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Makale1
Mechanisms of pediatric electrical injury. New implications for product safety and injury prevention.
Yazar :Rabban JT; Blair JA; Rosen CL; Adler JN; Sheridan RL
Adres : Harvard Medical School, Boston, Mass., USA.
Kaynak : Arch Pediatr Adolesc Med, 1997 Jul, 151:7, 696-700
Özet : To determine age-specific mechanisms of electrical injury in children, to examine product safety regulation of the major sources of electrical injury hazard, and to assess the adequacy of current prevention strategies. DESIGN: Case series of 144 pediatric and adolescent electrical injuries in patients seen in the specialized burn center and tertiary care hospital between 1970 and 1995, examination of Consumer Product Safety Commission product recall reports for electrical injury hazards between 1973 and 1995, and review of the National Electric Code. RESULTS: Eighty-six cases of electrical injuries resulted from low-voltage (< 1000-V) exposures, all occurring within the home. In children aged 12 years and younger, household appliance electrical cords and extension cords caused more than 64 (63%) of 102 injuries, whereas wall outlets were responsible for only 14 (15%) of injuries. Fifty-eight cases resulted from high-voltage exposures, accounting for 38 (90%) of 42 injuries in children older than 12 years. No federal safety regulations for electrical cords exist, although voluntary standards have been adopted by many manufacturers. Among 383 consumer products identified by the Consumer Product Safety Commission to be electrical injury hazards, 119 were appliance cords, extension cords, or holiday stringed light sets. Several products numbered more than 1.5 million units in US household distribution prior to the investigation by the Consumer Product Safety Commission. CONCLUSIONS: Household electrical cords are the major electrocution hazard for children younger than 12 years, yet no federal safety mandates exist. Despite voluntary standards, noncompliant manufacturers can introduce vast numbers of unsafe cords onto the US household market every year. Conversion of existing voluntary safety guidelines into federally legislated standards may be the most effective intervention against pediatric electrocutions.
Makale 2
A 15-year experience with varicella infections in a pediatric burn unit.
Yazar : Sheridan RL; Weber JM; Pasternak MM; Mulligan JM; Tompkins RG
Adres :Shriners Burns Hospital, Boston, MA 02114, USA. [email protected]
Kaynak : Burns, 1999 Jun, 25:4, 353-6
Özet : Because of their well described global immunosuppression, varicella infection may be hazardous in burned children. It is therefore important to prevent cross-infections within pediatric burn units. We describe a 15-year experience with varicella in a pediatric burn unit, focusing on the morbidity associated with the infection and measures that have been effective in the prevention of cross-infection. We found that varicella infection in acutely burned children is associated with pneumonitis, but little wound related morbidity. Despite the deceptively long incubation period, prompt identification and isolation of index cases was associated with an extremely low incidence of cross-infection. Until widespread administration of varicella vaccine confers herd immunity, varicella remains a threat to hospitalized young children, highlighting the importance of a well planned and executed index case isolation strategy.
Makale 3
Superiority of oral ketamine as an analgesic and sedative for wound care procedures in the pediatric patient with burns.
Yazar : Humphries Y; Melson M; Gore D
Adres : Evans Haynes Burn Center, Medical College of Virginia, Richmond 23298-0475, USA.
Kaynak : J Burn Care Rehabil, 1997 Jan, 18:1 Pt 1, 34-6
Özet : The management of pain and anxiety in pediatric patients with burns includes the challenge of striking a balance between inadequate versus excessive medication. Ketamine provides effective sedative, analgesic, and amnestic properties for children and has been used intravenously with good results. With its recent availability as an elixir, we speculated that ketamine given orally may provide effective analgesia and sedation during wound care procedures with a wide safety margin. To test this hypothesis, 19 pediatric patients with burns undergoing a wound care procedure were randomized to receive either ketamine oral suspension or 300 mg acetaminophen with codeine phosphate and diphenhydramine, our prior standard for analgesia and sedation. Intensity of pain was determined with use of a color slide algometer and demonstrated more than 400% reduction in pain with the use of ketamine (p < 0.05). The Ramsey scale was used to quantitate sedation and demonstrated that ketamine improved sedation by 360% (p < 0.05). These results substantiate improved analgesia and sedation with oral ketamine as compared to a commonly used narcotic and sedative in facilitating wound care procedures in pediatric patients with burns. These findings suggest that expanded use of ketamine oral suspension may be.
Makale 4
Fluid resuscitation in thermally injured pediatric patients.
Yazar : Marinov Z; Kvalténi K; Koller J
Adres : Burn Center, General Hospital RuÅzinov, Bratislava, Slovakia.
Kaynak : Acta Chir Plast, 1997, 39:1, 28-32
Özet : More than two-thirds of critical burns in special burn units are children. The burned child continues to represent a special challenge, since resuscitation therapy must be more precise than that for an adult with a similar burn. Children have a limited physiologic reserve and the pediatric fluid replacement therapy is based on the principle of separate calculation of physiological and pathological losses. We have reviewed the most widely accepted pediatric isotonic fluid protocols. All these protocols calculate for replacement of pathological losses with a need of 2 ml/kg/% BSAB (body surface area burn) or 4 ml/kg/% BSAB. We choosed the formulas of two Shriner's Burns Institutes--the Cincinnati and the Galveston Unit as representatives, and calculated the fluid therapy for model burn children weights of 10 kg, 30 kg with 20, 40, 60, 80% BSAB. The results of calculations where compared with physiologic parameters of children. In conclusions we could show, that the 4 ml/kg/% BSAB formulas do replace all theoretically predicted pathophysiologic losses due to burns. However, the 2 ml/kg/% BSAB formulas are more practical as a guideline for resuscitation of pediatric patients because of greater therapeutical range and better clinical response of children threatened by burn shock. It is important to remember that all formulas are only guides to fluid therapy, they should be modified according to individual needs and clinical status of the patient. Only successful restoring and maintaining perfusion pressures leads to optimal oxygenation of injured and noninjured tissues, which promotes spontaneous healing, prevents wound conversion, minimise bacterial colonisation, and prepares the injured areas for early grafting.
Makale 5
Body habitus as a predictor of burn risk in children: do fat boys still get burned?
Yazar : Barillo DJ; Burge TS; Harrington DT; Coffey EC; Shirani KZ; Goodwin CW
Adres : US Army Institute of Surgical Research, Fort Sam Houston 78234, USA. [email protected]
Kaynak : Burns, 1998 Dec, 24:8, 725-7
Özet : Previous research at this institute has demonstrated that heavy-for-age boys are more burn prone than their normal sized counterparts. As this study is now 26 years old, we reexamined the anthropomorphic indices of 372 children admitted to one burn center between January 1991 and July 1997 to determine if this trend was still evident. Male children were over-represented in the < or =5th and >95th percentiles for both height (p < 0.001, p < 0.05) and weight (p < 0.01, p < 0.001). Female children were over-represented in the < or =5th and > 95th percentiles for height (p < 0.01, p < 0.05). Twenty-eight percent of boys at or below the 5th percentile for weight were burned as a result of known or suspected intentional injury, compared to 5.9% of the entire pediatric burn population. (p < 0.0004). 'Fat boys' continue to be over-represented in the pediatric burn population. Additionally, in the more recent time period, boys at or below the 5th percentile for height or weight and girls= < 5th percentile or >95th percentile for height are also over-represented. The increased frequency of burn injury in small-for-age children may reflect an increased risk of burn injury secondary to neglect or nonaccidental trauma.
Makale 6
Effect of topical and subcutaneous epinephrine in combination with topical thrombin in blood loss during immediate near-total burn wound excision in pediatric burned patients.
Yazar : Barret JP; Dziewulski P; Wolf SE; Desai MH; Nichols RJ 2nd; Herndon DN
Adres : Shriners Burns Hospital, The University of Texas medical Branch, Galveston 77550, USA. [email protected]
Kaynak : Burns, 1999 Sep, 25:6, 509-13
Özet : Bleeding is a major concern during burn wound excision. To evaluate the efficacy of epinephrine to control blood loss, a prospective cohort of 42 pediatric patients were examined. Half of the patients received topical epinephrine to excised wounds and donor sites and subcutaneous epinephrine to scalp donor sites during total burn excision, while the other half did not. Both groups of patients received bovine topical thrombin sprayed at a concentration of 1000 U/ml. Mean blood loss in the epinephrine group was 1090 ml (range 20-4000), with a blood loss of 0.48+/-0.12 ml/cm2 excised, while the control group was 1271 ml (range 40-3750) and 0.51+/-0.15 ml/cm2. Differences in preoperative and postoperative hematocrits were respectively -3.4+/-7.8 and -4.6+/-7.5. The groups were not statistically different in this analysis. Subgroup analysis by age, burn size and time of burn to excision showed no differences. No complications or side effects of the use of the vasopressor solution occurred. In conclusion, no differences in blood loss were found between the groups. The routine use of local epinephrine during total wound excision in combination with topical thrombin in pediatric patients operated within 24 h after the admission may not be necessary. The effect of topical thrombin on blood loss should be analyzed separately.
Makale 7
Paediatric burns in Iceland. Hospital admissions 1982-1995, a populations based study.
Yazar : Elísdóttir R; Lúdvígsson P; Einarsson O; Thorgrímsson S; Haraldsson A
Adres : Department of Paediatrics, The University Hospital of Iceland, Reykyavik.
Kaynak : Burns, 1999 Mar, 25:2, 149-51
Özet : Epidemiological data of 290 children admitted to the Paediatric Department, University Hospital of Iceland, over a 14 year period, 1982-1995, are presented. The sex ratio boys/girls was 1.6. 72.8% were children four years and younger. Hot fluids was the most common cause of burn injuries, mostly caused by geothermal hot water. Only one child suffered from electricity burn injuries and none from corrosives. Most of the accidents occurred at home (81.4%). A decreasing number of children suffering from electricity and corrosive burn injuries reflects heightened awareness and improved safety in the home. We found a significant increase in the incidence of hot fluid burn injuries in Icelandic children compared to previous studies. This calls for preventive measures with regard to geothermal and other hot water burns in Icelandic children.