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Risk factors for repeated febrile seizures during the same febrile illness 同一发热性疾病中反复发热性惊厥的危险因素
Pub Date : 2020-12-09 DOI: 10.22470/pemj.2020.00157
S. Cho, Ji-hoon Kim, Y. Kyong, K. Cha, Hwan Song, S. Seol
Purpose: We aimed to identify the factors associated with the repeated febrile seizures (RFS), defined as recurrent seizures during the same febrile illness. Methods: We reviewed the medical records of children with febrile seizure who visited 4 academic emergency departments from October 2016 through September 2018. Differences were identified in variables regarding clinical and laboratory characteristics between the children with and without RFS. The RFS was the primary outcome. Logistic regression was conducted to identify factors associated with the occurrence of RFS. Results: Among 1,551 children, 922 were included in the study, of whom, 198 (21.5%) underwent RFS. Of the children with RFS, 188 (94.9%) underwent the recurrences within the initial 24 hours. Logistic regression showed focal seizure (adjusted odds ratio, 6.67; 95% confidence interval, 2.37-18.82), venous pH < 7.31 (5.89; 3.13-11.08), and postictal drowsiness > 30 minutes (1.90; 1.30-2.78) as the factors for RFS. Conclusion: In children with febrile seizure, focal seizure, acidosis, and prolonged postictal state may be independent risk factors for RFS. These findings may be informed to healthcare professionals and parents caring for children with febrile seizure.
目的:我们旨在确定与反复热性惊厥(RFS)相关的因素,定义为在相同的热性疾病中反复发作。方法:回顾2016年10月至2018年9月4个学术急诊科的热性惊厥患儿病历。在有RFS和没有RFS的儿童之间,在临床和实验室特征的变量中发现了差异。RFS是主要结果。采用Logistic回归分析确定与RFS发生相关的因素。结果:1551名儿童中,922名纳入研究,其中198名(21.5%)接受了RFS。在RFS患儿中,188例(94.9%)在最初24小时内复发。Logistic回归显示局灶性癫痫发作(校正优势比为6.67;95%可信区间,2.37 ~ 18.82),静脉pH < 7.31 (5.89;3.13-11.08),后睡意> 30分钟(1.90;1.30-2.78)作为RFS的因素。结论:热性惊厥患儿,局灶性惊厥、酸中毒、术后状态延长可能是RFS的独立危险因素。这些发现可告知保健专业人员和父母照顾儿童热性惊厥。
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引用次数: 0
Points & Pearls: Neonatal resuscitation in the emergency department. 要点与要点:急诊新生儿复苏。
Kathryn H Pade
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引用次数: 0
A case of neonatal lupus presenting with fever and skin rash in a 47-day-old girl 新生儿狼疮的病例表现为发烧和皮疹在一个47天的女孩
Pub Date : 2020-12-02 DOI: 10.22470/pemj.2020.00171
Y. Shin, Ji‐Man Kang, Jong Gyun Ahn
신생아 루푸스는 임신나이 16-26주에 모체 자가항체가 태반을 통해 전달되어 발생한다. 1954년에 Bridge와 Foley가 모체의 루푸스 관련 인자가 신생아에 전달되는 것을 확인했고, 같은 해 McCuistion과 Schoch가 첫 증 례를 보고했다. 이 질환은 핵단백 항원인 SSA, SSB 또는 U1-리보핵산단백질에 대한 자가항체를 가지는 전신홍반 루푸스, 쇠그렌증후군, 류마티스관절염 등을 진단받은 어 머니로부터 태어난 신생아 중 약 2%에서 발생한다고 알려 졌다. 피부증상(약 40%)이 가장 흔하고 혈구 이상(약 20%), 간기능 이상(약 15-25%)도 나타날 수 있으며, 가 장 치명적인 선천심장차단은 약 25%에서 나타난다. 신생아 루푸스의 임상증상은 선천심장차단 외에는 비특 이적이므로, 열 및 발진으로 응급실을 방문한 3개월 미만 영아에서 이를 감별하기 어렵다. 감염을 우선 감별해야 하 지만, 증상이 지속하면 비교적 드문 감별진단인 신생아 루 푸스를 의심해야 한다. 본 저자는 자가면역질환이 없는 어 머니로부터 태어난 47일 여아가 열 및 발진으로 응급실을 방문하여 패혈증 및 다형홍반을 의심했지만, 상기 질환으 로 최종 진단한 증례를 경험했다. 본 증례는 열 및 발진을 동반한 3개월 미만 영아의 감별진단에 이 질환을 포함해 야 한다는 시사점이 있어, 이를 문헌고찰과 함께 보고한 열과 발진을 주소로 응급실을 방문한 47일 여아에서 진단된 신생아 루푸스
新生儿狼群是在怀孕16-26周时,母体自身抗体通过胎盘传递而产生的。1954年,Bridge和Foley发现母体的狼疮相关因子被传递给新生儿,同年McCuistion和Schoch报告了第一个病例。据悉,该疾病发生在被诊断为对核蛋白抗原SSA、SSB或U1-核糖核酸蛋白质具有自身抗体的全身红斑狼疮、索格伦综合症、类风湿性关节炎等疾病的母亲出生的新生儿中,约2%的新生儿。最常见的皮肤症状(约40%)、血细胞异常(约20%)、肝功能异常(约15-25%)、最致命的先天心脏阻断(约25%)。新生儿狼疮的临床症状除先天性心脏被切断外,属于非特异性,因此因发烧及出疹来到急诊室的未满3个月的婴儿很难鉴别。虽然首先要鉴别感染,但如果症状持续下去,就要怀疑是比较罕见的鉴别诊断——新生儿卢普斯。作者在没有自身免疫疾病的母亲出生的47日,女婴因发烧及出疹来到急诊室,怀疑是败血症及多型红斑,但最终确诊为上述疾病。本病例暗示伴随发烧及出疹未满3个月的婴儿的鉴别诊断中应包括该疾病,因此将此文献考察并报告的发烧及出疹作为地址访问急诊室的47日女婴被诊断出的新生儿卢普斯
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引用次数: 1
A case of diabetic ketoacidosis and hyperosmolar hyperglycemic state complicated with iatrogenic left femoral arterial thrombosis in a 14-year-old girl with newly diagnosed type 2 diabetes mellitus 1例新诊断为2型糖尿病的14岁女孩糖尿病酮症酸中毒和高渗性高血糖并发医源性左股动脉血栓形成
Pub Date : 2020-12-01 DOI: 10.22470/pemj.2020.00136
Y. J. Kim, Yong Hyuk Kim
While diabetic ketoacidosis (DKA) is a major cause of morbidity and mortality of type 1 diabetes mellitus, recent studies have shown that 12%-56% of DKA cases occur in adults with type 2 diabetes mellitus (T2DM). Such cases are usually characterized by obese patients with family history of T2DM who show severe hyperglycemia and ketoacidosis. This specific form is termed ketosis-prone 2형 당뇨병을 처음 진단받은 14세 여자 환자에서 발생한 좌측 넓적다리동맥의 의인 혈전증을 동반한 당뇨병케토산증 및 고삼투질비케토산혼수 증례
While diabetic ketoacidosis (DKA) is a major cause of morbidity and mortality of type 1 diabetes mellitus;recent studies have shown that 12%-56% of DKA cases occur in adults with type 2 diabetes mellitus (T2DM)。Such cases are usually characterized by obese patients with family history of T2DM who show severe hyperglycemia and ketoacidosis。This specific form is termed ketosis-prone 2型糖尿病首次被诊断为糖尿病的14岁女性患者发生了左大腿动脉的人血栓同时伴有糖尿病酮症酸症及高渗透性鼻酸昏睡症
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引用次数: 0
Neonatal resuscitation in the emergency department. 急诊新生儿复苏。
Pub Date : 2020-12-01 Epub Date: 2020-12-02
Andrea T Vo, Christine S Cho

Although most neonates will not require resuscitation, emergency clinicians must be prepared to manage neonates who require respiratory assistance. This issue reviews current expert recommendations and consensus updates of the best practices in resuscitation of neonates. An overview of neonatal physiology provides a framework for understanding how neonatal resuscitation differs from that of children and adults. A step-wise, systematic approach is provided for identifying and managing newborns who require resuscitation. The treatment, management, and over-arching goals for neonatal resuscitation and newborn care are also reviewed.

虽然大多数新生儿不需要复苏,但急诊临床医生必须准备好管理需要呼吸辅助的新生儿。本期回顾了目前专家建议和关于新生儿复苏最佳做法的共识更新。新生儿生理学的概述为理解新生儿复苏与儿童和成人复苏的区别提供了一个框架。一个循序渐进的,系统的方法提供了识别和管理新生儿谁需要复苏。治疗,管理和总体目标的新生儿复苏和新生儿护理也进行了审查。
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引用次数: 0
Gender differences in characteristics of adolescents with suicide attempt at the emergency department 急诊科青少年自杀倾向特征的性别差异
Pub Date : 2020-11-25 DOI: 10.22470/pemj.2020.00115
Youn Ju An, S. Paek, O. Kim, J. A. Kim, J. Kwon, M. J. Kim
Purpose: This study was performed to investigate the gender differences in suicide attempts in adolescents. Methods: We reviewed the medical records of adolescents (≤ 18 years) who had visited a university hospital emergency department (ED) for suicide attempts from January 2018 through December 2019. General characteristics of the adolescents, details of the attempt, and outcomes were analyzed. The characteristics were age, gender, the Korean Triage and Acuity Scale, previous attempts, and psychiatric history. The details were initial Glasgow Coma Scale, attempt-arrival time, living alone, method, place, and motivation of the attempt, and concurrent use of alcohol. The outcomes included psychiatric consultation, ED length of stay, and ED outcomes. Results: A total of 86 adolescents were included. Their age ranged from 13 to 18 years, and girls accounted for 65.1%. The girls had more frequent psychiatric history than boys (66.1% vs. 30.0%; P = 0.001) without a significant difference in previous attempts (55.4% vs. 46.7%; P = 0.442). The most common methods of the attempt in the girls and boys were poisoning and sharp objects (53.3% [16 of the 30 boys] vs. 60.7% [34 of the 56 girls]; P = 0.002), respectively. No differences were found in the other details of the attempt and in the rate of psychiatric consultation. The girls had a longer ED length of stay (247.0 minutes vs. 186.5; P = 0.033), a lower rate of discharge against medical advice, and higher rates of hospitalization (discharge against medical advice, 53.6% vs. 76.7%; non-psychiatric, 23.2% vs. 3.3%; psychiatric, 12.5% vs. 0%; P = 0.003). Conclusion: Girls may make suicide attempts, usually by poisoning, and undergo relevant hospitalization, more often than boys. In contrast, boys usually use sharp objects, with a higher rate of discharge against medical advice and lower rates of the attempt and hospitalization.
目的:探讨青少年自杀倾向的性别差异。方法:我们回顾了2018年1月至2019年12月在某大学医院急诊科(ED)就诊的青少年(≤18岁)自杀未遂的医疗记录。分析青少年的一般特征、尝试的细节和结果。特征包括年龄、性别、韩国分诊和敏锐度量表、既往尝试和精神病史。细节包括最初的格拉斯哥昏迷量表、企图到达时间、独自生活、企图的方法、地点和动机以及同时使用酒精。结果包括精神科咨询、急诊科住院时间和急诊科结果。结果:共纳入86名青少年。年龄在13 - 18岁之间,女孩占65.1%。女孩比男孩有更频繁的精神病史(66.1%比30.0%;P = 0.001),之前的尝试无显著差异(55.4% vs. 46.7%;P = 0.442)。女生和男生最常见的自杀方式是投毒和利器自杀,分别占53.3%(30例男生中16例)和60.7%(56例女生中34例);P = 0.002)。在企图自杀的其他细节和精神病学咨询的比率方面没有发现差异。女孩ED停留时间较长(247.0分钟vs 186.5分钟;P = 0.033),不遵医嘱出院率较低,住院率较高(不遵医嘱出院,53.6% vs. 76.7%;非精神科,23.2% vs. 3.3%;精神科,12.5%对0%;P = 0.003)。结论:女孩可能有自杀企图,通常是中毒,并接受相应的住院治疗,比男孩多。相比之下,男孩通常使用尖锐物品,不遵医嘱出院的比率较高,尝试和住院的比率较低。
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引用次数: 1
A case of diabetic ketoacidosis with posterior cerebral artery territory ischemic stroke mimicking uncal herniation 糖尿病酮症酸中毒合并脑后动脉区缺血性脑卒中1例
Pub Date : 2020-11-16 DOI: 10.22470/pemj.2020.00122
Jin ho Kim, K. Cho, Min Sun Kim, Sun Jun Kim
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引用次数: 0
The effect of medically-attended injury experience on the use of home safety equipment 医疗护理伤害经验对使用家庭安全设备的影响
Pub Date : 2020-11-05 DOI: 10.22470/pemj.2020.00059
I. Jeong, S. Jung, Joohyun Suh, K. Ahn, J. A. Bae
Purpose: To assess the effect of medically-attended injury (MAI) on the use of home safety equipment, we analyzed the differences in parents’ perception and attitude about injury prevention, and use of home safety equipment depending on the children’s MAI experiences. Methods: From March 2018 through February 2019, we surveyed parents of children aged 5 years or younger via a mobile phone. The parents were divided into the MAI and non-MAI groups. The mobile survey focused on the perception and attitude about injury prevention, and use of home safety equipment (if not used, barriers). Results: Of the 204 parents, 75 (36.8%) reported their children’s MAI, comprising the MAI group. This group used the safety equipment more frequently than the non-MAI group (odds ratio, 7.03; 95% confidence interval, 3.39-14.59; P < 0.001). No significant differences between the 2 groups were found in the perception and attitude about injury prevention, barriers to the use of the equipment, and the type of the equipment in use. Conclusion: Parents’ experience in their children’s MAIs was associated with the use of home safety equipment, but it did not affect their perception and attitude about injury prevention. A visit to the emergency department with MAI is an opportunity for education on injury prevention and changes of the attitude.
目的:探讨医伴伤害(MAI)对家庭安全设备使用的影响,分析不同医伴伤害经历的家长对伤害预防和家庭安全设备使用的认知和态度的差异。方法:2018年3月至2019年2月,通过手机对5岁及以下儿童的父母进行调查。将父母分为MAI组和非MAI组。移动调查的重点是对伤害预防的看法和态度,以及使用家庭安全设备(如果没有使用,屏障)。结果:204名家长中,75名(36.8%)报告其子女患有MAI,构成MAI组。该组使用安全设备的频率高于非mai组(优势比,7.03;95%置信区间为3.39 ~ 14.59;P < 0.001)。两组在预防伤害的认知和态度、使用器械的障碍、使用器械的种类等方面差异无统计学意义。结论:家长在儿童MAIs中的经历与家庭安全设备的使用相关,但不影响其对伤害预防的认知和态度。带着MAI去急诊科是一个教育预防伤害和改变态度的机会。
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引用次数: 0
Points & Pearls: management of pediatric head and neck infections in the emergency department. 要点与要点:急诊儿科头颈部感染的处理。
Kathryn H Pade
{"title":"Points & Pearls: management of pediatric head and neck infections in the emergency department.","authors":"Kathryn H Pade","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":38199,"journal":{"name":"Pediatric emergency medicine practice","volume":"17 Suppl 11","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2020-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38574344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Management of pediatric head and neck infections in the emergency department. 急诊儿科头颈部感染的处理
Pub Date : 2020-11-01 Epub Date: 2020-11-02
Samira Abudinen-Vasquez, Michelle N Marin

Head and neck infections can spread to nearby structures, compromising the airway and progressing to life-threatening events. Pediatric head and neck infections can be difficult to recognize; emergency clinicians must know the signs and symptoms of head and neck infections for early diagnosis and urgent management in order to prevent complications and decrease hospitalization rates. This issue reviews presenting signs and symptoms of pediatric head and neck infections, discusses when diagnostic studies are indicated, and offers evidence-based recommendations for management. Conditions reviewed include mastoiditis, sinusitis, Ludwig angina, peritonsillar abscess, retropharyngeal abscess, Lemierre syndrome, and acute suppurative thyroiditis.

头颈部感染可扩散到附近的结构,危及气道并发展为危及生命的事件。儿童头颈部感染可能难以识别;急诊临床医生必须了解头颈部感染的体征和症状,以便早期诊断和紧急处理,以防止并发症和降低住院率。本期综述了小儿头颈部感染的体征和症状,讨论了何时需要进行诊断研究,并提供了基于证据的治疗建议。所回顾的疾病包括乳突炎、鼻窦炎、路德维希心绞痛、囊周脓肿、咽后脓肿、Lemierre综合征和急性化脓性甲状腺炎。
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引用次数: 0
期刊
Pediatric emergency medicine practice
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