Pediatric clinics of North America
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A great variety of problems referable to the cardiovascular system can prompt a visit to the pediatric emergency room. From the initial presentation of congenital heart disease, to the subsequent life-long management of these patients, to miscellaneous problems like Kawasaki disease and chest pain, the front-line pediatrician must be skilled in the recognition and early management of myriad complaints. This article focuses on information that can assist the emergency pediatrician in the evaluation and treatment of the cardiac patient from arrival in the emergency room until transfer of care to the pediatric cardiologist or inpatient staff.
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Pediatr. Clin. North Am. · Oct 1992
ReviewTriage, initial assessment, and early treatment of the pediatric trauma patient.
It should be clear from this overview of triage, assessment, and initial care that early involvement by the leader of the trauma team is essential. Because operative intervention is so often necessary, the trauma team leader should be a surgeon with specialized training in trauma. The complex decision-making process involves prioritizing approaches by emergency room physicians, pediatricians, and surgical specialties in patients with multiple injuries. Even with single-system injury a rapid and logical approach to assessment and treatment is necessary in light of an overall longer term management plan.
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Pediatr. Clin. North Am. · Dec 1991
ReviewNeonatal intensive care: is it worth it? Developmental sequelae of very low birthweight.
A significant portion of the health care dollar has been spent on neonatal intensive care since the early 1970s when technologic developments permitted salvage of very small premature infants. The wisdom of allocating so much for so few has been challenged, especially if the result is an increase in the number of severely mentally and motorically disabled children. Studies from around the world of the secular trends in mortality and morbidity for very and extremely low-birthweight babies uniformly indicate that there have been dramatic decreases in mortality and morbidity in the past 20 years. ⋯ Studies have failed to show a consistent influence of preterm birth on long-term behavior. Behavior is likely affected more by the social-emotional milieu in which the child is reared than prematurity itself. The environment seems to take over in importance in affecting cognitive functioning after the first several years of life.(ABSTRACT TRUNCATED AT 400 WORDS)
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When the physician is confronted with an oral pathologic condition in a child, the adage "common things happen commonly" should be applied. Congenital lesions such as palatal and alveolar cysts occur in almost 50% of newborns. ⋯ In addition, soft-tissue pathologies and discomfort associated with herpesvirus infections or recurrent aphthous ulcerations often present as a chief complaint. The physician's knowledge and treatment recommendations for common oral pathologies should be an integral component to the overall medical management of infants, children, and adolescents.
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An approach to the evaluation of a child who presents to the pediatrician with bruising is outlined. Important clues in the history and physical examination that suggest disorders of platelet number and function or coagulation abnormalities are presented. A scheme for using screening tests of coagulation and platelet function is followed by a brief summary of currently available therapies appropriate for bleeding episodes in children.