Current opinion in pediatrics
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Over the last 10 years, there has been a fundamental change in physicians' attitudes toward analgesia and sedation in pediatrics. In this time, basic and clinical research have provided a wealth of information. ⋯ Fortunately, the attitude of physicians toward these matters has changed significantly and much more attention is now paid to the alleviation of pain and provision of adequate sedation. However, there remains, according to most estimates, incongruity between these advances and what is practiced clinically.
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Curr. Opin. Pediatr. · Jun 1999
ReviewHyperbaric oxygen therapy in childhood carbon monoxide poisoning.
Hyperbaric oxygen therapy is the administration of 100% oxygen at pressures two to three times ambient pressure, and it significantly increases dissolved oxygen content. Although it has been used successfully to treat decompression illness and arterial air embolism, its role in the treatment of carbon monoxide poisoning remains somewhat controversial. ⋯ This review focuses on the unique aspects of carbon monoxide poisoning and hyperbaric oxygen therapy in the fetus, the newborn, the infant, and the child. In addition, it discusses general indications for and special and practical considerations in the use of hyperbaric oxygen therapy in children.
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Curr. Opin. Pediatr. · Jun 1999
ReviewHypoxic-ischemic brain injury: advancements in the understanding of mechanisms and potential avenues for therapy.
Hypoxic-ischemic brain injury occurs frequently in infancy and childhood. Events such as perinatal asphyxia, near drowning, respiratory arrest, and near sudden infant death syndrome cause significant mortality and morbidity. Despite current critical care practices, the outcomes from such injuries may be life-long neurologic deficits. ⋯ The development of new therapies for hypoxic-ischemic brain injury depends on such understanding. To date, the results of preclinical therapeutic trials have not demonstrated a "magic bullet." Nevertheless, the understanding of injury mechanisms has uncovered potential avenues for new therapies, particularly combination therapies or single interventions that have multiple effects. Clinical trials, using these strategies, are planned or have been recently begun and offer hope for advancements in treatment.
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The element mercury exists as inorganic, elemental, or organic species. Routes of exposure and toxicity in humans vary according to the species of mercury involved. ⋯ Although dimercaprol is contraindicated in organic mercury exposures, meso-2,3-dimercaptosuccinic acid and sodium 2,3-dimercapto-1-propanesulfonate may be used to chelate all species of mercury. Recent evidence suggests that their efficacy in organic mercury poisoning is uncertain.
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Head injuries in sports cause serious long-term problems. Appropriate acute and subacute management of both catastrophic and mild injuries can prevent secondary, potentially disabling or fatal injury. ⋯ The symptoms of a mild head injury may be transient, but the cumulative effect may have permanent long-term sequelae. Continued clinical, epidemiologic, and basic science research is needed to help prevent head injuries and their sequelae in the future.