Minerva pediatrica
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Bronchiolitis is the most common viral infection of the lower respiratory tract in infants in their first year of life, with an incidence peak between 3 and 9 months of age. The clinical profile of bronchiolitis results from the inflammatory obstruction of the small airways. ⋯ The first was produced by a special subcommittee created by the American Academy of Pediatrics (AAP) with the support of a few important international associations that deal with respiratory diseases including the American Thoracic Society and the European Respiratory Society; the second was drawn up by the Scottish Intercollegiate Guidelines Network (SIGN). This review sets out to update the management of children with bronchiolitis by discussing the salient points relating to diagnosis, treatment and prevention on the basis of the recommendations in these documents.
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The updated 2005 American Heart Association Pediatric Advanced Life Support guidelines aim to improve overall survival from cardiac arrest. These revised guidelines are result of extensive evaluation of scientific evidence and have become simplified to emphasize quality basic life support (BLS) and effective cardiac compressions. Successfully applied techniques of both basic and advanced life support are crucial in improving neonatal and pediatric resuscitation outcomes. This article reviews the scientific evidence and the updated management and treatment guidelines essential for the health care provider in caring for children with cardiac and respiratory arrest.
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Review
Procedural sedation and analgesia in children by non-anesthesiologists in an emergency department.
Procedural sedation and analgesia (PSA) is a standard of care for the management of acute procedural pain and anxiety in the emergency department (ED). However, there is evidence that PSA practice is still ineffective and potentially unsafe in many pediatric settings. PSA has to be regarded as a separate medical act that should be provided only by well-trained and credentialized professionals, within a context of transparency, registration and ongoing quality control. ⋯ An effective PSA program on a pediatric ED means that a professional is easily available at all times who is trained in the safe use of highly controllable drugs that match the sedation need and guarantee an optimal level of comfort without the need for forced immobilization or restraint. A high-quality PSA service includes the adequate use of local or topical anesthesia, the systematic application of non-pharmacologic techniques, the availability of effective PSA drugs and the possibility of rescue anesthesia in case PSA is unsuccessful or is expected to be ineffective or unsafe in a given patient. PSA for children, including deep sedation, should be formally incorporated in the training program for emergency physicians.
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Children with heart disease may present to the Emergency Department in many stages of life, with a range of cardiovascular manifestions, from minimally irritating palpitations to the life-threatening derangements of shock or lethal dysrhythmia. Cardiac emergencies are rare in children in comparison to adults. The pathophysiology differs: ischemic heart disease is virtually unknown, whereas most cases occur secondary to congenital heart disease. ⋯ The diagnosis, however, is not always straightforward, as evidenced by the non-specific clinical picture that can be presented by pediatric heart diseases. This article reviews pertinent issues concerning diagnosis and management of cardiac disorders with which children present to the emergency department. The initial diagnostic and specific therapeutic approach to these patients will be discussed.
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The prevalence of hypertension in the pediatric population is rising, coincident with the rise in childhood obesity worldwide. While most hypertensive children do not require emergent care, hypertensive urgencies and emergencies may be encountered in the outpatient clinic, the emergency department or the inpatient ward. To avoid the life-threatening complications associated with both hypertension and its treatment, the treating physician should be familiar with the presentation and management of pediatric hypertension. This review will serve to examine some of the important aspects of pediatric hypertensive urgencies and emergencies, including common causes, important features of diagnosis and options for medical management.