Psychiatrische Notfälle in der pädiatrischen Ambulanz

Mental disorders are common phenomena in childhood and adolescence and patients with psychiatric symptoms are frequently referred to emergency pediatric departments depending on local healthcare conventions. This article provides recommendations for this treatment situation on the basis of the available scientific evidence.     

Schmerztherapie in der p?diatrischen H?matologie und Onkologie

Pain occurs frequently at all ages and can impair quality of life significantly. Pain in the pediatric population is also a risk factor for a multitude of health problems in adulthood. In the case of hematological/oncological diseases, there are many possible causes of pain, making a detailed pain anamnesis essential. The gold standard for measuring pain is the child or adolescent??s self-evaluation of pain. Physiotherapy and integrative methods represent the main non-medicamentous treatments used. Medicamentous pain therapy in children and adolescents with hematological/oncological diseases is governed in principle by the WHO pain ladder, whereby opioids should be introduced early. Whether pain therapy should be administered on an in- or outpatient basis needs to be considered for each individual hematological/oncological patient.     

Pulmonale Infektionen in der p?diatrischen H?matologie und Onkologie

Pneumonia is the most frequent invasive tissue infection in children and adolescents with neoplastic diseases or hematopoietic stem cell transplantation and is associated with considerable mortality. Given the favorable prognosis of most pediatric cancers, the availability of reliable microbiological methods and effective antimicrobial and supportive interventions, a prompt and rational approach to diagnosis and treatment is of pivotal importance. This article reviews the differential diagnosis of invasive infections of the lower airways in this vulnerable patient population and provides algorithms for the diagnosis and management.     

Ethik in der pädiatrischen Forschung

Zusammenfassung In der Pädiatrie besteht der Bedarf an besserer wissenschaftlich fundierter medizinischer Praxis auf der Grundlage qualitativ hochwertiger Forschung über Wirksamkeit und Sicherheit der medizinischen Behandlung von Kindern. Um die besten Interessen des Kindes zu wahren, muss ein Gleichgewicht bestehen zwischen den ethischen Forderungen nach klinischer Forschung und gleichzeitiger Verhinderung jeglichen Schadens. Somit müssen die Grundsätze der guten klinischen Praxis, die in der Deklaration von Helsinki und in den Richtlinien der ICH, der EU-Direktive und anderen einschlägigen Dokumenten festgelegt wurden, in der pädiatrischen Forschung eingehalten werden. Evidente Unterschiede in Physiologie, Pathologie, Pharmakokinetik und -dynamik zwischen verschiedenen Altersgruppen und zwischen Kindern und Erwachsenen verlangen einwandfrei geplante und durchgeführte Studien, die die speziellen somatischen, emotionalen und mentalen Bedürfnisse der Kinder berücksichtigen. Um ein Forschungsprojekt beim Kind zu rechtfertigen, müssen die erwarteten Vorteile die erkennbaren Risken übersteigen, kompetentes Personal zur Verfügung stehen, die adäquate Information und Zustimmung erfolgen und jedes Forschungsprojekt durch eine mit den Rechten und Bedürfnissen der Kinder vertraute Ethikkommission approbiert worden sein.     

Bewegungstherapie in der pädiatrischen Onkologie

The prevention of disease- and treatment-related side effects is essential in pediatric oncology in order to improve the quality of survival. Additionally, clinical exercise programs are becoming increasingly important in pediatric oncology. Based on a specific problem analysis and data from the current literature, recommendations concerning the content and structural conditions of exercise programs in pediatric oncology were defined. The exercise programs should be conducted in familiar surroundings integrating parents and siblings. While supervised programs seem to be more effective, they must also fit into the patient’s daily life. Exercise programs should consider age-related physiological principles, diagnosis, side-effects, and physical functioning in order to achieve positive effects on physiological, psychological, social, and educative levels. According to the translational approach, all scientific results are integrated into the care structure within a pilot project.     

Tigecyclin (Tygacil?) in der p?diatrischen Anwendung

Tigecycline is an antibiotic of last resort approved for the treatment of complicated skin and soft tissue infections as well as complicated intra-abdominal infections in adults. Due to the emergence of highly resistant pathogens, however, its use could be mooted for children but for whom it has not been authorized. Because of its structural similarity to tetracyclines, treatment with tigecycline can elicit comparable adverse drug reactions. In March 2011 Pfizer Pharma GmbH announced a restriction for all fields of application based on numerically higher mortality among adults receiving tigecycline, which was also reported in various publications. A literature search yielded three case reports on administration in children and adverse drug reactions were observed in only one. By reason of these case reports and the data provided by Pfizer Pharma GmbH upon request, a dose of 1?mg/kg up to a maximum of 50?mg every 12?h in emergency situations would appear to be justifiable for children and adolescents >12?years of age. The indication for the use of tigecycline in children should be strictly defined and the course must be closely monitored in a tightly controlled setting.     

Rolle der Palliativmedizin in der pädiatrischen Intensivmedizin

Monatsschrift Kinderheilkunde - Die Implementierung der Palliativmedizin in die pädiatrische Intensivmedizin erscheint auf den ersten Blick widersprüchlich, gewinnt aber mit der Zunahme...     

Neue Behandlungskonzepte in der pädiatrischen Notfallversorgung

Technological innovations and the advent of standardized training formats, including high technology simulation laboratories have recently improved and facilitated pediatric emergency management. The proof of concept, actual impact and effectiveness of these changes have been evaluated in animal models, analysis of case series and skill improvement testing after training. In one of the most significant advances, efficient intraosseous vascular access can be established in less than 1 min using an electrical hand-held drill. Pediatric respiratory insufficiency can usually be managed with respiratory support via a face mask and bag; however, in patients with a difficult airway, laryngeal masks are an extremely useful device for airway management which can be trained with relative ease. Intubation is suitable only for physicians with relevant expertise. Additional escalation strategies for respiratory support include non-invasive ventilation prior to intubation. The current guidelines of the European Resuscitation Council recommend a chest compression-ventilation ratio of 15:2 which will result in improved coronary perfusion and higher training efficiency. Pharmacological resuscitation with adrenalin should only be performed using standard dosage via intravenous or intraosseous access. Hypothermia for neuroprotection after successful resuscitation of children has been shown to be effective for term newborn infants but currently no general recommendations for the pediatric population are possible. In the absence of an intravenous access, nasal administration of drugs results in rapid resorption and can be used for anticonvulsive treatment or even for analgesia/sedation. Crucial for successful treatment of pediatric septic shock is early and aggressive intravenous fluid resuscitation (up to 60 ml/kg) using chrystalloid solutions, so-called early goal directed therapy. Point-of-care ultrasound meanwhile significantly contributes to improved results for in-hospital pedriatric emergency management. In this paper, recommendations of pediatric and emergency societies are provided, the current literature is discussed and personal experience is reported in selected topics.     

Psychische Auffälligkeiten in der pädiatrischen Praxis

Survey, results and course

Based on early pediatric medical checkups 144 children with an average age of 9.1 years were examined using the Mannheim parent questionnaire. In one third of the children eating and sleeping problems were detected as well as attention problems and a variety of anxieties. A follow-up investigation was carried out 3.2 years later regarding the psychological status of the children with the Strengths and Difficulties Questionnaire (SDQ) and a questionnaire to measure functional health and well-being from the patient′s point of view (36-Item Short Form Health Survey SF 36). The results demonstrate the stability of psychological and emotional difficulties from childhood to adolescence.

Conclusion

Pediatricians play an important role (“gate keeper”) in early prevention of psychiatric disorders. Based on these results diagnostic and therapeutic knowledge should be intensified and taken into consideration in medical specialist curricula.     

Kardiologische Notf?lle im Kindes- und Jugendalter

Pediatric cardiac emergencies are less frequent than in adults and show specific age-dependent differences. Congenital heart disease diagnosed and treated or not can be found in early childhood, whereas acquired heart disease plays a role after the first year of life. All kinds and causes of myocardial dysfunction and cardiomyopathy occur in older children presenting as heart failure. Cardiac dysrhythmia can also be found in all age groups, being of supraventricular rather than ventricular origin. Coronary problems in childhood are rare in comparison with adulthood but can be a major problem in Kawasaki disease. Specific symptoms, such as cyanosis are infrequent so it is very important to rule out or diagnose a cardiac cause in an unclear emergency situation. Profound knowledge of pediatric cardiac disease is essential for emergency staff to diagnose and manage these situations in the best way possible.     

Respiratorische Notf?lle im Kindes- und Jugendalter

Dyspnoea, inspiratory stridor, wheeze, cyanosis and chest pain are common symptoms of respiratory emergencies in children and adolescents. The airways of infants and toddlers are narrow and soft and oxygen reserve is small. Muscle fatigue can quickly lead to respiratory insufficiency. Symptoms, diagnosis, differential diagnosis and therapy of foreign body inhalation, croup, epiglottitis, bacterial tracheitis, bronchiolitis and acute asthma are dealt with in detail.