Pediatric emergency care
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Minors frequently present to the ED for treatment without their legal guardians. In most such situations, it is best to contact the parents to obtain consent for treatment and to inform them about their child's problem. ⋯ In these situations, the law is sufficiently vague to protect the well-meaning physician who gives care to consenting minors for their own benefit. Of course, if problems result from the care which is rendered, the usual malpractice law will apply, and the physician will try to demonstrate that his treatment fit into one of the legal exceptions to the general rule.
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The approach to the injured child requires great care and clinical acumen to establish the diagnosis and institute appropriate treatment. Loss of life from occult internal hemorrhage or neurologic sequelae from a missed unstable cervical spine injury may be devastating. Yet, physicians in the ED must also know which children need only a careful physical examination, and when laboratory testing or admission is unnecessary. We have described a schema for providing appropriate care to children with trauma in such a way that specific issues about management can be reasonably approached by the emergency physician.
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A review of 247 pediatric emergency charts and 80 pediatric impatient charts was performed over a three-year period at a tertiary care children's hospital in Honolulu. The purpose of this review was to examine the causes of childhood burns in Hawaii in order to develop guidelines for anticipatory guidance regarding burn prevention. Most burns occurred in the 0.8- to 3.0-year age group. ⋯ Severe burns were mainly the result of scalds, fire, or contact with heating appliances. Burn severity and the causes of burns did not vary significantly with sex or ethnic or economic status. A burn prevention program which adequately addresses the unique cultural and climatic differences of this community, based on the data obtained, is described.
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We studied 40 children aged four months to 18 years seen in the Emergency Department (ED) to determine the spectrum of human bites and the incidence of infection in treated and untreated wounds. Initial data concerning time elapsed until a physician examined the bite, site and size of the bite, whether the bite was infected when first seen, and whether antibiotics were prescribed, were obtained from the ED chart. Follow-up by phone or mail was available on 33 of the 40 children. ⋯ Of the three on oral antibiotics, two were subsequently admitted to the hospital. Conclusions. We came to the following conclusions at the end of the study. (1) The majority of human bites in children are superficial and do not become infected. (2) Antibiotics do not appear to be useful in prophylaxis for minor bite wounds seen shortly after injury. (3) Follow-up is necessary for all bite wounds, since serious infection may develop, or an established, seemingly minor infection may worsen.
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Pediatric emergency care · Jun 1985
Incidence of serious infection in infants under age two months with fever.
Infants less than eight weeks of age in a busy urban emergency department were prospectively reviewed during a six-month period, from October 1, 1981 to March 31, 1982. An axillary temperature of 37.8 degrees C or higher was arbitrarily defined as significantly elevated. A total of 1,655 young infants were seen during this time period, with 122 having temperatures of 37.8 degrees C or higher (7%). ⋯ The degree of temperature elevation was not proportional to the severity of the illness. Total white blood cell count was less than 4,000/mm3 in two of the bacteremic patients. Cerebrospinal fluid pleocytosis was present in 13% of the patients undergoing lumbar puncture.