Thomas S. Morse

The value of radionuclide bone scanning in the early recognition of deliberate child abuse.

Forty-four children suspected of having been abused underwent Tc-99m diphosphonate bone imaging at the time of initial presentation for treatment of trauma or burns. Twenty-six had negative scans. These patients never showed X-ray evidence of skeletal injury although ten were abuse victims. Two skul

Pediatric outpatient surgery

Abstract Provided certain criteria are respected, children of all ages can be operated upon as outpatients. A wide variety of elective procedures lend themselves to this type of service. By expanding the scope of outpatient surgery, and by involving many surgical services, it is possible to achieve a volume that supports an outpatient surgical nursing unit. A years experience with such a unit is described. A total of 1235 pediatric surgical outpatient procedures were performed under general anesthesia without overnight hospitalization. We have found outpatient surgery performed along the lines described to be safer, more convenient, more economical, and kinder than conventional management on an inpatient basis.

Intentional burning: A severe form of child abuse

Intentional burning is a severe form of child abuse. During a three year period, 25 abused children were admitted to the burn unit of the Childrens Hospital, Columbus, Ohio. They represented 8% of all burned children admitted during this period. Four of the 25 are dead. The hallmarks of intentional burning include a story which does not explain the wound, previous or coexistant injuries, specific burn patterns and characteristic behavior of parents and children. Suspected cases must be reported, the child protected and the parents helped. Child abuse tends to be repeated with progressively severe attacks, often ending in death.

Radioisotope diagnosis of splenic trauma

Multiple injury or delay in seeking medical attention may prevent confident clinical diagnosis of splenic trauma. The spleen scan is a rapid, simple, noninvasive test useful in such circumstances. When peritoneal lavage is contraindicated, unrevealing, or inapproapriate, radioisotope imaging of the spleen can help confirm a suspicion of splenic injury.

Triage, technicians, and teaching in a children's emergency room

Abstract In a childrens teaching hospital the number of emergency visits increased to such an extent that they began to encroach upon the education of the house staff. Triage of some of the patients with minor medical problems to a staff physician in an adjacent but separate emergency room has provided relief for the pediatric house officers and better teaching for medical students. Technicians have sutured over 3000 lacerations per year, greatly reducing the load on the surgical house staff. These innovations provide a flexible way to maintain an appropriate balance between education and service.

Diagnosis of experimental renal trauma

Abstract The major problem in evaluating children with renal injuries is early identification of those who require operation. We have reported improved renal salvage after adopting the policy of studying every child with posttraumatic hematuria by emergency infusion intravenous pyelography. 1,2 In a few instances, particularly in children who might have vascular injuries requiring emergency operation, the infusion pyelogram did not permit an immediate diagnosis. Both arteriography 3 and renal scanning 4,5 have been advocated as the logical next step when visualization by pyelography is inadequate. We compared the diagnostic accuracy of the infusion intravenous pyelogram, the renal arteriogram, and the renal isotope scan in experimental renal injuries.

Synthetic arteriovenous shunts for hemodialysis in children

Abstract Venography is invaluable in the placement of synthetic arteriovenous shunts for hemodialysis. The forearm veins of uremic children are anatomically variable and may be hidden from view in edematous tissues and obstructed by scattered thrombi resulting from repeated vein punctures. Venography is used to select the vein which will most effectively carry blood away from the shunt, thus facilitating placement of the cannulae and increasing the length of time they can be expected to function.

Rectal Examination in Children: A Diagnostic Procedure of Major Importance

The only objection to a routine pediatric rectal exam ination is the fear of some emotional or physical trauma to the child. With gentleness and patience a rectal ex amination need not be traumatic. Rectal examination in children is as important as it is in adults and should be performed routinely. The omis sion of a rectal examination usually indicates that gloves and lubricant were not conveniently available for use during the physical examination. Gloves and lubricant should always be kept accessible wherever children are being examined.

Teaching initial management of shock in children

Common errors in managing shock in children are failure to recognize shock, failure to recognize continuing blood loss, and inadequate replacement due to lack of familiarity with the normal blood volume of children. For practical purposes, the normal blood volume of every child is considered to be 40 ml/lb (88 ml/kg). In hypovolemic shock the blood volume is reduced by at least one fourth. For initial management, an intravenous line is established, blood is drawn for cross matching, and 10 ml/lb (22 ml/kg) of Ringers lactate solution is administered as rapidly as possible. If this bolus, which represents one fourth of the normal blood volume, brings the blood pressure to normal, only maintenance fluid is then administered. If the child remains hypotensive, a second bolus of 10 ml/lb (22 ml/kg) is administered rapidly. Children who require a second bolus of Ringers lactate solution nearly always need blood transfusion also. Many have occult bleeding, usually in the abdomen. If intra-abdominal bleeding is thought to be possible but not definitely present, paracentesis using an angiocath is performed. If no blood returns, 10 ml/lb (22 ml/kg) of saline is instilled and the return considered significant if more than slightly pink.