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Chapter 1 Index
A. General Information
about the well child examination B. Nutrition Issues
C. Sleep Issues
D. Dental Issues
E. Anticipatory Guidance
--Discipline: Normal
Toddlers
--Discipline: To Spank
or Not to Spank
--Toilet Training: or Once Upon a Potty
--Reach Out and Read
--Anticipatory Guidance: Other Items to Ask
Birth – 6 years of age
--Smoking: Adverse
Effects on Children
--What’s New in Car Seats in 2002 |
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Water Safety: Prevention and Treatment of Drowning
Bolte: Contemporary Pediatrics, July 1999
Introduction: Drowning is a preventable cause of death; it
is responsible for 4000 deaths a year, about half of whom are children. Two
age groups are mostly affected: toddlers and adolescents (mostly male -
often associated with alcohol, drugs, or dares). Those brought to the
hospital in a comatose state often have a disastrous outcome. Most
drownings occur in fresh water and at home- bathtubs, swimming pools, hot
tubs, buckets, toilets as well as lakes and streams. Only 10% occur in
ocean water.
Prevention of Water Accidents: Anticipatory Guidance for Parents
- Do not leave babies or toddlers alone in the bathroom - ever. Not for
a second. Lock the toilet.
- Fence your swimming pool at least 4 feet high; keep gate locked; also
fence hot tub.
- Always have children wear life jackets when around water or in boats.
- Have children take swimming lessons, but never assume that child is
“drownproof” after that.
- If child has seizure disorder, allows have swimming be supervised.
- Learn CPR and encourage teenagers to learn as well. Can be
lifesaving.
Pathophysiology of drowning
- Hypoxia and aspirated fluid combine to produce pulmonary dysfunction.
- Final common pathway for pulmonary injury is the destruction of
surfactant and alveolar capillary membranes produces pulmonary edema (ARDS),
which results in atalectasis, poor lung compliance, shunting that results
in hypercarbia and hypoxemia.
- Gastric content aspiration can exacerbate the pulmonary injury - this
is what leads to pneumonia, sepsis, abscess formation.
- Hypothermia (defined as core temp less than 35 degrees) from
conductive loss and heat loss but also from hypothalamic and brain stem
injury from anoxia.
Treatment
1. At the scene:
- prompt resuscitation with effective ventilation. (Maintain the neck in
a neutral position to protect cervical spine). Do not try Heimlich unless
think foreign body aspiration.
- Remove wet clothing, cover with blanket, obtain core temperature and
transport
2. At the Emergency Room:
- assess ventilation and circulation.
- if core temp low, use humidified air, and give 20 cc/kg normal saline
that is warmed; may also use external rewarming packs, heat lights, etc.;
if temp <30 may need ECMO.
- laboratory tests: pulse oximetry, gases, X-Rays; glucose, lytes, BUN,
UA, blood alcohol
- hospitalize anyone with respiratory distress or neurologic
impairment. If symptoms are going to develop they do so in the first five
hours after the accident.
Prognosis: Much better for those receiving resuscitation at
the scene, and for those aggressively resuscitated in the ER. Bad
prognosis: child arrives in ER comatose, having a blood sugar over 200 mg/dL.
- 50% die; 50% of others are severely neurologically impaired. If alert in
ER, OK.
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