Pediatric emergency care
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Pediatric emergency care · Dec 1990
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of three formulations of TAC (tetracaine, adrenalin, cocaine) for anesthesia of minor lacerations in children.
A randomized, prospective, double-blind study comparing three formulations of the topical anesthetic solution TAC for laceration repair was undertaken in 250 children. The children's wounds were anesthetized with either TAC I (original formulation--0.5% tetracaine, 1:2000 Adrenalin, 11.8% cocaine), TAC II (1.0% tetracaine, 1:4000 Adrenalin, 7.0% cocaine), or TAC III (1.0% tetracaine, 1:4000 Adrenalin, 4.0% cocaine) prior to repair. The solutions were compared with respect to efficacy, acceptability, wound complications, and side effects. ⋯ Anesthesia for extremity wounds was adequate in only 39.9% of cases, regardless of TAC strength. Wound complications and side effects were within expected and acceptable limits. Our findings support use of TAC for face and scalp lacerations and a change to a less concentrated TAC preparation, such as our "TAC III," which is presumably safer for widespread use.
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Pediatric emergency care · Dec 1990
Case ReportsSymptomatic cerebral swelling complicating diabetic ketoacidosis documented by intraventricular pressure monitoring: survival without neurologic sequela.
A six-year-old boy developed symptomatic cerebral swelling four hours after the initiation of treatment for newly diagnosed diabetes mellitus complicated by ketoacidosis. Ventriculostomy documented intracranial pressure over a two-day period. ⋯ Intracranial pressure monitoring was a useful adjunct in management of this rare, but often lethal, complication of diabetes mellitus. One year later, both school performance and the results of a neurologic examination were normal.
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Pediatric emergency care · Dec 1990
Accuracy of flexible fiberoptic endoscopy in identifying abnormal endotracheal tube positions.
This study was carried out to investigate the accuracy of a simple, nonmaneuverable, flexible fiberoptic catheter in identifying both normal and abnormal endotracheal tube (ETT) positions. In addition, the utility of flexible fiberoptic endoscopy (FFE) for ETT position determination in inexperienced hands was examined. One adult dog was sedated and instrumented in the esophagus and trachea with identical ETTs. ⋯ There was no difference in performance by investigator training level or endoscopy experience. We conclude that FFE is a rapid and accurate method for determining both normal and abnormal ETT locations. ETT position determination can be confidently performed by health professionals with minimal training.
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Pediatric emergency care · Dec 1990
Case ReportsPott's puffy tumor: a complication of frontal sinusitis.
In children sinusitis is a frequent complication of upper respiratory infections but an infrequently considered diagnosis. Although most sinus infections are resolved without complications, when complications do occur they can be serious or life threatening. ⋯ This paper describes two patients with subperiosteal abscess resulting from frontal sinusitis, one with CNS and orbital extension. A brief literature review is presented, and presentation, diagnosis, and treatment are discussed.
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Pediatric emergency care · Dec 1990
Case ReportsPresentation and management of an acute caffeine overdose.
A one-year-old white female ingested approximately two to three grams of caffeine (200-300 mg/kg). The patient survived the ingestion with a maximum caffeine concentration of 385 micrograms/ml four hours postingestion. The child developed ventricular arrhythmias, seizures, metabolic disturbances, and severe pulmonary edema. She survived without apparent long-term sequelae despite having reached a serum caffeine concentration that is the second highest reported level in a survivor.