Pediatric emergency care
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Pediatric emergency care · Mar 1986
Factors influencing outcome of cardiopulmonary resuscitation in children.
We evaluated 47 pediatric patients after cardiopulmonary arrest. Patients entered the study with the onset of advanced life support. We followed them until death, or discharge from the hospital, occurred. ⋯ Eighteen (38%) were long term-survivors, while nine (19%) were short-term survivors. Favorable outcome is associated with the following factors: inhospital arrest, extreme bradycardia as the presenting arrhythmia, successful resuscitation with only ventilation, oxygen and closed chest massage, and a duration of CPR of less than 15 minutes. Age, sex, and race, as well as pupillary reaction and motor response at the onset of advanced life support, did not correlate with long-term survival.
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Pediatric emergency care · Dec 1985
A pediatric emergencies training program for emergency medical services.
Accidents are the leading cause of death in children, accounting for more pediatric deaths than all other causes combined. Accidents also account for 21.7 million injuries to children that require medical care annually. ⋯ The course consists of 18 hours of lectures and skill stations focusing on medical emergencies, care of the injured child, the special needs of the infant, and the emotional response of the child and family in an emergency. Test evaluations before and after the course from the 190 participants demonstrate a significant improvement in their knowledge and skills in treating pediatric emergencies (P less than 0.001).
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Pediatric emergency care · Dec 1985
Hyponatremia and seizures presenting in the first two years of life.
During a three-month period, 15 patients under two years of age presented with serum sodium concentrations less than 127 mEq/L. Seven (47%) of these patients presented with seizures. Hyponatremia accounted for a majority (58%) of the afebrile seizures in children under two years during this period. ⋯ Hyponatremia may account for more seizures in early life than has been appreciated. Physicians and parents should avoid dietary practices which promote water intoxication. The etiology, diagnosis, and management of water intoxication and hyponatremic seizures are discussed.
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Pediatric emergency care · Dec 1985
Case ReportsRhabdomyolysis and myoglobinuria as manifestations of child abuse.
Rhabdomyolysis should be suspected in cases of physical child abuse in which there is extensive soft tissue injury. It is easily investigated using the urinalysis and serum CPK levels. ⋯ A full recovery can be expected for adults with this disorder, but information about the pediatric population is sparse. Our series suggests rapid improvement with appropriate therapy.
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The approach to the injured child requires great care and clinical acumen to establish the diagnosis and institute appropriate treatment. Loss of life from occult internal hemorrhage or neurologic sequelae from a missed unstable cervical spine injury may be devastating. Yet, physicians in the ED must also know which children need only a careful physical examination, and when laboratory testing or admission is unnecessary. We have described a schema for providing appropriate care to children with trauma in such a way that specific issues about management can be reasonably approached by the emergency physician.