Pediatric emergency care
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Pediatric emergency care · Dec 1985
Hyponatremia and seizures presenting in the first two years of life.
During a three-month period, 15 patients under two years of age presented with serum sodium concentrations less than 127 mEq/L. Seven (47%) of these patients presented with seizures. Hyponatremia accounted for a majority (58%) of the afebrile seizures in children under two years during this period. ⋯ Hyponatremia may account for more seizures in early life than has been appreciated. Physicians and parents should avoid dietary practices which promote water intoxication. The etiology, diagnosis, and management of water intoxication and hyponatremic seizures are discussed.
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Pediatric emergency care · Dec 1985
A pediatric emergencies training program for emergency medical services.
Accidents are the leading cause of death in children, accounting for more pediatric deaths than all other causes combined. Accidents also account for 21.7 million injuries to children that require medical care annually. ⋯ The course consists of 18 hours of lectures and skill stations focusing on medical emergencies, care of the injured child, the special needs of the infant, and the emotional response of the child and family in an emergency. Test evaluations before and after the course from the 190 participants demonstrate a significant improvement in their knowledge and skills in treating pediatric emergencies (P less than 0.001).
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Pediatric emergency care · Dec 1985
Case ReportsRhabdomyolysis and myoglobinuria as manifestations of child abuse.
Rhabdomyolysis should be suspected in cases of physical child abuse in which there is extensive soft tissue injury. It is easily investigated using the urinalysis and serum CPK levels. ⋯ A full recovery can be expected for adults with this disorder, but information about the pediatric population is sparse. Our series suggests rapid improvement with appropriate therapy.
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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.