Pediatric emergency care
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Pediatric emergency care · Jun 1999
Randomized Controlled Trial Clinical TrialEffect of ketorolac in pediatric sickle cell vaso-occlusive pain crisis.
Ketorolac is a parenteral, nonsteroidal analgesic that does not have a narcotic's risks of respiratory depression, hypotension, or dependence. Its usefulness in providing pain relief in pediatric patients with acute vaso-occlusive crisis of sickle cell disease has not been studied to date. ⋯ We were unable to demonstrate a synergistic analgesic effect for ketorolac in the treatment of pain from acute vaso-occlusive crisis in pediatric sickle cell disease. Further investigations involving larger samples of sickle cell patients may be needed to further define a role for ketorolac in the acute management of sickle cell vaso-occlusive pain.
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Pediatric emergency care · Jun 1999
Review Case ReportsPurpura fulminans associated with Streptococcus pneumoniae infection in a child.
Neisseria meningitidis is the most frequent isolate associated with purpura fulminans in children. Although Streptococcus pneumoniae infection has been associated with purpura fulminans, with the exception of one adult, it has only been reported in immunocompromised hosts. ⋯ While systemic pneumococcal infection is common in childhood, progression to purpura fulminans does not typically occur in overtly healthy children. Our patient illustrates that invasive pneumococcal infection should be considered and empirically treated in a child who presents with purpura fulminans, even in the absence of preexisting functional or anatomic asplenia.
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This review presents an overview of scoring systems used in pediatric and adult trauma. Triage scoring systems, using readily available physical examination, physiologic, and/or mechanism of injury parameters, are used to determine appropriate prehospital referral patterns. The Trauma Score, Revised Trauma Score, Circulation/Respiration/Abdomen/Motor/Speech Scale, Prehospital Index, and Trauma Triage Rule were reviewed. ⋯ As presented, this trend includes both the elaboration of increasingly simple, field-oriented triage tools, and more complex mathematical techniques for trauma outcome analysis. Although not all systems were designed specifically with the pediatric patient in mind, validation or modification of these systems for the pediatric patient will likely occur in the future. It is anticipated that this field will continue to evolve with greater mathematical sophistication; a baseline familiarity of the early stages of this evolution may be of benefit to those caring for the pediatric trauma patient.
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Pediatric emergency care · Jun 1999
Comparative StudyDetermination of systolic blood pressure via pulse oximeter in transported pediatric patients.
To compare pulse oximetry waveform systolic blood pressure measurements (POWSBP) to measurements obtained by noninvasive blood pressure measurement (NIBPM) during the transport of children. ⋯ The use of pulse oximetry waveform systolic blood pressure measurement is a quick and easy method with which to obtain systolic blood pressure in children during transport and shows a close correlation to the standard noninvasive blood pressure measurement. If an automated blood pressure cuff is used, then a corrective equation [NIBP-S = 41.686 + 0.7377(POBPS)] is required. Further validation in a larger group of patients is recommended.
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Pediatric emergency care · Jun 1999
End-tidal carbon dioxide monitoring during sedation with a combination of midazolam and ketamine for children undergoing painful, invasive procedures.
Previous studies evaluating the respiratory effects of sedation regimens have focused on events such as a decline in O2 saturation or apnea. The current study used both end-tidal carbon dioxide (ETCO2) monitoring and pulse oximetry to evaluate the respiratory effects of midazolam and ketamine. ⋯ The incidence of adverse cardiorespiratory events associated with the current sedation regimen of midazolam-ketamine is lower than that reported with other commonly used regimens. The addition of ETCO2 monitoring provides an additional monitor to allow for early detection of airway obstruction or subclinical degrees of respiratory depression.