Background: Current practices of reporting critical laboratory values make it challenging to measure and assess the timeliness of receipt by the treating physician as required by The Joint Commission’s 2008 National Patient Safety Goals. Methods: A multidisciplinary team of laboratorians, clinicians, and information technology experts developed an electronic ALERTS system that reports critical values via the laboratory and hospital information systems to alphanumeric pagers of clinicians and ensures failsafe notification, instant documentation, automatic tracking, escalation, and reporting of critical value alerts. A method for automated acknowledgment of message receipt was incorporated into the system design. Results: The ALERTS system has been applied to inpatients and eliminated approximately 9000 phone calls a year made by medical technologists. Although a small number of phone calls were still made as a result of pages not acknowledged by clinicians within 10 min, they were made by telephone operators, who either contacted the same physician who was initially paged by the automated system or identified and contacted alternate physicians or the patient’s nurse. Overall, documentation of physician acknowledgment of receipt in the electronic medical record increased to 95% of critical values over 9 months, while the median time decreased to <3 min. Conclusions: We improved laboratory efficiency and physician communication by developing an electronic system for reporting of critical values that is in compliance with The Joint Commission’s goals.

We describe a 2009 H1N1 virus infection with a high viral load in a previously healthy infant who presented with complex febrile seizures and improved on oseltamivir without neurologic sequelae. Febrile seizures may be a complication in young children experiencing infection with high viral loads of 2009 H1N1 influenza virus. CASE REPORTIn March of 2010, a previously healthy 8-month-old male presented to the emergency room (ER) with 2 days of upper respiratory symptoms, including cough, congestion, fever to 102.5°F, and seizure activity. Three seizures occurred prior to presentation to the ER, each episode lasting up to 2 h. These events were accompanied by perioral cyanosis and emesis. The family history was significant for complex febrile seizures in the patient's mother and sister, who had no history of epilepsy. Upon arrival in the ER, the patient continued to have seizurelike activity described as "glassy-looking eyes" and limpness with concurrent myoclonal jerking of the head. His vital signs at presentation were as follows: rectal temperature, 103.3°F; heart rate, 132 beats per minute; respiratory rate, 40 breaths per minute. His level of consciousness was 9 on the Glasgow coma scale. His venous blood gas pH was 6.9, with a partial O 2 pressure (pO 2 ) of 77 mm Hg. Due to decreased breath sounds bilaterally, increased work of breathing, and diminished neurologic status, the patient was placed on mechanical ventilation and admitted to the intensive care unit (ICU). The results of noncontrasted computed tomography (CT) of the head, electroencephalogram (EEG), complete blood count (CBC), and a basic metabolic panel, including aspartate transaminase (AST) and alanine aminotransferase (ALT), were within normal limits, with the exception of a blood glucose level of 185 mg/dl. Urine, cerebrospinal fluid (CSF), blood, and respiratory specimens were collected for detection of potential pathogens. A nasopharyngeal swab (NPS) specimen revealed a positive PCR result for influenza A virus, which was further subtyped as 2009 H1N1. CSF studies were remarkable for pleocytosis, with 46 total cells in the chamber and a lymphocyte predominance and CSF glucose of 126 mg/dl; no red cells were observed. CSF protein was within normal limits at 30 mg/dl. A chest X-ray revealed a vague opacity suggestive of atelectasis, contusion, or infiltrate in the central left lung.The patient was started simultaneously on 24 mg oseltamivir every 12 h for the positive NPS and 500 mg ceftriaxone every 12 h for the chest X-ray findings. Temperatures up to 104°F rectally were recorded overnight in the absence of overt seizure activity. The following morning, the venous blood gas values normalized, and the patient was extubated and weaned from O 2 supplementation. Ceftriaxone therapy was changed to an oral cephalosporin. Bacterial cultures of urine, blood, and CSF were all negative. The patient was treated with 24 mg oseltamivir every 12 h for 5 days, and family members received oseltamivir for influenza prophylaxis. On day 3 of admission, the pat...

Extraadrenal pheochromocytomas and paragangliomas are rare entities within the pediatric population. We report the presentation of three synchronous extra-adrenal abdominal paragangliomas in an adolescent boy who carries a germline mutation in the succinate dehydrogenase B (SDHB) gene. Loss of heterozygosity of this allele was demonstrated by direct sequencing of DNA from two of his tumors, confirming loss of tumor suppressor function in the pathogenesis of these paragangliomas.