Pediatric emergency 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
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.