Biomedical subjects
Publications and source records attributed to R M Barkin.
The limping child often presents to the emergency department with a nonspecific history and physical examination. The components of gait, the pathophysiology of specific abnormalities, and the conditions that may produce long-term morbidity must be identified expeditiously to assure return to normal function. Ancillary data and imaging may be essential for appropriate management.
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A pediatric focus in the emergency department requires an understanding of age-specific parameters of assessment and management. Differential considerations are unique in the pediatric patient reflecting both congenital and acquired conditions. Respiratory problems, meningitis, seizures, and child abuse require careful assessment and aggressive intervention. When approaching the ill child, attention must be directed toward reducing anxiety and pain in the patient.
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Dehydration is a potential life-threatening event to the child and requires early recognition and correction. Precise fluid management and follow-up is essential.
Following toxic ingestions, attention must first focus on the stabilization of the patient with concurrent attention to the prevention of absorption and the enhancement of excretion of the toxic substance ingested. A careful history and physical examination supported by laboratory data should assist in defining ingested toxic agents.
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This article focuses on the specific anatomic differences in the pediatric patient when contrasted with the adult patient. An emergency physician must be familiar with these differences to provide the best emergency care. Because maintaining an adequate airway is so crucial to these patients, recognition of these differences in the infant and child may be a life-saving step.
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Safety and immunogenicity of a Haemophilus influenzae type b polysaccharide-diphtheria toxoid conjugate vaccine (PRP-D) was evaluated in infants seven to 14 months of age. PRP-D (80% of subjects) or saline placebo (20%) was randomly and blindly administered (two doses separated by two months). Incidence of mild reactions lasting less than 48 hr did not differ significantly between the placebo and vaccine recipients. Preimmunization levels of antibody to PRP were less than or equal to 0.15 micrograms/ml in 97% of subjects. A twofold increase in antibody concentration occurred in 88% of subjects following the first dose and in 99% following the second dose of vaccine. No change occurred in placebo recipients. Mean level of antibody and percentage of subjects with levels of antibody greater than or equal to 1 microgram/ml after vaccination increased with increasing age. Responses were related to vaccine lot but not to sex, race, or geographic location. Two doses of PRP-D in infants seven months of age and older induced antibody levels equal to or greater than levels in infants 24 months of age given the polysaccharide alone.
The clinical reactions and immunologic responses to two Haemophilus influenzae type b capsular polysaccharide vaccines were studied in 24- to 36-month-old children. A candidate vaccine (Connaught) induced greater than or equal to 1.0 microgram/ml of antipolysaccharide antibody in 37 (61.7%) of 60 infants 24 to 26 months of age; this compared with 8 (38.1%) of 21 infants 24 to 36 months of age given a licensed vaccine (Praxis). Reactions to both vaccines within 24 hours of administration were minimal; a smaller percentage of recipients of the candidate vaccine were asymptomatic (P less than 0.05). The lower levels of antibody production than previously reported may necessitate a reevaluation of current recommendations.
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Congestive heart failure in children is unusual as a presenting problem, and the nonspecific nature of the signs and symptoms in the pediatric population makes recognition difficult. Congenital heart disease is most common in the infant whereas older children most commonly develop congestive heart failure due to cardiomyopathy, myocarditis, electrolyte abnormalities, dysrhythmias, and, more rarely, endocarditis, and rheumatic carditis. Management focuses upon stabilization of the airway and ventilation while improving circulatory function. This is achieved by the use of inotropic agents, combined with attention to the volume and pressure overload, pulmonary problems, dysrhythmias, and ongoing follow-up.
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