Current opinion in pediatrics
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Curr. Opin. Pediatr. · Jun 1996
ReviewEmergency department management of house fire burns and carbon monoxide poisoning in children.
Fires continue to be a major killer of children, accounting for as many as 34% of fatal injuries in those younger than 16 years of age. Recent advances in burn care have improved to the extent that attention is being refocused on the initial resuscitation period as a time when significant improvements in mortality and morbidity may be achieved. Early invasive monitoring in selected patients may help children survive very severe burn injury. ⋯ Although it is clear that venous carboxyhemoglobin levels are similar to arterial levels, the treatment of children with significant poisoning has not been well studied. Hyperbaric oxygen therapy may be helpful in preventing serious central nervous system injury, but studies in children are lacking. Prevention of burns is far superior to treatment of burns.
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Curr. Opin. Pediatr. · Jun 1996
ReviewNutritional support of the pediatric intensive care unit patient.
Nutritional support of the critically ill or postoperative pediatric patient continues to develop as a clinical science in the face of technologic, pharmacologic, and nutritional science advances. For ethical and logistical reasons, however, clinical trials of new technologies and interventions often are performed first in adult subjects, and the pediatric intensivist and nutritionist are thereby left to draw conclusions from this literature. ⋯ The central role of estimating energy requirements in the intensive care unit, the development of enteral formulas with nutritional as well as possible immunologic properties, the use of anabolic hormones to attenuate the catabolic response to illness, the concept of "conditionally essential" amino acids, and the propensity to use the parenteral route of nutrition when the enteral route is still available are discussed. Future directions in nutritional support, including the development of nutritional pharmacotherapy, are also considered.
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Curr. Opin. Pediatr. · Jun 1996
ReviewTreatment of snake, insect, scorpion, and spider bites in the pediatric emergency department.
Most people seem to have a visceral fear of snakes, spiders, scorpions, and insects out of proportion to the actual danger they pose. The vast majority of bites and stings cause little more than local pain and never require medical attention. Nevertheless, physicians who work in the emergency department must be prepared to treat the few patients who present with anaphylactic reactions to Hymenoptera stings, as well as to recognize and treat those rare individuals who receive severe envenomation from poisonous snakes, spiders, or scorpions.
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Management of painful procedures in the neonate is less than optimal. Although evidence exists to support the infant's capacity to feel pain at birth, health professionals do not prescribe or administer adequate analgesia. This is largely because of the lack of published data on the safety and efficacy of pharmacologic interventions and lack of sufficient understanding of the benefits of nonpharmacologic measures. In this review, recent research on the safety and efficacy of pharmacologic and nonpharmacologic interventions for managing painful procedures in the neonate is summarized.
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Curr. Opin. Pediatr. · Dec 1995
ReviewNear-infrared spectroscopy for the in vivo study of cerebral hemodynamics and oxygenation.
With the advent of near-infrared spectroscopy (NIRS), it has become possible for the first time to make continuous measurements of in vivo cerebral oxygenation and hemodynamic changes at the bedside, in the intensive care unit, and in the operating room. NIRS has shown immense potential as a noninvasive technique for monitoring real-time cerebrovascular and oxygenation changes in the critically ill child. ⋯ Despite these advances in the clinical application of the NIRS technique, several basic controversies persist and are the focus of intense research in the area. This review provides an update on recent clinical studies using NIRS and outlines the likely future directions of the technique.