Pediatric emergency medicine practice最新文献

Febrile seizures are a common presentation to emergency departments. While established guidelines exist, variation in the management and treatment of febrile seizures persists across emergency departments. This issue reviews the definition of pediatric febrile seizure and discusses the presentation, differential diagnosis, management, and prognosis. Anticipatory guidance for families and disposition considerations are also provided.

Pediatric sexual abuse is a widespread problem impacting children and adolescents across all ages, races, ethnicities, and socioeconomic groups, and it is a topic that emergency clinicians caring for children need to be familiar with. A structured, multidisciplinary approach to the assessment, diagnosis, treatment, and follow-up of these patients is essential. This issue provides a comprehensive review of the current definitions, assessment techniques, diagnostic considerations, and management strategies for children who have experienced sexual abuse.

Traumatic wounds and lacerations are common pediatric presenting complaints to emergency departments. Although there is a large body of literature on wound care, many emergency clinicians base management of wounds on theories and techniques that have been passed down over time. Therefore, controversial, conflicting, and unfounded recommendations are prevalent. This issue reviews evidence-based recommendations for wound care, including wound cleansing and irrigation, anxiolysis/sedation techniques, closure methods, and postrepair wound care.

Children with skin and soft-tissue infections (SSTIs) commonly present to the emergency department, and while most of these infections are mild, some can be severe, with high morbidity and mortality. Emergency clinicians must be able to recognize frequently encountered SSTIs and be prepared to treat them appropriately. This issue reviews the various etiologies and patient presentations of common SSTIs, including purulent, nonpurulent, and necrotizing infections. Findings on the history and physical examination that can differentiate SSTIs from mimics are discussed, and evidence-based recommendations are provided for management.

Juvenile idiopathic arthritis (JIA) is the most common pediatric rheumatic disease. Children may present to the emergency department during the initial presentation of JIA or due to disease-related complications. Differentiating JIA from emergent causes of joint pain, including severe infections and malignancies, can be challenging. This issue reviews the clinical presentation of JIA, provides guidance for differentiating JIA from conditions with similar presentations, and offers recommendations for management of JIA and JIA-related complications in the emergency department.

When children and adolescents present to the emergency department with sports-related injuries, it can be challenging to differentiate apophyseal injuries from other common injuries such as fractures or muscle or ligament injuries. Recognition of apophyseal injuries can help facilitate optimal healing, prevent future injury, and minimize unnecessary testing. This issue reviews the major anatomic areas of apophysitis, presents guidance for activity modification and return precautions, and indications for when it is appropriate to refer patients for specialty care.

Headaches are a common reason for pediatric visits to the emergency department. Emergency clinicians must distinguish between common and dangerous secondary causes of headache and primary headache disorders such as migraine and tension-type headaches. This issue discusses the diagnosis of primary headaches by history and physical examination, the options for first-line treatment of primary headache and for severe or refractory migraines, and procedural interventions that may be considered when other therapies have failed. Guidance is provided for patient and family education regarding triggers, lifestyle modifications, and nutraceutical prophylaxis.

Testicular torsion is a urologic emergency, accounting for up to 15% of cases of acute scrotal pain. Rapid recognition and management are essential to ensure viability of the testis. Doppler ultrasound can be used to confirm the diagnosis of testicular torsion; however, recent studies suggest that a more judicious use of ultrasound may be safe, decrease delays in surgical management, and avoid unnecessary utilization of resources. This issue reviews the epidemiology and historical and physical examination findings of testicular torsion and other common causes of acute scrotal pain. The existing literature is reviewed and recommendations are provided to guide the emergency clinician in appropriate management and disposition of boys with acute scrotal pain.

COVID-19, the disease caused by SARS-CoV-2, has been disruptive worldwide. It was primarily a respiratory disease that affected many of the medically vulnerable, but the true impact of postacute sequelae of SARS-CoV-2 (PASC), which has been demonstrated to involve all organ systems, is now coming to light. In addition, a new disease entity emerged, multisystem inflammatory syndrome in children (MIS-C), which has had significant morbidity and mortality associated with it. This issue reviews the presentation, evaluation, and management of patients with COVID-19, MIS-C, and PASC. Additionally, the current literature supporting public health measures, as well as COVID-19 vaccinations and their complications are discussed.

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. The early management of severe traumatic brain injury is focused on mitigation and prevention of secondary injury, specifically by avoiding hypotension and hypoxia, which have been associated with poorer outcomes. This review discusses methods to maintain adequate oxygenation, maximize management of intracranial hypertension, and optimize blood pressure in the emergency department to improve neurologic outcomes following pediatric severe traumatic brain injury.