Current opinion in pediatrics
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The growing popularity of nonoperative treatment of children with splenic injuries has seduced some physicians into a false sense of security regarding care of the injured child. Although it has been established that hemodynamically stable children with splenic, hepatic, and even renal injuries can safely be treated "expectantly," this concept cannot be applied indiscriminately. Accurate diagnosis and effective care of the child with blunt abdominal trauma is an exercise of clinical precision that demands attention to detail and thorough evaluation. This review addresses this process in light of recent advances in diagnostic imaging and in consideration of recent reports analyzing different protocols for therapeutic decision making.
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Drowning and immersion injuries are leading causes of mortality and morbidity in children. An increasing amount of epidemiologic information is available. ⋯ Efforts at early neurologic prognostication and identification of victims who are likely to die or persist in a vegetative state are increasingly accurate and are highly relevant. Critical care physicians are more likely to withhold or withdraw support from victims who have minimal likelihood of meaningful recovery.
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Advances in pediatric anesthesia can contribute to improved care of children in other environments. As an example, drugs and dosages established in preoperative sedation of children provide a base for their application in sedation and pain relief of children undergoing painful procedures in the emergency unit, oncology treatment area, and radiology suite. ⋯ Monitoring techniques may similarly be developed in the operating suite then applied in emergency areas or critical care units. We examine a qualitative device for detecting carbon dioxide in the exhaled gases of an intubated child.