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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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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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.