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Biomedical subjects

Ghazala Q Sharieff

Publications and source records attributed to Ghazala Q Sharieff.

17 recordsLinked to original sources
PubMed2006

The pediatric ECG.

Knowledge of the basics of pediatric ECG interpretation is helpful in differentiating normal from abnormal findings. These basics include familiarity with the age-related normal findings in heart rate, intervals, axis, and waveform morphologies; an understand-ing of cardiac physiologic changes associated with age and maturation, particularly the adaptation from right to left ventricular predominance; and a rudimentary understanding of common pediatric dysrhythmias and findings associated with congenital heart diseases.

Adolescent↗
PubMed2006

Abdominal pain in children.

Abdominal pain and gastrointestinal symptoms such as vomiting or diarrhea are common chief complaints in young children who present in emergency departments. It is the emergency physician's role to differentiate between a self-limited process such as viral gastroenteritis or constipation and more life-threatening surgical emergencies. Considering the difficulties inherent in the pediatric examination, it is not surprising that appendicitis, intussusception, and malrotation with volvulus continue to be among the most elusive diagnoses. This article reviews both the self-limited and more life-threatening gastrointestinal conditions that may present in the emergency department.

Abdominal Pain↗
PubMed2006

Seizures in children.

Seizures are the most common pediatric neurologic disorder. Four to ten percent of children suffer at least one seizure in the first 16 years of life. The incidence is highest in children less than 3 years of age, with a decreasing frequency in older children. Epidemiologic studies reveal that approximately 150,000 children will sustain a first-time unprovoked seizure each year, and of those, 30,000 will develop epilepsy. This article describes the types, diagnoses, and management and disposition of this pediatric neurologic disorder.

Age Factors↗
PubMed2006

Newborn emergencies: the first 30 days of life.

The evaluation and appropriate management of the critically ill neonate requires knowledge of the physiologic changes and life-threatening pathologies that may present during this time period. A broad systematic approach to evaluating the neonate is necessary to provide a comprehensive yet specific differential diagnosis for a presenting complaint or symptom. Efficient recognition and prompt management of illness in the neonatal period may be life saving. Recently, it has become more important for the emergency department physician to be familiar with the neonate because of early discharge policies. This review provides a systematic approach to the recognition, emergency stabilization, and management of the more common newborn emergencies.

Algorithms↗
PubMed2006

Pediatric dysrhythmias.

Arrhythmias in children are less common than in adults but are increasing because of successful repair of congenital heart diseases. Supraventricular tachycardia is the most common symptomatic pediatric tachyarrhythmia. Atrial flutter and atrial fibrillation in children are attributed largely to structural heart disease. Bradycardia is defined as a heart rate less than the lower limit of normal for a child's age, and the most common cause is sinus bradycardia. Despite the infrequent occurrence of arrhythmias, it is crucial to expeditiously identify and treat certain rhythm abnormalities because they can lead to further decompensation.

Anti-Arrhythmia Agents↗
PubMed2005

Emergency physicians and the care of children.

The care of children is an integral aspect of emergency medicine. This article reviews the many important contributions that emergency physicians have made in advancing the acute care of children.

Child↗
PubMed2004

Pediatric cardiac disorders.

Although pediatric cardiac disorders are not commonly seen in the Emergency Department, they are important to identify to prevent further morbidity or mortality. Diagnosis may be complicated by the lack of classic complaints such as chest pain or palpitations that are commonly associated with cardiac disorders. In fact, presenting complaints associated with pediatric cardiac disorders, like "fussiness" or "difficulty feeding," may seem quite nonspecific. This article reviews pertinent issues concerning diagnosis and management of pediatric cardiac disorders including supraventricular tachycardia, congenital heart disease, prolonged QT syndrome, pericarditis, myocarditis, rheumatic fever, and endocarditis. It also reviews abnormal findings in pediatric electrocardiograms.

Diagnosis, Differential↗
PubMed2003

Acute esophageal coin ingestions: is immediate removal necessary?

AIMS: Coins are the most commonly encountered foreign body ingestions presenting to the emergency department (ED). The purpose of our study was to retrospectively evaluate a new institutional protocol implemented in 1998, in which healthy patients with acute (less than 24 h) coin ingestions located below the thoracic inlet, were observed at home with next-day follow-up. If repeat radiographs revealed a persistent esophageal foreign body, then the coin was removed. METHODS: The charts of all patients who presented to the ED with a complaint of esophageal foreign body were reviewed from 1 January 1998 until 31 December 2001. Patients were excluded if they had non-acute ingestions, known esophageal pathology, severe symptoms such as stridor or inability to tolerate oral fluids, or incomplete records. RESULTS: Of 31 patients with esophageal coin ingestions, 16 had coins above the thoracic inlet. Three of these patients were asymptomatic and all experienced spontaneous coin passage into the stomach within 2 h of ED presentation while awaiting coin removal. There were eight eligible patients with coins located below the thoracic inlet. Three of five patients with mid-esophageal coins experienced spontaneous coin passage while the remaining two required coin removal on next-day follow-up for persistent esophageal coins. Three of three patients with distal-esophageal coin ingestions experienced spontaneous coin passage. There were no complications in any of the patients who underwent delayed coin removal either due to the procedure itself or to a delay in therapy. CONCLUSIONS: Patients with acute esophageal coin ingestions may experience spontaneous coin passage and therefore, patients with coins located below the thoracic inlet with minor symptoms may be candidates for next-day follow-up. If repeat radiographs reveal a persistent esophageal coin, then the coin should be immediately removed. Furthermore, asymptomatic patients with coins above the thoracic inlet should undergo repeat radiographs in 2-5 h, as spontaneous coin passage may occur. Our protocol may also be more convenient and cost-effective as patients can be observed at home.

Child↗
PubMed2003

Abdominal surgical emergencies in infants and young children.

Surgical emergencies can be missed easily in children, who are not always able to volunteer relevant information. Awareness of the entities discussed in this review might help the EP uncover subtle clues to early diagnoses that might not be initially apparent. Ill-appearing children who have abdominal pain and vomiting should be considered to have ischemic or necrotic bowel until proven otherwise. Possible diagnoses include volvulus, intussusception, and necrotizing enterocolitis. Bilious vomiting, especially in a young infant, should be considered to be an indication of a high bowel obstruction such as midgut volvulus, which warrants immediate surgical consultation. Significant rectal bleeding with abdominal pain can result from intussusception, volvulus, or an inflamed Meckel's diverticulum. Rectal bleeding with unstable vital signs can result from an upper GI bleed (eg, peptic ulcer disease). Painless rectal bleeding can result from a Meckel's diverticulum, polyps, arteriovenous malformation, or a tumor. Examination of the genitalia is imperative, especially in boys, to exclude the possibility of an incarcerated hernia or testicular torsion.

Abdominal Pain↗
PubMed2003

Prolonged QT syndrome in children: an uncommon but potentially fatal entity.

Prolonged QT syndrome may be either congenital, as in Jervell and Lange-Nielsen or Romano-Ward syndromes, or acquired in nature. Affected children are at risk for syncope, seizures, dysrhythmias and sudden death. Physicians should consider long QT syndrome (LQTS) in all patients who present with syncope. A thorough personal and family history should be documented, with particular attention to prior syncopal episodes, congenital deafness, and unexplained sudden death. Syncope that is either recurrent or induced by exercise or stress is concerning and also should be noted. An electrocardiogram with manual calculation of the QT interval should be performed on all patients with a suggestive history. Furthermore, the diagnosis of LQTS warrants evaluation of all other family members. With recognition and appropriate treatment of affected patients, the potentially fatal consequences of LQTS may be prevented.

Adolescent↗
PubMed2003

The self-inflating bulb as an esophageal detector device in children weighing more than twenty kilograms: a comparison of two techniques.

STUDY OBJECTIVES: We confirm the ability of the self-inflating bulb to indicate endotracheal tube position in children and determine which method of bulb compression is more accurate. METHODS: This single-blind, prospective, single cohort, repeated measures comparison of the on-deflate and the off-deflate methods of bulb compression was conducted in the operating room of a children's hospital. Seventy-five patients weighing more than 20 kg were enrolled. All patients had an endotracheal tube placed in both the trachea and the esophagus, 5 mL/kg of air was insufflated into the stomach, and 4 measurements were obtained on each patient. The bulb was either applied to the endotracheal tube and then compressed (on-deflate method), or compressed before its attachment to the endotracheal tube (off-deflate method). The order in which the methods were utilized was determined by a computer-generated permuted block randomization scheme. The blinded assessor told the anesthesiologist when to start and stop the clock after each intervention. Five seconds was used as the cut-off time for which the clock was stopped. If the bulb reexpanded within 5 seconds, then the tube was considered to be in the trachea; if it did not reexpand, then this was considered to be an esophageal intubation. RESULTS: The mean patient age was 11 years. The on-deflate method had a sensitivity of 99% and a specificity of 92% for detecting tracheal intubations. The off-deflate method had a sensitivity of 99% and a specificity of 100% (95% confidence interval [CI] for the difference between methods: sensitivity -6 to 6, specificity -14 to 0.4). The inaccuracy rate for the off-deflate method was 1%, whereas the inaccuracy rate for the on-deflate method was 5% (Delta4; 95% CI 0.2 to 9). CONCLUSION: The self-inflating bulb is a reliable method of detecting endotracheal tube position in children. Furthermore, the off-deflate method may be more reliable and accurate than the on-deflate method when used in children weighing more than 20 kg.

Adolescent↗
PubMed2003

A rare case of Salmonella-mediated sacroiliitis, adjacent subperiosteal abscess, and myositis.

We report the case of a 16-year-old female who was ultimately diagnosed with Salmonella sacroiliitis, adjacent subperiosteal abscess, and myositis of the left iliopsoas, gluteus medius, and obturator internus muscles. Early and accurate recognition of this syndrome and other infectious musculoskeletal syndromes can prove difficult for the emergency physician, as these disease processes require special attention to pain of proportion to physical findings and a high index of suspicion.

Abscess↗
PubMed2003

The self-inflating bulb as an airway adjunct: is it reliable in children weighing less than 20 kilograms?

OBJECTIVES: To confirm the ability of the self-inflating bulb to indicate endotracheal tube (ETT) position in children weighing less than 20 kilograms, and to determine whether the presence of air in the stomach affects the bulb's accuracy. METHODS: This single-blind, prospective, single-cohort, repeated-measures, equivalence study was conducted in the operating room of a children's hospital. Seventy patients weighing less than 20 kilograms were enrolled. All patients had an uncuffed ETT placed in both the trachea and the esophagus. Measurements were initially obtained on both tubes without the presence of air in the stomach using the on-deflate method (the bulb is compressed after attachment to the ETT). Five mL/kg of air was then insufflated into the stomach and two additional measurements were obtained on each patient. The order in which the bulb was checked was determined by a computer-generated permuted block randomization scheme. The blinded assessor told the anesthesiologist when to start and stop the clock after each intervention. Five seconds was used as the cutoff time for which the clock was stopped. If the bulb re-expanded within 5 seconds, then the tube was considered to be in the trachea; if it did not re-expand, then this was considered to be an esophageal intubation. RESULTS: Median patient age was 2 years. The on-deflate method without air in the stomach had a sensitivity of 100% and a specificity of 94% for detecting tracheal intubations. With air in the stomach, the bulb had a sensitivity of 97% and a specificity of 96% (95% confidence interval [95% CI] for the difference between methods: sensitivity -3 to 10; specificity -10 to 7). The inaccuracy rate for the on-deflate method without air in the stomach was 3%, whereas the inaccuracy rate with air in the stomach was 4% (Delta -1, 95% CI = -5 to 4). There were no false positives or false negatives in the 24 patients weighing between 5 and 10 kilograms. CONCLUSIONS: The self-inflating bulb is a reliable method of detecting endotracheal tube position in children weighing less than 20 kg, even with the use of uncuffed endotracheal tubes. Furthermore, the presence of air in the stomach, simulating field conditions, does not affect bulb effectiveness in detecting endotracheal tube position.

Body Weight↗
PubMed2002

Common complaints in the first 30 days of life.

Visits to the emergency department (ED) by neonates and their parents can cause anxiety for parents and the ED staff. Many of the presenting complaints are unique to the neonatal population, and an understanding of both common problems and true medical emergencies is paramount. This article discusses the complaints the EDs have seen more frequently as a result of earlier newborn discharges from hospitals.

Consciousness Disorders↗
PubMedDate not supplied

Midazolam for the treatment of out-of-hospital pediatric seizures.

OBJECTIVE: To assess the effectiveness and safety of intravenous (IV) and intramuscular (IM) midazolam in the treatment of pediatric seizures by paramedics. METHODS: All cases in which paramedics treated patients under the age of 18 years with midazolam for seizures per county protocol were evaluated over a one-year period. Prehospital records were reviewed for treatment and reassessment, while the subgroup of patients who were transported to Children's Hospital were followed up for emergency department (ED) outcome. RESULTS: Midazolam was administered to 86 pediatric patients with ages ranging from 2 months to 14 years for the treatment of seizures per county protocol. There were 54 IV doses and 32 IM doses delivered. Of the 86 patients, post-intervention reevaluation was documented for 74 patients (86%) representing 49 IV and 25 IM doses. Improvement was reported for 91% (67/74) of patients. Greater success was reported with IV drug administration (47/49, 96%) as compared with 80% (20/25) with IM administration (p < 0.05). Four patients (three treated IM and one IV) had respiratory compromise necessitating field airway management. All four patients had respiratory compromise documented prior to midazolam administration. Forty-four patients were treated at Children's Hospital. Seven were intubated in the ED after having been given additional medications for seizures. None were intubated on arrival and none were felt to require intubation secondary to midazolam-induced respiratory depression. CONCLUSION: Prehospital IV midazolam is an effective intervention for pediatric seizures, while IM midazolam was associated with a 20% failure rate, with both having minimal risk of respiratory compromise.

Adolescent↗