Another study found that CRT was roughly three times more likely to be reported as normal in daylight conditions when compared to a dark room (94.2% vs. One study conducted in an urban pediatric emergency department examined the effect of room temperature on CRT in mildly ill, but well-hydrated patients aged one month to 12 years and found a statistically significant difference (0.85 +/- 0.45 seconds in the warm room vs. It should be acknowledged that the validity of CRT results may be affected by a multitude of factors, including differences in ambient conditions, patient age, skin pigmentation, presence of nail polish or artificial nails, and is even subject to intraobserver and interobserver reliability. While accurate assessment of intravascular volume status is best accomplished through a combination of these methods, this article will focus specifically on the measurement of capillary refill time and its growing application in guiding medical diagnosis and subsequent management. More objective indicators of hypovolemia include laboratory abnormalities (increased BUN, increased creatinine, increasing lactate, fluctuating hemoglobin levels, increased urine specific gravity, presence of oliguria/anuria) and radiographic derangements (increased collapsibility of the IVC on ultrasound, reduced cardiac chamber diameters on ultrasound or CT, changes in transpulmonary thermodilution). Briefly, markers of reduced perfusion include abnormal vital signs (hypotension, tachycardia, increased pulse pressure variation), deranged physical exam findings (delayed CRT, dry mucous membranes, poor skin turgor, absence of diaphoresis, altered mental status). Volume status can also be assessed via an assortment of other clinical exams and objective measurements. Information obtained from CRT assessment can then guide fluid resuscitation strategies, reassess an implemented therapy, and define the endpoint of treatment. Examples of these pathologic states include but are not limited to: hypo and hyperthermia, all forms of shock, hemorrhage, loss of plasma volume in burns, gastrointestinal losses through diarrhea or vomiting, over-diuresis, and anaphylactic reactions. The child regained full function of the ankle.Capillary refill time (CRT) is a useful and rapid metric in determining the intravascular volume status of ill patients, particularly those with conditions that arise or result from hypovolemia. A long leg cast was applied and removed after 6 weeks. This toddler was placed in a long leg posterior splint with flexion at the knee to prevent him from walking. This injury most commonly occurs at the knee and ankle and almost always results in growth stunting. V: Compression fracture or crush injury of the physis.Chronic disability may result unless perfect alignment is achieved. Surgery is required to realign all bony parts. IV: Fracture through all 3 bony areas: epiphysis, physis, and metaphysis.Surgery is often needed for repair however, prognosis is generally favorable. III: Fracture through the epiphysis and physis.The injury may result in minimal shortening of the involved extremity long-term complications, such as joint instability, growth arrest, compartment syndrome of the calf or foot, or osteochondroma formation, are unusual. This is the most common type of growth plate fracture. II: Fracture through the physis and metaphysis that spares the epiphysis.Prognosis is good-the fracture usually heals without sequelae. This is the most common type of fracture in newborns and young children. I: Fracture through the physis that causes the epiphysis to move away from the metaphysis.The type of injury determines patient prognosis, particularly the effect on growth and bone deformity: Most growth plate fractures can be divided into 5 categories based on the degree of damage (the Salter-Harris classification of epiphysial plate injuries). These findings classify this as a Salter II fracture. Laurie Meng, PA-C, of Savoy, Ill, reports that radiographs of the left ankle revealed a nondisplaced fracture of the tibia with extension through the physis (white arrow)-although difficult to visualize in this patient-and a nondisplaced incomplete fracture of the distal fibula (yellow arrow). He had full range of motion, strong distal pulses, and brisk capillary refill. The left ankle had no gross abnormality or soft tissue swelling palpation of the area produced discomfort. Prior medical records showed no history of broken bones or evidence of past abuse or questionable injuries. The child had not been able to bear weight on his left ankle since the fall and resisted his mother's efforts to put on his shoe. A 16-month-old toddler was brought to the emergency department after he and the sibling who was carrying him fell down a flight of stairs.
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