Pediatric emergency care
-
The ability to obtain an arterial blood gas analysis within a few minutes in most medical facilities enables the clinician to rapidly evaluate the acid-base status of his or her critically ill patients and to treat disorders as they appear. Although acid-base charts, graphs, and nomograms are available and can help to establish a diagnosis of acid-base disorders, the common practice is that most emergency and critical care clinicians tend to interpret acid-base data rapidly, usually without using any of these tools. The intent of this discussion is to provide the clinician with the pathophysiologic background of acid-base imbalance, the diagnostic criteria for acid-base disturbances, and the clinical approach to management. The standard arterial blood gas analysis, serum and urine electrolytes, and clinical assessment of the alveolar ventilation are the only data upon which this discussion is based.
-
A retrospective chart review of 102 consecutive cases of gunshot wound injuries in children was conducted. Victims were identified by emergency department log review and computer search for inpatient discharge diagnoses. Results are compared with other studies. ⋯ Nonpowder weapons were found to have inflicted major injury in as many patients as did handguns. Methodologic problems of studying gunshot wounds in children are discussed. It is suggested that injury prevention strategies address nonpowder weapons as well as handguns.
-
Pediatric emergency care · Dec 1987
Review Case ReportsNear-fatal caffeine intoxication treated with peritoneal dialysis.
Caffeine is generally regarded as a safe drug, as evidenced by its wide availability in "over-the-counter" preparations and beverages. However, it is capable of producing a lethal outcome in cases of intoxication. ⋯ Previous cases of caffeine intoxication meriting hospital care or resulting in death which have been reported in the English language medical literature are summarized. It is suggested that drug-drug interactions and the use of peritoneal dialysis and hemoperfusion be given particular consideration in such patients.
-
Pediatric emergency care · Dec 1987
Review Case ReportsGarlic burns: a naturopathic remedy gone awry.
We report the case of a child who sustained partial thickness burns from a garlic-petroleum jelly plaster, which had been applied at the direction of a naturopathic physician. A review of the literature reveals that "garlic burns" have not previously been reported, although medicinal properties of garlic have been investigated by physicians and biochemists. The pediatrician caring for children in an area where naturopathic medicine is routinely practiced should be aware of the potential side effects of plasters, poultices, and other "natural" remedies in children.
-
After prevention, of all the elements in the care of the drowned child, none is more important than the early institution of respiration and appropriate resuscitation. Observation of the asymptomatic patient with any history of alteration of consciousness or respiration during a drowning accident for at least 12 to 24 hours is mandatory. ⋯ Transfer of these severely injured patients to a pediatric referral center where intracranial pressure monitoring and intensive support are available offers the best hope. Provisions for psychosocial support and follow-up for family members are essential.