IMAGES IN EMERGENCY MEDICINE
Willard W. Sharp, MD, PhD; Wilma Chan, MD
0196-0644/$-see front matter
Copyright © 2014 by the American College of Emergency Physicians.
http://dx.doi.org/10.1016/j.annemergmed.2013.06.017
Figure 2. Pyloric ultrasonography demonstrating a hypoechoic
muscle width of 4 to 5 mm on either side of the pyloric canal
(pylorus muscle margins indicated by similar-appearing symbols).
Figure 1. Visible abdominal bulge that moved from the
patient’s left to right after formula feedings.
[Ann Emerg Med. 2014;63:289.]
Figure 3. Ultrasonography demonstrating pylorus length of
24 mm (pylorus margins indicated by “þ” symbol).
An 8-week-old male infant presented to the emergency department with 2 weeks of projectile vomiting. The parents noted he was
a well and avid feeder but also noted an “abdominal bulge” that moved from left to right during feedings (Figure 1). Vital signs were
normal, except for a weight of 11 lbs (15th percentile). Physical examination revealed dry mucous membranes and a capillary refill
greater than 2 seconds. No abdominal hernias or masses were palpated. Serum electrolyte studies revealed a potassium level of
3.3 mEq/L, chloride level of 82 mEq/L, and bicarbonate level of of 38 mEq/L. Ultrasonography was obtained (Figures 2 and 3).
For the diagnosis and teaching points, see page 308.
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Annals of Emergency Medicine 289
Risk Factors for Apnea in Pediatric Patients
6. Rainbow J, Browne GJ, Lam LT. Controlling seizures in the prehospital
setting: diazepam or midazolam? J Paediatr Child Health.
2002;38:582-586.
7. Gathwala G, Goel M, Singh J, et al. Intravenous diazepam, midazolam
and lorazepam in acute seizure control. Indian J Pediatr.
2011;79:327-332.
8. Chamberlain JM, Altieri MA, Futterman C, et al. A prospective,
randomized study comparing intramuscular midazolam with
intravenous diazepam for the treatment of seizures in children. Pediatr
Emerg Care. 1997;13:92-94.
9. Orr RA, Dimand RJ, Venkataraman ST, et al. Diazepam and intubation
in emergency treatment of seizures in children. Ann Emerg Med.
1991;20:1009-1013.
10. Chiulli DA, Terndrup TE, Kanter RK. The influence of diazepam or
lorazepam on the frequency of endotracheal intubation in childhood
status epilepticus. J Emerg Med. 1991;9:13-17.
11. Dieckmann RA. Rectal diazepam for prehospital pediatric status
epilepticus. Ann Emerg Med. 1994;23:216-224.
12. Norris E, Marzouk O, Nunn A, et al. Respiratory depression in children
receiving diazepam for acute seizures: a prospective study. Dev Med
Child Neurol. 1999;41:340-343.
13. Galustyan SG, Walsh-Kelly CM, Szewczuga D, et al. The short-term
outcome of seizure management by prehospital personnel: a
comparison of two protocols. Pediatr Emerg Care. 2003;19:221-225.
14. Seigler RS. The administration of rectal diazepam for acute
management of seizures. J Emerg Med. 1990;8:155-159.
15. Silbergleit R, Durkalski V, Lowenstein D, et al. Intramuscular versus
intravenous therapy for prehospital status epilepticus. N Engl J Med.
2012;366:591-600.
308 Annals of Emergency Medicine
Bosson et al
16. Gausche M, Lewis RJ, Stratton SJ, et al. Effect of out-of-hospital
pediatric endotracheal intubation on survival and neurological
outcome: a controlled clinical trial. JAMA. 2000;283:783-790.
17. Newgard CD, Hedges JR, Arthur M, et al. Advanced statistics: the
propensity score—a method for estimating treatment effect in
observational research. Acad Emerg Med. 2004;11:953-961.
18. Klein M, DeWitt TG. Reliability of parent-measured axillary
temperatures. Clin Pediatr (Phila). 2010;49:271-273.
19. Singhi S, Sood V. Reliability of subjective assessment of fever by
mothers. Indian Pediatr. 1990;27:811-815.
20. Warden CR, Frederick C. Midazolam and diazepam for pediatric
seizures in the prehospital setting. Prehosp Emerg Care.
2006;10:463-467.
21. Vilke GM, Sharieff GQ, Marino A, et al. Midazolam for the treatment of
out-of-hospital pediatric seizures. Prehosp Emerg Care. 2002;6:
215-217.
22. Holsti M, Sill BL, Firth SD, et al. Prehospital intranasal midazolam for
the treatment of pediatric seizures. Pediatr Emerg Care.
2007;23:148-153.
23. McIntyre J, Robertson S, Norris E, et al. Safety and efficacy of buccal
midazolam versus rectal diazepam for emergency treatment of
seizures in children: a randomised controlled trial. Lancet.
2005;366:205-210.
24. Scott RC, Besag FM, Neville BG. Buccal midazolam and rectal
diazepam for treatment of prolonged seizures in childhood and
adolescence: a randomised trial. Lancet. 1999;353:623-626.
25. Lahat E, Goldman M, Barr J, et al. Comparison of intranasal
midazolam with intravenous diazepam for treating febrile seizures in
children: prospective randomised study. BMJ. 2000;321:83-86.
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