Biomedical subjects
Publications and source records attributed to S M Selbst.
Chest pain in adolescents and younger children is most often benign, and cardiac causes are rare. We present a 16-year-old with chest pain temporally related to cocaine use and discuss the relationship between cocaine use and acute myocardial infarction that has been seen in the adult population. Pediatricians and emergency physicians should consider cocaine abuse in the evaluation of an adolescent with chest pain.
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Lead poisoning has infrequently resulted from gunshot wounds with retained lead particles in adults. This has not been previously found in children. The case of an 8-year-old boy in whom lead poisoning developed soon after a gunshot wound is reported. The child had no symptoms directly related to lead poisoning, but he received chelation therapy. The case demonstrates the need to consider lead poisoning in children with retained particles following gunshot wounds.
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Minors frequently present to the ED for treatment without their legal guardians. In most such situations, it is best to contact the parents to obtain consent for treatment and to inform them about their child's problem. However, in some emergency situations or problems involving adolescent health, it may be impractical or damaging to contact the parents. In these situations, the law is sufficiently vague to protect the well-meaning physician who gives care to consenting minors for their own benefit. Of course, if problems result from the care which is rendered, the usual malpractice law will apply, and the physician will try to demonstrate that his treatment fit into one of the legal exceptions to the general rule.
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Acute lead encephalopathy has become a rare syndrome in the United States. Early recognition of the disease, with institution of specific chelation therapy, is critical in order to minimize mortality and morbidity. Lead intoxication, however, may mimic other more common diseases. We report an 8-year-old child with known sickle cell anemia who presented initially with findings suggestive of vaso-occlusive crisis but who deteriorated rapidly and was found to have severe lead poisoning. We present her hospital course and review the management of lead encephalopathy in detail.
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In a retrospective study of chest pain, 267 children were identified. This gave an occurrence rate (per patient visit) of 0.249%. Male patients were identified as often as female patients, and teenagers as often as children less than age 12 years. Chest pain was found to be present for more than 1 month in 8.6% and for more than 1 year in 7.8%. Idiopathic chest pain was the most common diagnosis made, followed by functional pain (anxiety related) and musculoskeletal pain. Laboratory tests were not helpful in establishing the etiology of chest pain.
Thirteen cases of epiglottitis are reviewed in this paper. Fever and respiratory distress were the most common presenting symptoms. A lateral neck roentgenogram was a helpful laboratory test. Epiglottitis must be distinguished from viral croup and other causes of upper airway obstruction so that prompt treatment can be instituted. A suggested protocol for management of epiglottitis emphasizes the importance of establishing an artificial airway and administering intravenous antibiotics effective against Hemophilus influenzae type B.
Technical skills are an important and difficult part of managing a very sick or injured child. However, technical procedures are more often learned from experience than practice. This article reviews a variety of technical skills and procedures commonly performed in a pediatric emergency department. Each technical procedure can be practiced using live or artificial model for simulation.
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The effect of elevated blood lead levels on the blood pressure of children has not been clearly described. In order to define this association better, we conducted a cross-sectional study, evaluating the association between lead and high blood pressure. Using a Dinamap monitor to measure blood pressures, blood pressures and blood lead levels were measured in 149 children (ages 1-10 years) receiving medical care at the General Medical and Lead Poisoning Clinics at Children's Hospital of Philadelphia. Blood lead levels ranged from 7 to 70 mg/dL with a mean of 27 mg/dL. The mean systolic blood pressure was 108 mmHg and the mean diastolic reading was 63 mmHg. Higher systolic blood pressure was significantly correlated with increased weight, age, and height. Diastolic pressure was significantly associated with weight and height. There was a small, negative correlation between blood lead levels and systolic blood pressure, and a positive but insignificant correlation between lead levels and diastolic blood pressure. Our study population had both higher mean lead levels and a higher prevalence of hypertension than is true of the U.S. population as a whole. We concluded that elevated blood lead levels are not associated with elevated blood pressure in children.