Pediatr Ann
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Pediatric abdominal surgical emergencies may present the primary physician with a diagnostic challenge. A systematic approach will help to minimize missed diagnoses and resultant complications. ⋯ Prudent and directed use of laboratory and imaging studies will minimize misdiagnosis. The early involvement of surgical consultants in the care of pediatric patients who have significant abdominal symptoms or findings is always appropriate.
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Editorial Historical Article
"Those who cannot remember the past are condemned to repeat it'.
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Several factors increase the difficulty and urgency of airway management in children in the emergency setting. Early and appropriate airway management are of prime importance in improving the outcome of such patients. The major decision points of airway management include one's assessment of the airway and ability to perform endotracheal intubation. ⋯ Regardless of the technique chosen, appropriate personnel and preparation are mandatory to ensure the safe and effective management of the airway in the pediatric trauma patient. Due to the various skills and expertise of different subspecialists, a multidisciplinary approach to such patients is recommended. Such an approach may include pediatricians, emergency room physicians, surgical subspecialists, anesthesiologists, and critical care physicians.
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Pediatric cardiac emergencies require very specific treatment in the emergency room setting. Considering the possibility of a cardiac problem as the cause for the presenting symptoms is the initial step in successful management. Many patients present with what is initially considered a primary pulmonary disorder such as pneumonia, asthma, or bronchiolitis. ⋯ Supraventricular tachycardia is a frequent arrhythmia, especially in young children. If the patient is unstable, immediate intravenous administration of adenosine or synchronized cardioversion are the initial interventions. In stable patients, vagal maneuvers may be attempted to abort the arrhythmia.
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Significant morbidity and even mortality can result if early and aggressive resuscitation is not provided for children in shock. When faced with such patients, the initial therapy must include the basics of resuscitation including airway management and assisted ventilation when indicated. Correction of metabolic abnormalities such as hypoglycemia, hypocalcemia, and acidosis may partially correct the cardiovascular dysfunction. Fluids and inotropic agents are chosen based on the underlying pathology and the associated cardiovascular parameters.