Indian Journal of Trauma and Emergency Pediatrics

 ABSTRACT NOT Available

With the advent of better patient monitoring facilities and advancement of knowledge in maintaining vital parameters till near normal, emergency child care is a significant advance in field of pediatrics. This has ushered in new era of critical care and emergency treatment in pediatrics. A number of tertiary care centers in the form of intensive premature, neonate and child care units, with huge investment in infrastructure have come up. State of art infrastructure costs a fortune and escalates cost of quality care in pediatric treatment. Enactment of Consumer Protection Act along with inclusion of medical professionals in its ambit has put cases of alleged medical negligence in fast tract of judicial remedy. Heavy cost of emergency and critical care treatment has made this emerging pediatric subspecialty, a hotspot of litigations. In today\'s scenario, doctors are health risk managers of their critically ill patients, who need vigilant monitoring and timely treatment to avert further crisis and complications that are common and foreseeable. Any action or inaction of doctor in emergency room that accelerates or increases the health risk may result in allegation of breach of duty of doctor. Courts take lenient view regarding making errors in diagnosis. This is because so many diseases present to doctor with common symptom and sign complexes and doctors may make an error of judgment, if the disease presents with rare, atypical signs and symptoms. Doctor has liberty to choose treatment after arriving at tentative diagnosis. Courts take very strict view, if there is deficiency in procedure or conduct of a treatment. If a health damage or hazard occurs due to such breach of duty of doctor in emergency room then he may have to defend himself from the charges of medical negligence incourt. Since treatment costs are high and results of treatment of critically ill may sometimes result in some sort of disability or even death so compensations asked by patient litigant are astronomical.  

Key words: Emergency room care; Medical negligence; Duty of care in emergency; Critical care, Omission of duty; Death; Disability.  

No Abstract

No abstract

Measles is rightly called as captain of killer team in India. In Himachal Pradesh, despite high immunization coverage, the outbreaks are occurring. Based upon two outbreaks, we conducted a qualitative comparative study to describe the help seeking behavior of mothers of children with measles and to recommend appropriate remedial measures to prevent further outbreaks.Method: We reviewed the factors under beneficiaries\\\\\\\\\\\\\\\' related head. We used case-definition of measles adapted by the WHO. We conducted four Focus Group Discussions; two in Shahpur case block and two in Nagrota Bagwan comparative block with 20 mothers each in group. We enrolled all 69 mothers of children with measles and equal number of mothers in comparative similarly situated non measles block-matched for age and sex. We used a pre-designed pre-tested data collection semi structured qualitative questionnaire. We compared the responses from mothers of children exposed and unexposed to selected characteristics by Focus Group Discussions and in-depth interviews. Result: Eighty percent of respondents from case block call measles as Dharassali; 95% mothers have bodily experience of measles. 68% respondents under Shahpur block attribute measles to the curse of goddess-Mata ka vardaan hei and in other block, 55% hold contagion as the cause for illness. For treatment (help) seeking behavior of mothers, 68% from case block go for faith healers followed by 12% by village elders/neighbors/friends/relatives while 59% from comparative block opt for doctors. Nutritional care is given in the form of restricted diet in case area. As follow up practices in the post recovery phase from illness, 58% respondents from Shahpur block invoke the blessings of the goddess Sheetla while 68% of mothers from Nagrota Bagwan block attend the medical clinic.Conclusion/Recommendations: Faith healing is the principal help seeking behaviour in measles in poor hills. Aggressive IEC activities should be targeted for economic and social behavioral change rather than informing the community and (iii) Improving access to health care facility through provision of mobile services regularly in the remote areas.

Key word: Measles; Outbreaks; Beliefs and barriers; Help seeking behaviour.

Background: Rapid socioeconomic development in India during the last decade may have led to changes in the profile of childhood poisoning. Objective: To determine the profile and outcome of pediatric patients presenting with poisoning to a tertiary care center in North India. Methods: We prospectively enrolled 140 children aged 2 months to 18 years admitted with a definitive history of poisoning between August 2007 and August 2010. Results: The median age of the enrolled children was 3.5 years (IQR: 2, 10) and majority were boys (90%). Hydrocarbons (27.9%) and pharmaceutical products (16.4%) were the most frequently implicated agents. The incidence of suicidal poisoning was relatively high (10%), with girls being the predominant victims (8/14). Majority (83; 59.3%) required only observation. Definitive treatment in the form of antidotes and anti-venom was required in 9 (6%) children. The median (IQR) duration of hospital stay was 2 (1, 3) days and none of them died. Conclusion: The trends for childhood poisoning noted at our center were different from previous hospital-based studies in two important ways such as in the nature of the poisoning agents used and the higher incidence of suicidal poisoning.

Key words: Poisoning; Suicidal; Children.