Pediatric emergency medicine practice
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Pediatr Emerg Med Pract · May 2015
Review Case ReportsOptimizing emergency management to reduce morbidity and mortality in pediatric burn patients.
Burns in patients aged < 14 years are consistently among the top causes of injury-induced mortality in pediatric patients. Pediatric burn victims with large body surface area involvement have a multisystem physiologic response that differs from that of adult patients. The spectrum of management is vast and relies heavily on both the classification of the burn and the anatomy involved. ⋯ Additional goals include decreasing the risk of infection along with improving healing and cosmetic outcomes. Discharge care and appropriate follow-up instructions need to be carefully constructed in order to avoid long-standing complications. This article reviews methods for accurate classification and management of the full range of burns seen in pediatric patients.
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Pediatr Emerg Med Pract · Apr 2015
ReviewSeptic shock: recognizing and managing this life-threatening condition in pediatric patients.
Septic shock is a relatively rare but life-threatening condition in pediatric patients that can often be difficult to recognize in the emergency department. Once recognized, the emphasis of therapy is to reverse deficits in cellular respiration by increasing oxygen and other substrate delivery to tissue beds. ⋯ Goal-directed therapy is relatively straightforward, emphasizes the need for effective surveillance and timely recognition of this disease process, and has the potential to significantly reduce morbidity and mortality. This review discusses how to identify specific populations at the greatest risk for septic shock, lays out the essential components of goal-directed therapy, examines potential pitfalls in management, and distinguishes additional ways that emergency clinicians can avoid the devastating consequences of septic shock in pediatric patients.
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Pediatr Emerg Med Pract · Nov 2014
ReviewEvidence-based management of neonatal vomiting in the emergency department.
Vomiting accounts for up to 36% of neonatal visits to the emergency department. The causes of vomiting can range from benign to life-threatening. ⋯ A thorough review is presented, discussing various imaging modalities, including plain abdominal radiography, upper gastrointestinal studies, ultrasonography, and contrast enema. A systematic approach in the emergency department, as outlined in this review, is required to identify the serious causes of vomiting in the neonate.
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Drowning and submersion injuries are highly prevalent, yet preventable, causes of childhood mortality and morbidity. Although much of the resuscitation of the drowning pediatric victim is basic to all respiratory and cardiac arrest situations, there are some caveats for treatment of this type of injury. Risk factors for drowning victims include epilepsy, underlying cardiac dysrhythmias, hyperventilation, hypoglycemia, hypothermia, and alcohol and illicit drug use. ⋯ Diagnostic testing for symptomatic patients may include blood glucose level, arterial blood gas level, complete blood count, electrolytes levels, chest radiography, and cardiorespiratory monitoring with pulse oximetry and a rhythm strip. In this review, passive external, active external, and active internal rewarming techniques for treatment of hypothermic patients are discussed. A systematic approach to treatment and disposition or admission of pediatric drowning victims is also included, with extensive clinical pathways for quick reference.
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There are approximately 25 million emergency department visits by children each year in the United States. It can be challenging for healthcare providers to maintain the readiness of emergency departments in terms of equipment availability, policies and procedures for the care of children, and quality improvement for pediatric patients. ⋯ In the framework of the current healthcare system that is wrought with overcrowding, underfunding, and highly variable pediatric capabilities, children are arguably at the greatest risk for medical error. This issue reviews the current state of pediatric readiness in emergency departments, the necessary steps to ensure day-to-day readiness, the published guidelines for pediatric readiness, and systems-based innovations in pediatric readiness.