Pediatric emergency care
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Pediatric emergency care · Dec 2000
Review Historical ArticleEmergency department use of neuromuscular blocking agents in children.
There is no ideal neuromuscular blocking agent with a rapid onset and ultra-short duration of action with a good safety profile in children. Rocuronium, vecuronium, rapacuronium, and succinylcholine are currently the neuromuscular blocking agents most suitable for children who require RSI in ED settings. Succinylcholine is the only agent with rapid onset and ultra-short duration of action; however, it has many potential side effects, of which some (albeit rare) may be fatal. ⋯ For EDs that do not have access to rocuronium, vecuronium is frequently the agent of choice for RSI in children. Despite its longer onset of action and recovery, its side effects are minimal when compared to succinylcholine. If further studies confirm the safety profile of rapacuronium, its rapid onset and short duration of action will likely make it the neuromuscular blocking agent of choice for RSI.
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Pediatric emergency care · Dec 2000
The advanced pedi-bag program: a hospital-EMS partnership to implement prehospital training, equipment, and protocols.
The Advanced Pedi-Bag Program is a partnership between a trauma center and a county-wide EMS agency (LCEMS) with three major goals: 1) train all LCEMS paramedics in the American Heart Association's Pediatric Advanced Life Support (PALS), 2) stock each Life Squad with a specific bag containing the equipment necessary to treat both basic and advanced pediatric emergencies, and 3) develop treatment protocols for pediatric patients. ⋯ This partnership between a trauma center and an EMS agency resulted in improved training of county paramedics, Life Squads that have an Advanced Pedi-Bag with specific equipment and supplies to manage pediatric emergencies, and pediatric protocols that support the use of this equipment. Paramedics benefit from advanced training opportunities and patients benefit from improved prehospital care.
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Pediatric emergency care · Dec 2000
Review Case ReportsGamma-hydroxybutyrate, gamma-butyrolactone, and 1,4-butanediol: a case report and review of the literature.
GHB, GBL, and 1,4-BD are prevalent drugs of abuse in the United States. Unfortunately, attempts to regulate GHB have been circumvented by clandestine trafficking through the Internet and marketing of "natural" chemical precursors. Despite repeated FDA warnings to the public about their dangers as well as recent federal scheduling of GHB and GBL, they remain accessible as "club drugs" on Internet websites, as natural dietary supplements in health food stores, and as illicit products manufactured at home or in clandestine laboratories. EDs and poison control centers nationwide will undoubtedly continue to manage GHB, GBL, and 1,4-BD toxicities.
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Pediatric emergency care · Dec 2000
Should parents accompany pediatric interfacility ground ambulance transports? The parent's perspective.
Parental accompaniment can be a positive experience for the parent and the patient, as perceived by the parent. It can also be accomplished effectively without hindering the delivery of intratransport medical care by a nurse/nurse or nurse/physician transport team. This survey, along with the responses from other parents, led our team to adopt the position that a parent is welcome and encouraged to accompany the transport team if he or she wishes to. ⋯ The transport team reserves the option to ask that a parent not ride along if they suspect the parent might not function as a supportive team member (ie, the parent is belligerent, inebriated, or hostile). The parent normally rides in the passenger seat of the ambulance, and we encourage him or her to interact with the patient as much as possible. Occasionally parents ride in the back of the ambulance if the patient's situation allows for that option (ie, no anticipated need for potential interventions, number of team personnel, etc.).
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Pediatric emergency care · Dec 2000
Capnography during sedation/analgesia in the pediatric emergency department.
To measure changes in end-tidal carbon dioxide levels (ETCO2) during sedation/analgesia in pediatric patients and to describe ETCO2 changes associated with different sedation strategies. ⋯ Commonly used agents for pediatric sedation result in significant increases in ETCO2. ETCO2 is a useful adjunct in assessing ventilation and may serve as an objective research tool for assessing different sedation strategies.