Respiratory care clinics of North America
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Traumatic airway injuries are rare in children, partly due to their unique anatomy. The larynx is well protected from direct blows behind the mandibular arch, and only a small portion of the trachea is unprotected above the manubrium due to the relatively short neck. Furthermore, the tracheobronchial tree is less prone to injuries as compared with adults due to its elasticity. ⋯ These children need to be followed endoscopically for months and sometimes years in order to diagnose and treat stenoses as soon as they occur. Long-term pulmonary function has been shown to be excellent. Children with bilateral recurrent nerve paralysis may not fully recover voice or airway.
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Respir Care Clin N Am · Mar 2001
ReviewInitial assessment and management of pediatric trauma patient.
The initial evaluation and treatment of the pediatric trauma patient require an organized, thorough approach. All patients must be assumed to have multiple injuries until proven otherwise. ⋯ The adequate assessment and treatment of the ABCs will provide adequate treatment of the patient's other injuries, leading to an overall improvement in morbidity and mortality. Thus, the ABCs play an essential role in the initial evaluation and treatment of the pediatric trauma patient.
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The evaluation and management of oxygen delivery (Do2) and consumption (Vo2) of patients with acute medical and surgical illnesses have been subject to controversy and reevaluation. It has been established that a relationship between oxygen delivery and oxygen consumption exists, and is very complex, particularly in diseases in which various factors individually or collectively affect it. The care of critically ill patients routinely involves the manipulation of the Vo2-Do2 relationship, and extensive research, both experimental and clinical, has been done to improve our understanding of this relationship in health and disease with the hope for improved outcomes. ⋯ New noninvasive technologies to measure the adequacy of regional measures of oxygenation are being developed, with gastrointestinal tonometry getting much clinical attention. The exact role of these technologies in the management of critically ill patients, and whether they will improve survival, has not yet been determined. It is likely that the ability to care successfully for critically ill patients will come from a better understanding of not only global, but also regional, cellular, and subcellular metabolism.
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The definitions of hypoxemia and hypoxia, and basic pulmonary anatomy and oxygen delivery are reviewed. Low ambient oxygen, hypoventilation, ventilation-perfusion mismatch, and right-to-left shunt, the four basic mechanisms of hypoxemia are described in detail with patient examples. ⋯ Because getting oxygen into the blood stream is only half the story, mechanisms of tissue hypoxia in the setting of adequate oxygen exchange from the lungs to the blood are discussed. An algorithm is proposed for diagnosing patients who present with hypoxia.
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The ability to accurately assess respiratory function is essential in the management of critically sick patients. Such measurements help in the diagnosis, management, and outcome of the patients. Proper understanding and interpretation of these parameters is of paramount importance. Clinicians should appreciate the benefits and the limitations of these techniques.