Postdischarge adverse events related to sedation for diagnostic imaging are minor, mostly behavioral, but occur in a significant number of patients. Parents should be provided with detailed discharge instructions to anticipate such adverse events at home.

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To describe inpatient management of patients with croup admitted from the emergency department (ED). METHODS: In a multicentered, cross-sectional observational study based on retrospective chart review, we identified children 6 months to 5 years of age with a discharge diagnosis of croup. All patients were evaluated in the ED and treated with at least 1 dose of racemic epinephrine (RE) before admission. Children with hypoxia or directly admitted to the PICU were excluded. RESULTS: We identified 628 admissions for croup. Significant interventions, defined as additional RE, helium-oxygen use, or PICU transfer, occurred in 142 patients (22.6%). A total of 137 children received additional RE on the inpatient ward, and 5 received RE and were transferred to the PICU. No patient was treated with helium-oxygen. A total 486 (77.4%) of patients did not receive significant interventions postadmission. Length of stay for children not requiring significant intervention was, on average, ,24 hours (18.8 hours [SD 9.3]; range 1.2-111 hours). Children with tachypnea (odds ratio 5 2.5; P 5 .002) on arrival to ED and patients who had ED radiographs (odds ratio 5 1.7; P 5 .018) had increased odds of receiving a significant intervention after admission. CONCLUSIONS: Less than one-quarter of children admitted to the general wards for croup received significant interventions after admission. Tachypnea in the ED and use of radiograph were associated with an increased use of significant interventions.

An 11-week-old male infant was brought to an outside emergency department (ED) with the chief complaint of coffee ground emesis. He was vomiting about half of his feeds, 2 to 3 times a day for the last 2 days. On the day of presentation to the ED, he had 8 episodes of emesis over a 2-hour period, all of which were described by the mother as coffee ground and projectile. He usually drank 4 oz of Similac with iron every 2 to 3 hours, but his mother reported that it had decreased to 2 oz every 3 hours over the last 2 days. He had no fever or diarrhea. He did not have a bowel movement for the last 2 days. Prior to that, his bowel movements were normal without blood or melena. His mother had not noticed any abdominal distension or increased fussiness. There was no history of trauma or bleeding reported from other sites. He was born at term by normal vaginal delivery without any complications. There was no history of bleeding diathesis in the family.At the community ED, he was noted to be active, alert, hemodynamically stable and had a normal physical examination. A complete blood count (CBC) and coagulation studies were reported to be normal. X-ray of the abdomen revealed mild gastric distension but was otherwise normal. He received a normal saline bolus 20 cm 3 /kg. A nasogastric (NG) tube was placed that returned blood-tinged stomach contents, and he was transferred to our ED for further care.Physical examination at our ED revealed an alert, well-appearing vigorous infant with a temperature of 37.5°F, heart rate of 142 beats per minute, respiratory rate of 32 breaths per minute, and a blood pressure of 115/79 mm Hg. He had no pallor or scleral icterus. Anterior fontanelle was soft and level. His NG tube was in place with return of blood-tinged gastric contents. There was no active bleeding noted from anywhere else. His capillary refill was less than 2 seconds. He was breathing comfortably, and his lungs were clear to auscultation. His abdomen was soft and nontender, with no organomegaly or palpable masses and with normal bowel sounds. His skin had no petechiae, bruises, or ecchymoses. Rectal examination showed soft stool that was hem occult negative.