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Tue Jan 5 07:57:01 GMT 2010

UK its 16th birthday that you become adult. Those in labour go to obstetrics, however even if under 16.
Nick
On 5 Jan 2010, at 00:40, KMATTOX at aol.com wrote:

> I believe that when women have clear evidence of secondary sex  
> characteristics and have babies, and when men have pubic hair, smoke dope, rob  banks, 
> and sing base in the church choir, and even perhaps have had their Bar or  
> Bat Mitzvah, they do not belong on a kids floor.      Sometimes I wonder if 
> we have not got carried away with hospital "product  lines." and billing 
> objectives.   
> 
> k
> 
> 
> 
> 
> 
> 
> In a message dated 1/4/2010 6:19:05 P.M. Central Standard Time,  
> rfsmithmd at comcast.net writes:
> 
> Wow.  Amazing that by 17 he had already been sentenced to, served his time, 
> and been  released from an adult prison! At what age do you guys start 
> sending kids to  the big house in Texas?
> 
> I'm not sure it benefits anyone to start  deciding which of our patients 
> are "innocent" and which are not "innocent".  I've been proud of the efforts 
> trauma surgeons have made in the field of  violence prevention in order to 
> make it less likely that our special disease  is going to recur after 
> discharge. I thought it was pretty remarkable and  noteworthy that they took a 
> leadership role in this so we might not keep  seeing and treating the same young 
> people over and over again until they  finally showed up dead. 
> 
> Tough work though, and frustrating. And it's  unclear what may do any good. 
> 
> I'm not sure that biological capacity  equals emotional maturity and 
> adulthood. It used to be that Adolescent  Medicine and/or Peds thought that teens 
> had special issues and needs that were  important to address. Simply because 
> some kid has led a really shitty life  doesn't mean that ceases to be true. 
> And I'd like to think that we remain our  patient's advocates, especially 
> in the face of "outsiders" who may want to  demonize anyone who shows up on 
> the trauma service. It used to frost me when  some high capacity Peds centers 
> would consider crafting triage policies so  that they could avoid seeing 
> anyone who was tainted by violence and might  "contaminate" their other nicer 
> patients.
> 
> But perhaps I digress as well  as rant.
> 
> Rob Smith
> 
> 
> On Jan 4, 2010, at 4:09 PM,  kmattox at aol.com wrote:
> 
>> Because of LOW IN-Patient Census many  hospitals are now having a NEW  
>> struggle with this classic  discussion.    At what age does a kid  cease 
> being a 
>> kid and become an adult.     Certainly  physiologic and  anatomic 
> changes do 
>> not coincide with chronological age.    Many hospitals are now pleading 
> that 
>> ALL patients under the age of  18, 20, 21,  and even higher be admitted 
> by 
>> administrative order  to the Pediatric  Floor.   We recently had a 19 
> year old  
>> woman with three children  forced to be admitted to the  Pediatric floor. 
> 
>> We had two  17  year old gang  bangers, one of whom had already been in 
>> prison, and both  shot  in armed robberies forced to be admitted to the 
> pediatric  
>> floor.      
>> 
>> k
>> 
>> 
>> In a  message dated 1/4/2010 3:52:27 P.M. Central Standard Time,  
>> sanjaygupta99_91 at yahoo.com writes:
>> 
>> I agree  with Ian  Seppelt - Kids are not that much different from 
> adults.  
>> I  have  been a pediatric surgeon for 12 years and now an "Adult" surgeon 
> for 
>> 12 years  (I grew up ---like all kids do).  They have  the same 
> physiology 
>> etc,  just take care of the doses - base  them on weight etc, remember 
> that  
>> they have a correspondingly  larger surface area and need to be  better 
> warmed 
>> up than adult  counterparts.
>> 
>> It is much simpler to operate  upon a kid  than most adults and they 
> recover 
>> much faster and can withstand  a  complication or two better than a 
>> multi-morbid adult  can.
>> 
>> Those who  think that children are not just small  adults - keep the 
> legend 
>> going.  
>> Sanjay Gupta 
>> 
>> 
>> (No blackberry or I-phone.Do not care for  one either)  
>> 
>> 
>> 
>> ----- Original Message ----
>> From:  Ian Seppelt  <seppelt at med.usyd.edu.au>
>> To: Trauma-List  [TRAUMA.ORG]  <trauma-list at trauma.org>
>> Sent: Mon, January  4, 2010 12:48:15  AM
>> Subject: Re: kids penetrating trauma
>> 
>> I've had this debate  publicly at a conference against a  paediatric 
>> intensivist [general ICU not  just trauma]. My spin  (and the summary of 
> my side of 
>> this quite enjoyable   debate):
>> 
>> 1. Adults are big kids, and the same principles  should be  followed in 
> big 
>> kids as in little kids (and often  treatment of the big ones  will be 
>> improved if we remember the  dose is not 1 ampoule for all, etc)
>> 2.  Paediatricians have  actually done a dis-service to their patients by 
>> teaching  "kids  are different" because they have created a generation of 
>> doctors  and  nurses who are frightened of treating kids
>> 2. Life is a  continuous process  of degeneration, and there is no magic 
>> time  point where an individual moves  from one state to the next
>> 3.  For the most part kids are easy to treat,  because not much 
> degenerative  
>> disease has happened yet. Just do the right  thing.
>> 4.  Neonates are not small kids, they are a different species
>> 5.  All  the unique "paediatric stuff" (inborn errors of metabolism, 
> major   
>> developmental problems and so forth) are sorted out in the first year  of 
>> life,  either by diagnosis or death [so take a  history]
>> 6. Excluding the survivors  of point 5 above, there is  no difference 
>> between a 3 year old asthmatic and a  30 year old  asthmatic or a broken 
> 5 year old 
>> and a broken 50 year old,  except  the older ones have more degenerative 
>> problems and are  therefore harder to  treat [for example the only reason 
>> paediatric doses of salbutamol are not  given to adult asthmatics is the 
> 
>> underlying coronary disease which complicates  how much  tachycardia is 
> acceptable!!]
>> 
>> Obviously lots of highly   contentious statements but a fun debate to 
> have!
>> 
>> Cheers,  Ian
>> 
>> Ian  Seppelt, Sydney
>> 
>> Joe Nemeth, Mr  wrote:
>>> Thanks to everyone for  responding...not surprised by  the responses.
>>> 
>>> No case prompted  this query but  rather a preface to preparations for 
>> "trauma rounds" which I   have been asked to present at the local kids' 
> hospital 
>> in the next  couple of  weeks. I have my KEVLAR suite picked out  
> already....
>>> 
>>> I have  browsed the lit. on the  topic...with obvious conclusions...
>>> 
>>> Cases being made  for aggressive crystalloids (before blood arrives/OR) 
>> to   maintain a "certain BP" because of the waterfall phenomena and b/c 
> say a  
>> 5  y.o. 15 kg kid with 1.2 liters of juice has only a few  hundred of 
> cc's to 
>> spare before PEA arrest... 
>>> jn
>>> McGill
>>> Montreal
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>> 
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Dr NJD Macartney
ICU Director
Chase Farm Hospital
The Ridgeway
Enfield
EN2 8JL
+4420 8375 1074

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