Extravasation rates and complications of intraosseous needles during gravity and pressure infusion.

Objective: To compare the extravasation rates and insertion complications under gravity and 300 mm Hg (40 kPa) pressure infusion of threaded (SurFast and Sussmane-Raszynski intraosseous needles, Cook Critical Care, Bloomington, IN); and nonthreaded needles (16-gauge disposable intraosseous needle with 45 degrees trocar Cook Critical Care, Bloomington, IN; Jamshidi bone marrow needle; Baxter Health Care Corp, Valencia, CA).

Design: A prospective, randomized study.

Setting: An animal laboratory at a university center.

Comparison of transtracheal and extravascular Doppler determinations of stroke volume and cardiac output at various states of volume loading in piglets.

Objective: To assess the applicability of a new technology in neonates. Transtracheal Doppler and extravascular Doppler determinations of stroke volume and cardiac output were compared with thermodilution measurements at various states of volume loading in an animal model.

Design: Prospective, descriptive study.

Evaluation of the role of comparison radiographs in the diagnosis of traumatic elbow injuries.

This study attempted to determine whether comparison radiographic views of the uninjured elbow result in increased diagnostic accuracy. Physicians (one junior and one senior orthopaedic resident and an orthopaedic surgeon) were provided with a short clinical summary and asked to interpret radiographs of the injured elbow (IE) or both the injured and uninjured elbow (UE) in a randomized fashion from 25 children with elbow injuries. The overall percentage of correct diagnoses (one vs.

Retinal hemorrhage in the young child: a review of etiology, predisposed conditions, and clinical implications.

Retinal hemorrhage is a frequent finding in child abuse, but may also be associated with cardiopulmonary resuscitation, accidental trauma, and a variety of illnesses such as blood dyscrasias and infections. Although it is imperative that child abuse be considered in all children who present with retinal hemorrhages, whether retinal hemorrhages can be attributed to cardiopulmonary resuscitation in suspected cases of abuse poses a dilemma. The etiologies of retinal hemorrhage as well as the literature presently available to support or refute the various diagnoses are discussed.

Treatment of critical status asthmaticus in children.

Status asthmaticus is complex in its etiology and pathophysiology and may be associated with significant morbidity and mortality. Although there are many therapeutic options, specific inhaled beta 2-agonists, corticosteroids, and oxygen remain the mainstay of therapy. Several new drugs and some older drugs are being used in management; their exact role in treatment at present, however, relies largely on personal preferences.

Transtracheal Doppler in infants and small children following surgery for congenital heart disease: rational use of an improved technology.

Objective: To compare measurements of cardiac output utilizing an improved transtracheal Doppler technology with measurements obtained using two-dimensional echocardiography.

Design: Prospective, descriptive study.

Setting: Cardiovascular intensive care unit at a university medical center.

Pediatric and adult thoracic trauma: age-related impact on presentation and outcome.

Unlabelled: To assess the impact of age on presentation and outcome, 2,415 cases involving blunt and penetrating thoracic trauma over an 8-year period were reviewed retrospectively from a single level I trauma center. Of the 2,073 patients alive on arrival, 79 were 12 years of age or less (children), 137 were 13 to 17 years of age (adolescent), 1,742 were 18 to 59 years of age (adults), and 115 were 60 years of age or more (elderly). Chi-square analysis was performed relative to presentation (blunt versus penetrating), need for thoracotomy, and hospital mortality.

Comparison of pH and carbon dioxide tension values of central venous and intraosseous blood during changes in cardiac output.

Objective: To compare the pH and PCO2 values determined from of simultaneously corrected samples of central venous and intraosseous blood during sequential changes in cardiac output.

Design: Prospective, descriptive study.

Setting: An animal laboratory in a university medical center.

Education attainment level of caregivers versus readability level of written instructions in a pediatric emergency department.

Our objectives were 1) to determine the education attainment level (EAL) of parents attending the pediatric emergency department (PED); 2) to assess the readability level (RL) of the written instructions available to these parents; and 3) to revise these instruction forms at a level of comprehension based on the EAL of parents. We used a questionnaire of EAL and RL assessment using the SMOG and FOG readability formulas. We then revised the written instructions and used parents in the PED to pretest them.

Pediatric penetrating thoracic trauma: a five-year experience.

Penetrating thoracic trauma is managed nonoperatively in 85% of adult patients. We hypothesized that similar trauma in children would lead to proportionately more vital tissue damage and a higher rate of operative intervention. The pediatric penetrating thoracic trauma experience of a level one trauma center was analyzed over a five-year period.

Pharmacokinetics from multiple intraosseous and peripheral intravenous site injections in normovolemic and hypovolemic pigs.

Objectives: To examine: a) the rate and extent of delivery of radioactive tracers to the central circulation from the tibial, medial malleolar, distal femoral, and humeral intraosseous sites, as well as from a peripheral intravenous site; and b) the end-tidal CO2 response to injected sodium bicarbonate at these sites.

Design: Prospective, descriptive study.

Setting: Animal laboratory at a university medical center.

The utility of autopsies in a pediatric emergency department.

The role of the autopsy in verifying clinical diagnosis and as a quality assurance tool in pediatric emergency medicine has not been studied. We reviewed the charts of all children who died soon after arriving at to the pediatric emergency department between October 1985 and December 1989. Opinions as to clinical diagnoses and cause of death were obtained by presenting a summary of patient data, in a blinded fashion, to three emergency pediatricians.

Comparison of the acid-base status of blood obtained from intraosseous and central venous sites during steady- and low-flow states.

Objective: To compare the acid-base status of blood obtained from the tibial intraosseous site with that status obtained from a central venous site during stead- and low-flow states in a piglet model.

Design: A prospective, observational study.

Setting: Animal laboratory at a university medical center.

Experience with the hemophiliac child in a pediatric emergency department.

We conducted a retrospective chart review of all hemophiliacs followed by our pediatric hematology service from January 1, 1980 to December 31, 1989 inclusive, to determine the frequency and nature of their visits to our Emergency Department (ED). Of 36 patients studied, 26 were Factor VIII deficient (13 mild, 3 moderate, and 10 severe) and 10 had Factor IX deficiency (7 mild and 3 severe). No patient had red blood cell (RBC) antibodies or factor inhibitors.

An evaluation of the physical and functional characteristics of infant resuscitators.

Self-inflating resuscitators (SIRs) are commonly used to assist ventilation in the newborn. Despite their widespread use, there is limited information available on the functional and physical characteristics of SIRs. We studied five new infant bag-valve units to compare their physical characteristics, including reservoir, accumulator, and dead space volumes (VD), pressure relief mechanism (PRM), inspiratory resistance (RI), and functional mechanics including stroke volume (SV), fraction of delivered oxygen (FDO2), and cycle frequency at -5 degrees C, 20 degrees C, and 49 degrees C, using a test lung apparatus and experienced respiratory therapists.

Comparison of fluid infusion rates among peripheral intravenous and humerus, femur, malleolus, and tibial intraosseous sites in normovolemic and hypovolemic piglets.

Study Objectives: To compare infusion rates from various intraosseous sites (tibial, medial malleolar, distal femoral, and humeral) and at a peripheral IV site under gravity and pressure flow in normovolemic and hypovolemic states.

Design And Setting: A piglet model was used to assess rates of infusion under varying conditions in a university hospital animal laboratory. Analysis of variance was used to evaluate site differences.

Appropriateness of hospitalization in a Canadian pediatric hospital.

Allocation of limited resources in the Canadian health care system is hampered by a lack of studies addressing the appropriateness of the pediatric patient days in hospital. The authors retrospectively reviewed one hospital day per month in 1988, using a Pediatric Appropriateness Evaluation Protocol previously used in the United States. Of 878 inpatients, 852 charts were reviewed, and 26 charts were unavailable for study.

Relationship of cross-brain oxygen content difference, cerebral blood flow, and metabolic rate to neurologic outcome after near-drowning.

We evaluated the relationship of global cerebral blood flow, cross-brain oxygen content difference, cerebral metabolic rate for oxygen, intracranial pressure, and cerebral perfusion pressure to functional neurologic outcome in 12 comatose children on 2 consecutive days after near-drowning. Five children survived with functional neurologic outcome; five died and two survived with severe neurologic damage. Children who survived with functional neurologic outcome had a significantly higher cross-brain oxygen content difference (7.

An unanticipated increase in patient visits to a pediatric emergency department.

This study was conducted to explain a more than threefold increase in anticipated patient visits associated with the opening of a separate pediatric emergency department (PED) 2 miles from the nearest general emergency department. Population demographics and data pertaining to visits to other emergency departments were obtained. Parents visiting the new PED were surveyed using a standardized questionnaire.

Is a full team required for emergency management of pediatric trauma?

Pediatric trauma centers often do not meet the guidelines requiring a trauma team as recommended by the American Academy of Pediatrics (AAP). We reviewed our experience with a team consisting of a pediatric emergency physician, resident, nurse, and respiratory therapist. The surgical and pediatric critical care residents and staff were available within 5 minutes.