Current opinion in pediatrics
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Curr. Opin. Pediatr. · Jun 2007
ReviewThe new American Heart Association cardiopulmonary resuscitation guidelines: should children and adults have to share?
The latest American Heart Association guidelines for pediatric cardiopulmonary resuscitation (CPR) were published in December 2005. Changes from the 2000 guidelines were directed toward simplifying CPR. Infants, children, and adults now share the same recommendation for the initial compression:ventilation ratio. This is a significant change for pediatricians trained in the importance of a respiratory etiology of pediatric cardiopulmonary arrest. The present review will focus on the rationale behind these guideline changes. ⋯ Although based primarily on adult, animal, and computational models, the new compression:ventilation ratio, recommended for both initial pediatric and adult CPR, is a reasonable recommendation. The simplified CPR guidelines released in 2005 will hopefully contribute to improved bystander delivery of CPR and improved outcome.
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Curr. Opin. Pediatr. · Jun 2007
ReviewThoracic empyema, application of video-assisted thoracic surgery and its current management.
Pneumonia in children is frequently complicated by pleural effusions, which rarely progress to empyema. Appropriate clinical management depends on correctly diagnosing the stage of the disease process. Recently, increasing use of video-assisted thoracic debridement has altered the traditional management of pleural effusions and empyema in children, resulting in decreasing reliance on thoracentesis and earlier surgical intervention. ⋯ We propose a clinical algorithm supporting the early use of video-assisted thoracic debridement in the management of empyema in children.
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Curr. Opin. Pediatr. · Jun 2007
ReviewEmergency department evaluation and management of blunt abdominal trauma in children.
To discuss the emergency department evaluation and management of children with blunt abdominal trauma. The review will focus on both the clinical data that can help reduce the use of computed tomography in the evaluation of patients with blunt abdominal trauma and the evidence for the increased use of nonoperative management of patients with blunt abdominal trauma. ⋯ Recent research suggests that physical examination in combination with bedside ultrasonography may identify children at risk for intraabdominal injury. Screening laboratory data appears to be less sensitive to detect these injuries, but is useful in selected patients. Nonoperative management is appropriate in a majority of cases. Further research is needed to determine which low-risk patients with abdominal trauma can be managed with minimal or no exposure to radiation in the computed tomography scanner.
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Curr. Opin. Pediatr. · Jun 2007
ReviewAn update on the approach to apparent life-threatening events.
Apparent life-threatening events are an ongoing diagnostic dilemma for clinicians. Since most apparent life-threatening event episodes occur in infants under 6 months of age, they can generate considerable anxiety in parents and providers. This review will discuss issues to consider in the evaluation of infants after an apparent life-threatening event. To ensure proper management, a systematic approach should be taken to attempt to determine the cause of the event. ⋯ After a careful review of the literature, prone sleeping is one of the biggest risk factors for sudden infant death syndrome. The association between apparent life-threatening events and sudden infant death syndrome remains to be explored further, but current evidence suggests minimal risk after an apparent life-threatening event episode. This article will help clinicians prepare for this difficult challenge by providing up-to-date information and identifying problems to be addressed in future research.