American journal of diseases of children (1960)
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The controversy surrounding the diagnostic workup for simple febrile seizures has centered around the lumbar puncture. This focus has obscured the potential importance of other tests. A retrospective study was performed to determine the frequency of occult bacteremia in simple febrile seizures. ⋯ However, neither age nor history of febrile seizures affected the risk of bacteremia. These data suggest that patients with simple febrile seizures are at approximately the same risk for bacteremia as children with fever alone. Patients with simple febrile seizures should be treated in the same manner as other patients of the same age with regard to the performance of blood cultures.
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Four children with brain injury were later found to have coexisting spinal cord injury (SCI). Findings that warrant investigation for coexisting SCI include a dermatome pattern sensory loss; absence of movement and reflexes in either both arms or both legs with preservation in the remaining extremities; flaccidity; absence of sacral reflexes; diaphragmatic breathing without use of accessory respiratory muscles; bradycardia with hypotension; autonomic hyperreflexia; poikilothermia; unexplained urinary retention; history of neck pain; unexplained ileus; priapism; and the presence of clonus in an unconscious patient without decerebrate rigidity. If any of the above are present, the spine should be stabilized until either further diagnostic studies confirm SCI with treatment instituted or serial neurologic examinations confirm the absence of SCI.
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Peripheral intravenous cannula use in a neonatal intensive care unit was surveyed prospectively to ascertain the rate of complications and the factors influencing the life span of an intravenous cannula. During a three-month period in which 199 intravenous cannulas were inserted in 69 patients, only two significant infiltrations (1%) were observed in more than 5000 hours of intravenous therapy. ⋯ Pancuronium was associated with a significant prolongation of cannula life span--from 30 to 50 hours. We conclude that in this setting, the rate of clinically significant complications from intravenous cannula therapy is low.
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Intraosseous infusion of drugs for resuscitation and of fluids has been advocated as an alternate emergency technique to intravenous infusion. The reliability of intraosseous infusion of many substances has not been established. Glucose and dopamine hydrochloride are two commonly used emergency drugs in pediatric practice that have not been carefully studied when administered into the bone marrow. ⋯ A dopamine infusion was then administered through the bone marrow for 20 minutes. A statistically significant rise in blood pressure was observed two minutes after initiation of the infusion. Intraosseous infusion of hypertonic glucose and dopamine is an effective route by which to administer these medications and is potentially useful in emergency situations in which intravascular access is delayed.
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Residency training programs are the appropriate milieu in which physicians should receive specialized training in the diagnosis and management of child abuse. The purposes of the present study were to assess and compare residents' knowledge of child abuse and their attitudes toward the propriety of different forms of childhood discipline. We surveyed 192 residents from seven different training programs with questionnaires probing their knowledge of child abuse and their attitudes toward childhood disciplinary measures; 161 (84%) of the questionnaires were satisfactorily completed by residents in pediatrics (n = 87), family medicine (n = 51), and surgery (n = 23). ⋯ Scores were not related to year of training or attitudes toward childhood discipline but were correlated with self-reports of previous child abuse teaching. Residents' performance on a childhood disciplinary measure demonstrated wide latitude in their rating of the acceptability of 23 different modes of childhood discipline. Our findings indicate a need for a more systematic approach to residents' education in childhood intentional injuries and some value clarification of their attitudes toward various forms of childhood discipline.