The Surgical clinics of North America
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A summary of some of the more important aspects of brain, spinal, peripheral nerve and sport injuries of childhood is presented. Guidelines for the treatment of severe brain injury have been developed for adults, are currently employed with success to treat children, but much information still needs to be acquired about childhood brain injury so that better age specific treatment modalities could be implemented. ⋯ Peripheral nerve injuries are uncommon, often missed, and require skillful evaluation and early treatment by physical therapy and oftentimes surgery. Appreciation of the sequelae of cerebral concussion, education on proper sport techniques, body conditioning, and equipment upkeep are the mainstay of vigilant sport injury treatment and prevention.
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Surg. Clin. North Am. · Apr 2002
ReviewRehabilitation and outcome following pediatric traumatic brain injury.
The long-term outcome for a child who has sustained a traumatic brain injury must be viewed in the context of ongoing development and maturation. Although neuronal plasticity provides the potential for neuronal reorganization in a child's brain, it is the behavioral demands of the environment that allow the child to take advantage of this potential and to maximize recovery. Pediatric rehabilitation is the setting that provides the necessary experiences for stimulating neuronal reorganization following TBI. ⋯ Involvement and training of family members early in the recovery process is critical for successful long-term outcome. Family members are the individuals best equipped to ensure treatment compliance and follow through with treatment recommendations, in maintaining treatment gains, and in generalizing treatment effects beyond the medical settings. Despite the life-long ramifications of childhood TBI, pediatric rehabilitation is the necessary step in promoting recovery and successful long-term outcome.
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Surg. Clin. North Am. · Apr 2002
The evolution and current status of emergency medical services for children.
Emergency physicians have come to believe that comprehensive pediatric emergency care should be integrated into an overall medical system and organized regionally to address the special needs of children. Since our emergency medical systems have evolved in the care of adult trauma victims, we must look to that development for the origin of our present emergency medical services for children. Not until the 1970s did it became obvious that children, just as adults, should be included in an comprehensive emergency medical system for the care of their life threatening injuries. ⋯ With the further development of this concept of trauma units for children, pediatric surgeons, general surgeons involved in trauma care and pediatric emergency physicians have offered leadership to expand the emergency medical system for children to include life-threatening illness, as well as injuries. Thus, the organization of regional emergency medical services for children permits the highest quality management of children with life-threatening injuries and illness. This then is the final product: an inclusive, comprehensive emergency medical system for children for all life threatening conditions, both trauma and serious illness.
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Surg. Clin. North Am. · Apr 2002
Practical points in evaluation and resuscitation of the injured child.
The ultimate goal of resuscitation of an injured child is delivery of oxygen to intracellular organelles in order to maintain aerobic metabolism. This can be obtained by following ATLS protocols with immediate attention to the "ABCDE's" and compulsive reevaluation of the adequacy of resuscitation maneuvers. ⋯ Pediatric trauma is indeed a team endeavor, requiring the coordinated expertise and teamwork of prehospital EMS providers, trauma team members, and the pediatric trauma and rehabilitation centers. With careful and compulsive communication and coordination, injured children can be returned to their families in better mental and physical condition than pre-injury with reasonable expectation of a full and productive life.
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Surg. Clin. North Am. · Feb 2002
Vascular trauma in high-velocity gunshot wounds and shrapnel-blast injuries in Israel.
High-velocity gunshot and shrapnel-blast vascular injuries pose a great challenge and need to be approached in a systematic, multidisciplinary fashion. Early revascularization with temporary shunts, the use of autologous tissue, major venous reconstruction, a low threshold for fasciotomy, and reliable tissue coverage are the mainstays of management.