In 1818, James Blundell performed the first successful human blood transfusion in a woman with postpartum hemorrhage. Nearly 200 years later, about 15 million red blood cell (RBC) units are transfused annually in the United States. Many of these transfusions occur in the intensive care unit (ICU), where up to 30-50% of patients are transfused. Despite the frequency of RBC transfusions, there is little evidence that transfusions benefit patients.
This is a two-part article on the treatment of massive hemorrhage, which is something that can be seen in any emergency department, small or large, rural or urban. There have been recent changes in the use of blood and adjuvant therapies, in part from our military advances. These articles will review the current recommendations for massive transfusion. Part II of the article will review adjunct therapies, scoring systems, and complications of massive transfusion.
Urinary tract infections (UTIs) are a potential cause of fever in the pediatric patient. Early testing and a timely diagnosis are critical to avert complications and potential scarring of the kidneys. Complication rates in children younger than 90 days of age are 7% and include bacteremia, meningitis, and urosepsis, although a well-appearing infant with a CRP of < 4 mg/dL is significantly less likely to develop complications. The authors present a concise review of the current status of the diagnosis and management of pediatric UTIs.
