Emergency Drugs In Care Of Children

A study was conducted on 60 children (2-5 years old), admitted to the PER at Hospital de Clínicas de Porto Alegre (Brazil), due to an episode of acute asthma, refractory to conventional therapy (an oral dose of steroids and at least three doses of inhaled albuterol, associated or not with oxygen) were enrolled in a randomized, double blind, placebo controlled clinical trial. The randomization was performed in blocks of 10 patients, who received a "bronchodilator solution" (either saline or aminophylline), in two doses: on arrival at the PER and again 6h later. The intervention group received aminophylline 5mg/kg/dose diluted in normal saline (NS) solution up to a 20 ml volume, while the placebo group received plain NS, both in an infusion rate of 1 cc/min. The main outcomes were total length of hospital stay, length of supplemental oxygen use, number of bronchodilator nebulizations and/or aerosol inhalations performed and patient destination. The groups were compared using the Students t-test, Mann-Whitney test and Chi-Square test, accepting p<0.05 as significant.A study was conducted to quantify the usefulness and side effects of theophylline with or without ethylene diamine (aminophylline) in acute asthma. Of these, 29 study included an active control, such as adrenaline, beta-2 agonists, or leukotriene receptor antagonists, and 23 study compared theophylline (with or without ethylene diamine) with placebo or no drug.

Theophylline significantly reduced heart rate when compared with active control (p=0.01) and overall duration of stay (p=0.002), but beta-2 agonists were superior to theophylline at improving forced expiratory volume in one second (FEV1) (p=0.002). Theophylline was not significantly different from other drugs in its effects on respiratory rate, forced vital capacity (FVC), peak expiratory flow rate, admission rate, use of rescue medication, oxygen saturation, or symptom score. Closer examination of the data revealed that the medications given in addition to theophylline or control significantly changed the effectiveness of theophylline (subgroup difference: p<0.00001).A prospective study was conducted in Brazil to analyze adverse drug events (ADEs) related to admissions to a pediatric emergency unit and to identify the associated risk factors. In total, 1708 pediatric patients were included in this study.

Adverse drug events were the cause of hospital admission in 12.3% of the studied population. The majority of patients presenting with an ADE were in the age group of 0 to 5 years (61.6%), had a mean ± SD age of 4.9 ± 3.9 years, were female (51.2%), were Caucasian (72.0%), and had infectious disorders (49.3%). High frequencies of medication errors (68.8%), use of drugs to treat respiratory disorders (27.7%), and ADEs of mild severity (75.3%) were reported. The risk of being admitted to the pediatric emergency unit for any ADE increased in cases of neurological (odds ratio [OR], 4.63; 95% confidence interval [CI], 2.38-8.99), dermatological (OR, 3.16; 95% CI, 1.93-5.18), and respiratory (OR, 3.02; 95% CI, 1.89-4.83) disorders.

A high frequency of ADE-related admissions to the pediatric emergency unit was observed. The risk of being admitted to the pediatric emergency unit for any ADE increased in cases of neurological, dermatological, and respiratory disorders. Clinical pharmacists play an important role in the identification of ADEs and the education of child caregivers and health care providers concerning pediatric medication.A study aimed to compare the onset and duration of action of intrabuccal (IB, submucosal) space and intramuscular (IM) injection of ketamine in pediatrics.

This clinical trial study was carried out on 126 children of 1-15 years old referred to the emergency room of Al-Zahra and Kashani Hospitals in Isfahan and divided into two 63 populated groups of IM and IB. For one group randomly, 3 mg/kg IB ketamine was administered, and for another group, ketamine was injected intramuscularly at the dose of 5 mg/kg. The mean of time between injection and onset of drug effect in IM group was 5.71 min, whereas in IB group, it was 4.14 min (P < 0.0001). The mean of the duration of drug effect in IM group was 45.54 min, whereas in IB group, it was 24.63 min (P < 0.0001). Complications in IM group were significantly more reported than IB group (33.3% versus 11.1%, respectively, P = 003). The median of surgeon satisfaction in IM group was 3 and in IB group was 4 which was statistically significant (P = 0.007).IB method is preferred over IM method, and hence, it is recommended to use. An integrative review was undertaken to analyze the strategies, safety incidents and the phase of the medication process intended to prevent adverse events in pediatrics. The following descriptors were used: medication errors, patient safety and child. The most investigated phase of the medication process was the drug prescription. The safety incident rates varied between 0.91% and 54%. No methodological standardization could be identified in the studies. The reported prevention strategies were: use of electronic drug prescription, clinical simulation, dosing protocol and incident reports. It is important for the risk identification and planning of prevention strategies to support the global analysis of the medication process.There is a ritualistic use of sodium bicarbonate. Recent work has confirmed that the only indication for soda bicarbonate in the neonatal resuscitation was metabolic acidosis provided that respiration is already established- S.Gupte.

Epinephrine hydrochloride, Soda bicarbonate, Naloxone hydrochloride and Dopamine hydrochloride are necessary to resuscitate the neonates back to life - O P Ghai. Howel investigated on sodium bicarbonate administration in neonatal resuscitation and concluded that sodium bicarbonate is harmful to the neonate as it lowers the intracellular PH- something exactly which none would ever like to attain.