Profile of pediatric admissions with diagnosis of asthma at the San Pablo Hospital.

Bronchial Asthma morbidity and mortality appear to be increasing. In our continuing endeavor to investigate the asthma problem in Puerto Rico, we describe the profile or group of pediatric patients admitted with asthma during a three month period of time to a community hospital. This is intended to be an initial step in developing a more detailed study to evaluate risk factors for hospitalization and need for acute care management of children with asthma in Puerto Rico. We evaluated a group of patients admitted with the diagnosis of asthma (ICD-9 code 493). One hundred and nineteen admissions between August 22 and November 21, 1990 (ninety days) were reviewed retrospectively. Data extracted from the records included demographic, laboratory and physiological variables. Results were similar for both sexes. Asthma admissions represented 29 percent of the total admissions with a hospital stay of 4.07 +/- 1.09 days and age of 4.62 +/- 4.29 years (mean +/- SD). No pulmonary function tests were performed as criteria for admission. In conclusion, this study suggests that the need for hospitalization in children with asthma in a community hospital is based on clinical evaluation. The use of pulmonary function tests, peak expiratory flow measurement or both may not be suitable for the majority of children admitted with asthma due to age. Other criteria for younger children with asthma need to be developed.

Supraglottitis: the need of a standardized protocol.

Supraglottitis is an acute airway emergency requiring prompt medical intervention. Ten cases of epiglottitis treated at San Pablo Hospital are reviewed retrospectively. The controversies regarding this diagnosis are discussed. Due to a wide range of opinions concerning the proper management and treatment of epiglottitis, and the need of a standardized protocol, a simple and flexible protocol to be used by all physicians is proposed.

Joubert syndrome. Respiratory failure requiring home mechanical ventilation.

A case of Joubert's Syndrome with respiratory insufficiency requiring mechanical ventilatory support is presented. The case illustrates the complex clinical, ethical and technical aspects in the management of patients with this syndrome and the feasibility of extending mechanical ventilatory support to the home setting. A caring, knowledgeable care team and a loving supportive family are required to properly continue treatment in the home in cases of this rare syndrome.

Foreign bodies of the esophagus the San Pablo Hospital experience.

Between 1978 and 1990, a total of 76 cases of esophageal foreign bodies were taken to the operating suite at San Pablo Hospital. Of the 76 patients, 26 were in the pediatric age group, and 56 adults. Dysphagia and foreign body sensation were the predominant complaint. The radiographic study most frequently ordered was soft tissue neck x rays. Coins were the most common foreign body in the pediatric group, while bones were the most frequent in the adult group. Rigid esophagoscopy was the predominant form of treatment in both groups. The majority of cases were performed by the Otolaryngologist-Head and Neck Surgeon. Several complications occurred and there was one death. For the purpose of analysis and discussion the cases were divided into the pediatric age group and the adults.

Flexible bronchoscopy in children at the University of Puerto Rico Pediatric Hospital. Review of 324 consecutive patients.

Described are the findings resulting from 324 bronchoscopies performed with the flexible bronchoscope during the past 8 years at the University of Puerto Rico Pediatric Hospital. Neonates, infants, children and adolescents were included. The most frequent indications for the procedure were stridor, recurrent or persistent pneumonia, atelectasis, recurrent croup and persistent wheezing. An abnormality was detected in 88 per cent of the patients and the finding often resulted in significant modifications of treatment or allowed for reassurance. Complications were minor and there was no mortality. We conclude that the procedure, as we describe it, is save, effective and useful.

Chief complaint of 3,545 pediatric patients at the emergency room of San Pablo Hospital during a five months period.

A survey was made of the chief complaints at the Emergency Room of San Pablo Hospital of 3,545 pediatric patients seen between January 1 and May 31, 1988. Most common chief complaints involved the gastrointestinal system, trauma, and fractures. There was a wide range of chief complaints. Periodic surveys of this type should be useful in establishing priorities of pediatric training.