Pediatric emergency care
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Pediatric emergency care · Jul 2011
Case ReportsExtracorporeal membrane oxygenation as rescue therapy for methadone-induced pulmonary edema.
Opioid-induced pulmonary edema has been previously reported, but its mechanism remains unclear. The use of extracorporeal membrane oxygenation as rescue therapy for methadone-induced pulmonary edema has not been reported in the literature. We describe 2 cases of methadone ingestion complicated by pulmonary edema, acute respiratory distress syndrome, and circulatory failure successfully managed with venoarterial extracorporeal membrane oxygenation.
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The objective was to assess pediatric residents' attitudes toward and knowledge about medical malpractice before and after an educational intervention. ⋯ Pediatric residents are uncomfortable with their knowledge of medical malpractice and think it should be taught during residency. Confusion regarding responsibility to provide standard of care and underestimates of the likelihood of being sued and the time to notification of a suit support the need for malpractice education. An educational intervention improves background knowledge and self-reported documentation.
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Pediatric emergency care · Jul 2011
Mortality and child abuse in children presenting with apparent life-threatening events.
Children who present to the emergency department following an apparent life-threatening event (ALTE) often appear well, have a normal physical examination, and usually do well. The incidence of mortality following an event appears to occur infrequently, but has not been well described. However, it has been our experience that children who are victims of occult child abuse have a high mortality rate. ⋯ Although the subsequent mortality rate for children who present with an ALTE is low, child abuse was one of the identifiable causes of death and should be considered during evaluation of all children who present with an ALTE.
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Scorpion envenomation is a dangerous and common global event that can result in a variety of toxic clinical effects. These are typically managed with supportive care or antivenom. Antivenom use is controversial because of conflicting evidence of effectiveness for adrenergic toxicity. However, both controlled and uncontrolled studies have shown that antivenom is effective in resolving neuromotor toxicity associated with envenomations by the scorpions of genus Centruroides.
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Pediatric emergency care · Jul 2011
Review Randomized Controlled TrialUniversally poor outcomes of pediatric traumatic arrest: a prospective case series and review of the literature.
Few data are available on traumatic cardiopulmonary arrest in children. Efforts at resuscitation typically result in heavy utilization of finite resources with little understanding of which characteristics, if any, may be associated with success. The objectives of this study were to describe the outcome of children in traumatic cardiac arrest and to identify patients for whom aggressive resuscitation may or may not be warranted. ⋯ Children who had trauma resulting in cardiac arrest have universally poor outcomes, and survivors have severe neurological compromise. We are unable to identify a subset of patients for whom aggressive resuscitation is indicated. This is the largest prospective study of pediatric traumatic arrest to date.