ABSTRACT
Infection by SARS-COV-2, was first described in November 2019 in Wuhan, China. First chilean cases where reported in March 2020.Our objective was to identify epidemiological changes in the pediatric population in the emergency service of the Hospital Regional de Talca (HRT). We carried out an observational and retrospective study. The reason and number of consultations in pediatric patients in the emergency room was analyzed during the periods defined as "Pre-pandemic" and "Pandemic". The target population was all consulting patients between 0-15 years of age. We separated the cases according to the reason of consultation. We obtained the data from the HRT statistics department. The number of consultations decreased by 67.6% per month, while the number of patients who consulted in pediatric emergencies for respiratory symptoms decreased by 75.4% per month. Within the pandemic period, 15,101 COVID PCR samples were performed in pediatric patients, with 13.7% positivity. This allows us to see the epidemiological impact that this new disease has had on pediatric patients in the Maule región
Subject(s)
Humans , Child , Adolescent , Pediatrics , Pandemics , COVID-19/epidemiology , Hospitals, Public/statistics & numerical data , Epidemiology, Descriptive , Retrospective Studies , Emergency Service, Hospital/statistics & numerical data , Epidemiological Monitoring , COVID-19 Nucleic Acid TestingABSTRACT
Objective@#To investigate the effects of critical care chest ultrasonic examination (CCUE) by intensive care physician on fluid management among septic shock patients in pediatric intensive care unit (PICU).@*Methods@#Forty children from PICU who were diagnosed as septic shock in Shenzhen Bao′an Maternal and Child Health Hospital were included in this study.Twenty-two of them who were hospitalized in PICU during January 2017 to December 2018, under the care of 4 PICU physicians who had certificates of the Chinese Critical Ultrasound Study Group(CCUSG) were defined as CCUE group.Eighteen PICU patients from January 2014 to December 2015 having no access to CCUE were recruited as control group.Both groups were treated according to the septic shock management guidelines with routine anti-shock and anti-infection therapy, as well as mechanical ventilation.Fluid management following conventional protocol was performed in the control group.While in the CCUE group, CCUE was applied to monitor the hemodynamic status for adjustment in fluid management.@*Results@#Compared with the control group, the CCUE group had shorter mechanical ventilation time as well as less fluid intake and output within 48 hours after admission[(4.68±2.06)d vs.(7.33±0.49)d, (6.34±1.85)ml/(kg·h) vs.(8.55±0.39) ml/(kg·h), (2.47±1.22)ml/(kg·h) vs.(6.18±1.72)ml/(kg·h)] (P<0.05). The CCUE group also had a more positive fluid balance and larger dosage of midazolam and fentanyl administration[(3.87±2.33)ml/(kg·h) vs.(2.37±2.10)ml/(kg·h), (5.62±2.39)μg/(kg·min) vs.(1.68±0.82)μg/(kg·min), (1.41±0.39)μg/(kg·h) vs.(0.95±0.56)μg/(kg·h)] (P<0.05). The two groups showed no differences in vasoactive-inotropic score within 48 h(11.11±6.08 vs.9.90±4.12), dosage of furosemide[(1.07±0.52)mg/(kg.d) vs.(0.94±0.15)mg/(kg·d)], length of PICU stay[(10.73±7.48)d vs.(10.00±2.91)d], intubation rate after 1 hour of volume resuscitation[54.5%(12/22)vs.33.33%(6/18)] or mortality[8.3%(2/24)vs.5.3%(1/19)] (P>0.05).@*Conclusion@#Application of CCUE helps to optimize fluid management and shorten the ventilation time among children with septic shock in PICU.
ABSTRACT
PURPOSE: The telemedicine systems for both timely decision of patient transfer and accurate direction of patient treatment through remote consultation are required for better patient care in emergency situation. In this paper, we present noble design methods to implement the emergency telemedicine system suitable for emergency consultation. METHODS: The prototype system designed can encompass multimedia components including radiological images, medical record, biological signals, video conferencing and full-quality video, as well as can transmit changing data in real-time. In the first stage, experimental tests at the local networks analyzed the technical aspects of designed systems, and optimize the parameters subjectively to run them with affordable error. In the Second stage, two medical emergency cases were examined between two hospitals, the first was advanced airway management, and second was the management a patient with cardiac problem. RESULTS: Experimental tests at the local networks, all multimedia components can be represented to both terminals without any problems. Two cases of clinical experiment have performed to demonstrate the clinical usefullness. Orotracheal Intubation was done successfully by local hospital physician who was directed by specialist at distant hospital. The second case, a patient with cardiac problem was good managed by specialist via this telemedicine system without any problems. CONCLUSION: Inter-hospital experiments demonstrate the feasibility to be effectively used at emergency department.