Current opinion in pediatrics
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Curr. Opin. Pediatr. · Aug 2007
ReviewScreening for suicide risk in the pediatric emergency and acute care setting.
This paper reviews epidemiology, psychiatric comorbidities, risk factors, warning signs, screening measures, and issues related to screening for suicide risk in the pediatric emergency department and acute care settings. ⋯ Suicide is the third leading cause of death in adolescents. Although a prior suicide attempt is the single most important risk factor, affective, cognitive, family and peer factors also affect risk of completed suicide. Practitioners in the acute care and emergency department setting are well positioned to identify, assess, and appropriately refer these adolescents and their families. Screening instruments in this setting need to be accurate, brief, and relevant to patients, families, and providers. We propose a two-question algorithm that targets imminent risk for a suicide attempt. This type of screening also needs to be accompanied by hospital or community-based support systems for further assessment, intervention and follow-up.
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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
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
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
ReviewControversies in the evaluation and management of minor blunt head trauma in children.
We present data from recently conducted research regarding controversial aspects of the evaluation and management of children with minor blunt head trauma. ⋯ Research in the management of children with minor head trauma is actively evolving. We present a review of recent developments that can influence current clinical practice.