Pediatric emergency care
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In order to evaluate the impact of prehospital intravenous fluid therapy on the outcome of pediatric trauma patients and to evaluate the effect of such therapy on the on-scene interval, we performed a retrospective chart review of 50 pediatric trauma patients less than 18 years old transported directly from the field by Emergency Medical Services personnel with an intravenous catheter in place and admitted to the Trauma Service of a level I urban pediatric trauma center. As judged by an expert panel using a new grading system, prehospital intravenous fluid therapy was inconsequential to outcome in 47 of 50 patients, possibly beneficial in two of 50 patients, and possibly detrimental in one of 50 patients. ⋯ Placement of the catheter (at the scene vs in the ambulance) and prehospital fluid volume administered were independent of the Injury Severity Score. The role of prehospital fluid therapy in pediatric trauma patients in an urban setting requires reevaluation.
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Pediatric emergency care · Feb 1995
Childhood injuries and the importance of documentation in the emergency department.
The purpose of this study is 1) to evaluate the extent to which documentation of the medical record is completed for dependent children who present for evaluation of an acute injury, and 2) to examine the factors that favorably or adversely influence completion of the medical record. The emergency department (ED) ledgers of 669 children less than nine years of age were reviewed, including 172 (25.7%) who presented for evaluation of an acute injury. Each of the latter charts was examined for basic demographic data, as well as information about injury type and mechanism, ED provider, and involvement of social services personnel. ⋯ The 15 individual scores were equally weighted and summed, resulting in a total documentation score ranging from zero (failure to address or document any of the 15 variables) to 15 (all variables completely addressed/documented). The mechanisms of injury included falls from height (48.3%), direct blunt impact other than falls (26.7%), penetrating injury (6.4%), burn (5.2%), and ingestion (8.1%). Seventeen patients (9.9%) were admitted for primarily medical, and one (0.6%) for primarily social, indications; one patient died as a result of his injuries.(ABSTRACT TRUNCATED AT 250 WORDS)
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The objective of our study was to assess the demographics, incidence, types of symptoms, and outcomes of cigarette product ingestions in children. The study was a retrospective database review. Seven hundred children under six years of age ingesting cigarettes or cigarette butts reported to a Poison Control Center between 1988 and 1991. ⋯ We concluded that significant toxicity from the ingestion of cigarette products in children is rare. Vomiting within 20 minutes is the most common symptom. Its absence predicts a favorable outcome, even when large amounts are suspected to have been ingested.
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Pediatric emergency care · Feb 1995
Training, attitudes, and income profiles of pediatric emergency physicians: the results of a 1993 survey of the American Academy of Pediatrics Section on Pediatric Emergency Medicine.
In late 1993, 562 questionnaires were sent to members of the Emergency Medicine Section of the American Academy of Pediatrics; of the questionnaires sent, 65% (365) were returned. Data were collected on 280 full-time practicing pediatric emergency physicians (PEPs). Eighty-two percent of these full-time PEPs have been practicing pediatric emergency medicine for less than 10 years, and two thirds of them are males. ⋯ Approximately two thirds of these physicians feel that board certification in pediatric emergency medicine is a prerequisite for practicing; only one quarter feel that a fellowship in pediatric emergency medicine is required at this time. Average annual gross income for full-time PEPs was $111,000 per year; 62.8% of these physicians make more than $100,000 per year. PEPs indicated that diversity of their clinical practice and the medical acuity of their patients were the most desirable aspects of pediatric emergency medicine, whereas scheduling and the shift work nature of the profession, along with lack of follow-up in hospital practice, were seen as the least desirable aspects of the subspecialty.