PEDIATRICS Vol. 2 No. 2 August 1948, pp. 209-221
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Round Table Discussion

PEDIATRIC EMERGENCIES

JOHN AIKMAN M.D.

Chairman Aikman: Pediatrics and medicine in general are so full of emergencies that it is difficult to know which ones to consider. At times the line between medicine and surgery is not sharply drawn. The problems are different in various parts of the country due to social conditions, the local poisonous plants, insects, food poisonings, diseases and lastly customs of the people. The problems of Texas are in many ways different from those of New York. The ease with which emergencies develop make the physician humble, and the solutions of these problems require ingenuity, resourcefulness, and courage. Knowledge regarding these matters is almost impossible to secure on a minute's notice, especially outside of the hospital.

No emergencies present more variety and interest than the poisoning accidents of children. Here we have unusual, dramatic, and even fantastic problems presented for immediate solution and treatment. The constant introduction of new poisons into agriculture and industry is astonishing. Unfortunately, there is considerable lag before the danger of new chemicals is detected and effective measures for treatment found. The magnitude of the problems can be appreciated when we know that the California Agricultural Code has jurisdiction over nearly 5,000 materials introduced for pest control of all kinds. A large part of these may become a problem when brought in the reach of and in contact with the runabout child. The National Safety Council reports that poisoning was the third most important cause of accidental deaths in the home in 1944. Deaths from falls were 16,900, mostly in the aged; burns 6,300, about 30% in children less than five years of age; and 2,090 deaths were from accidental poisoning, 680 of these occurred in children under five years of age. In 1929 there were 530 deaths but in 1937 only 440 deaths were reported, 217 of which occurred during the second year of life. The increase in 1944 is probably due to the larger birth rate and to unsatisfactory living conditions.

Poisons will produce nearly every symptom from mild skin rashes to convulsions, coma and death. Poisoning may easily be mistaken for disease and the number of cases overlooked has been estimated as high as 80%. It has recently been pointed out that salicylate and especially aspirin may add confusing symptoms to those of the disease being treated. The amount of accidental poisoning in small children is impossible to determine because only the reporting of fatal cases is required.