This study suggests that many pediatric patients receiving cardiovascular medications tolerate enteral nutrition without adverse events. Further prospective studies are needed to determine whether enteral nutrition can consistently benefit these critically ill pediatric patients.
Child homicides in this cohort occurred primarily in younger children, among whom the most common cause of death was blunt trauma. Almost 20% of this subgroup had documented contact with the health care community for reasons other than routine care within a month before their death. Some of these presentations are suspicious for undiagnosed abusive injuries, which, if properly identified, could serve as opportunities for life-saving intervention.
Objective: To assess the compliance with national guidelines on child protection procedures and provision of paediatric services in major English emergency departments. Background: Victims of child abuse may present to emergency departments, and successful detection and management depends on adequate child protection procedures being in place. Two official documents published in 1999 provide recommendations for child protection procedures and staffing arrangements in emergency departments, and these can be used as standards for audit. Methods: Structured telephone questionnaire survey of English emergency departments receiving at least 18 000 child attenders per year. Results: Many of the standards are being met. Areas for improvement include: better access to child protection registers with clearer indications for their use; improved communication with other professionals such as the school nurse; more formal training for medical and nursing staff in the identification of potential indicators of child abuse; and improved awareness of local named professionals with expertise in child protection. More consultants with training in paediatric emergency medicine and more registered children's nurses are needed. Conclusion: Many nationally agreed recommendations are being met, but there is a need for improved training, increased numbers of specialised staff, and improved communication between professionals. There is considerable variation in practice between departments. C hildren make up 20%-30% of emergency department attendances.
The implementation of a dedicated pediatric-sedation service resulted in fewer incomplete studies related to inadequate sedation, in fewer canceled studies secondary to patient illness, in fewer referrals for general anesthesia, and in fewer recorded instances of sedation-associated hypoxia. These findings have important implications in terms of patient safety and resource utilization.
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