioactivity but highlights the importance of taking a complete drug, food and juice history when assessing patients with unstable anticoagulation.

An adolescent athlete with groin and hip pain

The case report is presented of a 14-year-old boy with persistent right hip and groin pain. After failing to respond to conventional management, the patient was admitted and investigated. He had a fever and raised inflammatory markers. MRI of the pelvis revealed pyomyositis of the right adductor compartment extending into the pelvis. Pyomyositis should be considered in a patient with pain disproportionate to the physical examination findings.

Inadvertent prostatic stimulation causing cardioversion of unstable superventricular tachycardia

The radiology investigation of renal colic in the emergency department

Sophia

Body found in plane’s landing gear bay in Japan – CNN.com

Tokyo, Japan (CNN) — A body was found in the landing gear bay of an airplane that arrived at Tokyo's Narita Airport Sunday, the airport announced. The dead man was not carrying a passport or personal belongings, airport police said. via Body found in plane’s landing gear bay in Japan – CNN.com. JFK to Narita. Someone was able [...] Related posts:Weirdest prescription? From an old HS buddy (also a Navy Man) now... The Foreign Body that Didn’t Exist Except, of course, that it did… A patient comes in... Guns on a Plane: Retraction and a big Yippee! In the email, and always willing to admit when I’m... Related posts brought to you by Yet Another Related Posts Plugin.

Beer May Be Good For Your Bones | LiveScience

If you downed one too many while watching the Super Bowl, here's at least one reason to hold your head high: Drinking beer can be good for your health. But seriously, a new analysis of 100 commercial beers shows the hoppy beverage is a significant source of dietary silicon, a key ingredient for bone health. via Beer [...] Related posts:Backpacker Blogs – Hallelujah: Beer Hydrates Better Than Water Backpacker Blogs – Hallelujah: Beer Hydrates Better Than Water Our... Nascar infield, alcohol and golf carts Just my patients, 2/3 falls involving the above resuted in... Related posts brought to you by Yet Another Related Posts Plugin.

Report a bad doctor to the authorities, go to jail? It might really happen for Anne Mitchell, RN in Winkler County, Texas : Respectful Insolence

Report a bad doctor to the authorities, go to jail? It might really happen for Anne Mitchell, RN in Winkler County, Texas : Respectful Insolence. He’s been on this from the beginning. Good news: one of the nurses was dismissed; bad news, the other is on trial. Atrocious. My grandparents lived in Winkler County (Kermit), and are gone [...] Related posts:Report a bad doctor to the authorities, go to jail? : Respectful Insolence Report a bad doctor to the authorities, go to jail?... Paging Dr. Flea The Trial Of A WhiteCoat – Part 1 « WhiteCoat’s... Is there a doctor in the house?: And I was doing so well Is there a doctor in the house?: And I was... Related posts brought to you by Yet Another Related Posts Plugin.

WD-40 may have screwed up here

Look at the picture of the new WD-40 can. It has a new pivoting gadget that combines spray or straw use without any plugging in, trying to find the little orifice with a stiff red piece of plastic, etc. As an engineering piece ( and without having used it ) it looks terrific. But, I [...] Related posts:Weirdest prescription? From an old HS buddy (also a Navy Man) now... Related posts brought to you by Yet Another Related Posts Plugin.

Military increases availability of morning-after pill – CNN.com

Washington (CNN) — All U.S. military health facilities around the world will now carry the emergency contraception pill known as Plan B One-Step, according to a new Department of Defense policy. The decision to carry the pill, often referred to as the morning-after pill, was based on a recommendation by the Pentagon's Pharmacy and Therapeutics Committee, [...] Related posts:Parkland hospital streamlines emergency room procedures | News for Dallas, Texas | Dallas Morning News | Life/Travel: Health Parkland hospital streamlines emergency room procedures | News for Dallas,... Off label drug use and medmal suits: should there be “Truth” in labeling? Pardon my silliness with “truth”, it’s an actual cause for... Related posts brought to you by Yet Another Related Posts Plugin.

Ohio.com – Akron General puts ER wait times on billboards, Internet

Trying to avoid a painfully long wait in the ER? One local hospital system is publicly sharing the current average wait time to see a doctor at all its emergency departments. Akron General Health System recently began advertising up-to-the-minute wait times for its emergency rooms on billboards throughout town. Six digital billboards in Akron are automatically updated every [...] Related posts:RealClearPolitics – Socialized Medicine? Bring It On Sometimes you can see the trees, and think it’s a... Column: Doctors ignore Internet at their own peril – Opinion – USATODAY.com Kevin, MD continues his takeover of the media, with another... CNN Political Ticker: Senate confirms Benjamin as surgeon general CNN Political Ticker: All politics, all the time Blog Archive... Related posts brought to you by Yet Another Related Posts Plugin.

RealClearPolitics – Video – Obama Mispronounces “Corpsman” At Prayer Breakfast

RealClearPolitics – Video – Obama Mispronounces “Corpsman” At Prayer Breakfast. And, I don’t care. Yes, he mispronounced a word I think he should have known, or asked about. He didn’t, and that’s just one of many things I wish he’d done differently. Who cares. He did recognize the service of this corpsman (pronounced cor-man), and to me [...] Related posts:VIDEO: Red Bull Racing gives a virtual tour of 2009 F1 rulebook – Autoblog VIDEO: Red Bull Racing gives a virtual tour of 2009... RealClearPolitics – Socialized Medicine? Bring It On Sometimes you can see the trees, and think it’s a... Holman Jenkins: Why Obama Bombed on Health Care – WSJ.com Holman Jenkins: Why Obama Bombed on Health Care – WSJ.com... Related posts brought to you by Yet Another Related Posts Plugin.

Grand Rounds Vol 6, No. 19 | A Groundhog’s Perspective on Med Blogs | More iPad

Grand Rounds Vol 6, No. 19 | A Groundhog’s Perspective on Med Blogs | More iPad. Grand Rounds from Doctor Rob. Fun! Related posts:ACP Internist: Grand Rounds at ACP Internist ACP Internist: Grand Rounds at ACP Internist Grand Rounds are... MedBlogs Grand Rounds 5:43 Medicine and Technology by Dr. Joseph Kim [part of the... Dr. Nick hosts Grand Rounds [...] Related posts:ACP Internist: Grand Rounds at ACP Internist ACP Internist: Grand Rounds at ACP Internist Grand Rounds are... MedBlogs Grand Rounds 5:43 Medicine and Technology by Dr. Joseph Kim [part of the... Dr. Nick hosts Grand Rounds The Godfather of the Medblog Grand Rounds series hosts this... Related posts brought to you by Yet Another Related Posts Plugin.

We’re Failing Our Residents: Training ED Docs for the Real W… : Emergency Medicine News

Emergency Medicine News: February 2010 – Volume 32 – Issue 2 – p 5, 24, 25, 26 Residents training in large urban centers typically see more than 200 patients a day. They have access to all subspecialty care, typically available 24 hours a day. Residents have around-the-clock access to angioplasty, interventional radiology, hand surgeons, neurosurgeons, and plastic [...] Related posts:John Peter Smith gets ACS accreditation as a Level 1 Trauma Center Congrats! FORT WORTH — Some of the most seriously injured... Parkland hospital streamlines emergency room procedures | News for Dallas, Texas | Dallas Morning News | Life/Travel: Health Parkland hospital streamlines emergency room procedures | News for Dallas,... More on the DO/MD controversy in Fort Worth I missed this the other day, but better late than... Related posts brought to you by Yet Another Related Posts Plugin.

Homoeopathy sceptics plan mass ‘overdose’ – Health News, Health & Families – The Independent

First, don’t do this: In what is being billed as “rationalism's Kool-Aid moment”, a mass “overdose” is being planned next week in protest at the marketing of homoeopathic medicines. More than 300 people who style themselves as “homoeopathy sceptics” will each swallow an entire bottle of homoeopathic pills in protest at the continued marketing of homoeopathic medicines [...] Related posts:A.M.A. Opposes Government-Sponsored Health Plan – NYTimes.com A.M.A. Opposes Government-Sponsored Health Plan – NYTimes.com Wow. I really... BBC NEWS | Health | Steaming hot tea linked to cancer From the ‘life causes cancer’ files: BBC NEWS | Health... Parkland hospital streamlines emergency room procedures | News for Dallas, Texas | Dallas Morning News | Life/Travel: Health Parkland hospital streamlines emergency room procedures | News for Dallas,... Related posts brought to you by Yet Another Related Posts Plugin.

A 9-month-old baby with subdural hematomas, retinal hemorrhages, and developmental delay

No abstract available

Closed head injury in children

No abstract available

The state of pediatric interfacility transport: Consensus of the Second National Pediatric and Neonatal Interfacility Transport Medicine Leadership Conference

Interfacility transport of pediatric and neonatal patients for advanced or specialty medical care is an integral part of our medical delivery system. Assessment of current services and planning for the future are imperative. As part of this process, the American Academy of Pediatrics and the Section on Transport Medicine held the second National Pediatric and Neonatal Transport Leadership Conference in Chicago in June 2000. Ninety-nine total participants, representing 25 states and 5 international locations, debated and discussed issues relevant to the developing specialty of pediatric transport medicine. These topics included: 1) the role of the medical director, 2) benchmarking of neonatal and pediatric transport programs, 3) clinical research, 4) accreditation, 5) team configuration, 6) economics of transport medicine in health care delivery, 7) justification of transport teams in institutions, and 8) international transport/extracurricular transport opportunities. Insights and conclusions from this meeting of transport leaders are presented in the consensus statement. (C) 2002 Lippincott Williams & Wilkins, Inc.

Small doses, big problems: A selected review of highly toxic common medications

No abstract available

Waste disposal units: Sharps

No abstract available

Mobile and stationary infant radiant warmers

No abstract available

Data acquisition in emergency medicine: Electronic communication using free text

Objectives: 1) To describe the content of medical data obtained from parents' use of free text during a computer interview; 2) To assess whether differences in parents' demographics or experience with computers differentiate their production of free text; and 3) To compare parents' entry of free text with the final physician-generated electronic medical record (EMR) regarding the chief complaint. Methods: Data entered by parents during a prospective trial of electronic data entry were examined. Content analysis of parents' free text entries examined absolute word count and categorized entries by type of information. Demographic and technology-related variables were analyzed against the type of information and the absolute word count. Two reviewers independently judged agreement between parents' and physicians' data for the chief complaint. Results: Of 100 parents enrolled, 30 entered data for the chief complaint using free text. Amount of free text entered ranged from 1 to 142 words with a median of 8 words. Parents' free text was categorized into 4 types of information: simple descriptive (n = 16), problem-focused (n = 7), descriptive plus a question agenda (n = 2), and descriptive with reference to past medical history (n = 5). Parental demographics and computer-related experience did not predict differential production of free text. Agreement between parents' and physicians' entries for the chief complaint was 80% (95% CI 66-94) [reviewer A] and 73% (95% CI 57-89) [reviewer B]. Seven of 30 parental entries (23%) provided data not contained in the EMR. Conclusions: When entering a chief complaint during an electronic interview, a majority of parents report descriptive data using short phrases. Good agreement between parents' and physicians' electronic report was demonstrated for the chief complaint. (C) 2002 Lippincott Williams & Wilkins, Inc.

Ventriculoperitoneal shunt migration presenting with vaginal discharge and hydrosalpinx in a 16-year-old patient

No abstract available

Hyperinsulinemia/euglycemia therapy for calcium channel blocker poisoning

No abstract available

Apnea monitors

No abstract available

Piercing injury hospitalization in children

Injuries from piercing or cutting instruments or objects are commonly seen in the pediatric emergency department. In this study, we present the epidemiology of piercing injuries resulting in hospitalization. Medical records for a one-year period with E-codes 920.0-920.9 were reviewed for victim-related demographic data, anatomic injury location, vehicle of injury, treatment, and hospital charges. The Abbreviated Injury Scale (AIS) was used to ascertain injury severity. The most common vehicles of injury were glass (n=24, 34%), nails (n=11, 16%), and needles (n=10, 14%). The median AIS score was significantly higher for hand injuries compared to the sample median AIS. Piercing injuries from consumer-related products were associated with the highest AIS scores (median=2.5). Although the mean AIS for all injuries was only 1.5, these injuries resulted in significant costs, with a mean hospitalization charge of $3884 +/- 3528. Surgical procedures under general anesthesia were required in 81% of the patients. (C) Lippincott-Raven Publishers.

Care of the female adolescent rape victim

No abstract available

Treating complications of circumcision

No abstract available

Cerebrovascular event, dilated cardiomyopathy, and pheochromocytoma

Cerebral infarction in children may be the result of various disease processes, including emboli from intracardiac sources, paradoxical emboli from the venous system, sickle cell disease, cyanotic heart disease, vasculitis affecting the carotid or cerebral vascular system, vascular anomalies, and prothrombotic states. We present a previously healthy adolescent who presented with the acute onset of hemiparesis. Work-up revealed a dilated cardiomyopathy with a left ventricular mural thrombus as the etiology of his cerebrovascular event. Although dilated cardiomyopathy (DCM) may predispose to the development of a mural thrombus and subsequent embolic events, there are no previous reports in pediatric-aged patients of the development of an embolic event as the presenting manifestation of DCM. Further investigation of the etiology of the DCM led to the diagnosis of a pheochromocytoma. Congestive heart failure and DCM as the presenting sign of pheochromocytoma has likewise not been reported in a pediatric-aged patient. We review this unlikely sequence of events, the diagnostic evaluation of such patients, and treatment options. (C) 2002 Lippincott Williams & Wilkins, Inc.

Pulmonary exhaled-air resuscitators: Manual, reusable; manual, disposable

No abstract available

The physician's deposition: Preparation and testimony of the medical malpractice defendant

No abstract available

Test characteristics of the urine Gram stain in infants <= 60 days of age with fever

Objective: The utility of the Gram stain for the preliminary diagnosis of urinary tract infections (UTI) in infants = 38.0[degrees]C presenting to a pediatric emergency department during 2 consecutive winter seasons. Single pathogen growth of >= 104 cfu/mL from a catheterized specimen and >= 103 cfu/mL from a suprapubic specimen was considered positive. A positive Gram stain was defined as the identification of any organisms. Urinalysis was tested for the presence of nitrites and for leukocyte esterase (LE). Urine microscopy was analyzed for white blood cells per high power field (WBC/hpf). Results: Fourteen of 246 patients were excluded; 11 because no Gram stain was completed. Of the remaining 232 patients, Gram stain had a sensitivity of 85.2% (95% CI 71.9-98.6%), a specificity of 99.0% (95% CI 97.7-100%), a likelihood ratio for a positive test of 87.3 (95% CI 21.8-349.9), and a likelihood ratio for a negative test of 0.15 (95% CI 0.06-0.37). There were 193 specimens for which a Gram stain and a complete UA and microscopy were completed and compared. Urine microscopy had a lower sensitivity and specificity than Gram stain for both >= 5 WBC/hpf and >= 10 WBC/hpf. In addition to the Gram stain, a dipstick negative for nitrites and LE had a low negative likelihood ratio (0.16), useful for decreasing the likelihood of a UTI. Conclusions: The Gram stain has excellent test characteristics for the preliminary diagnosis of a UTI in febrile infants. Patient disposition and therapy will likely change if clinical protocols and guidelines use the Gram stain rather than urine microscopy for preliminary diagnosis of UTI in infants. (C) 2002 Lippincott Williams & Wilkins, Inc.

Testicular torsion following orchiopexy

A case of testicular torsion one year after orchiopexy is presented. The occurrence of testicular torsion following surgery is a rare event which has the potential for diagnostic misadventures. To better delineate this condition, we performed a literature review of all reported cases of recurrent testicular torsion. Thirteen reported patients with testicular torsion following orchiopexy are presented and discussed. (C) Lippincott-Raven Publishers.

Optic neuritis in a child

A previously healthy four-year-old girl developed bilateral loss of vision over one day. Her course of optic nerve abnormalities, a related neurologic episode, and the response to corticosteroid therapy is presented. The diagnosis of optic neuritis in a child is made infrequently in an emergency department, but it must be considered in any patient presenting with an acute nontraumatic loss of vision. The characteristic findings associated with optic neuritis, and a review of childhood cases, are discussed. (C) Lippincott-Raven Publishers.

Use of the Pediatric Risk of Mortality Score as predictor of death and serious neurologic damage in children after submersion

Objective: To evaluate the Pediatric Risk of Mortality score (PRISM score) as a tool to evaluate the vital and neurologic prognosis of patients after submersion. Methods: We conducted a retrospective analysis of the clinical histories of patients admitted to a tertiary pediatric hospital, Hospital Sant Joan de Deu, Barcelona, Spain from December 1977 to December 1999 as a consequence of near-drowning. PRISM score was calculated for each patient with data obtained upon arrival at the hospital. The probability of death was calculated using this score. Results: There were 60 patients, divided into two groups as they were admitted to the Pediatric Intensive Care Unit (PICU group,n= 41) or to the Short Stay Unit (SSU group,n= 19). All patients in the SSU group survived without impairments, with PRISM scores =24 or with probability of death >=42% either died or had serious neurologic impairment. One third of patients with PRISM scores between 17 and 23 and/or probability of death between 16 and 42% either presented serious neurologic impairment or died. Conclusions: PRISM score enables the determination of either absence or presence of serious impairment or death in pediatric patients after submersion, if they present extreme values on this scale. However, in patients with intermediate PRISM scores, it is not possible to establish a reliable prognosis. (C) 2001 Lippincott Williams & Wilkins, Inc.

Severe Abdominal Trauma Involving Bicycle Handlebars in Children

Objectives: To emphasize the severity of the underlying injury which may not be realized during the initial patient admission to the emergency department. Methods: A retrospective case note review of children admitted to our institution with the severe abdominal injury. Results: Eight children were identified with the severe abdominal injury secondary to the trauma from a bicycle handlebar that needed special care in the intensive care unit. All injuries were due to blunt trauma. The mean delay from the time of the accident to the time of presentation was 34.5 hours. All patients had an imprint of the handlebar edge on the hypochondrium. There were 3 pancreatic lacerations, 1 duodenal laceration, 1 jejunal laceration, 1 liver laceration, 1 abdominoinguinal laceration that all required open surgery, and 1 duodenal hematoma that resolved in 4 weeks follow-up period. The patients who required open surgery were evaluated with computed tomographic scans before surgery. Conclusions: Children with an imprint made by the handlebar edge on the abdominal wall or give a clear history of injuries by a bicycle handlebar should be treated with great care. Early computed tomography evaluation may help to reduce the morbidity resulting from the delay in diagnosis of injuries to the internal organs. (C) 2010 Lippincott Williams & Wilkins, Inc.

Pediatric cardiopulmonary resuscitation: An update based on the new American Heart Association guidelines

No abstract available

Procalcitonin as a Marker of Severe Bacterial Infection in Children in the Emergency Department

Procalcitonin, the prohormone of calcitonin, is a relatively new and innovative marker of bacterial infection that has multiple potential applications in the pediatric emergency department. In healthy individuals, circulating levels of procalcitonin are generally very low (<0.05 ng/mL), but in the setting of severe bacterial infection and sepsis, levels can increase by hundreds to thousands of fold within 4 to 6 hours. Although the exact physiologic function of procalcitonin has not been determined, the consistent response and rapid rise of this protein in the setting of severe bacterial infection make procalcitonin a very useful biomarker for invasive bacterial disease. In Europe, serum procalcitonin measurements are frequently used in the diagnosis and the management of patients in a variety of clinical settings. To date, the use of procalcitonin has been limited in the United States, but this valuable biomarker has many potential applications in both the pediatric emergency department and the intensive care unit. The intent of this article is to review the history of procalcitonin, describe the kinetics of the molecule in response to bacterial infection, describe the laboratory methods available for measuring procalcitonin, examine the main causes of procalcitonin elevation, and evaluate the potential applications of procalcitonin measurements in pediatric patients. (C) 2010 Lippincott Williams & Wilkins, Inc.

Pediatric Emergency Medicine Fellowship Programs

No abstract available

Suicidal psychosis secondary to isoniazid

No abstract available

Sedation for peritonsillar abscess drainage in the pediatric emergency department

Objective: To evaluate the use of intravenous (IV) sedation in children during peritonsillar abscess (PTA) incision and drainage in the emergency department (ED). Design: Retrospective review of medical records of children with a diagnosis of PTA. Setting: The ED of a large, urban, academic children's hospital. Patients: Consecutive patients 18 years or younger presenting from April 1995 to November 1998. Methods: Information was retrieved from a time-based sedation record that included age, sex, ASA classification, time since last liquid or solid, agent and dose, level of sedation (A=alert, V=response to voice, P=purposeful response to pain, U=unresponsive), vital signs, complications, recovery time, and disposition. Results: Forty-two patients had incision and drainage performed with IV sedation in the ED. Mean age was 11.3 +/- 4.3 years (range 4-18 years); 57% were African-American, and 64% were female. Agents used included ketamine plus midazolam (K/M) (n = 36, 86%), morphine plus midazolam (n = 3, 7%), meperidine plus midazolam (n = 2, 5%), and nitrous oxide plus midazolam (n = 1, 2%). No cardiorespiratory complications, including laryngospasm, occurred. Vomiting occurred in 1 patient who received meperidine and midazolam. The deepest level of sedation reached included: 12% A, 64% V, and 24% P. No patient who had an abscess drained in the ED with IV sedation was admitted, and mean recovery time was 81.0 +/- 30.1 minutes. Conclusions: IV sedation in children for incision and drainage of PTA by skilled personnel in the ED may eliminate the need for admission and surgical drainage in the operating room. K/M was used most frequently, without adverse effect, and all patients were discharged from the ED. Because K/M may result in deep sedation, appropriate personnel and equipment must be present. (C) 2002 Lippincott Williams & Wilkins, Inc.

Multiple splenic infarcts associated with toxic shock syndrome

No abstract available

Case records of Wright State University: Recurrent stabbing chest pain

No abstract available

Narcotic-Sparing Effect of Ketorolac Sickle Cell Vaso-Occlusive Pain Crisis

No abstract available

Systemic Anaphylaxis Following Local Lidocaine Administration During a Dental Procedure

colon; We report a 4-year-old child who developed systemic anaphylactic reaction to lidocaine hydrochloride within 15 minutes after a dental procedure. Hypersensitivity to local anesthetics is not common; however, if anaphylaxis did happen, it required emergent and immediate resuscitation. To prevent such complications, complete medical history including drug allergy should be taken. Prompt administration of epinephrine and other resuscitative measures are life saving in such circumstance. All emergency room physicians should consider systemic anaphylaxis in patients with rapid vascular collapse and respiratory failure immediately following lidocaine administration for minor outpatient procedures. (C) 2004 Lippincott Williams & Wilkins, Inc.

Acetaminophen and ibuprofen dosing by parents

Background: Acetaminophen and ibuprofen are two of the most commonly used medications in children. It is our experience that parents often misdose these medications. Misdosing may lead to unintended toxicity or inadequate symptomatic improvement. There are limited data on the extent of misdosing of these antipyretics. We sought to determine the prevalence of and risk factors for inaccurate dosing by parents seeking care for their children in the emergency department (ED). Methods: A cross-sectional observational study was performed in an urban academic pediatric ED. Two hundred patients 10 years of age and younger who were given a known dose of acetaminophen or ibuprofen in the 24 hours prior to the ED visit were enrolled. The treating physician completed a questionnaire for each patient. Caregivers were asked about quantity and frequency of antipyretic use prior to the ED visit, the source of information used to determine dosage, and which factor (eg, age, sex, height, weight, height of fever, severity of illness) they considered most important in determining the correct dosage of medication. Doses of 10 to 15 mg/kg for acetaminophen and 5 to 10 mg/kg for ibuprofen were considered accurate. Results: Overall, 51% of patients received an inaccurate dose of medication, including 62% of patients given acetaminophen and 26% of patients given ibuprofen. Infants < 1 year old were more likely to receive an inaccurate dose (RR 1.40, P < 0.04, 95% CI = 1.06-1.86). Caregivers who stated that medication dosage was based on weight were less likely to give an inaccurate dose of medication (RR 0.71, P < 0.03, 95% CI = 0.52-0.97). Conclusions: Over half of the caregivers surveyed gave an inaccurate dose of acetaminophen or ibuprofen, particularly to infants. Caregivers who reported that antipyretic dosage was based on weight were less likely to misdose medication, suggesting a valuable role for patient education. (C) 2000 Lippincott Williams & Wilkins, Inc.

The emergency management of hyperglycemic-hyperosmolar nonketotic coma in the pediatric patient

No abstract available

Blood warmers: Dry heat, water bath, circulating fluid

No abstract available

Staphylococcal tracheitis, pneumonia, and adult respiratory distress syndrome

A child initially seen in the emergency department with respiratory distress was diagnosed with viral laryngotracheitis and discharged home on oral steroids. She returned the following day without abatement of her symptoms and was admitted with upper airway obstruction and pneumonia. Bacterial tracheitis was diagnosed when the tracheal aspirate grew a pure culture of Staphylococcus aureus. Hemodynamic instability and severe parenchymal lung disease ensued from septic shock and adult respiratory distress syndrome requiring inotropic support and assisted ventilation. Oscillatory ventilation was instituted when the patient failed conventional ventilation. (C) Lippincott-Raven Publishers.

Pediatric facial fistula

No abstract available

When choosing injectable penicillin for the treatment of group A beta-hemolytic streptococcal pharyngitis, there is a less painful choice

Objective: To determine whether injection of patients with Bicillin CR is less painful than injection with Bicillin LA. To discover if Bicillin CR with the addition of procaine, which doubles the volume, causes the injection to be less painful. Design: An experimental, double-blinded crossover design was used for this study. Setting: University children's and women's tertiary care emergency Department (ED) with an annual pediatric census of 22,000. Participants: A convenience sample was enrolled from the student body of a large university and house staff, and employees of a 152 bed children's and women's hospital in southern Alabama. The sample size was limited to 50 participants, all of whom completed the study. Methods: Each participant received two penicillin injections, one Bicillin CR and one Bicillin LA, and rated the pain of the injection immediately after the injection, 1 hour after the injection and 12 hours after the injection. A visual analogue scale was the tool used for measuring the pain. The penicillin injections were randomized using a random number generator. Results: For each of the three periods, comparisons of pain were made between the Bicillin CR versus Bicillin LA injections. Bicillin LA pain score values were consistently higher for all but the 12-hour comparison. These differences were statistically significant (P < 0.008-0.002). Conclusions: Injection of Bicillin CR with the addition of procaine to the benzathine penicillin G is statistically significantly less painful than the injection of Bicillin LA without the addition of procaine to the benzathine penicillin G, even though the Bicillin LA is one-half the volume of the Bicillin CR due to the addition of procaine to the Bicillin CR. (C) 2000 Lippincott Williams & Wilkins, Inc.

Erratum

No abstract available

Epidemiology of dental trauma treated in an urban pediatric emergency department

Study objective: To describe the epidemiology of traumatic dental injuries to children treated in an urban pediatric emergency department (ED). Design: A descriptive study of a consecutive series of patients. Setting: The ED of a large, academic children's hospital. Participants: Children presenting to the ED with dental trauma from December 1992 to November 1993. Results: Of 1459 children treated for dental emergencies, 541 had dental trauma (37%) and were enrolled in this study. Patients ranged in age from five months to 18 years. Fifty-nine percent of patients were less than seven years of age, and 59% of patients were male. Falls caused 63% of injuries, followed by being struck (17%), and motor vehicle crashes (2%). Injuries to the soft tissues included lacerations (32%), swelling (8%), abrasions (7%), and contusions (6%). Injuries to hard dental structures included tooth fractures (33%), luxations (18%), concussions (12%), avulsions (8%), and jaw fractures (1%). Tooth luxation and concussion were more common among children less than seven years of age, and fractures to the tooth crown with dentin exposure (Ellis class II) were seen most often among children with permanent dentition (x2 = 41.4, P < 0.005). The central incisors were the teeth most frequently traumatized. Conclusion: Findings of this large consecutive series provide a useful description of the epidemiology of this common type of pediatric trauma for pediatric emergency care providers. (C) Lippincott-Raven Publishers.

An Adolescent Scuba Diver With 2 Episodes of Diving-Related Injuries Requiring Hyperbaric Oxygen Recompression Therapy: A Case Report With Medical Considerations for Child and Adolescent Scuba Divers

colon; Worldwide, more than 1000 scuba (self-contained underwater breathing apparatus) diving injuries per year requiring hyperbaric recompression are documented. Approximately 80 to 90 fatalities per year are reported in North America. On average, there were 16 diving injuries requiring hyperbaric recompression therapy in scuba divers aged 19 years and younger in North America between 1988 and 2002. The youngest injured diver was 11 years old, and the youngest fatality was 14 years old during this time period. In the year 2000, certifying recreational scuba diving organizations lowered the minimum age to 8 from age 12 years for participation in the sport. We report a case of a highly trained adolescent scuba diver who, despite having advanced diving certifications, had 2 separate episodes of diving-related injuries requiring hyperbaric recompression therapy. A discussion of medical considerations in the care of the child and adolescent scuba diver is included. (C) 2005 Lippincott Williams & Wilkins, Inc.

Smoking in parents of children with asthma and bronchiolitis in a pediatric emergency department

Objectives: To determine smoking habits, levels of nicotine-addiction, readiness to quit, and beliefs about the effects of environmental tobacco smoke (ETS) of parents of children with bronchiolitis and asthma who present to a children's emergency department (ED). Design/Methods: This was a cross-sectional prevalence study of parents or legal guardians of children with asthma or bronchiolitis presenting to a pediatric ED. Results: Two hundred forty-nine parents/legal guardians comprised the study group. The mean age (+/-SD) was 30.0 (+/-8.9) years; 88% were female; 51% were nonwhite; 37% were educated beyond high school. The self-reported smoking prevalence was 41% (95% CI = 32-51). Smoking prevalence among parents of wheezing children varied according to education, income, and race, but not according to gender, age, or employment status. Of the 102 smokers in the sample, 84 (82.4%, 95% CI = 73-88) reported that they wanted to quit; 78 (76.5%, 95% CI = 68-84) stated that they wanted to quit within the next month. Forty-nine percent (95% CI = 39-59) scored above 4 on the Fagerstrom Test for Nicotine Dependence and were considered nicotinedependent. The majority of smokers admitted to smoking around their children (66.7%, 95% CI = 57-75). Many parents knew that ETS might contribute to the development of the following illnesses: colds/upper respiratory tract infections - 77.5%, otitis media - 68.6%, pneumonia - 50%, wheezing/asthma attacks - 86.3%, and SIDS - 31.4%. Conclusion: The prevalence of smoking and nicotine addiction among parents of children with asthma or bronchiolitis who bring their children to a pediatric ED is high. Many parents have some knowledge about the effects of ETS, and the majority would like to quit. Future studies to help determine the best way to deliver advice to parents on ETS exposure reduction and smoking cessation are warranted. (C) 2002 Lippincott Williams & Wilkins, Inc.

Pediatric Emergency Medicine Fellowship Programs

No abstract available

Hematuria in two school-age refugee brothers from Africa

No abstract available

Unintentional albuterol ingestion in children

This study was designed to determine the threshold dose for toxicity, the potential for serious medical complications, and the medical care required after unintentional albuterol ingestion in children. This study was prospective and descriptive. Data were obtained on pediatric albuterol ingestions evaluated emergently as reported to three regional poison control centers. Data elements included dose ingested, physical findings, medical treatment, and outcome. During 18 months, 78 patients who ingested albuterol and who received urgent medical evaluation were identified. Mean age was 2.8 years. The amount ingested ranged from 0.2 to 8.8 mg/kg. The most commonly reported signs of toxicity were tachycardia (57%, 44/78), widened pulse pressure (50%, 27/ 54), hyperglycemia (50%, 12/24), agitation (45%, 35/78), low serum carbon dioxide (42%, 10/24), vomiting (26%, 20/78), and hypokalemia (26%, 9/35). We found a threshold dose of 1 mg/kg for three or more signs of toxicity (P <.01). No patient required any specific treatment for toxicity. Seventy two percent of patients were discharged from medical care within six hours of ingestion. Albuterol overdose in children causes a variety of cardiovascular, neuromuscular, and metabolic effects that are usually benign. The threshold dose for the development of three or more signs of toxicity is 1 mg/kg or three to 10 times the recommended daily dose. Toxicity is short-lived and does not require specific therapy or hospital admission in most cases. (C) Lippincott-Raven Publishers.

Neurosurgical Aspects of the Shakn Baby Syndrome

No abstract available

A rare cause of intracranial hemorrhage: Factor X deficiency

Congenital factor X deficiency is a rare inherited coagulation disorder, characterized by prolonged prothrombin time and partial thromboplastin time. For the definite diagnosis, specific factor X level should be investigated. We describe a patient with factor X deficiency who had intracranial hemorrhage. Hematologic tests showed prolonged prothrombin time, partial thromboplastin time, and a factor X level of 5%. The patient's hemorrhage resolved with fresh frozen plasma replacement. In this article, we discuss the clinical features and management of factor X deficiency. (C) 2001 Lippincott Williams & Wilkins, Inc.

Lidocaine Use in Pediatric Urethral Catheterization

No abstract available

Sepsis in neonates and children: Definitions, epidemiology, and outcome

No abstract available

Coping with physician payment reform: What is it, and why should pediatric emergency physicians care?

No abstract available

Food Allergy Presenting as a "Septic"-Appearing Infant

No abstract available

Pediatric emergency medicine: Legal briefs

No abstract available