Pediatric emergency care
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Pediatric emergency care · Dec 2001
Procedures performed by pediatric transport nurses: how "advanced" is the practice?
Pediatric interfacility transport teams often rely on advanced practice nurses as primary care providers. These individuals may be required to transport patients without the presence of a physician. There is, however, little information in the medical literature regarding how frequently advanced practice transport nurses perform advanced procedures, how often these procedures are successfully performed, and the rate of complications associated with nurse-performed procedures. ⋯ Although they had considerable training for advanced procedures, the transport nurses rarely used these skills. All tracheal intubations performed by transport nurses were successful, and there were no adverse consequences related to intubation by a transport nurse.
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Pediatric emergency care · Dec 2001
Case ReportsBag-mask ventilation as a temporizing measure in acute infectious upper-airway obstruction: does it really work?
Jaw-thrust and bag-mask ventilation usually provide adequate oxygenation in patients with acute infectious upper-airway obstruction (AIUAO). It is the treatment of choice for patients on the way to hospital or in an emergency department until definitive stabilization is achieved with available resources. We report three fatal case studies showing ineffective bag-mask ventilation in AIUAO that raise concerns over this treatment. ⋯ Gastric inflation may occur and rapidly distend the stomach. This gastric distension interferes with ventilation by elevating the diaphragm, resulting in a decreased lung volume. Cricoid pressure could prevent gastric distension in these instances and should be recommended.
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Pediatric emergency care · Dec 2001
Pediatric sedation for procedures titrated to a desired degree of immobility results in unpredictable depth of sedation.
To test the hypothesis that the need to attain immobility during pediatric sedation for procedures determines the depth of sedation, which cannot always be predicted. ⋯ Pediatric sedation results in 4 categories of immobility. Complete immobility during painful and invasive procedures is associated with a higher incidence of adverse events. The depth of sedation (ie, CS, DS, or GA) required to achieve each category of immobility is unpredictable and varies from patient to patient. Thus, granting a limited sedation authority (conscious sedation only) to physicians may be of limited practical value.
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Pediatric emergency care · Dec 2001
Review Case ReportsSeat belt syndrome in children: a case report and review of the literature.
Characteristic patterns of injury to children in automobile crashes resulting from lap and lap-shoulder belts have been described for many years. These injuries are known as the "seat belt syndrome." We present a typical case of seat belt syndrome involving a 4-year-old boy and review the current literature on the topic, highlighting proposed mechanisms of intra-abdominal and spine injuries. In addition, recent research findings identifying a new pattern of injuries associated with inappropriate seat belt use in young children are reviewed. Emergency physicians must consider these seat belt-related injuries in the initial evaluation of any child involved in a motor vehicle crash who was restrained with the vehicle seat belt.
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Pediatric emergency care · Dec 2001
Multicenter StudyApplicability of Ottawa knee rule for knee injury in children.
Previous studies have shown that the application of the Ottawa knee rule (OKR) reduces the need for radiographs in adults with acute knee injuries. Our objectives were to describe the epidemiology and incidence of knee injuries in children with acute knee trauma and to validate the OKR in a pediatric population. ⋯ In the pediatric population studied, the OKR did not identify all patients with knee fractures. Future studies may consider modifying the OKR to accommodate the differences between pediatric and adult patients to improve the sensitivity of the rule while maintaining its specificity, before it can be applied routinely in clinical practice.