Pediatric emergency care
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Vascular access in young children frequently proves difficult in the prehospital setting. To assess the feasibility of training paramedics in the placement of intraosseous (IO) lines as an alternative to intravenous (IV) access, this pilot project studied a training program and treatment protocol for prehospital IO use. Paramedics underwent a training program in IO placement. ⋯ Although no patients achieved long-term survival, three were initially resuscitated from arrest. Paramedics can be trained in IO placement, and IO infusion can be used in prehospital pediatric care. Training methods, limitations, and implications for future use are discussed.
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Pediatric emergency care · Mar 1989
Prospective evaluation of selective criteria for imaging among children with suspected blunt renal trauma.
The evaluation of children with suspected blunt renal injury relies mainly on clinical assessment, urinalysis, and imaging studies. Because imaging studies rarely influence management, yet entail both risk and expense, we investigated a protocol to define their appropriate use. During a one-year period, children seen in the emergency department underwent a mandated radiographic evaluation for renal injury only if they had (a) severe injuries or (b) a urinalysis with greater than 20 RBC/hpf. ⋯ All children with abnormal imaging studies had greater than 20 RBC on urinalysis. None of the 16 children who were not studied radiographically developed complications related to renal trauma during short-term follow-up. Our findings support earlier recommendations for limiting the use of imaging for suspected blunt renal trauma in children with minor to moderate injuries and hematuria of less than or equal to 20 RBC/hpf.
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Pediatric emergency care · Mar 1989
Case ReportsNear-miss asphyxiation from a toy ball: a small parts failure.
The case report of a near-fatal asphyxiation of an 11-month-old child by a 26 mm (diameter) toy ball is presented. The lack of compliance with existing Consumer Product Safety Commission standards for small parts is discussed, and a recommendation is made regarding the coloring of ingestible objects.
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A case of knotting of a bladder catheter inserted to closely monitor a critically ill child is presented. The literature is reviewed, revealing knotting to be an unusual complication of this common pediatric procedure. Risk factors for knotting are discussed, and precautionary recommendations are presented.
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Pediatric emergency care · Mar 1989
Prehospital pediatric endotracheal intubation performance review.
Pediatric prehospital care was reviewed over a one-year period to determine success rate, causes of unsuccessful attempts, and complications of performing endotracheal intubation. The Milwaukee County Emergency Medicine Technician-Paramedics (EMT-Ps) responded to 1467 pediatric (less than 19 years of age) patient calls. This accounted for 11% of the patients who received EMT-P care during the study period. ⋯ Common difficulties in intubating the PNB patient included inability to visualize the glottis and cords secondary to mucus and/or vomitus, use of inappropriately small endotracheal tubes, and accidental extubation during transport. Difficulties in intubating impending respiratory failure patients included patient resistance and seizure activity. We recommend that the EMT-P training curriculum include a review of these difficulties and that prehospital pediatric endotracheal intubation performance be monitored and reviewed with the EMT-Ps.