Pediatric emergency care
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Pediatric emergency care · Jul 2009
Randomized Controlled Trial Comparative StudyA randomized clinical trial of lidocaine gel for reducing infant distress during urethral catheterization.
The purpose of this study was to determine whether a lidocaine-enhanced lubricant that was used topically and instilled into the urethra decreased infants' distress that was associated with catheterization. ⋯ The use of topical and intraurethral lidocaine resulted in a lower distress when compared with a topical lubricant, at a level approaching significance for global distress. When a subsection of the total distress score that measured infant cry was evaluated, the difference between the intraurethral lidocaine group and the group without intraurethral instillation was statistically significant. Although the results are promising, intraurethral lidocaine did not fully alleviate discomfort associated with urethral catherization. The use of lidocaine is suggested for pediatric patients undergoing urethral catherization; however, evaluation of additional agents and techniques for further decreasing pain is also warranted.
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Pediatric emergency care · Jul 2009
Randomized Controlled Trial Comparative StudyBackslab versus nonbackslab for immobilization of undisplaced supracondylar fractures: a randomized trial.
Immobilization of supracondylar fractures of the humerus, for 1 to 4 weeks in a backslab or a collar and cuff, produces good functional outcomes. This study assesses the pain associated with these 2 forms of immobilization. ⋯ For supracondylar fractures, use of an above-elbow posterior slab produces shorter duration of pain and reduces the time taken to become active again.
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Pediatric emergency care · Mar 2009
Randomized Controlled Trial Multicenter Study Comparative StudyEffect of high-fidelity simulation on Pediatric Advanced Life Support training in pediatric house staff: a randomized trial.
To assess the effect of high-fidelity simulation (SIM) on cognitive performance after a training session involving several mock resuscitations designed to teach and reinforce Pediatric Advanced Life Support (PALS) algorithms. ⋯ The use of high-fidelity simulation in a PALS training session resulted in improved cognitive performance by pediatric house staff. Future studies should address skill and knowledge decays and team dynamics, and clearly defined and reproducible outcome measures should be sought.
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Pediatric emergency care · Mar 2009
Randomized Controlled Trial Comparative StudyRandomized controlled trial of ultrasound-guided peripheral intravenous catheter placement versus traditional techniques in difficult-access pediatric patients.
We hypothesized that the use of ultrasound guidance would improve the success rate of peripheral intravenous catheter placement in pediatric patients with difficult access in a pediatric emergency department (ED). Our secondary hypotheses were that ultrasound guidance would reduce the number of attempts, the number of needle redirections, and the overall time to catheter placement. ⋯ In a sample of pediatric ED patients with difficult access, ultrasound-guided intravenous cannulation required less overall time, fewer attempts, and fewer needle redirections than traditional approaches.
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Pediatric emergency care · Nov 2008
Randomized Controlled Trial Comparative StudyEffect of cervical spine immobilization technique on pediatric advanced airway management: a high-fidelity infant simulation model.
Current guidelines recommend cervical spine immobilization during orotracheal intubation when traumatic injury is suspected in infants. We evaluated the effect of cervical spine immobilization techniques on orotracheal intubation performance with a high-fidelity infant simulator. ⋯ In this high-fidelity infant simulator model, cervical spine immobilization technique affected cervical extension angle and laryngeal visualization. Tracheal intubation associated events occurred in 33% of intubation attempts but were not different by technique. Time to achieve tracheal intubation, number of intubation attempts needed to succeed, and intubation-associated events were not affected by immobilization techniques. These results support Advanced Trauma Life Support recommendations to perform manual in-line immobilization in infants.