PREP for peds--patient physiology, rescuer responses, equipment, protocols. Size-up & approach tips for pediatric calls.

Well-orchestrated EMS calls demand a global size-up followed by a focused assessment and treatment plan. Use the PAT to rapidly answer the questions, "How sick?" and "How quick?" Knowledge of the child's physiological status allows you to make appropriate decisions about triage, how you should react, what equipment to prepare and what treatment and transport protocols to use. The PREP scheme gives you a consistent and reliable approach for every pediatric call, facilitating focused management for an unstable child and a more relaxed and confident encounter for the stable child and their family.

Elderly injury: a profile of trauma experience in the Sunshine (Retirement) State.

OBJECTIVE: By using mandatory discharge data from a state agency, the records of 116,687 patients hospitalized for treatment of injury were evaluated to develop an epidemiologic and demographic profile of this population and to compare outcomes of patients treated in state-designated trauma centers (TC) with those treated in nontrauma centers (NTC). METHODS: Injury severity was calculated by using the International Classification Injury Severity Score methodology to compute individual diagnosis survival risk ratios from 698,187 reported diagnoses, and then by using these survival risk ratios to determine probability of survival for every patient. The population was then categorized by age, injury type, treatment facility designation, injury severity as indicated by probability of survival, and discharge disposition. Incidence of potentially preventable death was compared between TC and NTC, as was the effect on outcome of noninjury comorbidity. RESULTS: The average age of this population was 58 +/- 26 years with significant skew toward the elderly in NTC (mean age, 62 +/- 26 years). The most commonly encountered injuries likewise reflected the elderly nature of this population. Although 71.3% received care in NTC, the majority of severely injured were treated in TC. Potentially preventable mortality (>0.5) was significantly lower in TC. The effect of noninjury comorbidity on outcome was better managed by TC, both in terms of decreased mortality and in proportion of patients discharged home. CONCLUSION: These data demonstrate the unique characteristics of injury victims treated in the state of Florida and indicate that the developing trauma system is demonstrating productivity in terms of avoidance of preventable death, efficient management of noninjury comorbid problems, and more complete recovery as indicated by proportion of patients discharged to home.

Unexpected good results after therapy for anisometropic amblyopia associated with unilateral peripapillary myelinated nerve fibers.

Unilateral extensive myelination of the peripapillary nerve fibers may be associated with anisometropic myopia, strabismus, and reduced vision. Despite aggressive occlusion of the normal eye, visual results are often disappointing, presumably due to associated structural abnormalities in the macula which limit visual potential. We report two cases, a 21-month-old child and a 23-month-old child with unilateral peripapillary myelination, ipsilateral high myopia, and dense amblyopia. Despite an abnormal macular reflex in each child, vision improved to 20/30 in one child and 20/50 in the other child after occlusion therapy. Visual results in these patients suggest that aggressive amblyopia therapy should be considered in patients with anisometropic amblyopia associated with extensive myelination continuous with the optic nerve. Not all patients with unilateral peripapillary myelinated nerve fibers, an abnormal macula, and myopia will have refractory amblyopia.

Suicide by ingestion of methyl ethyl ketone peroxide.

Methyl ethyl ketone peroxide (MEKP) is a free radical-generating compound used as a fiberglass resin hardener. A 41-year-old Haitian man developed severe metabolic acidosis, hemolysis, esophageal and gastric necrosis, and perforation of the stomach after drinking an undetermined amount of MEKP in a successful suicide attempt. The biochemical effects of free radicals explain the necrosis and hemolysis observed.