Pediatric emergency care
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Hereditary angioedema is a disorder characterized by decreased levels or function of complement C1 esterase inhibitor. Symptoms in children generally consist of recurrent episodes of soft tissue swelling. On rare occasion, it can cause airway edema which may lead to airway obstruction. ⋯ Initial management of this rare complication should be directed at establishing an adequate airway and ensuring good oxygenation and ventilation. In addition, prompt administration of C1 esterase inhibitor concentrate is the most effective means of stopping progression of laryngeal edema and other forms of swelling. Commonly used agents for airway edema such as glucocorticoids, antihistamines, H1-blockers, and epinephrine tend not to be effective for reducing swelling related to hereditary angioedema.
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Pediatric emergency care · Jan 2005
Envenomation by the Northern Blacktail Rattlesnake (Crotalus molossus molossus): case report.
The clinical course after a human envenomation by the Northern Blacktail rattlesnake (Crotalus molossus molossus) is not well described in the literature. The present report discusses a 12-year-old girl who was envenomated by C. molossus molossus and treated with antivenom (Crotalidae polyvalent immune Fab). ⋯ Hematologic and coagulation studies were within normal limits at follow up. The clinical effects of C. molossus molossus envenomation are reviewed, and previous reports of bites by C. molossus molossus are discussed and compared with our patient.
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Pediatric emergency care · Jan 2005
Evaluation of pediatric glucose monitoring and hypoglycemic therapy in the field.
As specific indications for glucose monitoring in pediatric patients are not standardized, we sought to evaluate our EMS system regarding the use of this test, so that objective data can be used for prehospital provider education. We performed a 5-year electronic search of prehospital records to assess pediatric patients who had glucose monitoring performed, with subgroup analysis on those requiring therapy. We found that 6018 pediatric patients received glucose monitoring with the most common chief complaints for testing including: seizure, "other medical," trauma head/neck, and OD/poisoning. ⋯ Age breakdowns for therapy were as follows: 0-4 years, 44 (11.9%); 5-9, 36 (9.7%); 10-14, 58 (15.7%); 15-19, 232 (62.7%). In the prehospital setting, the need to treat hypoglycemia in pediatric patients is infrequent. The chief complaints associated with the highest frequencies of hypoglycemia are seizures and altered neurologic status.
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Pediatric emergency care · Jan 2005
Case ReportsOcular irrigant alternatives in pediatric emergency medicine.
Minimizing pain and discomfort is an important consideration in pediatric ocular decontamination. The pH of an irrigant solution plays a significant role in its tolerability, because a solution with a pH that is too low or too high may cause edema and discomfort to the conjunctiva. We reviewed several available ocular irrigation solutions with respect to their chemical composition, pH, and cost efficiency. ⋯ Alternative ocular irrigant solutions available include Lactated Ringers solution (LR), which has a pH range between 6.2 and 7.5, buffered NS with pH adjusted to 7.4 with sodium bicarbonate, and Balanced Salt Solution Plus (BSS Plus), which has a pH of 7.4. Of these alternative solutions, all except BSS Plus are comparable in cost efficiency to NS. The use of more pH neutral solutions such as LR, NS with bicarbonate buffer, or BSS Plus may decrease ocular pain and irritation associated with copious irrigation, and may improve tolerance of ocular decontamination by a child.
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Pediatric emergency care · Jan 2005
Alternative model for a pediatric trauma center: efficient use of physician manpower at a freestanding children's hospital.
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. ⋯ Mortality outcome from trauma in a pediatric hospital using this alternative approach to trauma care was significantly better than predicted by TRISS methodology.