Pediatric emergency care
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Pediatric emergency care · Jul 2010
ReviewPain management of musculoskeletal injuries in children: current state and future directions.
Pain is the most common reason for seeking health care in the Western world and is a contributing factor in up to 80% of all emergency department (ED) visits. In the pediatric emergency setting, musculoskeletal injuries are one of the most common painful presentations. Inadequate pain management during medical care, especially among very young children, can have numerous detrimental effects. No standard of care exists for the management of acute musculoskeletal injury-related pain in children. Within the ED setting, pain from such injuries has been repeatedly shown to be undertreated. ⋯ There is a need to optimize the measurement, documentation, and treatment of pain in children. There is growing evidence that nonpharmacological methods can be introduced to improve analgesia in the ED, and efforts to help parents implement these methods at home might be advantageous to optimize outpatient treatment plans. In pharmacotherapy, ibuprofen has emerged as an appropriate first-line choice for mild-moderate orthopedic pain. Other oral opioids (hydrocodone, oxycodone) are gaining popularity over codeine, because of the current understanding of the pharmacogenomics of such medications.
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Pediatric emergency care · Jul 2010
ReviewAlternatives to intravenous rehydration in dehydrated pediatric patients with difficult venous access.
Intravenous (IV) catheter placement in the pediatric patient population can be challenging. Many health care providers automatically choose IV fluid administration to treat dehydration, often not considering other routes. This article reviews the available literature on difficulties in obtaining IV access in the pediatric population and discusses alternative methods for fluid replacement, their respective advantages and disadvantages, and place in therapy.