Pediatric clinics of North America
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Pediatr. Clin. North Am. · Feb 1997
ReviewRecent advances in the treatment of bronchiolitis and laryngitis.
Progress has been made in the treatment for patients with croup and bronchiolitis in the past decade. By intervening with pharmacologic agents, a better outcome has been documented in children with these diseases. A lower probability of hospital admission means that fewer health care dollars need to be expended in this area. ⋯ Use of intramuscular dexamethasone is difficult to justify in patients with croup who are able to ingest oral medications. Future studies need to examine dosing of glucocorticoids for inpatients with croup. In addition, an important question remains as to whether very mild croup patients (those with no evidence of respiratory distress) might benefit from glucocorticoids administered in the physician's office or the emergency department.
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The resuscitation of children from cardiac arrest and shock remains a challenging goal. The pharmacologic principles underlying current recommendations for intervention in pediatric cardiac arrest have been reviewed. Current research efforts, points of controversy, and accepted practices that may not be most efficacious have been described. ⋯ Lidocaine is the drug of choice for ventricular dysrhythmias, and bretylium, still relatively unexplored, is in reserve. Many pediatricians use dopamine for shock in the postresuscitative period, but epinephrine is superior. Most animal research on cardiac arrest is based on models with ventricular fibrillation that probably are not reflective of cardiac arrest situations most often seen in pediatrics.