Pediatric emergency care
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Pediatric emergency care · Feb 2000
The safety of etomidate for emergency rapid sequence intubation of pediatric patients.
To determine whether pediatric patients given etomidate for rapid sequence intubation (RSI) in the ED develop clinically important hypotension or adrenal insufficiency. ⋯ We found no evidence of clinically important adrenocorticoid suppression and a low incidence of clinically important hypotension when using etomidate for emergent pediatric RSI. Because other induction agents may also result in hypotension, prospective comparison studies are needed to further evaluate the safety of etomidate in this patient population.
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Pediatric emergency care · Feb 2000
Randomized Controlled Trial Clinical TrialChloral hydrate versus midazolam for sedation of children for neuroimaging: a randomized clinical trial.
The comparative safety and efficacy of chloral hydrate and midazolam for sedation of children has not been adequately studied. ⋯ We conclude that, in these doses, oral chloral hydrate may provide more effective sedation than midazolam for brief neuroimaging studies in young children.
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Pediatric emergency care · Feb 2000
Review Case ReportsNon-Q wave acute myocardial infarction in acute meningococcemia in a 10-year-old girl.
Children with acute meningococcemia may have impaired myocardial function resulting in low cardiac output despite normal intravascular volume. Severe meningococcal infection has been associated with acute interstitial myocarditis, endocarditis, and pericarditis, but not with myocardial infarction. ⋯ This is the first pediatric case of non-Q wave acute myocardial infarction associated with purpura fulminans in meningococcemia. Similarly, the association of high troponin I levels and meningococcemia has not been described previously. Although, the patient's genetic predisposition for myocardial infarction might have been a potential contributing factor, there was no angiographic evidence of coronary artery disease in this patient. Thereby, other factors related to shock, endotoxin, microthrombi of meningococcemia, and their treatment might have been also contributing. We propose possible mechanisms for this rare but serious complication of meningococcemia and review the literature.