Pediatric emergency medicine: legal briefs.
Explore the source record for details and available documents.
Adolescent↗
Biomedical subjects
J A Fein
Publications and source records attributed to J A Fein.
Using age-appropriate prolactin levels to diagnose children with seizures in the emergency department.
OBJECTIVE: To assess the utility of serum and cerebrospinal fluid (CSF) prolactin levels for identifying children who have experienced seizures. METHODS: A prospective cohort study was performed in a pediatric ED at an urban children's hospital. A convenience sample of children underwent blood and CSF analyses in the ED over a 2-year period. RESULTS: Thirty-five children (aged 3 months-15 years) with generalized tonic-clonic seizures and 48 ill control patients were studied. Both groups included febrile and afebrile patients. The patient characteristics in the seizure and control groups were similar with respect to age, fever, current medications, and blood, urine, and CSF cultures. When serum prolactin levels were assigned age-adjusted dichotomous values of "elevated" or "normal," the rates of elevation between the seizure and control patients were different (p < 0.001). The positive and negative predictive values of these age-adjusted levels were 68% (95% CI 47-85%) and 76% (95% CI 61-87%), respectively. The mean CSF prolactin levels of the seizure and control groups were not significantly different. In addition, there was no single threshold CSF prolactin level that could delineate seizure patients from control patients. CONCLUSIONS: Age-adjusted serum prolactin levels are useful only as an adjunct in the prospective evaluation of the individual pediatric patient for epileptic seizure activity. CSF prolactin levels are not useful in the diagnosis of generalized seizures in children in the acute care setting.
Adolescent↗
Latex allergy in pediatric emergency department personnel.
Allergy to natural latex proteins has been recently recognized as a dangerous entity among health care professionals. Cutaneous symptoms related to latex glove use vary from the redness and scaling of contact dermatitis to urticaria. In addition, anaphylactic reactions have been reported. We report the spectrum of reactions to latex glove use in 93 members of our emergency department (ED) staff during a one-month study period. In addition, we attempt to correlate these symptoms with serologic evidence of atopy and latex allergy. Eighty-four of these subjects underwent total serum immunoglobulin E and latex-specific radioallergosorbent test (RAST) testing. Fifty-four percent of subjects reported symptoms relating to latex glove use, categorized as either contact dermatitis (48.4%) or urticaria (5.4%). Of the urticaria group, two subjects reported additional symptoms related to latex glove use such as rhinitis, conjunctivitis, or sneezing. All three groups of subjects (asymptomatic, contact dermatitis, and urticaria) were alike with respect to age, sex, and race. The urticaria group reported a higher incidence of environmental allergies (chi 2, P = 0.02). Serum total immunoglobulin E levels and latex-specific RAST results did not differ among the three groups. The one subject with a positive latex-specific RAST reported urticarial and nasoocular symptoms when exposed to latex gloves. Seventeen percent of symptomatic subjects reported decreased use of latex gloves because of these symptoms. It was concluded that many members of our pediatric ED staff exhibit a sensitivity to latex antigens. Clinical symptoms, rather than serologic testing, must be used to identify latex-sensitive individuals in this setting. Recommendations are offered to assist in the identification and management of hospital personnel who exhibit allergy to latex-containing products.
Adult↗
Teaching emergency medicine to pediatric residents: a national survey and proposed model.
To assess how emergency medicine is taught to pediatric residents, a cross-sectional survey was performed using a written questionnaire distributed to the chief residents of accredited pediatric residency programs throughout the continental United States. Information requested included the demographics of the training program, the structure of the emergency department (ED) rotation, and the chief residents' perceptions of the quality of precepting in the ED. Eighty three percent of 149 institutions responded. The mean number of pediatric patients/year is 21,241 (range 500-100,000), supplying approximately 500 to 700 patients/resident/year. A freestanding pediatric ED serves as the main training site in 50% of programs, and 3% do not use an ED at all. Case-by-case, one-on-one precepting occurs in 91% of EDs. Precepting is performed mostly by pediatric attendings (74%) and general emergency medicine attendings (38%). Seventy-four percent of programs provide a formal orientation, and 88% provide end-rotation evaluations. Twenty-two percent of the chief residents consider their pediatric ED rotation as "average" when compared with the case-by-case precepting delivered in other hospital rotations; 39% consider the ED rotation as "above average," and 33% as "below average." Programs with core lecture series, skills workshops, and formal orientation and evaluation procedures are more likely to be regarded as "above average." Pediatric emergency medicine rotations provide ample opportunity for case-by-case precepting. Programs with an established curriculum and pediatric attending presence are more likely to be successful in this regard. The full potential of the ED rotation can be realized through faculty training in precepting and evaluation methods.
Child↗
Children with unrecognized human immunodeficiency virus infection. An emergency department perspective.
OBJECTIVE: To provide an approach toward the diagnosis of children with human immunodeficiency virus (HIV) infection in the acute care setting. DESIGN: Patient reports and review of recent literature. SETTING: Emergency departments or acute care clinics. SELECTION PROCEDURES: Analysis of important recent clinical publications. INTERVENTIONS: None. RESULTS AND CONCLUSIONS: The clinical and historical findings associated with pediatric HIV infection are occasionally subtle and differ from those findings in adults. In this article, we have divided the first presentation of HIV in the acute care setting into five categories: recurrent bacterial infections, failure to thrive, unexplained organomegaly, adolescents with HIV, and late presentation of perinatally acquired HIV. Each category is illustrated by a patient treated in the acute care setting. Recognition of these categories of presentation will hopefully assist acute care physicians in the early diagnosis of HIV infection.
AIDS-Related Opportunistic Infections↗
Diaphragmatic hernia masquerading as pneumothorax in two toddlers.
In two separate incidents, two toddlers with no previous history of respiratory ailments presented to the emergency department of a children's hospital with progressive respiratory distress. Both children had unilateral lung findings on auscultation and initial chest radiographs that were consistent with a pneumothorax. Thoracostomy and chest tube insertion were performed during initial resuscitation efforts. In both cases, subsequent radiographs revealed that the stomach was located in the left hemithorax, suggestive of a diaphragmatic hernia. Nasogastric tube insertion relieved the respiratory distress of these two children. Recognition of the "acquired" congenital diaphragmatic hernia in the setting of extreme aerophagia or mild abdominal trauma may prevent unnecessary procedures during the resuscitation of children with acute respiratory distress and unilateral lung findings.
Age Factors↗