Subject(s)
Analgesics , Craniocerebral Trauma , Emergency Medicine , Hypnotics and Sedatives , Tomography, X-Ray Computed , Child , Craniocerebral Trauma/classification , Craniocerebral Trauma/complications , Craniocerebral Trauma/diagnostic imaging , Female , Headache/diagnostic imaging , Headache/drug therapy , Headache/etiology , Humans , Male , Pediatrics , United StatesABSTRACT
OBJECTIVE: To determine the accuracy of portable bedside fluoroscopy in documenting postreduction fracture alignment in the pediatric emergency department (ED). DESIGN/SETTING: Prospective trial in an urban pediatric ED. PARTICIPANTS: Convenience sample of 80 pediatric patients requiring ED reduction of isolated long bone fractures. METHODS: Patients who underwent closed fracture reduction using portable fluoroscopic guidance (FluoroScan) in the ED were enrolled in the study. Postreduction images were obtained using both bedside fluoroscopy and conventional radiographs. A pediatric orthopedic subspecialist, blinded to clinical outcome, reviewed the fluoroscopic and radiographic images for adequacy of alignment and rated the utility of conventional radiography for fracture management. RESULTS: The patients were 2.5 to 16 years of age (mean 8.3). Distal radial and radioulnar fractures comprised 96% (76/80) of cases. Sixty-three percent of the fractures were displaced, and the mean angulation of the primary fracture site was 24 degrees . Fluoroscopy was found to be 100% sensitive (75/75 cases) and 100% specific (5/5 cases) in predicting postreduction fracture position when compared to conventional radiographs. Intra-rater observer agreement on the necessity of conventional postreduction radiographs was 0.92 (95% CI 0.82-1.00) using the kappa coefficient. In no case did postreduction radiographs alter acute fracture management. CONCLUSIONS: Bedside fluoroscopy with printed fluoroscopic images are highly reliable in evaluating fracture reduction and can replace conventional radiography in documenting adequate distal forearm fracture reduction when there is no intraarticular involvement.
Subject(s)
Emergency Service, Hospital , Fluoroscopy/standards , Fracture Fixation/methods , Point-of-Care Systems , Radius Fractures/diagnostic imaging , Ulna Fractures/diagnostic imaging , Adolescent , California , Child , Child, Preschool , Documentation , Female , Fluoroscopy/instrumentation , Fluoroscopy/methods , Humans , Male , Prospective Studies , Radius Fractures/therapy , Sensitivity and Specificity , Ulna Fractures/therapyABSTRACT
Two cases of idiopathic thrombocytopenia and one case of hemophilia with unexplained bruising are presented. The children were all initially thought to be victims of nonaccidental trauma until coagulation disorder screening tests were returned with abnormal values. A review of the literature of similar cases is presented. It is recommended that any child with unexplained or implausible bruising receive a screen for coagulation disorders consisting of a complete blood count with platelet count, prothrombin time, a partial thromboplastin time, and a bleeding times.
Subject(s)
Blood Coagulation Disorders/diagnosis , Child Abuse/diagnosis , Purpura, Thrombocytopenic, Idiopathic/diagnosis , Child, Preschool , Diagnostic Errors , Female , Hemophilia A/diagnosis , Humans , Infant , MaleABSTRACT
Although pneumonia is a known cause of pediatric abdominal pain, it may go unrecognized on a patient's initial evaluation. This is particularly true when the infection lies outside of the typically described basilar location. We report three pediatric patients in whom acute abdominal pain was the sole or primary manifestation of a nonbasilar pneumonia.
Subject(s)
Abdomen, Acute/microbiology , Abdominal Pain/microbiology , Pneumonia/diagnosis , Abdomen, Acute/complications , Abdomen, Acute/diagnosis , Child, Preschool , Diagnosis, Differential , Humans , Infant , Male , Pneumonia/complicationsABSTRACT
Diabetic foot disease results from two common pathologies: peripheral vascular disease and diabetic neuropathy. If these pathologies are not identified, ulceration may occur in the foot. Ulcers can lead to infection and finally amputation. This article discusses the components of the physical exam, current treatment for both pathologies, and client education. Because the two pathologies are similar in presentation, it is important for clinicians to distinguish between the two pathologies. Careful attention to the feet during the physical exam and assessment for symptoms can help distinguish the two pathologies. There are new treatments available for peripheral vascular disease to improve the client's circulation. Treatment of peripheral neuropathy is usually palliative, but can improve the client's quality of life. Through early identification and treatment of peripheral vascular disease and diabetic neuropathy, clients with diabetes can avoid ulceration. Client education is central to the treatment plan.
Subject(s)
Diabetic Foot/prevention & control , Diabetic Angiopathies/diagnosis , Diabetic Angiopathies/therapy , Diabetic Neuropathies/diagnosis , Diabetic Neuropathies/therapy , Humans , Patient Education as TopicABSTRACT
The purpose of this study was to measure the nociceptive threshold in hypothyroid patients by determining when the nociceptive flexion reflex of the lower limb occurs under percutaneous electrical stimulation of the sural nerve, given that this threshold is well correlated with pain sensation. Twelve hypothyroid patients and twelve control subjects participated in the study. In the case of the hypothyroid patients, the nociceptive flexion reflex (or RIII reflex) was measured before and six weeks after the onset of substitution treatment. The results clearly indicate that the nociceptive threshold of the patients with hypothyroidism was significantly higher than that of the control subjects. After six weeks of substitution treatment, the RII threshold return to normal. The analgesia observed in the hypothyroid patients in this study do not appear to be correlated with the blood TSH level. The possible mechanisms of these analgesic effects are discussed.
