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handbook of PEDIATRIC EMERGENCY MEDICINE handbook of PEDIATRIC EMERGENCY MEDICINE Edited by: P.O. Brennan Department of Accident and Emergency Medicine, Sheffield Children’s Hospital, Sheffield, UK K. Berry Department of Accident and Emergency Medicine, Birmingham Children’s Hospital, Birmingham, UK C Powell Department of Accident and Emergency Medicine, Royal Melbourne Children’s Hospital, Melbourne, Australia M.V. Pusic Division of Emergency Medicine, British Columbia Children’s Hospital, Vancouver, Canada © BIOS Scientific Publishers Limited, 2003 First published 2003 This edition published in the Taylor & Francis e-Library, 2005. “To purchase your own copy of this or any of Taylor & Francis or Routledge's collection of thousands of eBooks please go to www.eBookstore.tandf.co.uk.” All rights reserved. No part of this book may be reproduced or transmitted, in any form or by any means, without permission. A CIP catalogue record for this book is available from the British Library. ISBN 0-203-63424-1 Master e-book ISBN ISBN 0-203-63761-5 Adobe e-Reader Format ISBN 1 85996 242 4 (Print Edition) BIOS Scientific Publishers Ltd 9 Newtec Place, Magdalen Road, Oxford OX4 1RE, UK Tel. +44 (0)1865 726286. Fax +44 (0)1865 246823 World Wide Web home page: http://www.bios.co.uk/ Important Note from the Publisher The information contained within this book was obtained by BIOS Scientific Publishers Ltd from sources believed by us to be reliable. However, while every effort has been made to ensure its accuracy, no responsibility for loss or injury whatsoever occasioned to any person acting or refraining from action as a result of information contained herein can be accepted by the authors or publishers. The reader should remember that medicine is a constantly evolving science and while the authors and publishers have ensured that all dosages, applications and practices are based on current indications, there may be specific practices which differ between communities. You should always follow the guidelines laid down by the manufacturers of specific products and the relevant authorities in the country in which you are practising. Production Editor: Andrea Bosher. Contents Abbreviations vii Contributors x Preface xiii Acknowledgements xv 1. Introduction 1 P.O.Brennan PART I MEDICAL EMERGENCIES 2. Pediatric cardiopulmonary resuscitation and life-threatening emergencies 7 K.Berry, S.Verma and D.Moore 3. Shock 27 B.Stanhope 4. Cardiac emergencies 38 C.Powell 5. Respiratory emergencies 49 C.Powell 6. Neurological emergencies 67 C.Powell 7. Gastroenterological emergencies and abdominal pain 87 M.Smith, W.A.McCallion and C.Powell 8. Endocrine emergencies 104 C.Powell 9. Renal emergencies 115 C.Powell and T.Reade 10. Genital problems 128 M.Smith and W.A.McCallion 11. Hematological emergencies 135 C.Powell 12. Psychiatric emergencies 150 P.O.Brennan 13. Dermatological emergencies 161 P.O.Brennan 14. Poisoning in children 171 S.Denniston, M.Riordan, K.Berry and K.Lendrum 15. The crying baby and infant distress 183 C.Powell 16. Febrile child under 3 years 186 C.Powell PART II TRAUMA AND SURGICAL EMERGENCIES 17. Major trauma—general 189 M.Pusic 18. Specific major trauma 205 S.Gordon and M.Pusic 19. Head injury 215 S.Ali and M.Pusic 20. Emergency burn management including smoke inhalation 233 S.Gordon and K.Lendrum 21. Pediatric skeletal injuries 242 K.J.L.Black and M.Pusic 22. Minor trauma 260 M.Pusic and P.O.Brennan 23. Bacterial soft tissue infections 270 A.Freeburn and M.B.H.Smith 24. Ocular emergencies 277 P.O.Brennan 25. Emergencies of the ear, nose and throat 292 P.O.Brennan 26. Dental emergencies 306 P.O.Brennan 27. Child abuse 313 P.O.Brennan 28. Animal bites and stings 330 L.M.Evered PART III GENERAL TOPICS 29. Immunization 343 P.O.Brennan 30. Pain management 350 P.O.Brennan 31. Transport of the seriously ill child 365 G.Pearson 32. The dead and dying child 370 P.O.Brennan 33. Medicolegal issues 383 P.O.Brennan Emergency formulary 390 Index 407 Abbreviations ADH antidiuretic hormone APLS Advanced Pediatric Life Support ASOT antistreptolysin titre AT antitrypsin BP blood pressure BSA body surface area CPAP continuous positive airways pressure CRP C-reactive protein CSE convulsive status epilepticus CSF cerebrospinal fluid CSU catheter specimen of urine CVP central venous pressure CXR chest X-ray DMSA dimercapto-succino-acetic acid ENT ear nose and throat ESR erythrocyte sedimentation rate FBC full blood count G6PD glucose-6-phosphate dehydrogenase GCS Glasgow Coma Scale GIT gastrointestinal tract HBIG hepatitis B immunoglobulin HbsAg hepatitis B surface antigen hCG human choriogonadotropin HDCV human diploid cell vaccine HIDA 99mTc-HIDA scan (imino-diacetic acid derivative) HIV human immunodeficiency virus HRIG human rabies immune globulin ICP intracranial pressure ILCOR International Liaison Committee on Resuscitation INR international normalized ratio ITP idiopathic thrombocytopenic purpura LCP Legg-Calve-Perthes disease LFT liver function test LP lumbar puncture LRT lower respiratory tract infection MCP metacarpal phalangeal joint MCU micturating cysto-urethrogram MCV mean corpuscular volume MSBP Munchausen syndrome by proxy MSU mid-stream urine MVC motor vehicle collisions OD osteochondritis dissecans OI osteogenesis imperfecta PALS Pediatric Advanced Life Support PCEC purified chick embryo cell culture PDA patent ductus arteriosus PEEP positive end expiratory pressure PICU Pediatric Intensive Care Unit PK pyruvate kinase PTSD post-traumatic stress disorder RBC red blood cell RSV respiratory syncytial virus RVA rabies vaccine adsorbed SAH subarachnoid hemorrhage SCIWORA spinal cord injury without radiological abnormality SIDS sudden infant death syndrome SPA suprapubic aspiration SSSS staphylococcal scalded skin syndrome SVR systemic vascular resistance SVT supraventricular tachycardia TLC total lung capacity TPN total parenteral nutrition TSH thyroid stimulating hormone UKRC United Kingdom Resuscitation Council URTI upper respiratory tract infection UTI urinary tract infection VF ventricular fibrillation VSD ventricular septal defect VT ventricular tachycardia WBC white blood count