In one overnight shift on the orthopedics service, our team evaluated three different pediatric patients with the same underlying injury: a femoral fracture. But, the management of all three children was different and the underlying reason for the different management was age.
The management of patients in cardiogenic shock is often multifactorial, consisting of mechanical circulatory support, vasopressors and inotropes. While the latter two are the foundation of therapy, the literature is scarce on whether milrinone or dobutamine will be more effective. Prior comparisons are limited to a single randomized trial of patients awaiting heart transplant and two observational studies that showed no difference in in-hospital mortality
Khadija, an 11-year-old girl, is brought into the Paediatric Emergency Department rubbing a red, watering right eye. She explains that she has recently started wearing contact lenses, and is still getting used to putting them in. When she was putting the lenses in this morning she felt like she scratched her eye with her fingernail. She tells you that she is good with her hand hygiene – washing her hands before putting in the contacts – so did not tell her parents, thinking the pain would go away. Over the last few hours, the eye has become increasingly painful and red, and won’t stop watering. She feels like something is still in her right eye, despite taking her contact lenses out, but can’t see anything on the surface of her eye when she looks.
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