The Journal of pediatrics
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We retrospectively evaluated the records of 459 children who had normal findings on a neurologic examination after moderate head injury characterized by brief loss of consciousness. Skull x-ray examination had been performed in 358 children, and 52 (14%) had fractures. ⋯ Three children required surgical evacuation of hematomas between approximately 24 and 72 hours after injury. On the basis of these results, we conclude that in the absence of a skull fracture, most alert children without symptoms who have sustained moderate head injury may be safely discharged from the emergency department in the care of a competent observer.
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The Journal of pediatrics · Aug 1989
Hydrostatic reduction of ileocolic intussusception: a second attempt in the operating room with general anesthesia.
Over a 3-year-period, standard treatment with hydrostatic pressure from a contrast enema failed to reduce ileocolic intussusception in 31 of 62 children. With the child anesthetized in the operating room, a second contrast enema was given before laparotomy. Of the 31 intussusceptions, 21 (68%) were reduced without complication, thereby avoiding the discomfort, longer hospitalization, complications, and expense of surgery. ⋯ Success with the second enema may be related to the effects of general anesthesia. In addition, partial reduction with the first enema may improve blood flow from the intussusceptum so that it becomes smaller and easier to reduce with the second enema. Because it can easily be added to standard management protocols without increased risk, routine use of this second enema with anesthesia is recommended.