Seminars in pediatric surgery
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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.
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Advances in neonatal management have resulted in dramatic increases in survival in infants with birth weights less than 1,500 g. Extensive basic science and clinical research has led to a more comprehensive understanding of the physiological differences between the VLBW infant and larger neonates. Meticulous attention must be paid to appropriate fluid, electrolyte, nutrition, and temperature maintenance to achieve homeostasis and growth. Additionally, the clinician must be aware of the diagnostic and treatment modalities for the common complications seen in the premature infant to minimize mortality and long-term morbidity.
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Semin. Pediatr. Surg. · May 2000
ReviewNecrotizing enterocolitis in infants with very low birth weight.
Necrotizing enterocolitis (NEC) is a disease in which the primary risk factor is prematurity. Despite, and partially as a result of, the tremendous strides neonatal care has taken, it is a major cause of morbidity and mortality of the newborn. ⋯ The outcomes continue to improve, but there are significant sequelae. Prevention, which would be the best "cure," is elusive, in no small part because of the multifactorial nature of the etiology of NEC.