Gastric decontamination in the poisoned patient.
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Acetaminophen↗
Biomedical subjects
F Henretig
Publications and source records attributed to F Henretig.
Antibiotic administration to treat possible occult bacteremia in febrile children.
We performed a prospective, randomized, placebo-controlled, double-blind clinical trial of antibiotic administration to treat possible occult bacteremia in febrile children. A total of 955 children aged 3 to 36 months with temperatures greater than or equal to 39.0 degrees C and no focal bacterial infection were enrolled at the emergency departments of two children's hospitals from January 1982 until July 1984. Blood samples for culture were obtained, and the children were randomly assigned to receive either oral amoxicillin or placebo and were restudied approximately 48 hours after enrollment. Data were also collected on 228 children who could not be randomly assigned. Twenty-seven of the randomly assigned children (2.8 percent) had bacteremic infections with pathogenic organisms (Streptococcus pneumoniae, Haemophilus influenzae, and salmonella). There were no differences in the incidence of major infectious morbidity associated with bacteremia between the antibiotic and placebo groups--2 of 19 patients (10.5 percent) in the antibiotic group and 1 of 8 (12.5 percent) in the placebo group--although the power for this comparison was low. Antibiotics reduced fever (P less than 0.005) and improved the clinical appearance (P = 0.07) in the children with bacteremia but not in those without bacteremia. Although there were no statistically significant differences in the incidence of side effects, diarrhea tended to occur more often in the patients treated with amoxicillin (15 vs. 11 percent, P less than 0.10). We conclude that our data do not support the routine use of standard oral doses of amoxicillin in febrile children who do not have evidence of focal bacterial disease.
Amoxicillin↗
Lead poisoning in a child with a gunshot wound.
Lead poisoning has infrequently resulted from gunshot wounds with retained lead particles in adults. This has not been previously found in children. The case of an 8-year-old boy in whom lead poisoning developed soon after a gunshot wound is reported. The child had no symptoms directly related to lead poisoning, but he received chelation therapy. The case demonstrates the need to consider lead poisoning in children with retained particles following gunshot wounds.
Chelating Agents↗
Increased lead absorption in children with accidental ingestions.
Children with accidental ingestions exhibit excessive hand-to-mouth behavior. In a lead-burdened environment, hand-to-mouth behavior contributes to increased lead absorption. To test the hypothesis that accidental-ingestion patients experience greater lead absorption than other urban children, 95 children under 6 years of age with recent ingestions of nonlead-containing materials and a matched control group were compared. Ingestors had higher mean blood lead levels than controls (25.0 micrograms/dl versus 22.2 micrograms/dl, P = 0.036) and higher mean erythrocyte protoporphyrin levels (40.6 micrograms/dl versus 28.6 micrograms/dl, P = 0.006). Ingestion victims were more than three times as likely as controls to be classified as having increased lead absorption. Thumb-sucking was twice as common among ingestors as controls (37% versus 19%). These findings indicate that children with accidental ingestions are at greater risk of increased lead absorption than other urban children.
Child, Preschool↗
Temperature response to antipyretic therapy in children: relationship to occult bacteremia.
The response of rectal temperature to antipyretic therapy was studied in an attempt to identify a clinical characteristic that would distinguish children with occult bacteremia from those with sterile cultures of blood. Children 3-24 months of age with initial temperature recordings of 38.9 degrees C or greater had a blood culture drawn and received a standard dose (10mg/kg) of either aspirin or acetaminophen. Temperature was again recorded 60-120 minutes later. During the period of investigation, 255 patients were studied; 16 had bacteremia, and 239 had sterile blood cultures. There was no difference in the response to antipyretic therapy between the two groups. The mean decrease in temperature for each was similar (1.3 versus 1.05 degrees C, P = 0.14). The authors conclude that response to antipyretic therapy does not distinguish children who are bacteremic from those who are not.
Acetaminophen↗
Pediatric training in emergency medicine residency programs.
Endorsed emergency medicine (EM) residency programs were surveyed as to the nature and extent of training they provided in pediatric emergency care (PEC). In the surveys returned (82%) there were several important findings. The amount of time in PEC training was generally two months per year of training. This accounted for 16% of training time. However, the volume of pediatric patients was 25% of the overall patient population. There was wide variation in the sites of PEC training. Didactic sessions often did not cover even core topics. The training program directors were equally divided in their satisfaction with this aspect of their programs. Changes were recommended by 80% of the directors. Changes most often suggested were increasing pediatric patient exposure and obtaining PEC specialists as trainers.
Emergency Medicine↗
Otitis media: update on etiology and management.
Thirty children with clinical evidence of otitis media underwent tympanocentesis. Streptococcus pneumoniae was the predominant organism recovered (63%). Three cases of Hemophilus influenzae, alone or in combination with S pneumoniae, were identified. Other organisms found were Staphylococcus albus, Neiserria species. Group A B-hemolytic Streptococcus, and anaerobes. In four patients (13%) no organism was recovered. All isolates were ampicillin susceptible. No relationship was found between WBC, temperature, or age and the organism recovered. Tympanocentesis did not provide any information resulting in an alteration of therapy. Tympanocentesis may be indicated for relief of pain or for periodic surveillance of organism sensitivities, but is not justified in the emergency department for uncomplicated acute otitis media. [Friedman A, Fleisher GR, Henretig F, Handler S, Campos JM: Otitis media: Update on etiology and management. Ann Emerg Med 11:181-183, April 1982.]
Bacteria↗
Cellulitis: initial management.
Although Staphylococcus aureus and Streptococcus pyogenes cause the majority of cellulitis, recent studies have shown a significant role for Hemophilus influenzae in facial, and less frequently, nonfacial infections. We devised an algorithm for the initial management of cellulitis based on our previous investigations showing a correlation of this organism with fever, leukocytosis, and facial involvement. Children were divided into four groups characterized as follows: Group I - extremity, temperature less than 38.5 C; Group II - extremity, temperature greater than 38.5 C, WBC less than 15,000/cu mm; Group III - extremity, temperature greater than 38.5 C, WBC greater than 15,000/cu mm; and Group IV - facial. Forty-five children were successfully followed. There were 34 in Group I, five in Group II, one in Group III, and five in Group IV. Two children in Group IV and the only child in Group III had H influenzae, recovered form the blood (3) or a direct aspirate (1). All three were febrile, with a range of 39.5 C to 40.1 C and has an elevated white blood cell count with a range of 19,200/cu mm to 26,000/cu mm. With one exception, children with cellulitis not due to H influenzae did not have both fever and leukocytosis. This algorithm allows the clinician to identify children with H influenzae cellulitis who are at risk for septic complications while minimizing unnecessary diagnostic or therapeutic interventions.
Adolescent↗