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Spinal Shock

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1581. Intraosseous Access (Follow-up)

Access Updated: Dec 07, 2016 Author: Pegeen Eslami, MD; Chief Editor: Robert K Minkes, MD, PhD Share Email Print Feedback Close Sections Sections Pediatric Intraosseous Access Overview Overview Background In an acute resuscitation situation, after the airway is secured and adequate breathing and gas exchange are established, the next priority is to obtain vascular access. This is often difficult in infants and children. The physiologic processes of shock and hypothermia with resulting vascular (...) a peripheral vein. IO access provides a means of administering medications, glucose, and fluids, as well as (potentially) a means of obtaining blood samples. Such a situation would include any resuscitation; cardiopulmonary arrest; shock, regardless of etiology; life-threatening ; or lack of venous access resulting from burns, edema, or . In comparison with child and infant peripheral IV access, central lines, or umbilical lines, IO access is safer, is associated with fewer complications, can

2014 eMedicine Pediatrics

1582. Influenza (Follow-up)

, then a combination of neuraminidase inhibitors and M2 inhibitors can be used in confirmed cases of H5N1 infection For prophylaxis in high-risk and moderate-risk exposures, give oseltamivir for 7-10 days from the day of exposure Prophylaxis is not recommended for low risk groups For more information, see the . A combination of antiviral therapy (eg, oseltamivir and adamantanes if susceptibility is expected) and antibiotics is recommended if pneumonia and rapid progression is noted. If septic shock is present (...) immunodeficiency virus [HIV]) Persons who have any condition (eg, cognitive dysfunction, spinal cord injuries, seizure disorders, or other neuromuscular disorders) that may compromise respiratory function or the handling of respiratory secretions or that can increase the risk for aspiration Pregnant women who will be in their second or third trimester during influenza season Household members (eg, children aged < 5 y) of persons at high risk Providers of essential community services (eg, police, fire

2014 eMedicine Pediatrics

1583. Neurointensive Care for Traumatic Brain Injury in Children (Follow-up)

to: Intra-abdominal injuries Pericardial tamponade Hemothorax Pneumothorax Spinal cord injury causing spinal shock Raising the head of the bed to decrease venous obstruction may help to control ICP. Traditionally, elevation of the head to 30° in the midline position is recommended, but titration of head elevation to achieve the lowest ICP would be optimal. Again, care of the cervical spine must always be a consideration when moving patients with TBI. Posttraumatic hyperthermia (core body temperature (...) . This doctrine has critical consequences for patients with TBI. As noted earlier, secondary brain injury results in cerebral edema. The initial compensatory mechanisms for this increase in intracranial volume are displacement of the CSF to the spinal canal and displacement of venous blood to the jugular veins; these reactions prevent elevation of intracranial pressure (ICP). Once these compensatory mechanisms are exhausted, even small increases in cerebral edema and intracranial volume lead to profound

2014 eMedicine Pediatrics

1584. Juvenile Rheumatoid Arthritis (Follow-up)

patients with the ILAR categories of extended oligoarthritis, rheumatoid factor (RF) negative and RF-positive polyarthritis, psoriatic arthritis, enthesitis-related arthritis, and undifferentiated arthritis. [ ] Treatment in this group places less emphasis on initial NSAIDs. After 1 month of NSAID treatment in patients with low disease activity, or 1-2 months in those with moderate disease activity but without poor prognostic features (ie, hip or cervical spine involvement, positive RF or anti-cyclic (...) reasons. The development of pericarditis in children with systemic-onset JIA is usually an indication for admission. Previous Next: Exercise and Other Nonpharmacologic Therapy Exercise preserves joint range of motion and muscular strength, and it protects joint integrity by providing better shock absorption. Types of exercises that may be advised include a muscle-strengthening program, range-of-motion activity, stretching of deformities, and endurance and recreational exercises. Hydrotherapy is a good

2014 eMedicine Pediatrics

1585. Evaluation of the Pediatric Surgical Patient (Follow-up)

to an underlying process. Many children can make this differentiation if asked. Pain on examination may be caused by anal fissures externally, appendicitis in a low-lying appendix, or pelvic inflammatory disease. The surgeon may also detect a fecal impaction during the rectal examination of a child with constipation. Back and spine Scoliosis and other spinal deformities are obvious during examinations of the back. Vertebral tenderness to palpation may be a sign of trauma. Costovertebral angle tenderness may (...) as possible, but do not delay attempts at resuscitation. Computed tomography (CT) of the head is required if the patient has a history of loss of consciousness or has evidence of head injury on physical examination. Magnetic resonance imaging (MRI) of the spine may be needed to assess vertebral or spinal cord injury. [ ] Abdominal and pelvic CT is indicated if abdominal tenderness or distention is present on examination, if the chest radiograph depicts free air, or if intra-abdominal injury is a concern

2014 eMedicine Pediatrics

1586. Echinococcosis (Follow-up)

in Bavaria]. Dtsch Med Wochenschr . 1995 Aug 25. 120(34-35):1151-5. . Midyat L, Gökçe S, Onder A, Ozdemir Y, Mursalov G, Mir S. A very rare cause of childhood paraparesis: primary intradural extramedullary spinal hydatid cyst. Pediatr Infect Dis J . 2009 Aug. 28(8):754-5. . Rosenblatt JE. Laboratory diagnosis of infections due to blood and tissue parasites. Clin Infect Dis . 2009 Oct 1. 49(7):1103-8. . Salant H, Abbasi I, Hamburger J. The development of a loop-mediated isothermal amplification method (...) ):1075-9. . García MB, Lledías JP, Pérez IG, Tirado VV, Pardo LF, Bellvís LM. Primary Super-Infection of Hydatid Cyst--Clinical Setting and Microbiology in 37 Cases. Am J Trop Med Hyg . 2010 Mar. 82(3):376-378. . . Li Y, Zheng H, Cao X, Liu Z, Chen L. Demographic and clinical characteristics of patients with anaphylactic shock after surgery for cystic echinococcosis. Am J Trop Med Hyg . 2011 Sep. 85(3):452-5. . Li Y, Zheng H, Gu M, Cao X, Wen H, Liu Z, et al. Comparisons of Serum Total IgE, IgG

2014 eMedicine Pediatrics

1587. Meningitis, Bacterial (Overview)

and symptoms The 3 classic symptoms (less likely in younger children): Fever Headache Meningeal signs Symptoms in neonates: Poor feeding Lethargy Irritability Apnea Listlessness Apathy Fever Hypothermia Seizures Jaundice Bulging fontanelle Pallor Shock Hypotonia Shrill cry Hypoglycemia Intractable metabolic acidosis Symptoms in infants and children: Nuchal rigidity Opisthotonos Bulging fontanelle Convulsions Photophobia Headache Alterations of the sensorium Irritability Lethargy Anorexia Nausea Vomiting (...) who have features associated with poor prognosis, such as the following: Hypotension Shock Neutropenia Extremes of age Petechiae and purpura of less than 12 hours’ duration Disseminated intravascular coagulation (DIC) Acidosis Presence of the organism in white blood cells (WBCs) on peripheral smear Low erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) level Serogroup C disease Higher rates of fatality and physical sequelae (eg, scarring and amputation) are reported in survivors

2014 eMedicine Pediatrics

1588. Neonatal Resuscitation (Overview)

is necessary, slapping the soles of the feet or rubbing the back may be effective. The back should be visualized briefly for any obvious defect in the spine before beginning these maneuvers. If there is no response to stimulation, it may be assumed that the infant is in secondary apnea, and positive-pressure ventilation (PPV) should be initiated. At this point, the infant's respiratory rate, heart rate, and color should be evaluated. Most infants do not require further intervention. This is considered

2014 eMedicine Pediatrics

1589. Maternal Chorioamnionitis (Overview)

/microscopic examination of placenta, fetal membranes, umbilical cord [ ] Complete blood cell (CBC) count and inflammatory biomarkers, blood culture, and chest x-ray Controversial: Lumbar puncture of neonates See for more detail. Management Therapy for the mother and/or neonate with chorioamnionitis includes early delivery, supportive care, and antibiotic administration. Pharmacotherapy Antibiotic agents used in the treatment of chorioamnionitis include the following: Ampicillin and gentamicin Clindamycin (...) a full resuscitation, including intubation, providing positive-pressure ventilation Treatment of hypovolemia, shock, and respiratory and/or metabolic acidosis Surfactant replacement therapy Glucose homeostasis Assessment and treatment of thrombocytopenia and coagulopathy, if present Surgical option Cesarean section may be indicated to expedite the delivery. Although surgical intervention in the newborn is infrequently required in early-onset bacterial infections of the neonate, conditions that may

2014 eMedicine Pediatrics

1590. Coarctation of the Aorta (Overview)

, however, does not explain the variable degrees of isthmus and aortic arch hypoplasia associated with coarctation of the aorta. Next: Pathophysiology Coarctation of the aorta imposes significant afterload on the left ventricle (LV), which results in increased wall stress and compensatory ventricular hypertrophy. The afterload may be imposed acutely, as occurs following closure of the ductus arteriosus in neonates with severe coarctation. These infants may rapidly develop CHF and shock. Rapid (...) and should prompt repair of both the aneurysm and coarctation. Paralysis Although rare, paraplegia can occur from spinal cord ischemia, resulting from a compromised blood supply to the anterior spinal artery. [ , ] Risk of paralysis is increased with reduced arterial collateral vessels, prolonged aortic cross-clamping time, and intraoperative sacrifice of intercostal arteries, as well as other factors. Paralysis is uncommon in the presence of a well-developed arterial collateral supply, emphasizing

2014 eMedicine Pediatrics

1591. Burns, Electrical (Treatment)

. For high-voltage incidents, the source voltage should be turned off before rescue workers enter the scene. After ensuring scene safety, rescuers should approach victims of electrical injuries as both trauma and cardiac patients. Patients may need basic or advanced cardiac life support and should undergo spinal immobilization as indicated by the mechanism of injury. Given that injuries may be limited to a ventricular arrhythmia or respiratory muscle paralysis, aggressive and prolonged should (...) be initiated in the field for all electrical injury victims, as they are likely to be younger with fewer comorbid conditions and have better chances of survival after prolonged CPR. Next: Emergency Department Care Stabilize patients and provide airway and circulatory support as indicated by ACLS/ATLS protocols. Obtain airway protection and provide oxygen for any patient with severe hypoxia, facial/oral burns, loss of consciousness/inability to protect airway, or respiratory distress. Cervical spine

2014 eMedicine Pediatrics

1592. Burns: Surgical Perspective (Treatment)

on whole-body bone mineral content (BMC), lumbar-spine BMC, lumbar-spine bone mineral density (BMD), and height velocity. [ ] The extent of initial resuscitation efforts and the subsequent care of a burn-injured patient have a significant impact on whether the patient recovers or experiences complications, including the development of multiple organ dysfunction syndrome (MODS) and death. The Burn Research Group developed standardized protocols for patient care based on management principles derived (...) hypermetabolism and inflammation in severely burned children. Pediatr Crit Care Med . 2008 Mar. 9 (2):209-16. . Cochran A, Thuet W, Holt B, Faraklas I, Smout RJ, Horn SD. The impact of oxandrolone on length of stay following major burn injury: a clinical practice evaluation. Burns . 2013 Nov. 39 (7):1374-9. . Reeves PT, Herndon DN, Tanksley JD, Jennings K, Klein GL, Mlcak RP, et al. FIVE-YEAR OUTCOMES AFTER LONG-TERM OXANDROLONE ADMINISTRATION IN SEVERELY BURNED CHILDREN: A RANDOMIZED CLINICAL TRIAL. Shock

2014 eMedicine Pediatrics

1593. Bowel Obstruction in the Newborn (Treatment)

(over the vertebral column) and the "curly Q" twist. Gastrografin enema. Note the tiny, unused colon and the dilated (by swallowed air) proximal, obstructed intestine. Midgut volvulus. The bowel is eviscerated and the entire midgut is twisted counterclockwise, effecting reduction of the volvulus. The midgut volvulus is reduced. The peritoneal bands (Ladd bands) tethering the duodenum to the colon are divided, exposing the superior mesenteric vessels. Complicated meconium ileus. Volvulus (...) enema, respectively. Previous Next: Preparation for Operation Duodenal atresia Preoperative measures for duodenal atresia include fluid resuscitation and nasogastric decompression. The baby should be evaluated for trisomy 21. Duodenal atresia is considered a “midline embryologic defect,” and evaluation for associated anomalies should include echocardiography, head and renal ultrasonography, and vertebral skeletal radiography. Malrotation with volvulus Preoperative treatment of malrotation

2014 eMedicine Pediatrics

1594. Birth Trauma (Treatment)

of subgaleal hemorrhage. [ ] The diagnosis is generally a clinical one, with a fluctuant, boggy mass developing over the scalp (especially over the occiput). The swelling develops gradually 12-72 hours after delivery, although it may be noted immediately after delivery in severe cases. The hematoma spreads across the whole calvaria; its growth is insidious, and subgaleal hematoma may not be recognized for hours. Patients with subgaleal hematoma may present with hemorrhagic shock. The swelling may obscure (...) the fontanelle and cross suture lines (distinguishing it from cephalhematoma). Watch for significant hyperbilirubinemia. In the absence of shock or intracranial injury, the long-term prognosis is generally good. Laboratory studies consist of a hematocrit evaluation. Management consists of vigilant observation over days to detect progression and provide therapy for such problems as shock and anemia. Transfusion and phototherapy may be necessary. Investigation for coagulopathy may be indicated. Caput

2014 eMedicine Pediatrics

1595. Avian Influenza (Treatment)

, then a combination of neuraminidase inhibitors and M2 inhibitors can be used in confirmed cases of H5N1 infection For prophylaxis in high-risk and moderate-risk exposures, give oseltamivir for 7-10 days from the day of exposure Prophylaxis is not recommended for low risk groups For more information, see the . A combination of antiviral therapy (eg, oseltamivir and adamantanes if susceptibility is expected) and antibiotics is recommended if pneumonia and rapid progression is noted. If septic shock is present (...) immunodeficiency virus [HIV]) Persons who have any condition (eg, cognitive dysfunction, spinal cord injuries, seizure disorders, or other neuromuscular disorders) that may compromise respiratory function or the handling of respiratory secretions or that can increase the risk for aspiration Pregnant women who will be in their second or third trimester during influenza season Household members (eg, children aged < 5 y) of persons at high risk Providers of essential community services (eg, police, fire

2014 eMedicine Pediatrics

1596. Acute Myelocytic Leukemia (Overview)

formation, focal lytic lesions, or pathologic fractures MRI or CT scanning of the head, spine, or other affected areas: For patients with neurologic symptoms to rule out intracranial hemorrhage or infiltrative disease CT scanning of abdomen or sinuses: For abdominal pain or suspected infection of the large bowel; for early detection of asymptomatic sinusitis as cause of persistent, unexplained fevers Echocardiography: To exclude serious infections that affect heart function; also, perform before (...) chemotherapy and periodically with administration of high cumulative doses of anthracyclines (eg, daunomycin, idarubicin) Radionuclide imaging: To detect occult infection that cultures and other imaging modalities do not reveal (eg, occult osteomyelitis, occult deep-tissue infection) Procedures Bone marrow examination: To establish the diagnosis of AML Lumbar puncture and CSF examination: For diagnostic and therapeutic purposes See for more detail. Management The treatment of AML is directed toward 2 goals

2014 eMedicine Pediatrics

1597. Bacteremia (Overview)

; they are not recommended as routine screening laboratory studies for occult bacteremia Procalcitonin level – This appears to be more sensitive and more specific for bacterial infection than are other laboratory values currently used as screening tests and has good results in illnesses of short duration Urinalysis and urine culture Stool studies for children with diarrhea (eg, for Salmonella ) Plasma clearance rate (for meningococcal bacteremia) Lumbar puncture and cerebrospinal fluid (CSF) analysis Blood culture (...) by definition do not have clinical evidence other than fever (a systemic response to infection). [ ] First described in the 1960s in young febrile children with unsuspected pneumococcal infection, bacteremia is defined as the presence of bacteria in the bloodstream of a febrile child who was previously healthy; the child does not clinically appear to be ill and has no apparent focus of infection. [ , ] Occult bacteremia has been defined as bacteremia not associated with clinical evidence of sepsis (shock

2014 eMedicine Pediatrics

1598. Neonatal Resuscitation (Treatment)

is necessary, slapping the soles of the feet or rubbing the back may be effective. The back should be visualized briefly for any obvious defect in the spine before beginning these maneuvers. If there is no response to stimulation, it may be assumed that the infant is in secondary apnea, and positive-pressure ventilation (PPV) should be initiated. At this point, the infant's respiratory rate, heart rate, and color should be evaluated. Most infants do not require further intervention. This is considered

2014 eMedicine Pediatrics

1599. Neonatal Sepsis (Treatment)

, a follow-up lumbar puncture is recommended within 24-36 hours after initiation of antibiotic therapy. If organisms are still present, modification of the drug type or dosage is required to treat the meningitis adequately. Continue antibiotic treatment for 2 weeks after sterilization of the CSF or for a minimum of 2 weeks with gram-positive meningitis and 3 weeks with gram-negative meningitis. Meningitis complicated by seizures or persistent positive cultures may require extended IV antimicrobial (...) , Laborie S, Rabilloud M, Lapillonne A, Claris O. Outcome and prognostic factors in neonates with septic shock. Pediatr Crit Care Med . 2008 Mar. 9(2):186-91. . Adams-Chapman I, Stoll BJ. Neonatal infection and long-term neurodevelopmental outcome in the preterm infant. Curr Opin Infect Dis . 2006 Jun. 19(3):290-7. . Volpe JJ. Postnatal sepsis, necrotizing entercolitis, and the critical role of systemic inflammation in white matter injury in premature infants. J Pediatr . 2008 Aug. 153(2):160-3

2014 eMedicine Pediatrics

1600. Neurointensive Care for Traumatic Brain Injury in Children (Treatment)

to: Intra-abdominal injuries Pericardial tamponade Hemothorax Pneumothorax Spinal cord injury causing spinal shock Raising the head of the bed to decrease venous obstruction may help to control ICP. Traditionally, elevation of the head to 30° in the midline position is recommended, but titration of head elevation to achieve the lowest ICP would be optimal. Again, care of the cervical spine must always be a consideration when moving patients with TBI. Posttraumatic hyperthermia (core body temperature (...) . This doctrine has critical consequences for patients with TBI. As noted earlier, secondary brain injury results in cerebral edema. The initial compensatory mechanisms for this increase in intracranial volume are displacement of the CSF to the spinal canal and displacement of venous blood to the jugular veins; these reactions prevent elevation of intracranial pressure (ICP). Once these compensatory mechanisms are exhausted, even small increases in cerebral edema and intracranial volume lead to profound

2014 eMedicine Pediatrics

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