Pediatric clinics of North America
-
Pediatr. Clin. North Am. · Dec 1999
ReviewRapid sequence intubation of the pediatric patient. Fundamentals of practice.
Rapid-sequence intubation and rapid sequence induction of general anesthesia are synonyms and refer to the technique of choice for tracheal intubation in many pediatric patients in the emergency department. The principles of safe practice and basic standards of care uniformly apply to all clinical situations in which the technique is performed. RSI has two basic technical components: induction of general anesthesia and direct laryngoscopy with tracheal intubation. ⋯ Anticipation, recognition, and management of complications are inherent to the competent delivery of all medical care. The unanticipated difficult airway is arguably the most severe complication of RSI, and all individuals performing the technique must prepare in advance a specific plan for this scenario. As with all such skills or procedures, a quality assurance program is important to monitor care, and individuals practicing RSI need to take appropriate steps to maintain competence.
-
The growth of managed care has provided health benefits to millions of children while attempting to control the increase in health care costs. In adhering to these goals, MCOs are often at odds with emergency departments, and the emergency department physicians providing emergency care. The appropriateness or inappropriateness of emergency department visits can be disputed, but no criteria have been established. ⋯ The primary care provider is in a key position to inform parents about the types of pediatric emergencies, what to do in case one occurs, and to provide follow-up care. MCOs should incorporate clear information on pediatric emergencies. A mutual understanding of services needed, and how best to provide those services, are needed to forge a system that is responsive to children's emergency care needs.
-
Little attention has been focused on the identification of urinary tract infection (UTI) in young febrile children in the emergency department, despite recent information that suggests both a high prevalence and significant associated morbidity in this population. Most UTIs that lead to scarring or diminished kidney growth occur in children younger than age 4 years, especially babies in the first year of life. ⋯ Prevalence and risk factors are given so that clinicians may identify those febrile children at particularly high or low risk of UTI for selective management. Culturing methods, urine screening tests, and culture interpretation are reviewed and management strategies based on these results are suggested.
-
Ingestion of potentially poisonous agents is a common reason for children to present to an emergency department. The clinician must decide whether gastrointestinal decontamination is indicated for these patients. The controversy over the type of gastrointestinal decontamination is resolving and recent recommendations are reviewed. Also two new antidotes, fomepizole for toxic alcohols and octreotide for sulfonylureas, are reviewed.
-
As stated by the Committee on Adolescence of the AAP, All pediatricians who choose to see teenagers should be able to provide counseling about sexual behavior, education on contraceptive methods and prevention of sexually transmitted diseases, and assistance with access to family planning services, preferably in the office or, if necessary, by referral. Expansion of skills and office capabilities to provide routine reproductive health care for adolescents, including pelvic examinations, annual Pap tests, diagnoses of pregnancy, diagnoses and treatment of sexually transmitted diseases, and the prescription of contraceptives, is also encouraged. Pediatricians who have longstanding relationships with their patients, and who are admired and trusted are ideal for providing this care.