The art of referral: pediatricians and the emergency department

Article Abstract:

Effective communication between the pediatrician and emergency department (ED) is necessary to provide the best possible care to children with conditions requiring urgent attention. Pediatricians may refer patients to the ED for care of a severe condition such as infection or abdominal pain, when a diagnosis is uncertain or a rapid comprehensive evaluation is needed. They may also refer if a procedure is needed that cannot performed in the office. Children's National Medical Center in Washington, DC, is an example of a successful system for processing referrals in the ED. A dedicated referral telephone line facilitates communication, and a checklist is used to cover pertinent information such as allergies or significant medical conditions, transportation and estimated time of arrival, synopsis of current condition and expectations of referral.

Methods, Management, Practice, Emergency medical services, Pediatric emergencies, Medical referral, Hospitals, Hospital emergency services, Pediatricians

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Symptoms and spontaneous passage of esophageal coins

Article Abstract:

All children suspected of swallowing a coin should have an X ray whether or not they are symptomatic. It is safe to wait 24 hours before attempting removal of coins lodged in the lower esophagus because children may pass the coin into the stomach, and inflammation is unlikely to set in before this time. Seventy-three children were brought to an emergency room over an 18-month period because they had swallowed a coin. None of the 58 children who had a coin in the mid to upper esophagus passed it, even though considerable time had passed. The coins were removed surgically. However, 9 of 15 children with a coin in the lower esophagus passed it in 24 hours or less. Five children who had swallowed coins had no symptoms, and three of them required surgery. A delay could have increased complications.

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The Spontaneous Passage of Esophageal Coins in Children

Article Abstract:

Coins in the esophagus may pass into the stomach and intestines and be eliminated in some children. Coins are the most frequently ingested object in young children. Some pass into the stomach and intestines and are eliminated, but some become lodged in the esophagus. In a study of 116 with a coin in their esophagus, 84 had no history of esophageal disease and had no serious symptoms from the coin. X-rays taken at a later time showed that in 16 of these children, the coin passed into their stomach where it was easily eliminated. Children with more complicated cases may require surgery.

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