Abstract:
:We describe the first ziprasidone overdose with quantitative serum levels of a pediatric patient in coma and with pinpoint pupils. This case is an important contribution to the pediatric ziprasidone literature because it illustrates that ingestion of just 1 pill may result to profound mental status and respiratory depression in a child. H.C., a 30-month-old girl, presented to the emergency department approximately 30 minutes after an accidental ingestion of an adult family member's medication. The child was found on the floor surrounded by numerous pills and was witnessed to have ingested at least 1 tablet by a caregiver. After finding the child with the pills, the family observed the child for a brief period but transported her to the hospital after she became lethargic and unresponsive. The child received 2 doses of 0.4 mg of intravenous naloxone without change in her neurologic status. The child then underwent a rapid sequence intubation for airway protection and subsequently received gastrointestinal decontamination with 15 g of activated charcoal via the orogastric tube. Ziprasidone is an atypical antipsychotic drug that was approved by the Food and Drug Administration in February 2001 for the general treatment of schizophrenia in adults. Previously reported pediatric ziprasidone overdoses describe a syndrome of sedation, tachycardia, hypotonia, and coma consistent with that of the patient described in this paper. In pediatric ziprasidone overdose, QTc prolongation and hypotension have also been illustrated, but seizures have not been reported. An interesting aspect of this case is the development of pinpoint pupils unresponsive to naloxone. This phenomenon has been reported before with overdose of olanzapine, a similar atypical antipsychotic. The mechanism of miosis associated with overdose of atypical antipsychotics is unclear but is likely related to interference with central innervation of the pupil. Pupil size is maintained by a balance between sympathetic and parasympathetic neurohumeral tones. We propose that an overdose of an alpha-1 receptor blocking agent, such as ziprasidone, results in unopposed parasympathetic stimulation resulting in miosis.
journal_name
Pediatr Emerg Carejournal_title
Pediatric emergency careauthors
Fasano CJ,O'Malley GF,Lares C,Rowden AKdoi
10.1097/PEC.0b013e31819e3775subject
Has Abstractpub_date
2009-04-01 00:00:00pages
258-9issue
4eissn
0749-5161issn
1535-1815pii
00006565-200904000-00010journal_volume
25pub_type
杂志文章abstract:BACKGROUND:Since 1983, no study has evaluated the costs and complications involved in the inpatient evaluation of antibiotic therapy for febrile infants aged 29 to 60 days. METHODS:A prospective quality indicator/quality assurance study of low-risk febrile young infants (FYIs) was conducted during a 16-month period af...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e3181d1e180
更新日期:2010-03-01 00:00:00
abstract:OBJECTIVES:The majority of US children do not have access to an emergency department (ED) with a pediatric mental health care policy in place. Our objective was to understand factors associated with whether US EDs have a pediatric mental health care policy. METHODS:We analyzed data from the National Pediatric Readines...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001920
更新日期:2019-11-13 00:00:00
abstract:OBJECTIVE:This study was performed to determine the doses of midazolam used for sedation during procedures in children, and the frequency of adverse events. METHODS:We performed a retrospective analysis of data collected for a prospective study of flumazenil in children who had received midazolam for a procedure (n = ...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-199906000-00001
更新日期:1999-06-01 00:00:00
abstract::We describe two related cases of pertussis infection ("whooping cough"). This disease entity was almost completely eradicated through successful mass immunization programs. In the past decade it has demonstrated a steady rise in incidence. The epidemiology, clinical manifestations, treatment, and current vaccines for ...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:
更新日期:1993-08-01 00:00:00
abstract::Emergency department (ED) overcrowding has been a serious issue on the national agenda for the past 2 decades and is rapidly becoming an increasingly significant problem for children. The goal of this report is to focus on the issues of overcrowding that directly impact children. Our findings reveal that although over...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:10.1097/01.pec.0000280518.36408.74
更新日期:2007-07-01 00:00:00
abstract:OBJECTIVES:Although child abuse pediatricians are frequently asked to evaluate risk of abuse based on photographs, the effect of photographic quality on this process is presently unknown. Photographs of abused children are often taken by professionals without photographic training, and quality varies widely. This artic...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e31828e848e
更新日期:2013-05-01 00:00:00
abstract:OBJECTIVES:To evaluate changes in imaging practices for pediatric head trauma after publication of the Pediatric Emergency Care Applied Research Network (PECARN) guidelines, explore areas for quality improvement regarding neuroradiology referrals. We also sought to determine the prevalence of incidental findings discov...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000002124
更新日期:2020-06-12 00:00:00
abstract:INTRODUCTION:Since 1987 the average length of stay for infants following hospital delivery has decreased 1.8 days. This study was undertaken to evaluate the null hypothesis that early discharge of newborns from nurseries does not result in increased emergency department (ED) utilization during the first 10 days of life...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-199712000-00001
更新日期:1997-12-01 00:00:00
abstract::Immune thrombocytopenia (ITP) in children is usually a benign, self-limiting disorder. An acute Epstein-Barr virus (EBV) infection usually causes atypical lymphocytosis and mild decrease in platelets. Severe thrombocytopenia is an extremely rare complication. Anti-D immunoglobulin has been used for treatment of ITP in...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e318294f3a5
更新日期:2013-06-01 00:00:00
abstract::An anonymous survey was conducted in order to examine compliance with universal precautions in the Department of Pediatrics at Loyola University Medical Center in Maywood, Illinois. Completed questionnaires were returned by 23 faculty members, 29 residents, and 22 medical students. Gloves were worn consistently during...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-199009000-00004
更新日期:1990-09-01 00:00:00
abstract:OBJECTIVES:Pediatric refusal of medical assistance (RMA) is a potentially high-risk event with implications for both individual patient outcomes and greater emergency medical services system efficiency. The purpose of this study was to describe characteristics of pediatric RMA calls and outcomes. METHODS:Single emerge...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000002018
更新日期:2020-01-01 00:00:00
abstract::Alcaligenes faecalis is a gram-negative organism that is commonly found in the environment and may also be a part of normal fecal flora in humans. Although various infections with this bacteria have been described in the pediatric population, it has not been previously identified in infections as the pathogen after a ...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:10.1097/PEC.0000000000000645
更新日期:2017-07-01 00:00:00
abstract:OBJECTIVE:To determine if intramuscular (IM) penicillin is more effective than oral (PO) amoxicillin in the early outpatient treatment of pediatric patients with presumed bacterial pneumonia. METHODS:Prospective, randomized, evaluator-blinded, clinical trial. SETTING:Pediatric emergency department (ED) of an urban ch...
journal_title:Pediatric emergency care
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1998-10-01 00:00:00
abstract::Mesenteric cystic lymphangioma (MCL) is an uncommon, benign, slow-growing abdominal tumor that is derived from the lymphatic vessels (World J Gastroenterol. 2012;18:6328-6332, Radiographics. 1994;14:729-737). It is most often diagnosed in the head and neck of affected children. Rarely, a lymphangioma can develop withi...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001250
更新日期:2017-09-01 00:00:00
abstract:BACKGROUND:Published rates of delayed diagnosis of injury (DDI) in pediatric trauma vary from 1.0% to 18%. The purpose of this study was to determine the long-term trend of DDI over 10 years, to identify risk factors associated with DDI, and to elucidate patterns of DDI. METHODS:All patients aged 14 and younger who we...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e3181b0a07d
更新日期:2009-08-01 00:00:00
abstract:OBJECTIVE:Major studies (PECARN [Pediatric Emergency Care Applied Research Network], CATCH [Canadian Assessment of Childhood Head Injury]) that regulate the use of computed tomography (CT) algorithms in children with minor head trauma (MHT) have been conducted among children presenting in 24 hours after injury. In this...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000002011
更新日期:2020-01-10 00:00:00
abstract::We present the case of a 9-year-old female who presented after minor blunt abdominal trauma during a sporting event. On focused assessment with sonography for trauma, she was found to have an incidental renal mass, which was ultimately diagnosed as a renal cell carcinoma. In this report, we focus on the use of bedside...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000000242
更新日期:2014-10-01 00:00:00
abstract::The differential diagnosis for patients presenting in shock can be broad, making rapid diagnosis and management challenging. We present a case of a medically complex patient with presumed septic shock, diagnosed with a large pericardial effusion with evidence of tamponade using the rapid ultrasound in shock and hypote...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001891
更新日期:2019-08-01 00:00:00
abstract:OBJECTIVES:Radiographic survey of the entire aerodigestive tract (nares to anus) is common practice in children presenting to the emergency department following coin ingestion. The purpose of our study was to determine the optimal protocol for radiographic survey post-coin ingestion. We hypothesized that for children p...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001688
更新日期:2018-11-19 00:00:00
abstract:OBJECTIVE:The objective of this study was to compare the sensitivity and specificity of 2- and 4-film x-ray series when interpreted by pediatric emergency medicine physicians in the diagnosis of skull fracture in children. METHODS:A noninferiority crossover study was performed. The skull radiographs of the 50 most rec...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e3182a9f7c1
更新日期:2013-11-01 00:00:00
abstract::Priapism is an adverse effect of medications used to treat psychiatric disorders. Often, this condition is self-limiting but may require urologic intervention involving aspiration and injection to induce detumescence. A case of a 15-year-old patient with priapism secondary to a long-acting stimulant is presented to de...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000000485
更新日期:2015-07-01 00:00:00
abstract::The unlikely event of long-term complications in some pediatric fractures, such as midclavicular fractures, has allowed for management of these injuries with interventions that support the injured extremity rather than immobilize it while healing occurs. However, there is currently a growing body of evidence that advo...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:10.1097/PEC.0b013e3181ce310c
更新日期:2010-02-01 00:00:00
abstract:OBJECTIVES:Determine prevalence of participation and underimmunization rate in a regional immunization registry (IR) among patients presenting to a university pediatric emergency department (PED). Rate of agreement between parental report and documented immunization status was also measured. METHODS:A convenience samp...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/01.pec.0000125657.05196.55
更新日期:2004-05-01 00:00:00
abstract::Ultrasonography can be useful in the evaluation of children with abdominal complaints and may be the initial imaging modality in patients presenting with a newly recognized abdominal mass. Hepatoblastoma is an uncommon cause of acute abdominal pain in children and can rarely metastasize to the heart through vascular i...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001629
更新日期:2018-10-01 00:00:00
abstract:OBJECTIVE:Blood culture contamination rates (CRs) in emergency departments (EDs) vary from 1% to 9% in previous studies. High CRs cause unnecessary admissions, antibiotics, and costs. Different measures have been tried to improve CR. This study sought to determine the ED CR at Arkansas Children's Hospital (ACH) and eva...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e318230285b
更新日期:2011-10-01 00:00:00
abstract:OBJECTIVES:To describe the characteristics of childhood poisoning leading to consultation to 17 pediatric emergency departments in Spain. METHODS:During a 2-year period (January 2001 to December 2002), accompanying people of 2157 children with acute intoxication who visited consecutively at the emergency room were pro...
journal_title:Pediatric emergency care
pub_type: 杂志文章,多中心研究
doi:10.1097/01.pec.0000215651.50008.1b
更新日期:2006-05-01 00:00:00
abstract::During a 12-month period ending on 11/30/88, data were collected on 143 pediatric patients visiting a pediatric emergency department with burns. Sixty-four percent were males. Common causes of the burns included hot water (17%), hot food (23%), hot appliances (18%), and charcoal and grills (9%). Sixty-six percent of t...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-199104000-00004
更新日期:1991-04-01 00:00:00
abstract:BACKGROUND:Interfacility transfers occur frequently and often involve critically ill patients. Clear communication at the time of patient referral is essential for patient safety. OBJECTIVES:The objective of this work was to study whether a standardized inter-emergency department (ED) transfer communication template f...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e318289d7c1
更新日期:2013-04-01 00:00:00
abstract::A 5-year-old female with Charcot-Marie-Tooth neuropathy and a history of constipation presented to the emergency department with a new blistering buttocks rash, which was initially concerning for nonaccidental burn. Upon further investigation, it was found that Ex-Lax had been given to the patient for constipation. Th...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001498
更新日期:2019-07-01 00:00:00
abstract::Hip pain and fever in children include a broad differential. Most concerning is the possible diagnosis of a septic joint, which carries significant morbidity. We describe the case of a 13-year-old boy with fever and hip pain who was referred to the emergency department with concern for septic hip. The etiology was lat...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000000328
更新日期:2015-01-01 00:00:00