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Emergency Medicine Clinics of North America

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https://www.readbyqxmd.com/read/29622337/pediatric-emergencies-the-common-and-the-critical
#1
EDITORIAL
Sean M Fox, Dale P Woolridge
No abstract text is available yet for this article.
May 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29622336/pediatric-emergencies
#2
EDITORIAL
Amal Mattu
No abstract text is available yet for this article.
May 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29622335/pediatric-thoracic-trauma-recognition-and-management
#3
REVIEW
Stacy L Reynolds
Thoracic injuries account for less than one-tenth of all pediatric trauma-related injuries but comprise 14% of pediatric trauma-related deaths. Thoracic trauma includes injuries to the lungs, heart, aorta and great vessels, esophagus, tracheobronchial tree, and structures of the chest wall. Children have unique anatomic features that change the patterns of observed injury compared with adults. This review article outlines the clinical presentation, diagnostic testing, and management principles required to successfully manage injured children with thoracic trauma...
May 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29622334/pediatric-major-head-injury-not-a-minor-problem
#4
REVIEW
Aaron N Leetch, Bryan Wilson
Traumatic brain injury is a highly prevalent and devastating cause of morbidity and mortality in children. A rapid, stepwise approach to the traumatized child should proceed, addressing life-threatening problems first. Management focuses on preventing secondary injury from physiologic extremes such as hypoxemia, hypotension, prolonged hyperventilation, temperature extremes, and rapid changes in cerebral blood flow. Initial Glasgow Coma Score, hyperglycemia, and imaging are often prognostic of outcome. Surgically amenable lesions should be evacuated promptly...
May 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29622333/emergency-care-of-pediatric-burns
#5
REVIEW
Ashley M Strobel, Ryan Fey
Although the overall incidence of and mortality rate associated with burn injury have decreased in recent decades, burns remain a significant source of morbidity and mortality in children. Children with major burns require emergent resuscitation. Resuscitation is similar to that for adults, including pain control, airway management, and administration of intravenous fluid. However, in pediatrics, fluid resuscitation is needed for burns greater than or equal to 15% of total body surface area (TBSA) compared with burns greater than or equal to 20% TBSA for adults...
May 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29622332/emergency-department-management-of-pediatric-shock
#6
REVIEW
Jenny Mendelson
Shock, a state of inadequate oxygen delivery to tissues resulting in anaerobic metabolism, lactate accumulation, and end-organ dysfunction, is common in children in emergency department. Shock can be divided into 4 categories: hypovolemic, distributive, cardiogenic, and obstructive. Early recognition of shock can be made with close attention to historical clues, physical examination and vital sign abnormalities. Early and aggressive treatment can prevent or reverse organ dysfunction and improve morbidity and mortality...
May 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29622331/postoperative-tonsillectomy-hemorrhage
#7
REVIEW
Jessica J Wall, Khoon-Yen Tay
Post-tonsillectomy hemorrhage represents a potentially life-threatening condition that occurs in up to 5% of pediatric patients. Minor bleeding often precedes severe hemorrhage. Patients with minor or self-resolving bleeding should be observed in the emergency department or admitted for monitoring. Patients with severe bleeding should be immediately assessed for airway and hemodynamic stability. Management of severe bleeding includes immediate surgical consultation or initiation of the transfer process to a center with surgical capabilities, direct pressure to the site of hemorrhage with or without the additional of a hemostatic agent, possible rapid sequence intubation, and management of hemodynamic instability with volume resuscitation...
May 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29622330/pediatric-ventilator-management-in-the-emergency-department
#8
REVIEW
Garrett S Pacheco, Jenny Mendelson, Mary Gaspers
Pediatric mechanical ventilation is first initiated by emergency physicians when performing active airway management in a critically ill or injured child. When initiating and adjusting mechanical ventilation, the child has unique anatomy and physiology to consider. The EP is the first to respond to ventilator alarm triggers, and the initial medical provider to resuscitate the ventilated pediatric patient who is deteriorating while in the emergency department. This article uses cases to provide a framework to initiate and troubleshoot mechanical ventilation of pediatric patients in the emergency department...
May 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29622329/pediatric-emergency-noninvasive-ventilation
#9
REVIEW
Chad D Viscusi, Garrett S Pacheco
Noninvasive ventilation (NIV) has emerged as a powerful tool for the pediatric emergency management of acute respiratory failure (ARF). This therapy is safe and well tolerated and seems to frequently prevent both the need for invasive mechanical ventilation and the associated risks/complications. Although NIV can be the primary treatment of ARF resulting from multiple respiratory disease states, it must be meticulously monitored and, when unsuccessful, may aid in preoxygenation for prompt endotracheal intubation and invasive mechanical ventilation...
May 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29622328/inborn-errors-of-metabolism-in-the-emergency-department-undiagnosed-and-management-of-the-known
#10
REVIEW
Emily C MacNeill, Chantel P Walker
An inborn error of metabolism should be considered in any neonate who presents to the emergency department in extremis and in any young child who presents with altered mental status and vomiting. In children with unknown diagnoses, it is crucial to draw the appropriate laboratory studies before the institution of therapy, although treatment needs rapid institution to mitigate neurologic damage and avoid worsening metabolic crisis. Although there are hundreds of individual genetic disorders, they are roughly placed into groups that present similarly...
May 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29622327/imaging-gently
#11
REVIEW
Amy L Puchalski, Christyn Magill
Advances in medical imaging are invaluable in the care of pediatric patients in the emergent setting. The diagnostic accuracy offered by studies using ionizing radiation, such as plain radiography, computed tomography, and fluoroscopy, are not without inherent risks. This article reviews the evidence supporting the risk of ionizing radiation from medical imaging as well as discusses clinical scenarios in which clinicians play an important role in supporting the judicious use of imaging studies.
May 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29622326/what-to-do-when-babies-turn-blue-beyond-the-basic-brief-resolved-unexplained-event
#12
REVIEW
Anna McFarlin
The term "brief resolved unexplained event" was created to replace "apparent life-threatening event," narrowing the definition and providing evidence-based guidelines for management. The emphasis is placed on using clinical clues to classify patients as low risk or exclude them from the categorization altogether. Infants who meet low-risk classification can be briefly observed in the emergency department and be discharged home. Infants who demonstrate elements suggestive of a specific etiology should be evaluated and treated accordingly...
May 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29622325/pediatric-pain-management
#13
REVIEW
Aarti Gaglani, Toni Gross
Nearly 20 years ago, standards were established for hospitals to assess and treat pain in all patients. Research continues to demonstrate evolving trends in the measurement and effective treatment of pain in children. Behavioral research demonstrating long-lasting effects of inadequate pain control during childhood supports the concepts of early and adequate pain control for children suffering from painful conditions in the acute care setting. The authors discuss pain concepts, highlighting factors specific to the emergency department, and include a review of evidence for pharmacologic and nonpharmacologic treatments...
May 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29622324/pediatric-syncope-high-risk-conditions-and-reasonable-approach
#14
REVIEW
Paul C Schunk, Tim Ruttan
Syncope is a common presentation to the emergency room. Unlike in the adult population, most pediatric syncope has non-life-threatening causes, and minimal evaluation in the emergency department is appropriate with parental reassurance. Despite this benign prognosis, care must be made to find uncommon and potentially fatal causes. The primary purpose of evaluation of the patient with syncope is to determine whether the patient is at increased risk for death and needs either admission to the hospital or an expedited outpatient evaluation...
May 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29622323/pediatric-minor-head-injury-2-0-moving-from-injury-exclusion-to-risk-stratification
#15
REVIEW
James Jim L Homme
Visits for pediatric minor blunt head trauma continue to increase. Variability exists in clinician evaluation and management of this generally low-risk population. Clinical decision rules identify very low-risk children who can forgo neuroimaging. Observation before imaging decreases neuroimaging rates. Outcome data can be used to risk stratify children into more discrete categories. Decision aids improves knowledge and accuracy of risk perception and facilitates identification of caregiver preferences, allowing for shared decision making...
May 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29622322/bronchiolitis-from-practice-guideline-to-clinical-practice
#16
REVIEW
Maybelle Kou, Vivian Hwang, Nadira Ramkellawan
The American Academy of Pediatrics' clinical practice guideline in bronchiolitis was last updated in 2014 with recommendations to improve care for pediatric patients with bronchiolitis. As most treatments of bronchiolitis are supportive, the guideline minimizes the breadth of treatments previously used and cautions the use of tests and therapies that have a limited evidence base. Emergency physicians must be familiar with the guidelines in order to apply best practices appropriately.
May 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29622321/evaluation-and-management-of-dehydration-in-children
#17
REVIEW
Genevieve Santillanes, Emily Rose
The article discusses the evaluation of dehydration in children and reviews the literature on physical findings of dehydration. Pediatric dehydration is a common problem in emergency departments and wide practice variation in treatment exists. Dehydration can be treated with oral, nasogastric, subcutaneous, or intravenous fluids. Although oral rehydration is underutilized in the United States, most children with dehydration can be successfully rehydrated via the oral route. Selection of oral rehydration solution and techniques for successful oral rehydration are presented...
May 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29132585/seismology-and-advances-in-trauma-resuscitation
#18
EDITORIAL
Christopher Hicks, Andrew Petrosoniak
No abstract text is available yet for this article.
February 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29132584/damage-control-advances-in-trauma-resuscitation
#19
EDITORIAL
Amal Mattu
No abstract text is available yet for this article.
February 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29132583/the-evolving-science-of-trauma-resuscitation
#20
REVIEW
Tim Harris, Ross Davenport, Matthew Mak, Karim Brohi
This review summarizes the evolution of trauma resuscitation from a one-size-fits-all approach to one tailored to patient physiology. The most dramatic change is in the management of actively bleeding patients, with a balanced blood product-based resuscitation approach (avoiding crystalloids) and surgery focused on hemorrhage control, not definitive care. When hemostasis has been achieved, definitive resuscitation to restore organ perfusion is initiated. This approach is associated with decreased mortality, reduced duration of stay, improved coagulation profile, and reduced crystalloid/vasopressor use...
February 2018: Emergency Medicine Clinics of North America
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