Pediatric emergency care
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Pediatric emergency care · Aug 2000
Case ReportsCNS toxicity after topical application of EMLA cream on a toddler with molluscum contagiosum.
EMLA (eutectic mixture of local anesthetics) cream is used topically to provide local anesthesia for a variety of painful superficial procedures. Although the side effects of EMLA are usually mild and transient local skin reactions, potential life threatening complications can be encountered. We report a case of central nervous toxicity after EMLA application for curettage of molluscum contagiosum lesions in a pediatric patient. This complication was the result of a therapeutic misadventure that led to an excessive application of EMLA cream over an extensive area causing an overdose of lidocaine and prilocaine with their subsequent systemic toxicities.
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Pediatric emergency care · Aug 2000
Uses and complications of central venous catheters inserted in a pediatric emergency department.
To describe the incidence, indications, insertion sites, duration, and complications of central venous catheter (CVC) insertion in patients in a pediatric emergency department (ED). ⋯ Central venous catheterization, particularly using the femoral approach, appears to a safe method of obtaining central venous access in the critically ill infant, child, or young adult.
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Pediatric emergency care · Jun 2000
Resident training in pediatric critical care transport medicine: a survey of pediatric residency programs.
The Accreditation Council for Graduate Medical Education (ACGME) Program Requirement for Pediatrics includes specific objectives that pediatric residents participate in both the pre-hospital care of acutely ill or injured patients and the stabilization and transport of patients to critical care areas. Previously, residents were often included as the physician component for many pediatric critical care transport teams. Subsequent regionalization of transport services and development of nurse-only transport teams prompted us to determine the current level of resident participation in pediatric critical care transport as well as how individual residency programs were meeting the educational objectives. ⋯ Pediatric resident participation in critical care transport varies widely among pediatric critical care transport teams. The degree to which residents participate in the transport team would appear to have diminished in comparison to previous studies. Transport teams often use other resources, such as nurses, fellows, or attendings, to lead their transport teams. Pediatric resident exposure to and participation in Transport Medicine varies among programs, as do the methods used to prepare residents for their experience.
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Pediatric emergency care · Jun 2000
Characteristics and outcome of children with carbon monoxide poisoning with and without smoke exposure referred for hyperbaric oxygen therapy.
To describe the clinical characteristics and outcome of children with carbon monoxide (CO) poisoning with and without smoke exposure referred for hyperbaric oxygen therapy (HBOT), and to determine the association between any of these characteristics and death. ⋯ These preliminary data suggest that children with COP alone who are treated with HBOT are at low risk for dying regardless of initial COHb level. Children with CO/SI have a significantly higher risk of dying than those children with COP alone. A combination of smoke inhalation, low temperature, high COHb level, respiratory arrest, and cardiac arrest is highly associated with death. Prospective studies are needed to confirm and further define these associations.