ABSTRACT
Prehospital care has become a well-defined specialty service in Canada, with various levels of paramedics providing specialized care to children before their arrival to hospital. The equipment required may vary according to the needs of the population being served and the level of training of the paramedics who are providing the care. The present statement provides a current list of the minimum equipment recommended for the provision of prehospital care to neonatal and paediatric patients. The most notable change to the present guideline is the addition of an automated external defibrillator, which has been added to reflect the most recent version of the paediatric advanced life support recommendations for the provision of basic life support.
ABSTRACT
Severe hypernatremia has been associated with a wide variety of central nervous system lesions. Neurologic sequelae are the usual outcome in those cases in which a lesion has been documented neuroradiologically. The authors report a 7-month-old male with severe hypernatremia who developed obtundation after correction of the electrolyte imbalance. Magnetic resonance imaging revealed bilateral thalamic signal changes that resolved on follow-up study, in accordance with complete clinical recovery. To the authors' knowledge, bilateral thalamic signal changes are previously unreported findings associated with hypernatremia. Pertinent literature and the clinical course of the authors' patient are the basis for questioning currently recommended guidelines for the rate of correction of hypernatremia.
Subject(s)
Brain Edema/etiology , Hypernatremia/complications , Thalamus , Brain Edema/pathology , Dehydration/complications , Dehydration/therapy , Electrolytes/adverse effects , Fluid Therapy/methods , Humans , Hypernatremia/therapy , Infant , Magnetic Resonance Imaging , Male , Remission, Spontaneous , Thalamus/pathologyABSTRACT
Iron deficiency is a common pediatric problem affecting 20%-25% of the world's infants. Most commonly causing anemia, iron deficiency is also implicated in such neurologic sequelae as irritability, lethargy, headaches, developmental delay, and infrequently papilledema, pseudotumor cerebri, and cranial nerve abnormalities. Rarely has iron deficiency been recognized as a significant cause of stroke in the adult or pediatric populations. We report a series of 6 children, 6 to 18 months of age, who presented with an ischemic stroke or venous thrombosis after a viral prodrome. All patients had iron deficiency as a consistent finding among the group, and other known etiologies of childhood stroke were excluded. These patients provide evidence of a strong association between iron deficiency and ischemic events in children between 6 and 18 months of age.
Subject(s)
Anemia, Iron-Deficiency/complications , Cerebrovascular Disorders/etiology , Adult , Anemia, Iron-Deficiency/diagnosis , Brain/pathology , Brain Ischemia/diagnosis , Brain Ischemia/etiology , Cerebral Infarction/diagnosis , Cerebral Infarction/etiology , Cerebrovascular Disorders/diagnosis , Diagnosis, Differential , Female , Humans , Infant , Intracranial Embolism and Thrombosis/diagnosis , Intracranial Embolism and Thrombosis/etiology , Magnetic Resonance Imaging , Male , Neurologic Examination , Sinus Thrombosis, Intracranial/diagnosis , Sinus Thrombosis, Intracranial/etiology , Tomography, X-Ray ComputedABSTRACT
High-dose acetaminophen (HDAC) produces hepatocellular necrosis and cytotoxic changes in other tissues that express mixed-function-oxidase (MFO) activity. N-acetylcysteine (NAC), administered within 8 hr of HDAC exposure, replenishes reduced glutathione and prevents these effects. Numerous cell culture and animal studies have demonstrated that NAC may differentially protect normal cells compared with malignant cells from the toxic effects of chemotherapeutic agents and radiation. It was therefore proposed that HDAC with NAC rescue may be effective in malignancies that express MFO activity. To test this hypothesis, a phase I trial of HDAC with NAC rescue was conducted on 19 patients with advanced cancer. HDAC was escalated from 6 to 20 g/m2 PO using a standard IV NAC rescue regimen. A total of 78 treatments were administered. Moderate fatigue, anorexia, and weight loss were the main toxicities observed. Transient grade 3 liver toxicity was noted following 1 treatment. Alopecia and renal and hematological toxicities were not observed. Responses after 4 courses administered weekly were as follows: response in at least 1 site-8 (partial 3, improved 3, mixed 2); stable disease-3; progressive disease-3; inevaluable-5. In conclusion, HDAC was tolerated with moderate fatigue, anorexia, and weight loss but few other effects using a standard IV NAC rescue regimen. A maximum tolerated dose was not reached at 20 g/m2. A 3/19 (15.8%) partial response rate was observed.
