Additions Are Needed

Abstract

As advance analgesia is not possible, venipuncture must be performed on the conscious child. If there is an indication for venipuncture, tedious and painful failed punctures must be avoided. A maximum of two attempts should be made at the classical and promising sites of puncture. If those fail, intra-osseous puncture should be performed. The possible complications are of secondary importance only. The best puncture site is at the transition between the proximal and mid third of the lower leg. If the Cook needle is used, the infant’s lower leg must rest on the palm of the operator, in order to avoid greenstick fractures. The sentence “Symptomatic hyperglycemia in childhood is almost always due to diabetic ketoacidosis” is totally unacceptable. Ketoacidosis is a symptom, not the cause of excessive hyperglycemia. Volume replacement is actually very important in the therapy of hyperglycemic ketotacidosis. If however 0.9% NaCl solution is infused, the acidosis may be enhanced, as there is a lack of metabolisable anions. A balanced electrolyte solution is to be preferred here. Table 3 is not very helpful. It is hardly possible to distinguish between “dry” and “dried out” mucus membranes. Experience has shown that the clinical evaluation of the child should be based on the general condition, respiration and circulation, with the help of the Pediatric Assessment Triangle. This tool is a valuable didactic aid when the severity of a pediatric emergency is to be assessed.