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Evaluation and management of pediatric hypertensive crises: hypertensive urgency and hypertensive emergencies
Patel NH,Romero SK,Kaelber DC
Open Access Emergency Medicine , 2012,
Abstract: Nirali H Patel,1 Sarah K Romero,2 David C Kaelber31Division of Emergency Medicine, Akron Children's Hospital, Akron, OH, USA; 2Division of Emergency Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH, USA; 3Departments of Information Services, Internal Medicine, Pediatrics, and Epidemiology and Biostatistics, The Center for Clinical Informatics Research and Education, The MetroHealth System and School of Medicine, Case Western Reserve University, Cleveland OH, USAAbstract: Hypertension (HTN) in the pediatric population is estimated to have a world-wide prevalence of 2%-5%. As with adults, pediatric patients with HTN can present with hypertensive crises include hypertensive urgency and hypertensive emergencies. However, pediatric blood pressure problems have a greater chance of being from secondary causes of HTN, as opposed to primary HTN, than in adults. Thorough evaluation of a child with a hypertensive emergency includes accurate blood pressure readings, complete and focused symptom history, and appropriate past medical, surgical, and family history. Physical exam should include height, weight, four-limb blood pressures, a general overall examination and especially detailed cardiovascular and neurological examinations, including fundoscopic examination. Initial work-up should typically include electrocardiography, chest X-ray, serum chemistries, complete blood count, and urinalysis. Initial management of hypertensive emergencies generally includes the use of intravenous or oral antihypertensive medications, as well as appropriate, typically outpatient, follow-up. Emergency department goals for hypertensive crises are to (1) safely lower blood pressure, and (2) treat/minimize acute end organ damage, while (3) identifying underlying etiology. Intravenous antihypertensive medications are the treatment modality of choice for hypertensive emergencies with the goal of reducing systolic blood pressure by 25% of the original value over an 8-hour period.Keywords: hypertension, hypertensive crisis, hypertensive emergency, hypertensive urgency, pediatrics, diagnosis and treatment
Prevalence and predictors of hypoxemia in acute respiratory infections presenting to pediatric emergency department  [cached]
Singhi S,Deep A,Kaur H
Indian Journal of Critical Care Medicine , 2003,
Abstract: Rational & Objective: Early detection of hypoxemia and oxygen therapy improves the outcome of children with acute respiratory illnesses (ARI). However, facility to measure oxygen saturation (SpO2) is not available in many health facilities of resource poor countries. We have studied prevalence of hypoxemia in children with ARI and examined value of various clinical signs to predict hypoxemia. Subjects & Methods: Consecutive children, aged 2 months - 59 months, with respiratory symptom(s) attending the pediatric emergency service between Oct 2001 to December 2002 were studied. Presence or absence of cough, nasal flaring, ability to feed/drink, cyanosis, chestwall indrawing, wheeze, tachypnoea (respiratory rate >50/min in children up to 11 months and >40/min up to 59 months), crepitations on auscultation and oxygen saturation (SpO2, by Nellcore pulse oximeter) and clinical diagnosis were recorded. Results: Of 2216 children studied 266 (11.9%) had hypoxemia (SpO2 £90%). It was seen in 73.8% of 126 patients with WHO defined very severe pneumonia, 25.8% of 331 patients with severe pneumonia, 11% of 146 patients with bronochiolitis and 6.5% of 338 patients with acute asthma. Most sensitive indicators of hypoxemia were chestwall indrawing (sensitivity-90%, negative predictive value -98%) and crepitations (sensitivity-75%, negative predictive value 95.7%) while the best positive predictive value was seen with cyanosis (71.4%) and inability to feed (47.6%). Nasal flaring had the good balance of sensitivity (64%), specificity (82%) and positive predictive value (33%) among the signs studied. Conclusion: None of the clinical signs of respiratory distress had all the attributes of a good predictors of hypoxemia. Chest wall indrawing was the most sensitive and 'inability to feed/ drink' was the most specific indicator.
Evaluation and management of pediatric hypertensive crises: hypertensive urgency and hypertensive emergencies
Patel NH, Romero SK, Kaelber DC
Open Access Emergency Medicine , 2012, DOI: http://dx.doi.org/10.2147/OAEM.S32809
Abstract: luation and management of pediatric hypertensive crises: hypertensive urgency and hypertensive emergencies Review (952) Total Article Views Authors: Patel NH, Romero SK, Kaelber DC Published Date November 2012 Volume 2012:4 Pages 85 - 92 DOI: http://dx.doi.org/10.2147/OAEM.S32809 Received: 10 April 2012 Accepted: 23 August 2012 Published: 06 November 2012 Nirali H Patel,1 Sarah K Romero,2 David C Kaelber3 1Division of Emergency Medicine, Akron Children's Hospital, Akron, OH, USA; 2Division of Emergency Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH, USA; 3Departments of Information Services, Internal Medicine, Pediatrics, and Epidemiology and Biostatistics, The Center for Clinical Informatics Research and Education, The MetroHealth System and School of Medicine, Case Western Reserve University, Cleveland OH, USA Abstract: Hypertension (HTN) in the pediatric population is estimated to have a world-wide prevalence of 2%-5%. As with adults, pediatric patients with HTN can present with hypertensive crises include hypertensive urgency and hypertensive emergencies. However, pediatric blood pressure problems have a greater chance of being from secondary causes of HTN, as opposed to primary HTN, than in adults. Thorough evaluation of a child with a hypertensive emergency includes accurate blood pressure readings, complete and focused symptom history, and appropriate past medical, surgical, and family history. Physical exam should include height, weight, four-limb blood pressures, a general overall examination and especially detailed cardiovascular and neurological examinations, including fundoscopic examination. Initial work-up should typically include electrocardiography, chest X-ray, serum chemistries, complete blood count, and urinalysis. Initial management of hypertensive emergencies generally includes the use of intravenous or oral antihypertensive medications, as well as appropriate, typically outpatient, follow-up. Emergency department goals for hypertensive crises are to (1) safely lower blood pressure, and (2) treat/minimize acute end organ damage, while (3) identifying underlying etiology. Intravenous antihypertensive medications are the treatment modality of choice for hypertensive emergencies with the goal of reducing systolic blood pressure by 25% of the original value over an 8-hour period.
Incidence of Serious Bacterial Infections in Ex-premature Infants with a Postconceptional Age Less Than 48 Weeks Presenting to a Pediatric Emergency Department  [cached]
Inoue, Nobuaki,Kim, Tommy Y,Birkbeck-Garcia, Anne Marie,Givner, Andrew
Western Journal of Emergency Medicine : Integrating Emergency Care with Population Health , 2009,
Abstract: Objectives: Premature infants are at higher risk of developing serious bacterial infections (SBI). However, the incidence of SBI in ex-premature infants presenting to the emergency department (ED) remains undetermined. The objective of this study is to examine the incidence of SBI in ex-premature infants with a postconceptional age of less than 48 weeks presenting to a pediatric ED.Methods: A retrospective medical record review was conducted on 141 ex-premature infants with a postconceptional age of less than 48 weeks who had a full or partial septic work up completed in a pediatric ED between January 1, 1998 and March 31, 2005.Results: The overall median gestational age at birth was 35 weeks (IQR 33-36 week) and the overall median postconceptional age at ED presentation was 40 weeks (IQR 37-42 weeks). Thirteen (9.2%) infants were found to have a SBI. Five subjects had pneumonia, four with bacteremia, two with pyelonephritis, and two with a concomitant infection of meningitis/pneumonia and bacteremia/pyelonephritis.Conclusion: The results of this study reveal that the incidence of SBI in ex-premature infants with a postconceptional age of less than 48 weeks is similar to in-term infants (9.2%) and is consistent with previously published incidence rates in-term infants (10%).[WestJEM. 2009;10:37-40.]
Crisis Hipertensivas. Hypertensive crises.
Graciela Florat García,Raymid García Fernández,Damaris Hernández Véliz,David García Barreto
Revista Cubana de Cardiología y Cirugía Cardiovascular , 2000,
Abstract: Con el propósito de caracterizar los pacientes con crisis hipertensivas que acuden al Cuerpo de Guardia del Instituto de Cardiología y Cirugía Cardiovascular, se realizó un estudio observacional prospectivo en 128 pacientes consecutivos con cifras elevadas y síntomas atribuibles de ataque a órgano diana. De los 128 pacientes 12 (9,3 %) fueron emergencias y 86 (67 %) fueron urgencias. Las crisis hipertensivas fueron significativamente más frecuentes en mujeres que en hombres. Veintiocho pacientes con crisis no tomaban medicamentos, 49 recibían un solo medicamento y 17 habían abandonado el tratamiento por más de 3 vidas medias de excreción. Los pacientes acudieron al cuerpo de guardia con mayor frecuencia en la ma ana y al final de la tarde. Durante la noche hubo disminución significativa de pacientes con crisis. Los días de la semana en que se presentaron mayor cantidad de crisis fueron los martes y miércoles. El síntoma más frecuente al ingreso fue dolor precordial seguido de cefalea. Los medicamentos más eficaces para ocasionar normotensión resultaron ser la nifedipina y la clonidina. El captopril fue significativamente menos eficaz (p < 0,05). La nifedipina tuvo un riesgo relativo de modificar la onda T del electrocardiograma 12,3 veces mayor (p < 0,0001) que el resto de los medicamentos. Los pacientes con crisis hipertensivas que acuden al Cuerpo de Guardia del ICCV, son en su mayoría urgencias que deben tratarse en la consulta externa, las emergencias se presentan con síntomas y signos atribuibles al ataque a órgano diana, no por la hipertensión en sí. In order to characterize the patients with hypertensive crisis that attend the Emergency Department of the Institute of Cardiology and Cardiovascular Surgery an observational descriptive study was conducted among 128 consecutive patients with elevated readings and symptoms attributable to attack to a target organ. Of the 128 patients, 12 (9.3%) were emergencies and 86 (67%) were urgencies. The hypertensive crises were much more frequent in women than in men. 28 patients with crisis did not take any drug, 49 received only one drug and 17 had stopped the treatment through more than 3 mean excretory ducts. The patients went to the emergency department mostly in the morning and late in the afternoon. A signficant reduction of patients with crisis was observed during the evening. On Tuesdays and Wednesdays there were more crises than in the rest of the week. The commonest symptom on admission was precordial pain followed by headache. The most efficient drugs to obtain normotension were nifedipine and cloni
Frequency of Gastroenteritis in Pediatric Emergency Department  [cached]
Suat Bicer,Gulhan Tunca Sahin,Berkun Koncay,Dilek Yavuzcan
Cocuk Enfeksiyon Dergisi , 2008,
Abstract: Aim: Acute gastroenteritis is an important cause of hospital admissions during childhood. The aim of the study was to determine the incidence of rotavirus gastroenteritis in patients admitted to our pediatric emergency department. Material and Methods: Stool specimens of 1767 children admitted to our pediatric emergency department during a one year period (2007) with acute gastroenteritis, were analyzed. Group A rotavirus were investigated in the stool specimens with the immunochromatographic test. All information was collected retrospectively from recorded data. Results: In 422 of the 1767 stool specimens (23.9%), rotavirus antigen were determined. The highest rate of rotavirus infection was detected from December to June, with a peak incidence during January and February, and the lowest during summer months. The incidence of rotavirus positive cases was higher among children between 0-2 years of age. Conclusion: In conclusion, rotavirus is an important cause in children with acute gastroenteritis and it should be investigated routinely, especially in the winter and spring months.
Pediatric rapid sequence intubation: emergency department approach
Amélia Gorete Afonso da Costa Reis,Marcelo de Carvalho,Claudio Schvartsman
Einstein (S?o Paulo) , 2006,
Abstract: The present paper describes the current knowledge on rapidsequence intubation applied to critical cases in the EmergencyDepartment. A bibliographic search was performed through Medlineand Lilacs databases. Keywords used for search were: rapidsequence intubation and emergency tracheal intubation. Rapidsequence intubation consists of appropriate use of medications tofacilitate emergency tracheal intubation and decrease its adverseeffects. This technique requires an organized approach involvingsedatives and paralyzing agents. It should, therefore, be performedonly by skilled professionals, who will take into account the risksand benefits of the procedure after careful assessment of thepatient’s conditions. Although several potential complications mayoccur, efficacy and safety of rapid sequence intubation weredocumented and proved to reduce the risks of tracheal intubation.This is achieved by rapid anesthesia induction, which mitigatesthe autonomic reflexive response caused by the directlaryngoscopic procedure, and by prompt occurrence of idealconditions which makes laryngoscopy easier, reducing the risksof pulmonary aspiration. In conclusion, rapid sequence intubationis the method of choice in most pediatric emergency intubationssince it is associated with a high success rate and a low incidenceof adverse reactions when it is carried out by skilled professionals.
Surveillance of Airborne Adenovirus and Mycoplasma pneumoniae in a Hospital Pediatric Department  [PDF]
Gwo-Hwa Wan, Chung-Guei Huang, Yhu-Chering Huang, Ju-Ping Huang, Su-Li Yang, Tzou-Yien Lin, Kuo-Chien Tsao
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0033974
Abstract: This investigation evaluated the distributions of airborne adenovirus and Mycoplasma pneumoniae in public areas in the pediatric department of Children's Hospital in northern Taiwan. The airborne viral and bacterial concentrations were evaluated twice a week for a year using filter sampling with an airflow rate of 12 liters per minute for eight hours in the pediatric outpatient department and 24 hours in the pediatric emergency room. Real-time polymerase chain reaction assays were conducted for analysis. Approximately 18% of the air samples from the pediatric emergency room were found to contain adenovirus. Approximately forty-six percent of the air samples from the pediatric outpatient department contained Mycoplasma pneumoniae DNA products. High detection rates of airborne adenovirus DNA were obtained in July and August in the pediatric public areas. Airborne Mycoplasma pneumoniae was detected only in July in the pediatric emergency room and the peak levels were found from August to January in the pediatric outpatient department. Airborne particles that contained adenovirus and Mycoplasma pneumoniae were the most prevalent in the pediatric public areas. The potential relationship between these airborne viral/bacterial particles and human infection should be examined further. Keywords: adenovirus; Mycoplasma pneumoniae; filter sampling; real-time polymerase chain reaction; hospital; pediatric public areas.
The Pediatric Emergency Department: A Substitute for Primary Care?  [cached]
Haltiwanger, Katherine A,Pines, Jesse M.,Martin, Marcus L
Western Journal of Emergency Medicine : Integrating Emergency Care with Population Health , 2006,
Abstract: Objectives: Pediatric emergency department (PED) patients often present with non-urgent complaints. We attempted to estimate the perceived degree of urgency of the visit and to identify reasons for seeking non-urgent care in the PED by patients and parents. Methods: A prospective survey was completed by parents (for children 17 and younger) and patients (18-21) presenting to a suburban academic PED that sees approximately 15,000 patients per year. A convenience sample of participants was enrolled. Results: Three hundred and five of 334 surveys were completed (91% response rate) over a 3-month period. Twenty-four percent of the chief complaints were perceived by those surveyed as emergent or possibly life-threatening, 23% were felt to be very urgent, and 52% were deemed somewhat urgent or minor. Twenty-five percent of those with minor or somewhat urgent complaints arrived by ambulance. Weekend visits and minority race correlated with a lower degree of perceived urgency. Overall, 79% of those surveyed identified a primary care provider (PCP) for themselves or their child. Of those, 54% had attempted to contact the PCP prior to coming to the PED. Six percent of those who attempted to reach their primary care providers were able to contact them and 52% were told to come to the PED. Conclusions: More than half of patients and parents presenting to the PED believed they had minor or somewhat urgent complaints. While the majority of patients have a regular provider, limited access to timely primary care and convenience may make the PED a more attractive care option than primary care for many parents and patients.
Prevalence of Genetic Disorders in Pediatric Emergency Department Al Galaa Teaching Hospital  [PDF]
N.A. Meguid,S.M. El Bayoumi,N.F. Hamdi,W.N. Amen
Pakistan Journal of Biological Sciences , 2003,
Abstract: To determine the prevalence and patterns of presentation of cases with suspected genetic disorders among neonatal pediatric emergency department. A retrospective and prospective review of pediatric emergency department admissions at Al Galaa Teaching Hospital among one year; suspected infants with genetic disorder are prone to full clinical evaluation with special emphasis on any associated anomalies or facial malformations, meticulous pedigree construction, chromosomal analysis for karyotyping and metabolic studies when indicated. Infants with suspected genetic diseases represent 11.1% among patients admitted to PED. Of these 50% were related to single gene disorders, 22% had chromosomal aberrations, 20% were due to multifactorial etiology and 8% had sporadic isolated anomalies. Parental consanguinity was found in 40% of these cases. We concluded that genetic disorders due to single gene defect are the most common pattern of malformations. This could be related to the high consanguinity rate among Egyptian population. Also emphasized that it is important for emergency physicians, neonatologists and pediatricians to be familiar with common genetic diseases, their acute presentations and complications. Awareness of underlying genetic disorders and accurate diagnosis are required for appropriate management and proper counseling.
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