Robert G. Bolte's research while affiliated with University of Utah and other places

Publications (20)

Article
Emergently ill infants and children are often inadequately recognized and stabilized by health care facilities in low- and middle-income countries. Limited reports have shown that process improvements and prioritization of emergency care for children presenting to the hospital can improve pediatric hospital mortality.A dedicated pediatric emergency...
Article
Pediatric care providers in the developing world face daunting challenges, often exceeding available resources. This challenge presents an opportunity for constructive involvement in international medicine by pediatric emergency medicine (PEM) physicians. The significant need for providing improved pediatric care worldwide dovetails with a high lev...
Article
Amiodarone is a class 3 antiarrhythmic agent used for a broad range of arrhythmias including adenosine-resistant supraventricular tachycardia, junctional ectopic tachycardia, and ventricular tachycardia. Compared with adults, there are few data on its use in children with arrhythmias resistant to conventional therapy. National and international gui...
Article
Our objective was to describe young children injured through the use of infant carrier car seats, comparing them with children injured through other fall mechanisms. We performed a retrospective chart review of children 18 months or younger with a fall mechanism of injury presenting to the emergency department of a tertiary care level 1 pediatric t...
Article
Freestanding children's hospitals may lack resources, especially surgical manpower, to meet American College of Surgeons trauma center criteria, and may organize trauma care in alternative ways. At a tertiary care children's hospital, attending trauma surgeons and anesthesiologists took out-of-hospital call and directed initial care for only the mo...
Article
Few studies have addressed the presentation and clinical impact of pediatric pelvic fractures. We sought to describe pediatric blunt trauma patients with pelvic fracture (PF) and to evaluate the sensitivity and specificity of physical examination at presentation for diagnosis. Retrospective analysis of all PF and control (NPF) patients from our ped...
Article
To determine the incidence of appendiceal perforation (AP) among children with acute appendicitis (AA) and determine factors associated with AP. Retrospective chart review. Emergency department (ED) of Primary Children's Medical Center (PCMC). 131 children less than 17 years of age with AA diagnosed in the PCMC ED. The overall rate of AP was 47%. O...
Article
Fluid resuscitation of infants and children is a common management problem in prehospital and emergency department care. We present two cases of children who received 5% dextrose in water as the initial resuscitation fluid. Bolus administration of hypotonic fluid contributed to fatal outcomes in these cases, Recommendations are made for eliminating...
Article
The purpose of this study was to determine the applicability of two accepted outpatient management protocols for the febrile infant 1-2 months of age (Boston and Philadelphia protocols) in febrile infants 1-28 days of age. We retrospectively reviewed charts of patients 1-28 days of age with a temperature greater than or equal to 38.0 degrees C. Cri...
Article
Delay in the provision of definitive care for critically injured children may adversely effect outcome. We sought to speed care in the emergency department (ED) for trauma victims by organizing a formal trauma response system. A case-control study of severely injured children, comparing those who received treatment before and after the creation of...
Article
To compare historical features, physical examination findings, and testicular color Doppler ultrasound in pediatric patients with epididymitis, testicular torsion, and torsion of appendix testis. A retrospective review of patients with the diagnosis of epididymitis, testicular torsion, or torsion of appendix testis. Ninety patients were included in...
Article
The transport of a patient with asthma can range from routine to overwhelming. While the majority of asthmatic patients seen in an emergency department are easily managed with routine therapy, a significant percentage may require increased therapies, interventions, and monitoring not available at the initial institution. We present several cases of...
Article
To evaluate the effectiveness of a pediatric trauma course taught in a developing country. A pediatric trauma course was designed with didactic presentations and reinforced with small group case discussions. Subjects included a general trauma overview, head trauma, airway/chest trauma, cervical spine trauma, abdominal trauma, shock, burns, and orth...
Article
Motor vehicle-related trauma is the leading cause of death in children in the United States. All states have pediatric restraint requirements for passenger vehicles to help prevent these deaths and injuries. Only a few states, however, possess safety laws or restrictions for passengers who ride in the back of pickup trucks. A retrospective review o...
Article
The use of an initial bolus of insulin prior to the initiation of low-dose insulin infusion therapy was evaluated in 56 episodes of diabetic ketoacidosis (DKA) in 38 children. The cases were randomly assigned to a group that received a bolus of insulin (n = 24) and to a group that did not (n = 32). After the first hour of insulin therapy, the decli...
Article
Vascular access in young children frequently proves difficult in the prehospital setting. To assess the feasibility of training paramedics in the placement of intraosseous (IO) lines as an alternative to intravenous (IV) access, this pilot project studied a training program and treatment protocol for prehospital IO use. Paramedics underwent a train...

Citations

... Sylverken et al. [9] reported that redirecting limited resources to pediatric emergency care is associated with the reduction in early in-hospital mortality, especially in LMICs. Therefore, this death audit of pediatric referrals was conducted to ascertain the risk factors predicting early in-hospital mortality within 48 hours of admission and to determine the demographic profile, disease-related factors, and system-based factors related to referral of under-five children to the pediatric emergency of a tertiary care hospital. ...
... Our findings align well with previously reported studies using administrative data sets and medical record reviews [4,7,[21][22][23][24]. While some identified factors have been noted previously [8,[25][26][27], this is the first study to provide this level of detail and identify targets for intervention across the spectrum of fall mechanisms among infants of this age. ...
... New POC devices must be capable of testing for a variety of pathogens present at a particular disaster site, and also properly integrated and used to decrease response 16 Salmonella paratyphi (blood) Water, food borne Nonspecific 17,18 Streptococcus pneumoniae (blood) Inhalation (continued on next page) times and improve patient outcomes. During Hurricane Katrina, a variety of different locations and types of POCT were used featuring an array of POC tests covering chemistry, hematology, and other analyte categories. ...
... An IV insulin bolus should not be used at the start of therapy; it is unnecessary,163,165 can precipitate shock by rapidly decreasing osmotic pressure, and can exacerbate hypokalemia.• If the child shows marked sensitivity to insulin (e.g., some young children with DKA, children with HHS, and some older children with established diabetes), the insulin dose may be decreased, provided that metabolic acidosis continues to resolve. ...
... 4 Traditionally, IO infusion was mostly used in pediatric cases, but adult IO infusion has become increasingly common. [3][4][5][6][7][8][9]11 Placement Effectiveness of a Drill-Assisted Intraosseous Catheter ...
... Four programmes utilized OSCE assessments [22,29,31,33], and five used simulation and hands-on skills assessments [21,37,42,51,55]. Thirteen programmes used surveys to assess provider-perceived knowledge attainment [20,32,34,36,40,[45][46][47]50,53,60,61], and nine used surveys to assess providers' confidence in their skills [45,49,50,52,54,56,[58][59][60][61]. ...
... 5 Missed TT is one of the most common reasons for litigation in the United Kingdom and as such patients who present with other causes of ATP undergo surgery unnecessarily when TT cannot be excluded. 6,7 EAU guidelines state that clinical decision-making on TT should be based on examination findings, with Doppler ultrasound (US) helpful in reducing unnecessary scrotal explorations if not delaying emergency intervention. [8][9][10] The utility of US for diagnostic purposes is contested in view of its operator dependency, potential for delaying surgery and limitation in pre-pubescent patients. ...
... General activation of a multidisciplinary trauma team, stroke team and pediatrics team improve patient outcomes significantly [24][25][26]. In more than 66% we had a complete multidisciplinary team on arrival of the patient. ...
... About 5 to 15% of febrile infants under 29 days of age evaluated in the emergency department (ED) have invasive bacterial infection (IBI) defined as meningitis or bacteremia and severe bacterial infection (SBI) without bacteremia including mainly urinary tract infection (UTI) (1)(2)(3)(4). Whereas urinalysis is highly sensitive for detecting UTI in febrile neonates (5), actual ED clinical prediction rules combining clinical and biological data (6)(7)(8) fail to recognize all IBI in febrile neonates (9). Because missed-IBI may lead to severe complications (10), all febrile neonates are classified as at high risk of IBI regardless of any clinical or biological factors, and their treatment involves broad-spectrum antibiotic intravenous administration and hospitalization (11). ...
... The dose of fluid during these 4 phases of fluid therapy needs to be adjusted on the basis of the unique physiologic needs of each patient, and a specific protocoled dose is not able to be applied to all patients. 8,9 A variety of IVFs are commercially available for use in infants and children. These solutions principally vary by their specific electrolyte composition, the addition of a buffer, and whether they contain glucose (Table 1). ...