Congenital anomalies of the tracheobronchial tree are rare occurrences; however, they can lead to pulmonary complications. A tracheal bronchus is an anatomic variant in which an ectopic bronchus originates directly from the tracheal wall above the carina. Presented is a case of intraoperative hypoxemia due to right upper lobe collapse. Despite what appeared to be proper endotracheal tube positioning, this clinical scenario was found to be the result of endotracheal tube obstruction of a tracheal bronchus supplying the right upper lobe. Fiberoptic bronchoscopy proved to be a rapid diagnostic and therapeutic tool, as the endotracheal tube was able to be visually positioned above this aberrantly located bronchus.

Adult↗

PubMedDate not supplied

Usage of emergency medical services by children with special health care needs.

OBJECTIVE: To describe the usage of emergency medical services (EMS) by children with special health care needs (CSHCN). METHODS: All EMS runs and related hospital records for children aged 0-17 years in Utah in 1991-92 were linked. The CSHCN status was determined from ICD-9 diagnoses using three available definitions. The amounts of EMS usage were compared between CSHCN and other children. A pediatric intensive care practitioner determined CSHCN status by chart review for 915 children transported by EMS to a pediatric tertiary care hospital, and his classification was compared with the CSHCN status assigned by the three ICD-9-based definitions. RESULTS: The three definitions assigned CSHCN status for 2% to 24% of children using EMS. When compared with other children, CSHCN were more likely to be admitted to the hospital, more likely to use EMS for transfer between health care facilities, and more likely to receive prehospital procedures such as intravenous therapy. In the group of children whose charts were reviewed individually, one ICD-9-based definition most closely agreed to determination of CSHCN status by a pediatric intensive care practitioner. CONCLUSIONS: Children with special health care needs who use EMS are more likely to receive advanced life support service, to receive prehospital procedures, and to be transferred from one health care facility to another. There is need for a specific and measurable definition of CSHCN that can be applied to existing health data.

Adolescent↗