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Pediatric Emergency Medicine Practice

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https://www.readbyqxmd.com/read/28362251/syncope-in-pediatric-patients-a-practical-approach-to-differential-diagnosis-and-management-in-the-emergency-department
#1
Collen Fant, Arl Cohen
Syncope is a condition that is often seen in the emergency department. Most syncope is benign, but it can be a symptom of a life-threatening condition. While syncope often requires an extensive workup in adults, in the pediatric population, critical questioning and simple, noninvasive testing is usually sufficient to exclude significant or life-threatening causes. For low-risk patients, resource-intensive workups are rarely diagnostic, and add significant cost to medical care. This issue will highlight critical diseases that cause syncope, identify high-risk "red flags," and enable the emergency clinician to develop a cost-effective, minimally invasive algorithm for the diagnosis and treatment of pediatric syncope...
April 2017: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/28252382/pneumothorax-in-pediatric-patients-management-strategies-to-improve-patient-outcomes
#2
Matthew Harris, Joshua Rocker
The clinical presentation of pneumothorax is highly variable. Spontaneous pneumothoraces may present with subtle symptoms when a small air leak is present, but can progress to hemodynamic instability in the setting of tension physiology. The etiologies are broad and the severity can vary greatly. A trauma patient with a pneumothorax may also have the added complexity of other potentially life-threatening injuries. While there is a wealth of evidence-based guidelines for the management of pneumothoraces in the adult literature, the approach to pediatric patients is largely extrapolated from that literature without a significant evidence base...
March 2017: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/28027458/altered-level-of-consciousness-evidence-based-management-in-the-emergency-department
#3
REVIEW
Joo Lee Song, Vincent J Wang
A child who presents to the emergency department with an altered level of consciousness can be clinically unstable and can pose a great diagnostic challenge. The emergency clinician must quickly develop a wide differential of possible etiologies in order to administer potentially life-saving medications or interventions. The history, physical examination, and appropriate diagnostic tests can aid greatly in rapidly narrowing the differential diagnosis. Once initial stabilization, workup, and first-line interventions are completed, most patients who present with unresolved or unidentified altered level of consciousness should be admitted for further evaluation and close monitoring...
January 2017: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/27893360/vaccine-preventable-diseases-in-pediatric-patients-a-review-of-measles-mumps-rubella-and-varicella
#4
REVIEW
Deborah A Levine
Vaccine-preventable diseases such as measles, mumps, rubella, and varicella continue to plague children and adults worldwide. Although public health programs have helped decrease the prevalence and sequelae of these diseases, outbreaks still occur. To limit the spread of these diseases, emergency clinicians must be able to readily identify the characteristic presentations of the rashes associated with measles, rubella, and varicella, as well as the common presenting features associated with mumps. Diagnostic laboratory studies are not usually necessary, as a complete history and physical examination usually lead to an accurate diagnosis...
December 2016: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/27775898/managing-acute-complications-of-sickle-cell-disease-in-pediatric-patients
#5
REVIEW
Sathyaseelan Subramaniam, Jennifer H Chao
Sickle cell disease is a chronic hematologic disease with a variety of acute, and often recurring, complications. Vaso-occlusive crisis, a unique but common presentation in sickle cell disease, can be challenging to manage. Acute chest syndrome is the leading cause of death in patients with sickle cell disease, occurring in more than half of patients who are hospitalized with a vaso-occlusive crisis. Uncommon diagnoses in children, such as stroke, priapism, and transient red cell aplasia, occur more frequently in patients with sickle cell disease and necessitate a degree of familiarity with the disease process and its management...
November 2016: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/27668985/severe-traumatic-brain-injury-in-children-an-evidence-based-review-of-emergency-department-management
#6
REVIEW
Kirsten Morrissey, Hilary Fairbrother
More than 1.7 million traumatic brain injuries occur in adults and children each year in the United States, with approximately 30% occurring in children aged < 14 years. Traumatic brain injury is a significant cause of morbidity and mortality in pediatric trauma patients. Early identification and management of severe traumatic brain injury is crucial in decreasing the risk of secondary brain injury and optimizing outcome. The main focus for early management of severe traumatic brain injury is to mitigate and prevent secondary injury, specifically by avoiding hypotension and hypoxia, which have been associated with poorer outcomes...
October 2016: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/27547917/carbon-monoxide-poisoning-in-children-diagnosis-and-management-in-the-emergency-department
#7
REVIEW
Theodore E Macnow, Mark L Waltzman
Approximately 5000 children present to the emergency department annually with unintentional carbon monoxide poisoning. Children may be more vulnerable to carbon monoxide poisoning because of their increased metabolic demand and their inability to vocalize symptoms or recognize a dangerous exposure, and newborn infants are more vulnerable to carbon monoxide poisoning because of the persistence of fetal hemoglobin. Mild carbon monoxide poisoning may present as viral symptoms in the absence of fever. While headache, nausea, and vomiting are the most common presenting symptoms in children, the most common symptom in infants is consciousness disturbance...
September 2016: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/27462838/acute-rheumatic-fever-an-evidence-based-approach-to-diagnosis-and-initial-management
#8
REVIEW
Kajal Khanna, Deborah R Liu
Acute rheumatic fever is an inflammatory reaction involving the joints, heart, and nervous system that occurs after a group A streptococcal infection. It typically presents as a febrile illness with clinical manifestations that could include arthritis, carditis, skin lesions, or abnormal movements. Of these, the cardiac manifestations of acute rheumatic fever are most concerning, as children may present in acute heart failure and may go on to develop valvular insufficiency or stenosis. Because this is a rare presentation to emergency departments in developed countries, it is crucial for clinicians to keep a broad differential when presented with clinical presentations suspicious for acute rheumatic fever...
August 2016: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/27328168/ebola-virus-disease-epidemiology-clinical-presentation-and-diagnostic-and-therapeutic-modalities
#9
Marlie Dulaurier, Katherine Moyer, Rebecca Wallihan
Ebola virus disease (EVD) is a severe multisystem disease. Prehospital personnel, hospitals, and clinicians must be prepared to provide care for patients with EVD, with special attention to rigorous infection control in order to limit the spread of infection. Children with EVD are an especially challenging population, as the initial symptoms are nonspecific and difficult to differentiate from several common infections. For children presenting with a syndrome consistent with EVD, it is extremely important that healthcare workers identify epidemiologic risk factors, such as recent travel to an affected country or exposure to a patient with suspected or known EVD...
July 2016: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/27232771/procedural-ultrasound-in-pediatric-patients-techniques-and-tips-for-accuracy-and-safety
#10
REVIEW
Sophia Lin
Point-of-care ultrasound is becoming more prevalent in pediatric emergency departments as a critical adjunct to both diagnosis and procedure guidance. It is cost-effective, safe for unstable patients, and easily repeatable as a patient's clinical status changes. Point-of-care ultrasound does not expose the patient to ionizing radiation and may care ultrasound in pediatric emergency medicine is relatively new, the body of literature evaluating its utility is small, but growing. Data from adult emergency medicine, radiology, critical care, and anesthesia evaluating the utility of ultrasound guidance must be extrapolated to pediatric emergency medicine...
June 2016: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/27096879/congenital-heart-disease-in-pediatric-patients-recognizing-the-undiagnosed-and-managing-complications-in-the-emergency-department
#11
REVIEW
Pavan Judge, Garth Meckler Mshs
Congenital heart disease is the most common form of all congenital malformations and, despite advances in prenatal and newborn screening, it may present undiagnosed to the emergency department. Signs and symptoms of congenital heart disease are variable and often nonspecific, making recognition and treatment challenging. Patient presentations can range from life-threatening shock or cyanosis in a neonate to respiratory distress or failure to thrive in infants. Advances in surgical techniques have improved short- and long-term survival of infants and children with congenital heart disease, but these children are at risk for a variety of complications related to the underlying or surgical anatomy and physiology...
May 2016: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/27104813/pediatric-ingestions-emergency-department-management
#12
REVIEW
Stacy M Tarango Md, Deborah R Liu Md
Pediatric ingestions present a common challenge for emergency clinicians. Each year, more than 50,000 children aged less than 5 years present to emergency departments with concern for unintentional medication exposure, and nearly half of all calls to poison centers are for children aged less than 6 years. Ingestion of magnetic objects and button batteries has also become an increasing source of morbidity and mortality. Although fatal pediatric ingestions are rare, the prescription medications most responsible for injury and fatality in children include opioids, sedative/hypnotics, and cardiovascular drugs...
April 2016: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/26894868/cervical-spinal-injury-in-pediatric-blunt-trauma-patients-management-in-the-emergency-department
#13
Andrew Dixon
Spinal injuries from blunt trauma are uncommon in pediatric patients, representing only about 1.5% of all blunt trauma patients. However, the potentially fatal consequences of spinal injuries make them of great concern to emergency clinicians. Clinical goals in the emergency department are to identify all injuries using selective imaging and to minimize further harm from spinal cord injury. Achieving these goals requires an understanding of the age-related physiologic differences that affect patterns of injury and radiologic interpretation in children, as well as an appreciation of high-risk clinical clues and mechanisms...
March 2016: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/26794147/ventriculoperitoneal-shunt-complications-in-children-an-evidence-based-approach-to-emergency-department-management
#14
REVIEW
Jacqueline Bober, Jonathan Rochlin, Shashidhar Marneni
Although much is known about ventriculoperitoneal shunts, there are still large gaps in the literature and no evidence-based guidelines on management. To date, there is no general consensus on workup and treatment, and there are many differing diagnostic and therapeutic strategies for management of complications. Ventriculoperitoneal shunt complications can be separated into 3 categories: mechanical failure, infection, and functional failure. Knowing the basic anatomy of ventriculoperitoneal shunts, the time of shunt placement, and the clinical manifestations suggestive of potential complications can help with the management of patients with ventriculoperitoneal shunts...
February 2016: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/27125015/diagnostic-emergency-ultrasound-assessment-techniques-in-the-pediatric-patient
#15
REVIEW
Joshua Guttman, Bret P Nelson
Emergency ultrasound is performed at the point of care to answer focused clinical questions in a rapid manner. Over the last 20 years, the use of this technique has grown rapidly, and it has become a core requirement in many emergency medicine residencies and in some pediatric emergency medicine fellowships. The use of emergency ultrasound in the pediatric setting is increasing due to the lack of ionizing radiation with these studies, as compared to computed tomography. Utilizing diagnostic ultrasound in the emergency department can allow clinicians to arrive at a diagnosis at the bedside rather than sending the patient out of the department for another study...
January 2016: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/26682501/diagnostic-emergency-ultrasound-assessment-techniques-in-the-pediatric-patient
#16
Joshua Guttman, Bret P Nelson
Emergency ultrasound is performed at the point of care to answer focused clinical questions in a rapid manner. Over the last 20 years, the use of this technique has grown rapidly, and it has become a core requirement in many emergency medicine residencies and in some pediatric emergency medicine fellowships. The use of emergency ultrasound in the pediatric setting is increasing due to the lack of ionizing radiation with these studies, as compared to computed tomography. Utilizing diagnostic ultrasound in the emergency department can allow clinicians to arrive at a diagnosis at the bedside rather than sending the patient out of the department for another study...
January 2016: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/26569627/management-of-fever-and-suspected-infection-in-pediatric-patients-with-central-venous-catheters
#17
REVIEW
Courtney Brennan, Vincent J Wang
The use of indwelling central venous catheters is essential for pediatric patients who require hemodialysis, parenteral nutrition, chemotherapy, or other medications. Fever is a common chief complaint in the emergency department, and fever in a patient with a central venous catheter may be related to a common cause of fever, or it may be due to a catheter-associated bloodstream infection. Catheter-associated bloodstream infections may also lead to additional complications such as sepsis, septic shock, or septic complications including suppurative thrombophlebitis, endocarditis, osteomyelitis, septic emboli, and abscesses...
December 2015: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/26488231/pediatric-chest-tubes-and-pigtails-an-evidence-based-approach-to-the-management-of-pleural-space-diseases
#18
REVIEW
Jonathan Strutt, Anupam Kharbanda
Pediatric thoracostomy procedures are used in the emergency department to treat diseases of the pleural space. As children have unique thoracic anatomy and physiology, they may present with management challenges that the emergency clinician must consider. This issue reviews the use of chest tubes and pigtail catheters in pediatric patients, techniques and indications for placement, and possible complications. Diagnostic and treatment options for diseases of the pleural space, such as spontaneous pneumothorax, traumatic injury, and parapneumonic effusions/empyema, are examined...
November 2015: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/26510331/inhaled-foreign-bodies-in-pediatric-patients-proven-management-techniques-in-the-emergency-department
#19
REVIEW
Megan Maraynes, Konstantinos Agoritsas
Foreign body inhalation affects thousands of children every year, and it remains a significant cause of morbidity and mortality in children. Inhaled organic or inorganic foreign bodies can become lodged in the posterior nasopharynx, larynx, trachea, or bronchi. Presentation of foreign body inhalation can range from nonspecific respiratory symptoms to respiratory failure associated with a choking episode. In this issue, an in-depth review of the etiology, pathophysiology, diagnosis, and treatment of inhaled foreign bodies is presented...
October 2015: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/26284379/hemophilia-and-von-willebrand-disease-in-children-emergency-department-evaluation-and-management
#20
REVIEW
Kevin R Schwartz, Max Rubinstein
Hemophilia and von Willebrand disease are the most common inherited bleeding disorders encountered in the emergency department. Evidence suggests that the management of bleeding disorders in the emergency department is currently suboptimal, and literature to guide evaluation and management in this setting is limited, though some guidelines do exist. The emergency clinician must have a high index of suspicion for new diagnoses, particularly in young patients with unprovoked bleeding and children with multiple or severe bleeds...
September 2015: Pediatric Emergency Medicine Practice
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