Pediatric clinics of North America
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Routine screening for phenylketonuria and congenital hypothyroidism has become an integral part of pediatric practice in the United States. Screening for several other metabolic disorders is now entering the second or third decade of use. New information is available for the pediatrician for both groups of disorders that will be of help in caring for children in the years to come.
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Pediatr. Clin. North Am. · Apr 1993
ReviewThe organization of a pediatric critical care transport program.
Highly specialized pediatric critical care centers have matured significantly over the past two decades; however, access to this care is limited to tertiary care facilities and constrained by geography. With the advances of transport medicine, great distances can be spanned to bring critical care to the patient and provide effective treatment and safe transport systems where specialized care was previously unavailable. A patchwork of diverse transport systems perform pediatric transports with significant differences in the level of pediatric critical care. The optimal transport system has yet to be fully defined, but many successful systems share fundamental elements of organization.
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The incidence, epidemiology, and pathophysiology of drowning and near-drowning are presented. Particular attention is paid to the neurologic and pulmonary pathophysiology indicators for monitoring and laboratory tests. Special attention to transportation of patients is given, and treatment in the field, emergency department, and pediatric intensive care unit is delineated.
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Air transport has become an integral element of pediatric transport programs. The use of both fixed-wing (airplane) and rotorwing (helicopter) aircraft has increased. ⋯ As the acuity of patients requiring air transport has increased, more sophisticated and specialized training in the areas of flight physiology and transport medicine is required. The limitations of air transport and air transport vehicles must be understood to assure that the optimal modality is selected for a specific transport.
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Pediatr. Clin. North Am. · Apr 1993
ReviewEvaluation, treatment, and transport of pediatric patients with shock.
Early recognition and correct treatment of shock remain the most important keys to preventing the death and disability frequently caused by this condition in children. The pediatrician plays a vital role in this process and in referral of the patient for transport to tertiary care centers, where shock is best managed. ⋯ Discussion centers on clinical clues to recognition, on simple measures available to increase tissue oxygenation, and on the issues of pretransport and transport treatment. Support of airway and breathing, vascular access, and correct fluid therapy remain the cornerstones of successful treatment.