Pediatric emergency care
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Near-infrared spectroscopy is a noninvasive means of determining real-time changes in regional oxygen saturation of cerebral and somatic tissues. Hypoxic neurologic injuries not only involve devastating effects on patients and their families but also increase health care costs to the society. ⋯ Although 20th century advances in the understanding and management of resuscitation of critically ill and injured children have focused on global parameters (ie, pulse oximetry, capnography, base deficit, lactate, etc), a growing body of evidence now points to regional disturbances in microcirculation that will lead us in a new direction of adjunctive tissue monitoring and response to resuscitation. In the coming years, near-infrared spectroscopy will be accepted as a way for clinicians to more quickly and noninvasively identify patients with altered levels of cerebral and/or somatic tissue oxygenation and, in conjunction with global physiologic parameters, guide efficient and effective resuscitation to improve outcomes for critically ill and injured pediatric patients.
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Pediatric emergency care · May 2011
Randomized Controlled Trial Comparative StudyCost-efficiency assessment of 3 different pediatric first-aid training models for caregivers and teachers in Shanghai.
The object of this study was to assess, in cost-effective measures, 3 different models for pediatric first-aid training among caregivers and teachers. ⋯ Although interactive training model may slightly increase the rate of trainees who passed the course, the cost-effectiveness of video instruction training model is clearly superior.
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Pediatric emergency care · May 2011
Comparative StudyManagement of uncomplicated nail bed lacerations presenting to a children's emergency department.
This study examined the mechanisms of injury and the pattern of care for children who presented to the emergency department with uncomplicated nail bed lacerations. ⋯ Most nail bed injuries in children occur at home, and the door seems to be the major mechanism of injury. Approximately 57% of these are children younger than 5 years. Only 42% of uncomplicated nail bed lacerations are treated by emergency physicians, yet there is no significant difference in outcomes between plastic surgeons and emergency physicians. Our study suggests that there is a role in public education for primary prevention, and with proper training, pediatric emergency physicians can treat uncomplicated nail bed lacerations.
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Pediatric emergency care · May 2011
Comparative StudyAdherence of families to a group a streptococcal pharyngitis protocol used in a pediatric emergency department.
In an effort to limit inappropriate antibiotic use for children with pharyngitis, our pediatric emergency department (PED) has implemented a strep throat protocol using preprinted prescriptions given to families pending pharyngeal swab results. We sought to determine the rate of adherence of families managed with this protocol and to identify whether clinical features are associated with adherence. ⋯ Most families are adherent to our GAS pharyngitis protocol. Very few families filled prescriptions when the swab result was negative. Age was the only factor influencing adherence. Our current GAS pharyngitis protocol is an effective management strategy for children presenting with pharyngitis to the PED.
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Pediatric emergency care · May 2011
Comparative StudyEndotracheal tube and laryngeal mask airway cuff pressures can exceed critical values during ascent to higher altitude.
Tracheal mucosal perfusion is compromised at an endotracheal tube (ETT) cuff pressure of 30 cm H(2)O, and blood flow is obstructed at a pressure of 50 cm H(2)O. ⋯ This model indicates that ETT cuffs inflated before air transport are likely to exceed critical pressure levels rapidly during flight. In addition, there will be loss of ETT cuff pressure, with loss of a good seal, during descent if a cuff is initially inflated at peak altitudes. Therefore, we suggest ETT cuff pressures should be monitored and adjusted continuously during ascent and decent.