Mild head injury in children: identification, clinical evaluation, neuroimaging, and disposition.

Pediatric head injury presents in various degrees of severity. Early intervention in the patient with a severe head injury is the key to preventing secondary central nervous system damage. Patients with a head injury are easily identified, often by clinical examination alone. However, patients with a mild head injury present a challenge to practitioners, particularly in identification, knowing what is important in the clinical evaluation, deciding whether to use neuroimaging, and knowing where to send the child for observation. Use of the Glasgow Coma Score, primary survey, and identification of historic and clinical features that are suggestive of severe head injury may guide pediatric nurse practitioners in providing appropriate medical care and disposition.

The black widow: is she deadly to children?

Pediatric cases of black widow spider envenomation (BWSE) were reviewed in order to assess the morbidity and mortality in children with BWSE, and to make recommendations for optimal therapy. The methodology includes a retrospective chart review in an urban pediatric tertiary care hospital. Included were all pediatric patients admitted with the BWSE diagnosis in the last 10 years (1984-1994). The results are based on 12 children with ages ranging from 15 months to 18 years. The BWSE syndrome is characterized by several common systemic effects. Our cases revealed abdominal pain (100%), hypertension (92%), muscle complaints (75%), a target lesion (75%), and irritability/agitation (66%) as the most common symptoms. Treatments used included antivenin, calcium gluconate, benzodiazepines, and opioids. Eight of 12 patients recovered (had relief of symptoms) within 24 hours, often by 12 hours. Antivenin did appear to bring quicker relief of symptoms. Hypertension was severe but asymptomatic in all patients. There were no complications or deaths resulting from BWSE.