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SummaryThis case report emphasizes the varied manifestation of CO poisoning and its genesis from methylene chloride. Because DCM is now an ingredient in many popular spray paints, the ingredients should be checked routinely in toxic exposures. Manufacturer's suggestions concerning the use these products in ventilated areas to avoid harmful effects do not always protect the consumer, and the public should be well informed regarding this issue.

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The guidance in this statement does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. All policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffi rmed, revised, or retired at or before that time.

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Abstract. Objectives: To determine the relative effectiveness of pediatric asthma care among patients treated by a dedicated asthma center (AC) vs children who use the emergency department (ED) as a site of primary asthma care. Methods: A retrospective casecontrol design was used. A random sample of AC cases was selected from a designated comprehensive AC over a 12-month period. Concurrent ED control patients were identified from all cases of pediatric asthma from five urban hospitals based on two or more ED visits. Cases and controls were matched (1:2) based on age and National Heart, Lung, and Blood Institute (NHLBI) asthma severity of illness classification. A telephone survey was administered to the caregivers of all enrolled patients in the study sample. Results: Four elements of pediatric asthma care were examined: quality, access, hospital utilization, and functional impact of disease. Demographic data were similar between the ED cases and the AC controls. In terms of quality of care, the AC patients were more likely to use maintenance antiinflammatory medications, 60.2% vs 22.5% (OR = 5.3; 95% CI = 2.9 to 9.7) and more likely to be taking medications at school, 71.4% vs 48.1% (OR = 2.7; 95% CI = 1.5 to 4.7). In terms of access to care, the AC families were more likely to have a physician to call to assist with outpatient management, 98.2% vs 65.0% (OR = 25.3; 95% CI = 9.0 to 76.9). Frequent ED utilization (Ն1 visit/month) was less likely in the AC patients, 9.2% vs 22.0% (OR = 0.35; 95% CI = 0.16 to 0.79) and school absenteeism was lower as well (9.5 Ϯ 6.7 days vs 16.6 Ϯ 10.3, p < 0.001). Additionally, the caregivers of the AC patients missed fewer workdays (4.7 Ϯ 2.8 vs 7.4 Ϯ 4.1; p = 0.03). Conclusions: Significant disparities in quality, access, resource utilization, and functional impact exist between AC and ED patients. Emergency physicians have a unique opportunity to improve the public health by directing ED patients toward pediatric AC treatment. Key words: pediatrics; asthma; asthma center; emergency department utilization. ACADEMIC EMERGENCY MEDICINE 2001; 8:709-715 A STHMA is currently the most common chronic condition affecting children in the United States and has been the leading cause of childhood disability over the last 25 years. 1 There are approximately 5 million children in the United States diagnosed as having asthma, 2 and the prevalence of pediatric asthma has increased by approximately 50% over the last decade. Asthma accounts for more than 10 million missed school days annually and an estimated loss of more than $1 billion in productivity by working parents of asthmatic children.3 The direct and indirect monetary costs relating to asthma were estimated to be $11.3 billion in 1998. 4 Hospital visits for pediatric asthma have increased significantly. Over the last decade, asthma admission rates for infants 0-4 years old have nearly doubled, and for school-aged children 5-14 years old, the rate of hospital admission has increased nearly 65%.2,4,5 Additionally, emergency departme...

Retained fecalith after an appendectomy is an uncommon complication frequently associated with intra-abdominal abscess. Treatment options include percutaneous, open, or laparoscopic drainage of the abscess and retrieval of the fecalith, as antibiotics and drainage alone are usually insufficient. Laparoscopy offers the advantages of enhanced visualization of the abdomen, improved cosmesis, and a quicker return to normal daily activities. The principles of laparoscopic treatment include the careful identification of all anatomic landmarks, as the abscesses are frequently adherent to intra-abdominal structures compromising the safety of the operation. In this paper, we present 2 cases of laparoscopic drainage of an intra-abdominal abscess with retrieval of a fecalith in pediatric patients 1 and 6 weeks after an initial appendectomy and a review the literature.

A multidisciplinary approach to protocol development and implementation significantly increased compliance to a topical analgesia protocol for pediatric patients undergoing nonurgent painful procedures in a community medical center.