When compared with other referral sources, RPCC triage results in fewer unnecessary ED visits in this age group. Increasing prehospital use of poison centers would likely decrease unnecessary ED referrals and related costs.
Purpose of StudyMost nonemergent visits to the emergency department (ED) include fever or pain in the chief complaint. This study was designed to examine the use of ibuprofen and acetaminophen for fever and/or pain prior to ED visits, highlighting patients who were given no medications prior to the visit and noting whether parents would have brought their children to the ED if fever or pain had resolved with medication.MethodsThis is a convenience sample of children > 8 weeks old presenting to a Children's Hospital ED with complaints of fever and/or pain. Our goal was to capture nonemergent patients; patients were excluded if referred by a pediatrician, were immunocompromised, or arrived by EMS. One investigator administered a questionnaire to all participants. Data were entered into Epistat® for statistical analysis.ResultsBetween 6/04 and 8/04, we enrolled 116 patients: 51% female, 51% African-American, 46% Caucasian, and 2% Hispanic. Of all study patients, 51% were insured by Medicaid, 29% had private insurance, and 20% had no insurance. 66% had a private pediatrician, 27% went to health departments, and 7% had no primary pediatrician. Mean patient age was 4.8 (SD 4.9) and mean parental age was 31.2 (SD 10.6). The mother completed the questionnaire in 69% of cases. Parental education varied between 6th grade and postgraduate degrees. Chief complaint included fever in 51% and pain in 84%. Mean length of time with fever was 2.7 days (SD 3.6 d) and mean length of time with pain was 3.6 days (SD 4.8 d). Caregivers gave no medications for pain or fever in 23% of patients (95% CI 15.9, 32). Acetaminophen was given to 44% of patients prior to ED visit and 48% had received ibuprofen prior to ED visit. Of those patients who received ibuprofen and/or acetaminophen, 63% were given appropriate doses, 36% were given too little, and 4% were given too much. 54% of parents reported that if pain or fever had resolved with medication, they would not have brought their children to the ED.ConclusionMany parents give ibuprofen or acetaminophen prior to ED visits for pain and fever (77%), but only 2/3 of parents give appropriate doses of these medications. About one-half of parents reported that they would not have brought their children to the ED if pain or fever had resolved at home. Parents should be counseled on appropriate dosing as well as appropriate use of ibuprofen and acetaminophen at home when children have pain or fever.
IntroductionThe term heat-related illness encompasses a continuum of disorders from minor illnesses, such as heat cramps, to the life-threatening heatstroke. Certain populations are at greater risk for developing these illnesses: the elderly, those with chronic medical conditions, those with mental illnesses, and children. Children are more likely to suffer from heat-related illnesses because of an increased surface area to body mass ratio because of a decreased amount of sweating in response to heat and because they do not instinctively replace fluid losses or limit exercise in extreme heat. Neonates and infants are at even greater risk because they have poor thermoregulatory control.Case ReportA 17-day-old black male, born at 36 weeks, presented to the emergency department (ED) by ambulance with fever, tachycardia, hypotension, poor perfusion, altered mental status, and impending respiratory failure. The mother had noted that the patient "looked sick " after a 31/2-hour car ride without air conditioning on a hot July day in Alabama. His temperature at home was 104.0 degrees; he had vomited bright yellow emesis, was breathing fast, and would not keep his eyes open. In the ED he was intubated, was resuscitated with 60 cc/kg of normal saline (which resulted in improved perfusion, heart rate improving from 250 to 182, and the first obtainable blood pressure of 55/12), and was started on empiric antibiotics after blood, urine, and spinal fluid cultures were obtained. His physical exam was significant for a markedly distended abdomen with stacked loops of bowel as well as a grossly bloody stool. He was admitted to the intensive care unit where resuscitation continued with normal saline, packed red blood cells, fresh frozen plasma, and dopamine. His initial head CT was normal and his echocardiogram showed normal heart structure and function. His upper GI was negative for volvulus, and all abdominal X-rays showed no signs of necrotizing enterocolitis. All bacterial cultures were negative. CSF enteroviral PCR and HSV PCR were both negative. His coagulopathy slowly resolved. He remained in the hospital for 12 days and was discharged home with an abnormal neurologic exam (increased tone throughout), but all other organ systems were back to normal.DiscussionThis case highlights the fact that the differential diagnosis for neonates presenting with shock is vast. While we had the history of hyperthermia after an extended period of time in a hot car, we had to consider all other causes of shock in this age group.
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