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Forestier A, Gehri M, Guilbaud O, Ramelet AS. Emergency consultations for male adolescents: Somatic and psychological characteristics and profiles of regular users. A retrospective chart review. Arch Pediatr 2019; 26:393-399. [PMID: 31630901 DOI: 10.1016/j.arcped.2019.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/28/2019] [Accepted: 08/02/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Male adolescents' mental health has been understudied compared to their female counterparts and is not well known among health professionals. This is particularly problematic in emergencies because the number of such patients is increasing. OBJECTIVES To identify the type of demand for care and the characteristics of male adolescents' emergency room visits. To describe the sociodemographic data and clinical characteristics of regular users. METHOD This is a retrospective study of all medical records of male adolescents aged 14-18, admitted between 2014 and 2015 to the pediatric emergency room of a Swiss university hospital. Sociodemographic and clinical data (e.g., degree of urgency, diagnosis, length of stay, emergency service use, and emergency discharge destinations) were collected. Descriptive and multivariate analyses were performed using STATA 13.1 software. RESULTS Over the 2-year study period, 2045 male adolescents consulted in emergency departments for a total of 3199 admissions. The average age was 15.6 years (SD, 1). Most consultations were non-urgent (93%) and the reasons included musculoskeletal (43%), dermatological (13%), and digestive (10%) complaints. Forty-two male adolescents (2%) had four or more visits within the 2-year period and were considered regular users; they were also more likely to have psychological complaints (adjusted OR, 5.04; 95% CI, 1.81-13.72) and comorbidities (adjusted OR, 2.55; 95% CI, 1.25-5.21) when compared to their counterparts with fewer than four visits. CONCLUSION Since regular users are at greater risk of having psychological complaints and comorbidities during their first emergency room visit, a systematic assessment of these adolescents' mental health levels and overall health indicators is recommended.
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Affiliation(s)
- A Forestier
- University institute of higher education and research in healthcare, Biopôle 2, route de la Corniche 10, 1010 Lausanne, Switzerland; School of health sciences, Avenue de Champel 47, 1206 Geneva, Switzerland.
| | - M Gehri
- Department woman, mother, child, University Hospital of Lausanne, Rue du Bugnon, 1010 Lausanne, Switzerland
| | - O Guilbaud
- University hospital of Lausanne, service universitaire de psychiatrie de l'enfant et de l'adolescent (SUPEA), 1010 Lausanne, Switzerland
| | - A S Ramelet
- University institute of higher education and research in healthcare, Biopôle 2, route de la Corniche 10, 1010 Lausanne, Switzerland
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Sanchis Zozaya J, Bodenmann P, Blaser J, Côté M, Pahud-Vermeulen B, Monnat M, Nsengywumva C, Hunziker B, Rojas-Urrego A, Ambresin A, Faucherre F, Gehri M. 2.11-P11The public health response for greater efficiency in the treatment of unaccompanied refugee minors in Switzerland. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky048.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Sanchis Zozaya
- Department of Ambulatory Care and Community Medicine (Policlinique Médicale Universitaire - PMU), Lausanne, Switzerland
| | - P Bodenmann
- Department of Ambulatory Care and Community Medicine (Policlinique Médicale Universitaire - PMU), Lausanne, Switzerland
| | - J Blaser
- Department of Ambulatory Care and Community Medicine (Policlinique Médicale Universitaire - PMU), Lausanne, Switzerland
| | - M Côté
- Department of Ambulatory Care and Community Medicine (Policlinique Médicale Universitaire - PMU), Lausanne, Switzerland
| | - B Pahud-Vermeulen
- Department of Ambulatory Care and Community Medicine (Policlinique Médicale Universitaire - PMU), Lausanne, Switzerland
| | - M Monnat
- Service of Public Health, Lausanne, Switzerland
| | - C Nsengywumva
- Foster Home Services for Asylum Seekers - Etablissement Vaudois d'Accueil des Migrants (EVAM), Lausanne, Switzerland
| | - B Hunziker
- Child Psychiatry Department - SUPEA/DP-CHUV), Lausanne, Switzerland
| | - A Rojas-Urrego
- Child Psychiatry Department (SPPEA/Fondation de Nant), Vevey, Switzerland
| | - A Ambresin
- Interdisciplinary division for adolescent health (DISA/CHUV), Lausanne, Switzerland
| | - F Faucherre
- Transcultural Psychiatry Unit (Unité Psy&Migrants/DP-CHUV), Lausanne, Switzerland
| | - M Gehri
- Department of Pediatrics, Children's Hospital (HeL/CHUV), Lausanne, Switzerland
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Perret S, Gehri M, Pluies J, Rossi I, Akre C. [Families' experiences and satisfaction with a pediatric emergency service]. Arch Pediatr 2017; 24:960-968. [PMID: 28911938 DOI: 10.1016/j.arcped.2017.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 05/23/2017] [Accepted: 08/03/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Today, pediatric emergency services receive a rising number of "non-urgent" cases, which are due to parental anxiety or a miscomprehension of medical explanations. The aim of this study was therefore to understand what those families experience and need when they consult in such cases, in order to respond with adapted solutions. METHODS Semi-structured interviews and questionnaires with parents, after the consultation or in the waiting room. RESULTS Based on the families' narratives, we present the results in six steps, which correspond to the steps they experience from the decision to go to the hospital to the consultation. Families' experiences are very satisfactory regarding the quality of medical care, the relationship between staff and children, and the staff's overall attitude. Critical points concern practical aspects (parking, food, and play facilities); the waiting time and the lack of information; and the communication between the medical staff and the parents, most particularly related to their anxiety and waiting time. DISCUSSION The results show first that parents have multiple preoccupations: many stress factors and organizational difficulties are added to their child's disease. These preoccupations are mostly related to the lack of information about the waiting time, information that they would need to organize their day and their time in the hospital. Second, the results show that parental anxiety influences their decision to come to the emergency department, their experience of care and of the waiting time, and their judgment about the quality of the medical care. Considering this, families requested practical improvements (i.e., more toys in the waiting room), and suggest more communication and presence from the medical staff. Based on their demands, we suggest an agenda of care in four steps: a waiting time, a time for sharing, a time for information giving, and a validation time. CONCLUSIONS Overall, parents are stressed and anxious when they come to the emergency department and request more reassurance, attention, and explanations from the healthcare staff. We propose a final "validation time" to verify that the medical explanations are understood as well as the emotional state of the family. In this way, we can ensure good follow-up care at home, avoid unnecessary readmissions, and promote parental health education.
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Affiliation(s)
- S Perret
- Hôpital de l'enfance de Lausanne (HEL), centre hospitalier universitaire Vaudois (CHUV), 16, chemin de Montétan, 1000 Lausanne, Suisse.
| | - M Gehri
- Hôpital de l'enfance de Lausanne (HEL), centre hospitalier universitaire Vaudois (CHUV), 16, chemin de Montétan, 1000 Lausanne, Suisse
| | - J Pluies
- Université de Lausanne (Unil), quartier Unil-Mouline, bâtiment Géopolis, 1015 Lausanne, Suisse
| | - I Rossi
- Université de Lausanne (Unil), quartier Unil-Mouline, bâtiment Géopolis, 1015 Lausanne, Suisse
| | - C Akre
- Hôpital de l'enfance de Lausanne (HEL), centre hospitalier universitaire Vaudois (CHUV), 16, chemin de Montétan, 1000 Lausanne, Suisse
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Gasser CRB, Yersin C, Gehri M. P-135 – Urgences pédiatriques: création d'une consultation infirmière indépendante. Arch Pediatr 2015. [DOI: 10.1016/s0929-693x(15)30318-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gasser CRB, Joseph J, Gehri M, Pauchard J. P-136 – Torsion ovarienne: revue de littérature et identification des signes prédictifs. Arch Pediatr 2015. [DOI: 10.1016/s0929-693x(15)30319-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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6
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Spaggiari S, Hafen G, De Goumoens L, Gehri M, Di Paolo E, Pannatier A. CP-126 Validation of inhalation technique videotaped in asthmatic children under 5 years. Eur J Hosp Pharm 2015. [DOI: 10.1136/ejhpharm-2015-000639.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Wandeler G, Pauchard JY, Zangger E, Diawara H, Gehri M. Which clinical signs predict hypoxaemia in young Senegalese children with acute lower respiratory tract disease? Paediatr Int Child Health 2015; 35:65-8. [PMID: 25547179 DOI: 10.1179/2046905514y.0000000153] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Acute lower respiratory tract diseases are an important cause of mortality in children in resource-limited settings. In the absence of pulse oximetry, clinicians rely on clinical signs to detect hypoxaemia. OBJECTIVE To assess the diagnostic value of clinical signs of hypoxaemia in children aged 2 months to 5 years with acute lower respiratory tract disease. METHODS Seventy children with a history of cough and signs of respiratory distress were enrolled. Three experienced physicians recorded clinical signs and oxygen saturation by pulse oximetry. Hypoxaemia was defined as oxygen saturation <90%. Clinical predictors of hypoxaemia were evaluated using adjusted diagnostic odds ratios (aDOR). RESULTS There was a 43% prevalence of hypoxaemia. An initial visual impression of poor general status [aDOR 20.0, 95% CI 3.8-106], severe chest-indrawing (aDOR 9.8, 95% CI 1.5-65), audible grunting (aDOR 6.9, 95% CI 1.4-25) and cyanosis (aDOR 26.5, 95% CI 1.1-677) were significant predictors of hypoxaemia. CONCLUSION In children under 5 years of age, several simple clinical signs are reliable predictors of hypoxaemia. These should be included in diagnostic guidelines.
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Pauchard JY, Pittet A, Gehri M. [Which maintenance intravenous fluid in paediatrics in 2015?]. Rev Med Suisse 2015; 11:122-123. [PMID: 25799667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
For 50 years, hypotonic solutions have been used as liquid of maintenance in paediatrics owing to the article of Holliday and Segar. For two decades, studies have shown that these hypotonic fluids can foster the acquisition of hyponatremias. The most recent literature data (meta-analysis and randomized studies) confirm that hypotonic fluids are not suitable for children hospitalized with surgical or medical problems. Current recommendations must take these results into account and advocate the use of isotonic saline solutions as maintenance intravenous fluid therapy.
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Rey-Bellet Gasser C, Gehri M, Yersin C. [Paediatric emergency: creation of an independent nurse practitioner consultation]. Rev Med Suisse 2015; 11:120-121. [PMID: 25799666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Consultations in the Paediatric Emergency Department (PED) continue to climb regularly. Emergency Nurse Practitioner consultations have long been created in the English speaking countries. Since January 2013, an indepen- dent nurse consultation, under delegated medical responsibility, exists in the multidisciplinary PED of the Children's Hospital of Lausanne. The mean consultation time is the same as the medical consultation and the overall waiting time hasn't decreased yet. But a well definite working frame, a systematic approach, as well as the continual medical supervision possibility, make it a safe, efficient and appreciated consultation, by both patients and professionals.
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10
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Espejo LM, Gehri M, Soldini N. [Sport: practiced from birth?]. Rev Med Suisse 2014; 10:1438-1444. [PMID: 25141563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Physical activity in children is on the decline, leaving room for sedentary behaviour. Children are mentally over stimulated through the use of screens, but their physical condition is diminishing. The benefits of physical activity in adults are well known. Although paediatric literature is less abundant, the benefits of regular physical activity in young children are real and extend into adulthood. The promotion of physical activity can be made by any responsible adult in a child's entourage. It means clarifying the confusion between physical activity and sport, evaluating the balance between the physical and sedentary behaviour of the children and their families and establishing with them the possible necessary changes. PAPRICA--young childhood is 4 hour interdisciplinary training session approaching these various themes.
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11
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Kies C, Pauchard J, Gehri M. SFP PC-71 – Evaluation des examens radiologiques lors des infections urinaires de l’enfant. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)72221-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Dony C, Ranson MO, Gerdy P, Gehri M, Coti BP. [Pediatrics. Screening for nutritional deficiencies in hospitalized children: new practices at the Hôpital de I'Enfance in Lausanne]. Rev Med Suisse 2013; 9:138-139. [PMID: 23409654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Screening for undernutrition among hospitalized children requires a systematic assessment of dietary intake. The development of a new tool for quick and playful assessment of dietary intake, called "Fleur" ("Flower"), at the Hôpital de l'Enfance in Lausanne allows to identify children at risk of undernutrition and to adapt their nutrition to their specific needs.
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Affiliation(s)
- C Dony
- Département médico-chirurgical de pédiatrie, Hôpital de I'Enfance, CHUV, 1011 Lausanne.
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13
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Pauchard JY, Gehri M, Vaudaux B. [Pediatrics. Using the McIsaac score for the indication of rapid diagnostic testing in children with streptococcal pharyngitis]. Rev Med Suisse 2013; 9:136-137. [PMID: 23409653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The McIsaac scoring system is a tool designed to predict the probability of streptococcal pharyngitis in children aged 3 to 17 years with a sore throat. Although it does not allow the physician to make the diagnosis of streptococcal pharyngitis, it enables to identify those children with a sore throat in whom rapid antigen detection tests have a good predictive value.
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Affiliation(s)
- J-Y Pauchard
- Département médico-chirurgical de pédiatrie, CHUV, 1011 Lausanne.
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14
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Krähenbühl JD, Beaulieu C, Gehri M. Evaluation of a novel in-vitro diagnostic device for the detection of urinary tract infections in diaper wearing children. Swiss Med Wkly 2012; 142:w13560. [DOI: 10.4414/smw.2012.13560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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15
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Fischer CJ, Giannoni E, Truttmann AC, Tolsa JF, Chevallay M, El Ezzi O, Seneggen E, Hohlfeld J, de Buys Roessingh A, Pauchard JY, Gehri M, Hauschild M. [Pediatrics]. Rev Med Suisse 2012; 8:51-56. [PMID: 22303741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Several preliminary studies suggest that prophylactic administration of probiotics reduces the incidence of necrotizing enterocolitis (NEC) in preterm infants, and several neonatology units have introduced this treatment under strict surveillance. Nonetheless, breast milk feeding remains the mainstay of NEC prevention. The beta-blocker propranolol, known for its effectiveness on cutaneous hemangiomas, is also proving useful for the treatment of subglottic or visceral hemangiomas. Following the decrease in severe bacterial infections thanks to widespread vaccinations, the McCarthy clinical score has regained importance in the prediction of the risk of bacterial infection in febrile infants. It is easy to use, economical, and has a diagnostic value comparable to laboratory tests. The new WHO growth charts have been introduced in Switzerland in 2011 to take into account the increasing regional and ethnic variations in our country. Any significant change in growth velocity should prompt an evaluation of the need of further investigations.
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Affiliation(s)
- C J Fischer
- Service de néonatologie, Département médico-chirurgical de pédiatrie, Hôpital de l'enfance, CHUV et Université de Lausanne
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Posfay-Barbe K, Galetto-Lacour A, Grillet S, Ochs M, Brookes R, Kraehenbuhl J, Cevey-Macherel M, Gehri M, Gervaix A, Siegrist CA. Immunity to pneumococcal surface proteins in children with community-acquired pneumonia: a distinct pattern of responses to pneumococcal choline-binding protein A. Clin Microbiol Infect 2011; 17:1232-8. [DOI: 10.1111/j.1469-0691.2010.03389.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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17
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Vandertuin L, Vunda A, Gehri M, Sanchez O, Hanquinet S, Gervaix A. [Intestinal intussusception in children: truly a classic triad?]. Rev Med Suisse 2011; 7:451-455. [PMID: 21452514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Intussusception in children is not a frequent pathology but it is important to consider when working in a paediatric emergency department due to the potential serious complications in the case that the diagnosis is not rapidly identified. The majority of cases are idiopathic and in only 10% of patients will a pathological lead point be found. One would be in error to wait for the classical triad presentation before beginning the appropriate diagnostic testing. Hence, the diagnosis of intussusception should be suspected in all children, under the age of 3 years, with acute colicky abdominal pain. In this practical review, we have included the clinical experience in intussusception seen in 2 Swiss university paediatric hospitals.
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Affiliation(s)
- L Vandertuin
- Service d'accueil et d'urgences pédiatriques, Département de l'enfant et de l'adolescent, HUG, Genève.
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18
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Gehri M, Flubacher P, Chablaix C, Curchod P. [Pediatrics. The PAT: a simple and rapid tool for the assessment of the severely ill or injured child]. Rev Med Suisse 2011; 7:64-66. [PMID: 21309178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The Pediatric Assessment Triangle (PAT) has become the cornerstone for the assessment and treatment of a critically ill or injured infant/young child. Now incorporated to the PALS course, it can be taught to all levels of health care providers in charge of severly-ill children. The PAT is a rapid and simple observational tool suitable for pediatric assessment regardless of complaint or underlying diagnosis. It can be introduced in every emergency department, especially those having relatively infrequent encounters with very sick children. Implementation of such a tool needs formal theoritical and practical education skills, rapid availability of experienced pediatric seniors and spaces specifically intented for children.
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Affiliation(s)
- M Gehri
- Hôpital de l'enfance, CHUV, 1011 Lausanne
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Krahenbuhl JD, Piol N, Gehri M. [Utility of Gamma Interferon blood tests in the diagnosis of tuberculosis infection in children]. Rev Med Suisse 2007; 3:522-4, 526-7. [PMID: 17410938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Considering the ongoing difficulty with the interpretation of the tuberculin skin test and the importance of a correct interpretation of each situation in order to benefit from treatment, a lot of expectations are placed in the new Gamma Interferon blood tests. The aim of this article is to recall the basic principles of these tests and to review the evidence of their utility in paediatrics. In children, although the evidence is still insufficient, the blood tests can be useful in combination with the tuberculin skin test.
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Affiliation(s)
- J D Krahenbuhl
- Département médico-chirurgical de pédiatrie Hôpital de I'enfance CHUV, 1007 Lausanne.
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Fanconi S, Gehri M, Benkebil F, Nydegger A, Cachat F, Zeier G, Pastore YD, Diezi M. [Pediatry]. Rev Med Suisse 2007; 3:155-60. [PMID: 17354542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
During the previous year, several changes occurred in paediatric patient's management. The new PALS recommendations redefine the rhythm and the rate between cardiac massage and ventilation as well as the indications for defibrillation. The choice of the test for Helicobacter Pylori depends on the age of the patient and on the clinical situation. New anti-hypertensive drugs allow to limit the progression of chronic renal disease with hyper-tension and/or proteinuria. The choice between immunoglobulins, steroids, splenectomy and rituximab to treat chronic thrombocytopenic purpura treatment is a therapeutic challenge. Finally, a new approach is presented for diagnosis and treatment of iron overload in chronic hemoglobinopathies.
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Affiliation(s)
- S Fanconi
- Service de pédiatrie, Hôpital de l'enfance, Département médico-chirurgical de pédiatrie, CHUV, Lausanne
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21
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Landry JS, Gehri M, Gervaix A. [Recognition of cardiorespiratory distress and failure in children]. Rev Med Suisse 2005; 1:2477-82. [PMID: 16320541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Every pediatrician and general practitioner can face children with life-threatening conditions in their private practice. Recognition of symptoms of respiratory failure and shock is essential to initiate therapy promptly in order to prevent the development of cardiopulmonary failure. This article provides clinical information on detecting critical respiratory and cardiac conditions, anticipating cardiac arrest in children, establishing priorities in care, and transferring to an emergency center.
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Affiliation(s)
- J S Landry
- Service d'accueil et d'urgences pédiatrique, Hôpital des enfants HUG, 1211 Genève 14.
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Jequier M, Thurler-Thiele F, Lepori D, Gehri M. [Radiological quiz of the month. A case of a swollen and painful testis in a child]. Arch Pediatr 2005; 12:1513-4, 1500. [PMID: 16122918 DOI: 10.1016/j.arcped.2005.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2005] [Accepted: 06/30/2005] [Indexed: 11/17/2022]
Affiliation(s)
- M Jequier
- Département médico-chirurgical de pédiatrie, hôpital de l'Enfance de Lausanne, ch. de Montétan 16, 1000 Lausanne 7, Suisse
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Krahenbuhl JD, Di Paolo E, Steiner S, Gehri M. [Reimbursement policy for ambulatory treatment of pediatric infections with ceftriaxone]. Rev Med Suisse 2005; 1:1814-5. [PMID: 16119297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- J-D Krahenbuhl
- Mario Gehri Hôpital de l'enfance, Ch. de Montétan 16 1007 Lausanne.
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Affiliation(s)
- B Laubscher
- Department of Paediatrics, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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Gehri M, Krahenbuhl JD, Landry JS, Gervaix A. [Acute dyspnea in children]. Rev Med Suisse 2005; 1:486-90. [PMID: 15790016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Respiratory disease and acute respiratory difficulties are life threatening problems frequently met in paediatric medicine. Since parents often call their doctor first, telephone triage is important in the correct management of children with respiratory distress. On arrival in the office or the emergency department, a child with dyspnea should rapidly be assessed for signs of severity and respiratory compromise. Oxygenation and early initiation of specific treatment are priorities in the management. Only a simple and rigorous clinical process, based on the essential, will reach all these objectives without delay. As soon as the child's situation is stabilised, the doctor decides what are the appropriate modalities for transfer. This article aims at reviewing these different issues.
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Affiliation(s)
- M Gehri
- Département médico-chirurgical de pédiatrie, Hôpital de l'enfance de Lausanne, CHUV, 1000 Lausanne 4.
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Perrelet A, Zellweger JP, Talla I, Ndiaye Y, Gautier E, Gehri M. The oxygen concentrator: an appropriate technology for treating hypoxaemic children in developing countries. Int J Tuberc Lung Dis 2004; 8:1138-41. [PMID: 15455602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
The World Health Organization (WHO) recommends supplying oxygen in developing countries by concentrators because cylinders pose considerable logistic and financial problems. This technology was employed to treat children in a hospital in Ndioum, Senegal, who met the WHO oxygenation criteria. There were clear clinical and financial benefits, but neither the nurses' knowledge of the various techniques of oxygen supply nor the maintenance service were satisfactory. The use of concentrators should be encouraged in developing countries. A strategy including technical training, maintenance and monitoring should be adopted. Corrective actions were undertaken in Ndioum, and several concentrators are now being used on a regular basis.
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Affiliation(s)
- A Perrelet
- Department of Paediatrics, Hôpital de l'Enfance, Lausanne, Switzerland
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Jotterand C, Roulet M, Lepori D, Gehri M. [Radiologic case of the month]. Arch Pediatr 2002; 9:307-9. [PMID: 11938543 DOI: 10.1016/s0929-693x(01)00769-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- C Jotterand
- Département médico-chirurgical de pédiatrie, hôpital de l'enfance, Lausanne, Suisse
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Zangger E, Gehri M, Krähenbühl JD, Zuberbühler D, Zellweger JP. Epidemiological and economical impact of tuberculosis in an adolescent girl in Lausanne (Switzerland). Swiss Med Wkly 2001; 131:418-21. [PMID: 11571846 DOI: 2001/27/smw-09757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED Patients with pulmonary tuberculosis (TB) can infect people in their environment but children and adolescents are rarely contagious. A recent case of an adolescent girl in Lausanne, however, proved to be infectious and required extensive contact tracing. SUBJECTS AND METHODOLOGY The source case was a 15-years-old adolescent girl of African origin. Upon her arrival in Switzerland in 1994 the tuberculin skin test was 14 mm. The patient did not receive preventive treatment. She developed smear-positive pulmonary tuberculosis in May 1999. Contact tracing identified contacts in the surrounding population. The contact persons were divided into 3 groups according to their proximity. The first group consisted of close family and friends, the second of classmates and teachers and the third of more distant contacts. Costs were also evaluated. RESULTS Of the 53 people examined, 24 (45%) were infected and required treatment. Eight out of 9 cases (88%) were infected in the first group (including another case of culture-positive pulmonary tuberculosis). Fourteen out of 33 cases (42%) in the second group and 2 of 11 (18%) to the third group. Passing from one proximity group to the next decreased the relative risk of infection 4 fold. The costs of contact tracing and treatment are estimated at over CHF 24,000. CONCLUSIONS (1) Pulmonary TB can be contagious even in adolescents. (2) Subdividing contacts into proximity groups allows for better targeting of the people to be screened. (3) Contact tracing and the high costs involved could have been avoided if the patient had received preventive chemotherapy upon her arrival in Switzerland.
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Affiliation(s)
- E Zangger
- Hôpital de l'Enfance, Lausanne, Switzerland
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Zangger E, Gehri M, Krähenbühl JD, Zuberbühler D, Zellweger JP. Epidemiological and economical impact of tuberculosis in an adolescent girl in Lausanne (Switzerland). Swiss Med Wkly 2001; 131:418-21. [PMID: 11571846 DOI: 10.4414/smw.2001.09757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
UNLABELLED Patients with pulmonary tuberculosis (TB) can infect people in their environment but children and adolescents are rarely contagious. A recent case of an adolescent girl in Lausanne, however, proved to be infectious and required extensive contact tracing. SUBJECTS AND METHODOLOGY The source case was a 15-years-old adolescent girl of African origin. Upon her arrival in Switzerland in 1994 the tuberculin skin test was 14 mm. The patient did not receive preventive treatment. She developed smear-positive pulmonary tuberculosis in May 1999. Contact tracing identified contacts in the surrounding population. The contact persons were divided into 3 groups according to their proximity. The first group consisted of close family and friends, the second of classmates and teachers and the third of more distant contacts. Costs were also evaluated. RESULTS Of the 53 people examined, 24 (45%) were infected and required treatment. Eight out of 9 cases (88%) were infected in the first group (including another case of culture-positive pulmonary tuberculosis). Fourteen out of 33 cases (42%) in the second group and 2 of 11 (18%) to the third group. Passing from one proximity group to the next decreased the relative risk of infection 4 fold. The costs of contact tracing and treatment are estimated at over CHF 24,000. CONCLUSIONS (1) Pulmonary TB can be contagious even in adolescents. (2) Subdividing contacts into proximity groups allows for better targeting of the people to be screened. (3) Contact tracing and the high costs involved could have been avoided if the patient had received preventive chemotherapy upon her arrival in Switzerland.
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Affiliation(s)
- E Zangger
- Hôpital de l'Enfance, Lausanne, Switzerland
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Gehri M, Hunziker B, Géraud F, Rouffaer D, Sopa S, Cruz CS, Métraux JC. [Migrant populations at the Hôpital de l'Enfance of Lausanne (HEL): evaluation inquiry, taking care and contribution of cultural mediators-translators]. Soz Praventivmed 2000; 44:264-71. [PMID: 10674319 DOI: 10.1007/bf01358975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The number of patients belonging to migrant populations who consult Lausanne's Hôpital de l'Enfance (HEL) has increased massively in an exponential manner. HEL is a facility dedicated to children with a vocation of public health and training in a university setting and it has to make a point of developing an adequate and pertinent health care system for these populations. In order to do this, a study was undertaken in the form of a prospective survey including over a thousand ambulatory patients. Administrative data (origin, date of migration, nature of the permit and legal situation), social data (home language, professional situation, number of siblings), medical (diagnosis) and psychosomatic data (sleep, enuresis) was recorded as well as data testing the level of understanding between carrier and patient. The study allowed us to define priorities of intervention: introduction of a service of translators--cultural mediators trained by the association "Appartenances" (as well as on going follow-up and assessment of this service), training of health care workers in the fields of cultural mediation and the different aspects of migrant population medicine and, finally, the creation of a steering group within the Institution. Having allowed rapid and spectacular improvement in the quality of the service provided by the HEL, this process is also included in the will to improve health care given to migrant populations at local and national levels in accordance with the priorities defined by the WHO in this domain. It is this experience which is reported in this paper.
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Affiliation(s)
- M Gehri
- Hôpital de l'Enfance de Lausanne
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Gehri M. [Sudden infant death: a drama in spectacular regression]. Rev Med Suisse Romande 2000; 120:269-76. [PMID: 10815460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Affiliation(s)
- M Gehri
- Hôpital de l'Enfance de Lausanne.
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Scalfaro P, Haenggi MH, Roulet E, Gehri M, Stucki P, Schaller MD, Cotting J. [Carbon monoxide poisoning in children: never trivialize]. Rev Med Suisse Romande 2000; 120:259-62. [PMID: 10815458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The risks linked to tissular hypoxemia after carbon monoxide (CO) poisoning are well known. Unawareness of CO exposure and of its complex pathophysiology may delay appropriate treatment and lead to long term neuropsychological sequelae. We report two cases of children treated in our institution and review the main issues regarding the optimal management. A high index of suspicion for carbon monoxide poisoning when dealing with an unclear neurological clinical presentation is mandatory. Classical therapy with normobaric 100% oxygen has to be instaured immediately. Hyperbaric oxygen therapy must be considered when anamnestic symptoms or clinical signs suggest neurological involvement even when carboxyhemoglobin values are low or already normalized.
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Affiliation(s)
- P Scalfaro
- Département médico-chirurgical de pédiatrie, Soins intensifs médico-chirurgicaux de pédiatrie et Soins intensifs de médecine, CHUV, Lausanne
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Genton B, Gehri M. Routine screening of children returning home from the tropics. Authors' definition of asymptomatic children is not the one usually accepted. BMJ 1999; 319:121; author reply 122. [PMID: 10398644 PMCID: PMC1116200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Genton B, Gehri M, Okereke E, Gelletlie R, Tolboom JJM, Brouwer ML, Hardeman JHJ. Routine screening of children returning home from the tropics. BMJ 1999. [DOI: 10.1136/bmj.319.7202.121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Jeannet PY, Roulet E, Maeder-Ingvar M, Gehri M, Jutzi A, Deonna T. Home and hospital treatment of acute seizures in children with nasal midazolam. Eur J Paediatr Neurol 1999; 3:73-7. [PMID: 10700542 DOI: 10.1053/ejpn.1999.0185] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Rectal diazepam is widely used in the treatment of acute seizures in children but has some disadvantages. Nasal/sublingual midazolam administration has been recently investigated for this purpose but never at home or in a general paediatric hospital. The aim of this open study was to determine the efficacy, the tolerance and the applicability of nasal midazolam during acute seizures in children both in hospital and at home. We included known epileptic children for treatment at home and all children with acute seizures in the hospital. In all, 26 children were enrolled, 11 at home and 17 in the hospital (including two treated in both locations); only one had simple febrile seizure. They had a total of 125 seizures; 122 seizures (98%) stopped within 10 minutes (average 3.6 minutes). Two patients in the hospital did not respond and in three, seizures recurred within 3 hours. None had serious adverse effects. Parents had no difficulties administering the drug at home. Most of those who were using rectal diazepam found that nasal midazolam was easier to use and that postictal recovery was faster. Among 15 children who received the drug under electroencephalogram monitoring (six without clinical seizures), the paroxysmal activity disappeared in ten and decreased in three. Nasal midazolam is efficient in the treatment of acute seizures. It appears to be safe and most useful outside the hospital in severe epilepsies, particularly in older children because it is easy for parents to use. These data should be confirmed in a larger sample of children. Its usefulness in febrile convulsions also remains to be evaluated.
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Affiliation(s)
- P Y Jeannet
- Department of Pediatrics, Neuropediatric Unit, CHUV, Lausanne, Switzerland
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Gehri M. [Respiratory emergencies in pediatrics: priority problems]. Rev Med Suisse Romande 1996; 116:767-72. [PMID: 8966453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- M Gehri
- Service de pédiatrie du CHUV, l'Hôpital de l'Enfance-Lausanne
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Gehri M. [The sick child upon return from the tropics]. Rev Med Suisse Romande 1996; 116:779-84. [PMID: 8966455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- M Gehri
- Service de Pédiatrie du CHUV, Lausanne
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