Pediatric emergency care
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Pediatric emergency care · Jun 1992
Comparative StudyHigh-flow sheaths for pediatric fluid resuscitation: a comparison of flow rates with standard pediatric catheters.
We evaluated high-flow intravenous devices designed specifically for fluid resuscitation of infants and children. Fluid flow rates with 4-, 5-, and 6-Fr high-flow sheaths and 18-, 20-, and 22-gauge catheters were measured and compared. Flow rate is significantly faster with the 4-Fr sheath (P less than 0.0001) than with the 18-, 20-, or 22-gauge catheter. The high flow rates possible with the sheaths make them ideal for use in patients who require rapid fluid resuscitation.
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Pediatric emergency care · Jun 1992
Case ReportsVitamin K deficiency, intracranial hemorrhage, and a subgaleal hematoma: a fatal combination.
An exclusively breast-fed infant, who did not receive vitamin K prophylaxis at birth, presented with signs of raised intracranial pressure. Her clinical course was compounded by a lumbar puncture, which revealed blood in the cerebrospinal fluid, and a large subgaleal hematoma, which developed at the puncture site of an attempted scalp vein catheterization, resulting in coning, hypovolemic shock, and death. A major coagulopathy was present, probably caused by vitamin K deficiency. The necessity for vitamin K prophylaxis in all newborns and the timing of lumbar puncture in the critically ill child are discussed.
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Pediatric emergency care · Jun 1992
Case ReportsInterfacing with police in the pediatric emergency department.
In summary, ED staff and local police departments should make a concerted effort to work together. The ED director should develop management protocols in conjunction with local police chiefs to plan strategies in advance. ⋯ It may also be helpful to arrange tours of the ED so that police know where to go when they are called to the ED. All of these efforts should foster better care of children in the ED and will reduce tensions between the dedicated groups who work with such children.
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Pediatric emergency care · Jun 1992
Can early bacterial complications of aspiration with respiratory failure be predicted?
We studied the early infectious complications of all children admitted for intensive care over a six-year period who were at high risk of having severe aspiration of gastric or pharyngeal secretions. Patients were only analyzed if they required mechanical ventilation for acute respiratory failure, had a blood culture obtained in the first 48 hours, and survived at least 24 hours. Infections were identified by positive blood cultures. ⋯ Infected patients tended to be older (P less than 0.05). No diagnostic features in the first two days of hospitalization reliably identified those who would develop early infections (P greater than 0.05). Since early life-threatening infection is common and cannot be reliably predicted by clinical signs, we recommend aggressive bacteriologic surveillance and the administration of IV antibiotics on admission to all patients in respiratory failure requiring mechanical ventilation after presumed aspiration of gastric or pharyngeal secretions.