Pediatric emergency care
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Pediatric emergency care · Feb 2001
Pediatric pre-hospital advanced life support care in an urban setting.
To describe pediatric advanced life support (PALS) in a single urban environment and clarify educational priorities for ALS pre-hospital providers and pediatric medical control physicians. ⋯ A limited number of chief complaints make up the majority of PALS transports. Initial and continuing education for ALS providers needs to reflect the importance of these critical entities. Education for urban pre-hospital providers should reflect that certain procedures will be only executed every few years (eg, pediatric intubation) or once in the career of an ALS pre-hospital provider (eg, intraosseous access). With a limited amount of pediatric teaching time, paramedic education will have to strike a careful balance between teaching about the chief complaints most frequently encountered and teaching rare, high-risk procedures that could provide maximal support for the uncommon critically ill child. On-line medical control physicians need to be prepared to direct and support the management by ALS pre-hospital providers for the chief complaints most frequently seen in pediatric patients.
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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.