Pediatric emergency care
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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.
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Minors frequently present to the ED for treatment without their legal guardians. In most such situations, it is best to contact the parents to obtain consent for treatment and to inform them about their child's problem. ⋯ In these situations, the law is sufficiently vague to protect the well-meaning physician who gives care to consenting minors for their own benefit. Of course, if problems result from the care which is rendered, the usual malpractice law will apply, and the physician will try to demonstrate that his treatment fit into one of the legal exceptions to the general rule.
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A review of 247 pediatric emergency charts and 80 pediatric impatient charts was performed over a three-year period at a tertiary care children's hospital in Honolulu. The purpose of this review was to examine the causes of childhood burns in Hawaii in order to develop guidelines for anticipatory guidance regarding burn prevention. Most burns occurred in the 0.8- to 3.0-year age group. ⋯ Severe burns were mainly the result of scalds, fire, or contact with heating appliances. Burn severity and the causes of burns did not vary significantly with sex or ethnic or economic status. A burn prevention program which adequately addresses the unique cultural and climatic differences of this community, based on the data obtained, is described.