Pediatric emergency care
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Pediatric emergency care · Aug 2010
Comparative Study Clinical TrialPediatric residents' ability to perform a lumbar puncture: evaluation of an educational intervention.
To assess the baseline ability of pediatric residents to successfully perform a lumbar puncture (LP) and to evaluate the impact of an educational intervention on this skill in both a simulated and clinical environment. ⋯ After an educational intervention, pediatric first-year residents performed a simulated LP better than a group of second-year residents who had greater clinical LP experience. The low number of clinical LPs performed limits our ability to determine the educational intervention's impact in the clinical setting and reinforces the concern that recent changes to pediatric residencies may negatively impact residents' procedural experience.
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Pediatric emergency care · Aug 2010
Comparative StudyThe use of vasoactive agents via peripheral intravenous access during transport of critically III infants and children.
Many experts recommend that vasoactive agents be infused via a central venous line (CVL) because of the potential risk of infiltration, but CVL placement in pediatric patients is often challenging. We hypothesized that it is safe to administer vasoactive infusions via peripheral intravenous (PIV) line in critically ill infants and children during interhospital transport. ⋯ Results from our series suggest that administration of vasoactive medications via PIV line during transport of critically ill infants and children is safe. The risk for complications increased with higher infusion rates and longer duration of therapy. Prompt transitioning of vasoactive infusions to a CVL may lead to fewer complications but does not seem to be necessary before transport.
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Pediatric emergency care · Aug 2010
Case ReportsRecurrent coagulopathy and thrombocytopenia in children treated with crotalidae polyvalent immune fab: a case series.
Recurrent signs and symptoms after initial treatment and control of coagulopathy and thrombocytopenia after American pit viper (crotaline) envenomations have been previously described in patients treated with Crotalidae polyvalent immune Fab antivenom (FabAV). The significance and necessity of treatment of these recurrent abnormalities are uncertain. Our goal was to further characterize recurrent coagulopathy or thrombocytopenia in pediatric patients. ⋯ The cases presented here suggest administration of FabAV may correct delayed coagulopathy associated with crotaline envenomations. The first 3 cases illustrate that in the face of severe derangements in laboratory values, most envenomated patients treated with FabAV do not develop significant bleeding. These cases may respond to additional antivenom alone. However, case 4 illustrates that hemodynamically significant spontaneous bleeding can occur. Until more data are available, readministration of FabAV is a reasonable first-line therapy for delayed coagulopathy associated with crotaline envenomations.
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Pediatric emergency care · Aug 2010
Case ReportsReversal of intractable hypoxemia with exogenous surfactant (calfactant) facilitating complete neurological recovery in a pediatric drowning victim.
To report the successful reversal of intractable hypoxemia after exogenous surfactant (calfactant) administration, facilitating neurological recovery in a toddler cold-water drowning victim with significant circulatory arrest time. ⋯ Surfactant replacement with calfactant is a rational, useful, and potentially lifesaving treatment for acute hypoxemic respiratory failure due to drowning.