Guillain-Barre syndrome (GBS) is an acquired disease of the peripheral nervous system which causes demyelination and leads to weakness, ataxia, and areflexia. There are a variety of forms of the syndrome, and although it is found in all age groups, it is rare in children less than two years of age. The present complaint of weakness, ataxia, or lower extremity pain in the pediatric population should cause the practitioner to consider GBS in the differential. We describe a case of a 14-month-old girl presenting with weakness and the inability to ambulate who was diagnosed with GBS. The purpose of this paper is to review the emergency medicine diagnosis and management of Guillain-Barre syndrome in children.
Pelvic fracture is a result of devastating injuries and is usually encountered in conjunction with other life-threatening injuries. The aim of the current study was to determine the outcome determinants of patients with pelvic fractures referred to a large trauma center in southern Iran. This retrospective cross-sectional study was conducted in a level I trauma center over a period of three years from 2012 to 2015. We included all patients with pelvic fractures whose medical records had sufficient data. Data were compared between good condition and poor conditions. A total of 327 patients with mean age of 40.1 ± 19.7 years were included. Poor condition was defined as being associated with higher heart rate (p=0.002), lower systolic blood pressure (p<0.001), lower diastolic blood pressure (p=0.002) lower Glasgow Coma Scale (GCS) on admission (p<0.001) and higher Injury Severity Score (ISS) (p<0.001). Those with poor conditions had significantly higher admission to ICU (p<0.001), higher rate of surgical interventions (p<0.001) and higher mortality (p<0.001). The hospital length of stay (p<0.001) and ICU length of stay (p=0.025) were also longer in those with poor condition. Lower hemoglobin, lower pH, higher heart rate, lower systolic blood pressure, lower GCS on admission and higher ISS were important outcome determinants of traumatic pelvic fractures.
Background: According to Advanced Trauma Life Support, chest radiography must be performed during the initial evaluation of patients with trauma. We studied the CXR performed in the emergency room of Rajaie Hospital to determine its usefulness. Methods: In this prospective study, patients who referred with high-energy trauma from December 2013 until April 2014 were recruited. Their demographic characteristics, including age, gender, and cause of trauma were recorded. Meticulous medical history was taken from all patients and they were examined by emergency medicine specialist. Simple radiographic CXR was performed for selective patients and image findings and their mediastinal width were recorded. All statistical analysis was performed using SPSS software version 20.0 and P-value less than 0.05 was considered significant. Results: Of the total 790 patients assessed, 137 patients were female (17.3%) and 655 were male (82.7%). Mean age of patients was 35.13±17.01 (ranging from 12 to 91); Mean mediastinal width was 80.9±11.45 mm (range: 49.2-142.29). The most common causes of trauma included car-to-patient accident in 131 patients (16.5%), motor-to-car accident in 128 patients (16.2%), car turnover in 103 (13%), falling down in 93 (11.7%), and stab wound 88 (11.1%). The most common pathologic finding included rib fractures (42.7%), pneumothorax (11.6%), abnormal diaphragmatic findings (10.3%), and hemothorax (8.3%). Conclusion: The results of the current study, in accordance to previous studies, suggest rib fractures, pneumothorax, abnormal diaphragmatic findings, and hemothorax as the most frequent findings in CXR that need to be assessed meticulously. Moreover, the majority of patients were young males and the most frequent causes of trauma included car accidents, falling down, and stab wound. Therefore, paying attention to their diagnosis and treatment may increase the survival of this important group of patients.
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