Seminars in pediatric surgery
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Semin. Pediatr. Surg. · Feb 2001
Glasgow Coma Scale predicts coagulopathy in pediatric trauma patients.
The aim of this study was to determine if neurologic findings at the time of initial resuscitation can predict coagulation abnormalities resulting from head injury. Fifty-three children with head injury were reviewed for Glasgow Coma Scale (GCS), prothrombin time (PT), international normalized ratio (INR), partial thromboplastin time (PTT), use of fresh frozen plasma (FFP) and outcome. Twenty-six of the 53 children (49%) presented with a GCS of 15 and 27 (51%) had a GCS less than 14. ⋯ Children with GCS less than 14 are at risk for intracranial injury and coagulopathy, this risk increases inversely with the GCS. Children who present with a GCS less than 8 should have FFP prepared at the time of admission. These data may guide the use of laboratory tests and blood bank resources during trauma resuscitation.
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Semin. Pediatr. Surg. · Feb 2001
Prehospital endotracheal intubation for severe head injury in children: a reappraisal.
Controversy exists regarding the efficacy of prehospital assisted ventilation by endotracheal intubation (ETI) versus bag-valve-mask (BVM) in serious pediatric head injury. The National Pediatric Trauma Registry (NPTR-3) data set was analyzed to examine this question. NPTR-3 (n = 31,464) was queried regarding the demographics, injury mechanism, injury severity, prehospital interventions, transport mode, mortality rate, injury complications, procedure and equipment failure or complications, and functional outcome of seriously head-injured patients (n = 578) with comparable injury mechanisms and injury severity who received endotracheal intubation (ETI) (n = 479; 83%) versus those who received BVM (n = 99; 17%). ⋯ Procedure and equipment failure or complications, and functional outcome, were similar between the 2 groups. Prehospital endotracheal intubation appears to offer no demonstrable survival or functional advantage when compared with prehospital bag-valve-mask for prehospital assisted ventilation in serious pediatric head injury. Injury complications appear to occur somewhat less often among patients intubated in the field.
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Various models have been proposed for optimal care of children in the trauma centers of general hospitals. The authors discuss the determinants of successful pediatric trauma care. In-house trauma surgeons, a consensus protocol for the first 20 minutes of resuscitation, real-time involvement of radiologists as part of the trauma team, and professional respect are the basis of teamwork.
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In the United States nearly 2 million people are burned every year; about 100,000 burns are moderate to severe and require hospitalization and about 5,000 deaths occur because of burns. The overall improvement in mortality and outcome of patients with severe burn trauma over the last decades can be attributed to the following: (1) emergency medical treatment with aggressive early resuscitation, (2) respiratory care and treatment of inhalation injury, (3) control of infection, (4) early burn wound excision and grafting, and (5) modulation of the hypermetabolic response to trauma. ⋯ Also discussed are changes in respiratory management of burn patients and therapy of inhalation injury, infection control measurements, early burn wound excision and wound coverage, and the nutritional and pharmacological modulation of the hypermetabolic response to trauma. All these burn therapy regimens need to be continuously reassessed in clinical use and further improved to achieve still better outcome and quality of life for burn victims.