Emergency medicine clinics of North America
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The role of the emergency physician in optimizing outcome for the maternal and fetal victims of trauma is pivotal. Knowledge of the anatomic and physiologic changes of pregnancy aid in understanding the nuances of care of the pregnant trauma patient. Both catastrophic and noncatastrophic trauma can be managed with confidence and expertise by recalling the maternal and fetal pathophysiologic responses to trauma. Burns and electrical injuries carry significant fetal risks, which may be minimized by rapid and knowledgeable emergency care.
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Emerg. Med. Clin. North Am. · Aug 1991
ReviewAn approach to pediatric trauma. Unique anatomic and pathophysiologic aspects of the pediatric patient.
Effective evaluation and management of the pediatric trauma patient is based on knowledge of the unique anatomic and pathophysiologic differences in children. An understanding of these differences along with the trauma resuscitation guidelines established by the American College of Surgeons will allow the trauma team to provide systematic and comprehensive resuscitation of the child with multiple injuries. Continued research in the field of pediatric trauma resuscitation and the ongoing efforts of the National Pediatric Trauma Registry will continue to advance our understanding and management of injured children.
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Accurate patient triage to provide early identification of potentially seriously ill or high-risk infants and children is an important part of any emergency care system. Use of the SAVE-A-CHILD mnemonic in a busy ED setting provides systematic organization of important clinical observations that may serve as markers of serious disease. Early recognition of the high-risk patient will reduce morbidity and mortality. The discussion included may be helpful to emergency physicians in training their staff to provide a safe triage environment.
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Emerg. Med. Clin. North Am. · Aug 1991
ReviewRapid sequence anesthesia induction and advanced airway management in pediatric patients.
A rapid controlled induction of anesthesia is useful to facilitate emergency intubation and to reduce the complications of intubation in pediatric patients. A protocol for rapid sequence intubation and suggestions for optimizing airway management in the Emergency Department are described. The use of end tidal carbon dioxide monitoring and pulse oximetry are strongly advocated to monitor all intubations in the Emergency Department.
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Depressed patients and suicidal patients are common Emergency Department patrons with the potential for serious morbidity or death. Dysphoric mood, vegetative symptoms, and negative perceptions of oneself, the environment, and the future are characteristic of depression. Often, the patient is unaware of the depression and presents with a variety of somatic complaints, chronic fatigue, or pain syndromes. ⋯ Consultation with a psychiatrist or another mental health professional is desirable for any potentially suicidal patient. Many such patients can be safely treated as outpatients with proper referral; certain high-risk individuals will need to be admitted to the hospital. The decision to either hospitalize or discharge can be difficult and the emergency physician should admit the patient if doubt exists.