Indian Journal of Trauma and Emergency Pediatrics

In this article, we have tried to review the evidence regarding the use of second line agents in status epilepticus, comparing phenytoin and valproate in particular. While phenytoin continues to be used as the preferred second line agent, valproate is equally effective and safe. However, there is need for generating more evidence particularly with respect to safety profile of these two drugs in comparison to each other so that, a consensus may be arrived at in future as to, which is the best second line drug among these two agents in terms of both safety and efficacy.

Keywords: Phenytoin, Valproate; Status epilepticus; Second line agents; Diazepam; Midazolam.

Pneumothorax is a recognised cause of respiratory distress in the neonatal period. It may occur spontaneously (idiopathic) or secondary to various underlying lung diseases. In considerable cases of pneumothorax, intercostal drain is inserted to relieve respiratory distress. Pneumothorax results in longer hospital stays due to the requirement of these surgical interventions. But, here we would like to take the opportunity to share our clinical experience of the newborn with spontaneous pneumothorax with mild to moderate respiratory distress who recovered completely with conservative management with an oxygenenriched atmosphere and no surgical intervention.

Keywords: Spontaneous pneumothorax; Newborn; Pneumothorax; Intercostal drain.

Establishing a patent airway is one of the basic and most important components of basic and advanced life support. However, despite the availability of excellent guidelines/simulation training hypoxic arrests continue to occur in the emergency. This is because, most of the times the child may not be assessed properly in cases of mild to moderate distress at presentation and red flag signs are often missed. Simple measures like pacing a towel or ensuring sniffing position or position of comfort in case of breathing difficulty are not instituted in time eventually leading to a respiratory compromise. Use of appropriate sedatives, analgesics before using muscle relaxants is not ensured, resulting in pain and anxiety in the patient as well as in the care giver as ideal intubating conditions is not achieved in such cases. Use of bag and mask ventilation as a bridging measure in cases of failure of intubation may be life-saving and all health care providers involved in the care of critically ill children, should be skilled in this important procedure if they were to save the life of these patients. In this review, we have once again tried to reemphasize these important principles of airway management in a simple and comprehensive manner. Our emphasis is on simple measures to open the airway, use of airway adjuncts, technique of rapid sequence intubation with a simplified table on drugs commonly used during this important procedure and trouble shooting in an intubated patient. This review is targeted at all fellows in emergency medicine and intensive care and practising paediatricians involved in the care of critically ill/ injured child.

Keywords: Airway; Intubation; Rapid sequence intubation; Bag mask ventilation; RSI; Sedatives; Muscle relaxants; Analgesics. 

Advanced airway management in the pediatric emergency department is the first line of management in a critically ill child. Clinical condition of the patient, skills of ER (emergency room) personnel, influence outcome of this procedure. This prospective study describes the success rates, immediate complications and the environmental, patient and physician factors that influence complication rates of rapid sequence intubation (RSI) in the Pediatric Emergency Department of a tertiary care Pediatric Hospital, over a period of 1year, Of the 64 intubations, 39% were in infants, 43.7% had pre-existing illness, 28% required bag and mask ventilation for preoxygenation. Most common complication was right bronchus intubation. Majority were intubated at the first attempt. Success at first attempt, and complications correlated with the experience of doctors. Conclusion: ER doctors are highly competent in performing RSI with acceptable complication rates. The need for using bag valve mask during RSI is not uncommon. Every paediatrician should be trained in RSI for securing the airway of a critically ill child.

Keywords: Rapid sequence intubation; Intubation; Bag valve mask.