Indian journal of pediatrics
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The vast majority of children with heart murmurs have an 'innocent' murmur. Differentiation of such murmurs from those due to structural cardiac disease, so called 'pathological' murmurs, is largely clinical. Pediatricians are capable of differentiating one from the other, provided a detailed evaluation is done. This article outlines the salient features of innocent murmurs that help us recognize them clinically.
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The debate concerning the choice of crystalloids or colloids for resuscitation of the critically ill child is still unsettled. Moreover, the use of albumin in critically ill patients has been increasingly questioned because of the lack of clear-cut advantages over crystalloids as well as the concern for cost and the very minor risk of infection. ⋯ There may be niche areas such as hypoalbuminic states, cirrhosis and burns where albumin may have distinct benefits. Alternatively synthetic colloids may be useful, however, concerns about coagulation problems and organ dysfunction persists.
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To compare pH and PCO2 values of simultaneously obtained arterial, arterialized capillary, and venous blood samples and also to compare oxygen saturation (ASaO2) measured in arterial blood and oxygen saturation by pulse oximetry (PSaO2). ⋯ Even though arterial blood gas analysis is the gold standard, and when an arterial blood gas sample cannot be obtained, a combination of arterialized capillary blood gas and pulse oximetry can be effectively used in acutely ill children of all ages. Venous samples have a good correlation with arterial samples for pH but are not useful for monitoring blood gas status in acutely ill children.
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[corrected] Foreign body inhalation is an extremely serious problem in children and sometimes result in sudden death. The current mortality rate from foreign body inhalation is between 0% and 1.8% according to various studies. In spite of this, undiagnosed and unsuspected foreign bodies still occur in the airway. ⋯ Tracheobronchial foreign bodies should be strongly suspected in pediatric age group who present with a suggestive history, even when physical and radiographic evidence is absent. The modalities of diagnosis, management and outcome are discussed.
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A 9-month-old infant who was diagnosed to have right-sided diaphragmatic hernia with no other associated anomalies, is being reported here. He had presented with cough for one month and respiratory difficulty for one-week duration and history of bilious vomiting two days prior to admission. ⋯ He underwent a successful correction of the defect. So radiological finding of pleural effusion with displacement of mediastinum to the left and the presence of bowel gas high in the right upper quadrant should alert the possibility of a right-sided Bochdalek hernia.