Pediatria_

CME REVIEWARTICLE
Pharmacological Management of the Agitated Pediatric Patient

Abstract: Children with behavioral or psychiatric complaints are often evaluated in pediatric emergency room settings, and may present as agitated or violent at any point during the evaluation process. Emergency departmentYbased practitioners should be aware of risk factors associated with agitation and should be able to assess the agitated patient in a timely fashion. Management may require the use of pharmacological agents that can mitigate agitation safely and effectively, thus ensuring good outcomes for patients and emergency department staff.
Key Words: psychiatry, agitation, pharmacological management, behavioral, pharmacology
(Pediatr Emer Care 2010;26: 856-863)
PDF (140 K)

REVIEWARTICLE
Updated American College of Critical Care Medicine-Pediatric Advanced Life Support Guidelines for Management of Pediatric and Neonatal Septic Shock: Relevance to the Emergency Care Clinician

Abstract: Shock is a major preventable cause of morbidity and mortality in children referred to emergency care. The recently updated American College of Critical Care Medicine guidelines for the management of newborns and children with septic shock emphasize the role of emergency care in improving survival and functional outcomes. Implementation of these guidelines of stepwise use of fluids, antibiotics, and, if necessary, inotropes within the first hour of admission to the emergency department can reduce mortality and neurological morbidity risks 2-fold. Therapies should be goal directed to maintain age-specific threshold heart rates and blood pressure as well as a capillary refill of less than 3 seconds or 2 seconds or less. Inotropes should be delivered through peripheral intravenous or intraosseous access when central access is unavailable because delay in inotrope delivery can greatly increase mortality risks. Emergency care systems should be organized to facilitate recognition, triage, and treatment of shock in the first hour. Emergency departments should be stocked with ready access to antibiotics, fluids, and inotrope infusions, and clinicians should be trained in the delivery of goal-directed fluid, antibiotics, and inotrope therapies in the first hour of resuscitation. For newborns, in addition to fluids, antibiotics, and inotropes, a prostaglandin infusion should be available within 10 minutes if duct-dependent congenital heart disease is a
possibility.
Key Words: sepsis, septic shock, guidelines, resuscitation
(Pediatr Emer Care 2010;26: 867-869)
PDF (543 K)