Superman play and pediatric blunt abdominal trauma.

Two pediatric patients with life-threatening intra-abdominal injuries associated with Superman play are presented. The cases illustrate the importance of knowing the mechanism of injury in the assessment of children with blunt abdominal trauma. The diagnostic value of liver enzymes and the controversies surrounding the radiographic assessment of pediatric blunt abdominal trauma are presented.

Standardized instructions: do they improve communication of discharge information from the emergency department?

To determine whether standardized instructions enhance communication of discharge information, we provided 197 parents of children in whom otitis media was diagnosed with one of three types of instruction at the time of discharge from a pediatric emergency department: (1) instruction by individual housestaff and medical students after consultation with an attending physician (control group); (2) standardized verbal instructions given by housestaff and students trained in their use (verbal group); or (3) the same instructions given to the verbal group, together with a type-written copy of the information to take home (verbal + written group). Prior to leaving the emergency department and, again, by phone, 1 and 3 days later, parents were questioned concerning the prescribed medication's name, dose, frequency, and duration of administration (medication data), three signs of improvement, and eight signs indicating the need for medical advice (worrisome signs). The mean percentage of correct responses per parent in each group was computed for each information category. Both at exit interview and at follow-up, parents receiving either form of standardized instructions showed significantly greater knowledge of information related to their child's illness than did controls. Information regarding medication data was more likely to be communicated to parents in all groups than were signs of improvement or worrisome signs. The addition of written instructions to standardized verbal instructions did not improve parental recall of discharge information.

Pediatric intramuscular injections: do you know the procedure and complications?

The practice of outpatient intramuscular antibiotic therapy for infants and children at risk for serious bacterial infections is an attractive alternative to hospitalization. The use of this alternative is likely to increase. Pediatric emergency physicians and pediatric residents at our institution were surveyed to determine their knowledge of intramuscular injection techniques. The dorsogluteal site is contraindicated in infants and children, but it was selected for 14 (21%) of the patients presented in the survey. One-inch needles are recommended for children 0 to 24 months of age, but 1 1/2-inch needles were preferred for 13 (30%) of these younger children. A volume of 1 ml to be injected at one site was exceeded 10 (47%) times. Such practices increase the risk for infectious complications and neurovascular and muscle injuries. To avoid these complications, guidelines for pediatric intramuscular injections are presented.