Pediatric emergency medicine practice
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Pediatr Emerg Med Pract · Nov 2013
ReviewEmergency management of blunt chest trauma in children: an evidence-based approach.
Pediatric trauma is commonly encountered in the emergency department, and trauma to the head, chest, and abdomen may be a source of significant morbidity and mortality. As children have unique thoracic anatomical and physiological properties, they may present with diagnostic challenges that the emergency clinician must be aware of. ⋯ Diagnostic and treatment options for commonly encountered injuries such as pulmonary contusions, rib fractures, and pneumothoraces are examined. Additionally, this review discusses rarely encountered--yet highly lethal--chest wall injuries such as blunt cardiac injuries, commotio cordis, nonaccidental trauma, and aortic injuries.
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Pediatr Emerg Med Pract · Oct 2013
Review Case ReportsPediatric nerve blocks: an evidence-based approach.
Successful injury management is often dependent upon optimal pain control. Many injuries do not require procedural sedation or systemic analgesia, and emergency clinicians have used peripheral nerve blocks for several decades for these injuries. ⋯ Peripheral nerve blocks have a high rate of success for effective local anesthesia and a low rate of complications, making them an attractive option for analgesia in the management of some injuries. This evidence-based review summarizes the advantages and disadvantages of peripheral nerve blocks, reviews commonly used local anesthetics, describes the landmark technique for the most common nerve blocks used in pediatric emergency medicine, and presents literature on ultrasound-guided technology.
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Pediatr Emerg Med Pract · Sep 2013
Review Case ReportsAn evidence-based approach to electrical injuries in children.
Electrical injuries, while uncommon, can be associated with significant morbidity and mortality. In children, the injuries tend to occur in the household; in adolescents, they are most often associated with misguided youthful exploration outside the home. Injuries in adults are primarily occupational and due to workplace accidents. ⋯ High-voltage electrical exposures usually cause severe burns, whereas victims of lightning strikes may have no obvious physical injury but may present in cardiopulmonary arrest. Strategies to prevent electrical injuries have been developed and should be discussed with families and healthcare providers to reduce the incidence of these injuries in children. This review highlights the current literature related to the evaluation and management of children with electrical injuries presenting to the emergency department.
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Headaches are a common complaint among children, with increasing frequency in adolescence. According to the Agency for Healthcare Research and Quality, more than 3 million Americans seek emergency care every year due to headaches, and one-third of them are attributable to migraines. ⋯ This issue reviews the broad differential of primary and secondary headaches in the pediatric emergency department, summarizes effective strategies for diagnosis, and evaluates the current evidence supporting safe, appropriate treatment. As emergency clinicians treat increasingly more medically complex patients, they should be aware of the best current practices to evaluate and treat headaches in the pediatric population.
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Pediatr Emerg Med Pract · Jun 2013
Capnography in the pediatric emergency department: clinical applications
Capnography, often referred to by emergency clinicians as end-tidal carbon dioxide monitoring, is a noninvasive method of measuring cardiopulmonary and metabolic parameters that can be utilized in many clinical applications. Growing evidence in the literature in support of the use of capnography has led to increased clinical use of this modality in many pediatric subspecialties. ⋯ This issue reviews the technology and physiology involved in measuring exhaled carbon dioxide and the interpretation of waveforms, and it highlights uses for capnography in pediatric patients in the emergency department. Uses include confirmation of intubation, maintenance of ventilation in intubated and nonintubated children, monitoring of effectiveness of cardiopulmonary resuscitation, and as an adjunct for monitoring of sedated children and children with lower respiratory disease and metabolic derangements.