Doctors warn that using domestic spoons to give children medicine increases overdose risk
July 14, 2010
Parents are being urged not to use domestic spoons to give children medicine after a study found significant differences in capacity. A parent using one of the biggest domestic teaspoons would be giving their child 192 per cent more medicine than a parent using the smallest teaspoon and the difference was 100 per cent for the tablespoons. This increases the chance of a child receiving an overdose or indeed too little medication.
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What difference can a pediatric surgeon make?

Pediatric surgeons specialize in the surgical care of children. They are surgeons who, by training, are oriented toward working with children and understanding their special needs.

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More than 50% of all child injuries are either caused or related to car or bicycle crashes.

Like Mother
Like Daughter:
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Empyema

Empyema is a chest infection. Unlike pneumonia, which is an infection in the lung, empyema occurs in the space between the lung and the chest wall known as the pleural space (or pleural cavity). In children, empyema is usually a complication of pneumonia. Inflammatory reaction to the pneumonia produces fluid in the pleural space (“effusion”). If the infection from the pneumonia spreads to this fluid, pus may accumulate, resulting in empyema.

The doctor may suspect an effusion or empyema by listening to the chest with a stethoscope. Breath sounds will sound muffled or distant.

Tapping the chest over an effusion sounds dull rather than resonant. A chest x-ray will confirm the effusion; films taken with the patient in different positions may indicate whether the fluid flows freely. A CT scan or ultrasound of the chest reveals the anatomical location of the fluid and may provide information about the underlying lung infection.

Treatment decisions are based on the stage at which the condition is diagnosed. In the early phase of empyema, an effusion is present. If the effusion is large, treatment is directed toward removal of the fluid. This can be accomplished by drawing off the fluid under local anesthesia by inserting a small catheter into the pleural space. The fluid is withdrawn for analysis and culture. A very large pleural effusion may interfere with the child’s ability to breathe; removal of the fluid can be both diagnostic and therapeutic. Although removing the fluid often makes breathing more comfortable, some reaccumulation of the fluid is likely when ongoing pneumonia is present. A patient with a large effusion who has difficulty breathing may benefit by having a chest tube inserted which is left in place to allow excess fluid to drain. If the effusion is not infected, one can expect it to resolve as the lung infections clears. Further intervention is not usually necessary unless breathing problems recur.

Fluid that does not flow freely may be trapped (or “loculated”) or may represent the thicker, gel-like material characteristic of empyema. Removal of such material from the chest with a catheter is usually not possible, and a different plan of therapy must be selected. Options include medical therapy with or without placement of a chest tube, or by combined medical and surgical intervention. A child with a small empyema is usually treated with intravenous antibiotics for 10 to 14 days. Additional antibiotics may be given by mouth for 1 to 3 weeks thereafter. If the child responds to the antibiotics (does not need oxygen, breathes easily, becomes afebrile, regains appetite, and no longer looks ill), then no further intervention is indicated. A chest tube may benefit a free-flowing effusion but will not benefit empyema that has become gelatinous and tenacious. Surgical intervention is then indicated.

Studies have shown that early evacuation of a significant empyema reduces hospital stay and hastens the child’s return to normal activities. The trade-off is that an operation is needed. Open thoracotomy and evacuation of the empyema is effective but requires a rather large incision in the chest wall. Recent application of video-assisted minimal access techniques (VATS) allows evacuation of the empyema to be accomplished with a much more rapid recovery and far less patient discomfort.

For the video assisted operation, general anesthesia is needed. A small incision (1/2 – 3/4 inch) is made in the chest wall. The lung is partially deflated and a telescope is inserted into the pleural space so that the surgeon can see. One or two additional small incisions are then made and a variety of instruments are used to evacuate as much fluid, pus, and debris as possible from the pleural cavity. Care is taken to avoid injury to the lung although the pneumonia may have already broken through the surface of the lung. Chest tubes are usually left through the incisions to promote further drainage of the infection. Once drainage stops and there is no air leak from the lung, the chest tubes are removed. This may take several days to a week or, sometimes, longer. Some surgeons instill medication through the chest tube to help break up the adhesions that may form after the VATS operation.

Long-term studies show that most patients recover without significant problems. Lung function and exercise tolerance usually returns to normal 3-6 months after the acute illness. Early diagnosis of effusion associated with pneumonia and prompt intervention reduces the complications associated with the disease. Surgical intervention for advanced empyema speeds recovery and reduces hospital stay.