Tag Archive for: Children

PEDIATRIC INTENSIVE CARE UNITS–WHAT YOU NEED TO KNOW

Most expectant and recently delivered parents are familiar with the term Neonatal Intensive Care Unit or NICU (“nick-u”) which might be necessary in the case of a newborn that arrives sick or premature. For that reason, all hospitals who deliver babies are required to have access to a NICU, just in case.

But what happens when an older infant or child requires intensive care? Are they also cared for by the NICU unit?

The answer is no. NICU patients are typically newborns, although some NICUs care for babies up to two months old. Beyond that, a Pediatric Intensive Care Unit or PICU is required for all children, generally up to the age of 18.

What’s important to know is that PICUs are specialized units that don’t exist in all hospitals. Therefore, it is important that parents find out where the nearest PICU is located so their little ones can receive the best care if and when they are seriously or critically ill or injured.

For example, let’s say a 3-year-old child has fallen from a height that caused a brain injury and they are showing signs of a severe concussion or worse. That child would require hospitalization in a PICU for intensive monitoring and treatment by specialized physicians and nurses until they were stable and continuing to improve.

PICUs are most often located in medical centers that are teaching hospitals. A teaching hospital trains physicians in all areas of medicine, from pediatrics to neurology to orthopedics and so on. They have 24/7/365 capacity to provide rapid care to babies, children and adolescent patients.

What you need to bear in mind is that these represent only a small percentage of the hospitals in the greater Los Angeles area.

So what happens if the paramedics arrive and determine that your baby or child requires hospitalization?

Paramedics are extensively trained to evaluate and treat infants and children both in your home and en route to the hospital. Please follow their instructions and lead as they are making decisions based on sound clinical judgement.

If they determine that your little one will likely need intensive care, they will not take them to a hospital that cannot care for them, however, it is also possible that they will go to a medical center where your pediatrician does not have admitting privileges.

It goes without saying that ideally, you would want your child to go to a medical center where your pediatrician admits and practices.

So, an important question to ask and one that all parents should know the answer to is where does your pediatrician admit the most serious patients? 

It’s helpful to know that pediatricians have admitting privileges at one or more of these medical centers – in fact, many have done their resident training at these centers – but don’t take anything for granted. If you don’t already know, please ask your pediatrician where she or he admits little ones.

In Los Angeles, the following medical centers have a PICU:

  • UCLA Medical Center (Westwood)
  • Cedars-Sinai Medical Center
  • Children’s Hospital of L A.
  • County USC Medical Center
  • most Kaiser Permanente hospitals
  • The recently enlarged Providence/Cedars Tarzana hospital also has a critical care unit for pediatrics
  • In outlying areas, Loma Linda Medical Center and Harbor UCLA Medical Center should be included in the list

Save a Little Life™ is dedicated to educating parents, family members, and care providers to respond to most pediatric health emergencies, if needed. Never underestimate the importance of that knowledge. Keeping CPR and airway emergency skills current can make the biggest difference in critical health events.

 

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BEE PREPARED

Most of us will likely be stung by a bee or yellow Jacket at some point in our lives. What should you expect if this happens to your little one?

As you might expect, there will be some pain or discomfort at the site and it is usually accompanied by local swelling, a feeling of heat and itching around the location. On occasion, the swelling might move from one hand to the forearm. This is not that uncommon. Itching may continue for several days and can be alleviated by a cool compress to the area.

How do I remove the stinger?

The stinger itself is a hollow tube through which venom enters the body. The preferred method for removal is to use something firm like a credit card to sweep the stinger off from the side. Grabbing the stinger with tweezers or your fingernail will likely eject additional venom into the person.

What does a severe reaction look like?

The following reaction(s) to a bee sting that require immediate attention include:

  • Hives, in parts or larger sections of the body
  • Nausea/vomiting
  • Stomach cramps
  • Any swelling of the body not associated with the site…particularly in the neck, face, tongue that might affect breathing

Some reactions are not specific to the site itself. If there is some swelling elsewhere, consider using an anti-histamine such as Benadryl. The liquid version enters the body more quickly, plus many young ones cannot swallow a pill.

Continue to observe the person closely and if needed, go to a local emergency department.

What to do when the bite victim has a known, severe allergic history to bee stings

If the bite victim has a known, severe allergic history to bee stings you should expect severe symptoms within minutes. If an EpiPen is available, use it as directed, then call 9-1-1. Driving to a hospital under these circumstances has risks, including traffic accidents.

What is an EpiPen?

EpiPen is a commonly known brand name of an auto-injectable device that delivers the drug epinephrine, a life-saving medication used when someone is experiencing a severe allergic reaction, known as anaphylaxis.

Do I need an EpiPen at home, even if no one in the household has a known allergy?

Most pediatricians will not prescribe one unless there is a confirmed history of a severe reaction to any substance that could cause a life-threatening event.

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CANDY OR CANNABIS?

California authorities recently seized 2.2 million illicit cannabis packages designed to look like popular food snacks and candy. The sting operation focused on 11 storefronts in the city’s Toy District where businesses were making and selling packaging used to deceive customers.

According to the L.A. Times, “The packages seized in the sweep were empty, but designed to mimic popular food and candy, including Sweet Tarts sour gummies and Twinkies adorned with rainbow sprinkles, which officials said could make them attractive to children. Such packages would not be permitted in the legal marijuana market.”

Under state law, cannabis goods must be labeled to ensure that consumers know what they are buying and to prevent products from being misused. Sellers are required to have packaging that is child-resistant, resealable and opaque if it’s an edible product. Vetted products feature a marijuana leaf symbol and an exclamation mark inside a triangle.

Unfortunately, the illegal weed market is aware of this, so some are now illegally creating packaging with a forged seal to sell their black market products.

Each of the seized packages was labeled with a forged California marijuana seal, giving would-be purchasers the false impression that the products inside had been vetted by the state. 

Obviously, this poses a danger to consumers.

Governor Newsom responded stating “We will not tolerate criminal activity that undermines the legal market, especially when it puts children at risk.”

Department of Cannabis Control Director Nicole Elliot added that such counterfeit packaging can potentially pose danger to consumers, “especially when it is ripping-off well-known brands that are attractive to children.”

Why is cannabis such a risk to children?

Children react very differently to cannabis than adults. Their reaction is extremely variable with symptoms varying from none at all to a coma. In a previous post we took a look at this issue and why it has become such a concern.  You can find that article Cannabis Poisoning In Children Is On The Rise here.

In our Pediatric CPR & Family Safety Class we always discuss potential risks to little ones who might accidentally consume any substance that might harm them. Our emphasis is on the 4 specific groups of potential toxins including drugs (of all kinds), plants, flowers and common chemicals used around the home for cleaning.

We strongly recommend the following guidelines:

• Keep all medications well hidden and out of sight of toddlers and children
• Be aware that little ones are always observing adults and might think that what they consume is OK for them
• Know the toxicity of common (indoor plants) as well as those in your garden
• All chemicals used for cleaning, disinfecting, or insecticides must be kept well out of reach and in cabinets that have good quality locks

If you believe that there has been an ingestion of any substance by your little one, please call California Poison Control immediately @ 1-800-222-1222.

HOW TO RECOGNIZE CANINE STRESS RESPONSES

The L.A. Times recently ran an article on the rising increase of dog bites that are sending record numbers of us to local Emergency Rooms. The numbers are actually quite troublesome.

A recent study cited 48,596 ER visits that were related to dog bites, a number that reflects a 12% increase from the previous year and 70% higher than 2005. That equates to 125 ER visits for dog bites per 100,000 California residents.

Why the increase?

As many a 45% of American households now have at least 1 dog. That number is higher than it’s ever been owing to the large number of adoptions that took place during the pandemic when people were suffering from isolation.

Some dogs, like people, respond to unusual stress with aggressive behavior but unfortunately, the initial warning signs may go unnoticed. According to the article, a large number of puppies (and adult dogs as well) were hastily adopted during the pandemic and never properly socialized which has resulted in unaddressed behavioral issues.

State figures and a recent study by public health researchers show that, in California, children and young adults are the age groups most likely to make ER visits for dog bites.

The most serious injuries often involve the head and neck, making little children especially vulnerable. Nationwide, children under 5 were more than twice as likely to die from dog bites as members of other age groups.

What to look for?

Canine aggression occurs “on a ladder” of escalating behaviors and not all of them are obvious unless you know what to look for.

Easy to remember are the 5 Fs:

  • fret
  • fidget
  • fight
  • flight
  • freeze

Initial signs of discomfort also might include lip-licking, looking away, or yawning. The behavior starts to escalate when the dog begins stiffening up, staring, or crouching with a tucked tail. And things can worsen if an active toddler or small child gets too handsy.

According to Elizabeth Stelow, chief of the Behavior Service at the UC Davis Veterinary Medical Teaching Hospital,  owners should learn to recognize anxiety in dogs and understand their body language. When dogs owners repeatedly miss the signs of distress, biting may occur.

Dogs who are punished regularly are  also more inclined to bite. Negative feedback such as collars that deliver electronic stimulation, choke chains, and/or pronged collars were also identified in the article as another source of great stress.

Although aversive techniques appear to work by subduing the animal’s behavior, that result is often deceptive. Fear-based learning can push dogs to stop engaging in any behavior, good or bad, as the dog becomes fearful of a negative response.

The American Veterinary Society of Animal Behavior encourages owners to focus on positive reinforcement, rewarding dogs for what they do right. Motivating good behavior with treats, toys, verbal praise, and other positive choices make for a much happier and better-behaved pet.

Be sensitive to any signs that might lead to aggressive behavior.

Dogs are such an important part of our family, our lives, and our wellbeing. Let’s make sure that we equally value the wellbeing of our canine friends.

CAUTION: COLORFUL CURIOSITIES

Parents who have taken our CPR & Family Safety Class will recall that the class highlights poison prevention, and for good reason.

The most recent report from the Consumer Product Safety Commission (CPSC) shows an alarming increase in both serious and fatal poisonings…especially in the 0-4 age group.

The numbers show an increase in fatal poisonings of 37% from 2020 to 2021 with a significant increase of 66% from ’21-’22. These numbers are on the rise and Emergency Departments and the CPSC are sounding the alarm.

In particular we are looking at:

  • All Acetaminophen (Tylenol) products – especially liquid versions
  • Narcotics/opiates
  • Hallucinogenic substances (including ingestible cannabinoids)
  • Ibuprofen agents

One very simple thing to keep in mind is this:

Children are attracted to bright, colorful items whether it’s pills or cleaning supplies and chemicals used for washing clothes and dishes.  It all looks like candy to them.

The essentials of poison prevention are well known  but sometimes we need reminding.

Be sure to follow these essential guidelines:

  • Keep ALL medications well out of reach of children
  • Only administer pediatric medications as prescribed by your pediatrician
  • Check age and size-related dosing of anti-fever drugs. For example: Tylenol and Ibuprofen medications both come in infant and toddler strength
  • Never use words like “sweet” or “candy” when trying to get your little one to take medication as they will get the wrong message
  • Any recreational drugs need to be either very well hidden or in a locked container
  • Make sure that all relatives and/or care providers understand these safety rules

Keep your loved ones safe and healthy.