Pediatric emergency care
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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.
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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.
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A survey of 24 existing pediatric emergency medicine fellowship programs as of December 1987 was conducted in order to characterize the following attributes of training in pediatric emergency medicine: amount of clinical time, required and elective rotations, didactic and research experience, patient volume, and staffing. Time spent in the emergency department varies between three and 10 months annually, with a mean of 34.5 hours per week. ⋯ Patient volume varies between 20,000 and 70,000, with a median of 41,000. The data offered should act as a reference for the further development of new and existing programs.