Hypokalemia complicating emergency fluid resuscitation in children.

Our clinical observations suggested that vigorous fluid therapy in children often resulted in hypokalemia. A retrospective review was conducted of four years of admissions to a pediatric intensive care unit. A total of 29 patients were identified who received at least 20 ml/kg of intravenous fluid in their first hour of care and had a pretreatment and posthydration serum K obtained. The potassium levels dropped from a mean pretreatment value of 4.6 +/- 1.0 mEq/L to a mean of 3.3 +/- 0.8 mEq/L (P less than 0.005). Coincidental arterial pH measurements were available in 16 cases. A separate analysis of potassium change in this group revealed that pH change alone could not account for the drop in serum K. Significant hypokalemia may occur after aggressive rehydration of critically ill pediatric patients.

Bacterial tracheitis: a resurfacing airway emergency.

Children presenting to the emergency department with symptoms of upper respiratory distress represent a diagnostic and therapeutic challenge. An acute onset associated with fever most often indicates epiglottitis or laryngotracheobronchitis. Presented here is a case of acute bacterial tracheitis, a life-threatening entity that apparently has reemerged recently. Prompt recognition is essential but can be difficult. Historical perspectives, clinical features, and pitfalls in diagnosis and management are discussed.

Emergency applications of intraosseous infusion.

Vascular access is an important step in the care of the critically ill child but can be very difficult and time consuming. Recently, intraosseous infusion has experienced a resurgence as a rapid alternative to venous cannulation. Several cases illustrate the usefulness of this technique in the emergency department. Included are the first reports of the use of intraosseous diazepam and succinylcholine.

Comparison of intraosseous, central, and peripheral routes of sodium bicarbonate administration during CPR in pigs.

Obtaining venous access continues to be one of the most difficult problems faced by a physician caring for the pediatric patient in cardiac arrest. Our study examined the use of the intraosseous route (through the bone) to obtain venous access for sodium bicarbonate administration in a cardiac arrest model. Ventricular fibrillation was induced in 23 domestic swine. Cardiopulmonary resuscitation was performed for five minutes and sodium bicarbonate (1 mEq/kg) was administered through a peripheral IV line (n = 6), a central IV line (n = 5), or intraosseously (n = 6). Controls (n = 6) did not receive bicarbonate. Blood pH was sampled every two minutes for 30 minutes from the right ventricle, left ventricle, and femoral artery. An analysis of variance revealed that the central and intraosseous routes were significantly different (P less than .05) from the peripheral group, and that all three groups were significantly different (P less than .05) from the control. Pathology studies revealed only minor damage to bone when sodium bicarbonate was administered intraosseously. These data demonstrate that the intraosseous route is a rapid and effective alternative for venous access in a cardiac arrest model.

Prosopagnosia: a double dissociation between the recognition of familiar and unfamiliar faces.

Two cases of a dissociation between prosopagnosia and impaired capacity to match familiar faces were studied. Recognition of familiar faces recovered in the first patient, whereas prosopagnosia persisted in the second patient despite recovery of matching unfamiliar faces and other visuoperceptive skills. This double dissociation is discussed in relation to current views of prosopagnosia.

Visual field recognition memory for right-handed females as a function of familial handedness.

Recognition memory for nonsense words presented vertically and unilaterally in the left and right visual fields was investigated in right-handed females as a function of the memory interval and familial handedness. The subject decided whether another nonsense word presented in central vision after memory intervals of 0, 5, or 10 sec. was the same as the stimulus word. The exposure duration producing a recognition accuracy of about 75% for each subject was employed and ranged from 5 to 28 msec. Right-handed females with only right-handed family members demonstrated right visual field superiorities indicative of a slight left hemisphere specialization for memory but not for reception of verbal material. Field superiorities obtained for right-handed females with a left-handed parent or sibling were not significant. In general, less complete lateralization of linguistic function in females was indicated and the importance of familial handedness in cerebral asymmetry of function was confirmed.

Adaptive Behavior Scale as a screening measure for special-education placement.

The utiltiy of the Adaptive Behavior Scale in the special-education placement of 126 institutionalized mentally retarded children and adolescents was examined. An investigation of relationships among Adaptive Behavior Scale (Part 1) scores, Wide Range Achievement Test scores, and IQ scores revealed a significant relationship between Adaptive Behavior Scale scores as well as between IQ scores and achievement test scores. Adaptive Behavior Scale and IQ were the most effective scores in providing significant discrimination between the special-education training levels. Adaptive Behavior Scale subdomain percentage scores were discussed as criteria for a computer-assisted placement of mentally retarded students in a special-education program.