Zusammenfassung
Hintergrund
Die Diagnosestellung einer Kindesmisshandlung kann mit Irrtümern in beide Richtungen verbunden sein; einerseits können Misshandlungen unentdeckt bleiben oder aber ...Misshandlungen fälschlicherweise als Ursache für Verletzungen angenommen werden. Derartige diagnostische Irrtümer können dazu führen, dass Kinder dem misshandelnden Umfeld weiterhin ausgesetzt werden oder aber Kinder zu Unrecht in Obhut genommen und von ihrer Familie getrennt werden.
Methoden
Kinderschutzfälle aus den letzten 10 Jahren wurden retrospektiv anhand der elektronischen Krankenakte auf falsch-positive Fälle untersucht. Ein positives Ethikvotum der LMU München zur Publikation liegt vor.
Ergebnisse
Die als falsch-positiv identifizierten Fälle hatten als Ursache für vermeintliche nichtakzidentelle Verletzungsmuster eine genetisch gesicherte Osteogenesis imperfecta Typ 6, einen Lichen sclerosus und eine Hämophilie B. In allen Fällen wurde das Jugendamt miteinbezogen, in allen Fällen kam es zu einer Belastung für Eltern und Kinder, in einem Fall kam es zu einer, im Nachhinein ungerechtfertigten, temporären Inobhutnahme.
Diskussion
Eine interdisziplinär und multiprofessionell besetzte Kinderschutzgruppe an der Kinderklinik kann notwendige Differenzialdiagnosen ins Gespräch bringen und die Koordination mit dem Jugendamt und der Polizei erleichtern. Die Inobhutnahme durch das Jugendamt ist einerseits eine wichtige Maßnahme, um Kinder und Jugendliche vor weiteren Gefährdungen zu schützen, andererseits sollten ungerechtfertigte Inobhutnahmen vermieden werden, weil die daraus resultierende Trennung von Eltern und Kind zu erheblichen Belastungen führen kann. Die Konsultation der Rechtsmedizin ist hilfreich, um die Diagnose entsprechend einzugrenzen oder aber um alternative, medizinische Diagnosen anzubieten.
Myocarditis and malignant dysrhythmias are unusual presentations in pediatric patients. We report a series of 4 patients with myocarditis and arrhythmia who presented to community emergency ...departments and were transported to a pediatric tertiary-care center. Three of the patients required extracorporeal life support. We discuss considerations for stabilization and transportairway and ventilation, hemodynamic support, induction and sedation medication choices, transport decisions, and the traits of an ideal receiving center.
To identify the effect of perflubron on gas exchange and lung mechanics during high frequency oscillatory ventilation in an animal model.
Prospective randomized animal trial.
Eighteen Yorkshire ...swine.
Three groups of six animals each were investigated: control (high frequency oscillatory ventilation alone), low dose perflubron (high frequency oscillatory ventilation plus perfluoro-octyl bromide PFOB-Lo, 1.5 mL/kg), and high dose perflubron (high frequency oscillatory ventilation plus PFOB-Hi, 3 mL/kg). Lung injury was induced with repeated saline lavage and amplified for 1 hr using large tidal volumes. Perflubron (Alliance, CA) or a sham dose (room air) was administered with bronchoscopic guidance. The animals were transitioned to high frequency oscillatory ventilation starting at a mean airway pressure of 15 cm H2O. Mean airway pressure was increased (inflation phase) by 5 cm H2O every 15 mins to a maximum mean airway pressure of 40 cm H2O. During the deflation phase, mean airway pressure was reduced by 5 cm H2O every 15 mins to a mean airway pressure of 15 cm H2O.
Oxygenation was improved and pulmonary shunt fraction was reduced for PFOB-Hi compared with the control group only at a mean airway pressure of 15 and 20 cm H2O. At a maximal mean airway pressure of 40 cm H2O, oxygenation was not different between the groups, but pulmonary artery pressures were elevated in both PFOB-groups compared with the control group. During the deflation phase, oxygenation, pulmonary shunt fraction, and pulmonary artery pressures were adversely affected by PFOB-Hi and PFOB-Lo.
Although PFOB-Hi compared with the control group improved oxygenation and reduced pulmonary shunt fraction only during the first pressure steps of a formal stepwise recruitment maneuver during high frequency oscillatory ventilation, this effect was not sustained during maximal recruitment. During the deflation phase, both PFOB groups were associated with worse gas exchange compared with the control group. PFOB also produced significant pulmonary hypertension in comparison with the control group.
Abstract High-frequency oscillatory ventilation (HFOV) allows effective recruitment of atelectasis while delivering minimal tidal volumes at rates exceeding the normal respiratory rate. HFOV is ...considered in the setting of failing conventional ventilation in patients with acute lung injury, indicated by arterial hypoxaemia despite peak inspiratory pressures of more than 35 cm H2 O or oxygenation indices of more than 13 on two or more arterial blood gas analyses. The initial mean airway pressure on HFOV is set 5–8 cm H2 0 higher than the last mean airway pressure during conventional ventilation. Increasing the mean airway pressure increases alveolar recruitment and oxygenation, whereas CO2 elimination is directly related to the peak-to-trough pressure amplitude, and negatively correlated with the device frequency. Weaning from HFOV and the transition to conventional ventilation is considered on resolving lung disease and minimal settings on the oscillator (mean airway pressure 15−20 cm H2 O, amplitude ⩽4.0, FiO2 <0.6).
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