Clinics in chest medicine
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Clinics in chest medicine · Dec 1987
ReviewEvaluation and stabilization of the critically ill child.
Because the timely treatment of children in accidents or with serious illnesses usually is successful, it is vital that the life-threatening problem promptly be recognized. Although the principles of resuscitation are identical in the child and adult, age-related differences in anatomy and pathophysiology may make this task challenging for the physician who usually cares for adults. In this article, a systematic approach to evaluation and initial stabilization of the pediatric patient is discussed. Decisions and methods in safely transferring a critically ill pediatric patient are also reviewed.
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The management of the pulseless, nonbreathing pediatric patient continues to be a frustrating experience because mortality and morbidity are high. Improvement in outcome awaits a better understanding of the pathophysiology of organ ischemia and reperfusion injury. In the interim, early recognition and therapy of respiratory and circulatory failure are the only effective means to affect outcome. ⋯ Ventricular arrhythmias are treated with defibrillation or cardioversion as appropriate. Infrequently, lidocaine or bretylium may be needed. Once the patient has been stabilized, further care is best delivered at a tertiary care center with a pediatric intensive care unit.
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Clinics in chest medicine · Dec 1987
ReviewThe normal and abnormal pediatric upper airway. Recognition and management of obstruction.
The pediatric airway is particularly vulnerable to obstruction because of its anatomy, size, and susceptibility to disease and trauma. This article concentrates on the differences between the pediatric and adult airway, congenital and acquired pathology affecting the airway, and the recognition and management of obstruction.
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Invasive monitoring is an important aspect of the care of the infant or child with multisystem organ dysfunction or severe acute respiratory failure. The indications for these procedures in children vary little from current recommendations for adults. The size, anatomy, physiologic responses, and pathophysiologic processes in children frequently require modifications in the placement and maintenance of these lines, and in the interpretation of the data. The literature suggests that although the absolute numbers may vary, broad therapeutic goals may be identified and treated in pediatric patients as in older patients.