Initial assessment and stabilization of the critically injured child.

The care that the child receives during the initial resuscitation and stabilization of a life-threatening injury makes a critical difference in long-term outcome. Children who die as a result of a traumatic injury usually do so because of airway compromise, irreparable CNS injury, or bleeding. Hypoxia is the final common event by which these three kill children. If hypoxia is prevented or recognized and treated early, its effects can be reversed before they become permanent. The potential for a good outcome is maximized by expert nursing care for the critically injured child. Expert nursing care includes rapid and accurate assessment and interventions during both the primary and secondary surveys. Knowledge of the anatomic and physiologic differences between children and adults guides the nurse in holistic care of pediatric trauma victims; the nurse must also understand and address the emotional needs of the patients and their families.

Pediatric issues in multisystem trauma.

Pediatric trauma is a national epidemic. It is the leading killer of children between the ages of 1 and 14 years, and is a major cause of disabling injuries. This is a major concern to society when one considers not only the tragedy to the family, but the implications of the loss of work potential, the length and cost of rehabilitation, and the effects on growth and development. Children have been shown to have better potential for recovery than adults, especially with head injuries. This potential can and must be maximized by expert nursing care. Nursing care includes precise assessment, formulation of nursing diagnoses based on assessment, and interventions guided by the appropriate nursing diagnosis. Research has demonstrated the positive impact nursing care has on the trauma patient; more studies are needed, especially for the pediatric trauma victim. Nurses are in a position to provide leadership in the area of pediatric injury prevention, and can educate legislators and the public about how to manage this public health epidemic. Children are our society's most precious resource. This resource can be protected by further research in all areas of pediatric trauma, including trauma prevention, resuscitation, and nursing interventions to further maximize the outcome.

When the lung fails. Acute respiratory distress syndrome in children.

Caring for the child with ARDS is a challenge. Many new ventilatory techniques have been introduced to maximize a good outcome. Nevertheless, it is obvious that regardless of therapy, expert nursing care is critical. Astute observation, knowledge of the different therapies, identification of complications, and attention to the needs of the child and family are needed to make care truly holistic.

Caught in the crossfire: children, guns, and trauma.

Violence, especially that related to the use of firearms, has become a leading cause of death in children in the United States. Providing physical and psychosocial care for the child with a gunshot wound is a nursing challenge. Nurses can and must play a major role in helping to prevent this public health problem.

Caught in the crossfire. Children, guns, and trauma: an update.

The dramatic increase in violence-related deaths in the last few years demands that violence be recognized as a public health emergency. Even though mortality rates in children have decreased overall and deaths from injuries have also decreased, the rate of violence-related mortality has increased. Violence does not know the limits of cities, age, sex, or race; everyone, everywhere is affected. The recognition of violence as a leading cause of mortality and morbidity in children must become a national priority. By making a commitment to tackle the problem of violence, nurses and other health care professionals can make a significant contribution to society at large.

The pediatric cardiovascular surgery patient: a case study.

The pediatric cardiovascular surgery patient has many needs, based not only on the complexity of the surgical procedure, but also on anatomic, physiologic, and emotional differences. These differences have implications for nursing care in the postoperative period. This article focuses on the special needs of a child who required correction of a congenital heart defect. The specialized knowledge required by the pediatric critical care nurse to make accurate assessments of the child's status and to intervene appropriately are emphasized. Issues surrounding the care of the family of the child who experiences cardiac surgery are highlighted.