The most common adult chronic diseases affect 1 in 3 adults and account for more than three-quarters of US health care spending. The major childhood drivers of adult disease are distinctly nonmedical: poverty, poor educational outcomes, unhealthy social and physical environments, and unhealthy lifestyle choices. Ideally, well-child care (WCC) would address these drivers and help create healthier adults with more productive lives and lower health care costs. For children without serious acute and chronic medical problems, however, traditional pediatric preventive services may be largely ineffective in addressing the outcomes that really matter; that is, improving lifelong health and reducing the burden of adult chronic disease. In this article, we examine what role WCC has in addressing the major childhood drivers of adult disease and consider various models for the future of WCC within pediatrics.
There are no reports of cyanide poisoning in the anaesthetic literature. Nevertheless, the prognosis in these cases is by no means hopeless 1 and a survival rate in excess of 97 % can be anticipated in correctly treated cases.The purpose of this paper is to outline the principles of modern therapy for anaesthetists and casualty officers who may be involved in treating acute cyanide poisoning. C A S E R E P O R TThe patient was a 19 year old man who was employed in a photographic department. During the course of his work a bag of potassium cyanide powder burst in his face; following this, he had a drink of water and immediately afterwards complained of stomach cramp. The ambulance service gave prior warning of the case. The patient arrived twenty minutes later in the Accident Department. On examination he looked grey and ill, was unconscious and had a blood pressure of 90170.Inhalations of amyl nitrite were administered and an alkaline gastric lavage performed. Simultaneously, 0.3g sodium nitrite and 12.5g sodium thiosulphate were given intravenously. A sample of venous blood withdrawn prior to the injection, was observed to be bright red in colour. This part of the resuscitation was completed within ten minutes of arrival, by which time the patient had regained consciousness but was restless and complained of severe abdominal pain. Attempts at swallowing provoked retching and exacerbations of the abdominal pain. An intravenous drip of 5 % dextrose was set up. He was then transferred to the Intensive Care Unit.Two hours later the patient complained of tingling and numbness in his hands and further abdominal cramps. A second injection of 0.15g sodium nitrite and 6.258 sodium thiosulphate was given intravenously. The symptoms subsided and his previously grey colour improved. He was given one more dose of sodium nitrite 0.3g and sodium thiosulphate 12.5g ten hours later for a further episode of abdominal pain, during which he became grey in colour and developed opisthotonos.Episodes of abdominal pain continued for the next 48 hours. After considerable reassurance that the effects of the cyanide had indeed worn
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