Pediatric emergency medicine practice最新文献

Although the incidence of pediatric venous thromboembolism is increasing, it is often overlooked in children due to the overall low incidence. This issue reviews the epidemiology of pediatric venous thromboembolism, including the factors that have led to its increasing prevalence, and discusses the physiology of hemostasis and coagulation. Key features of the history and physical examination, as well as identification of risk factors, are reviewed, as these have the most diagnostic value for venous thromboembolism in pediatric patients. Recommendations are also provided for diagnostic testing and management in the emergency department.

In a 2016 clinical practice guideline, the American Academy of Pediatrics (AAP) created and introduced the term brief resolved unexplained event (BRUE). This guideline defined specific criteria for diagnosis of BRUE and provided a set of guidelines for evaluation of these infants as well as characteristics that indicate a BRUE will have a low risk for a repeat event or a serious underlying disorder. This issue reviews the definition and broad differential diagnosis of a BRUE, highlights the criteria for risk stratification of infants who experience a BRUE, summarizes the management recommendations for patients with a lower-risk BRUE, and examines the available literature that evaluates the impact of the AAP guidelines in the years since its publication.

Adolescent substance use continues to be a prevalent problem and is a cause of morbidity, mortality, and high rates of resource utilization. The variability in presentations of drug intoxication can make accurate identification of the ingested substance, and thus efficient treatment, challenging. This issue provides a review of typical presenting signs, symptoms, and physical examination findings of commonly used drugs. Evidence-based recommendations are offered for a general approach to managing adolescent patients who present with drug intoxication, with specific guidance, when indicated.

Children who have suffered physical abuse may present to the healthcare setting multiple times before a diagnosis is made. Emergency clinicians must be able to recognize sentinel and severe signs of nonaccidental trauma and pursue an appropriate evaluation to prevent further injury. This issue offers evidence-based recommendations for the identification and management of nonaccidental trauma in children. Key historical and physical examination findings that should trigger an evaluation for physical abuse are reviewed. Recommendations are given for obtaining diagnostic studies and consulting with specialists. Guidance is provided for documenting and reporting findings when nonaccidental trauma is suspected.

Mammalian bites in children carry risk for infection, adverse cosmetic outcomes, and emotional distress. Emergency clinicians must carefully assess bite wounds and consider any risk factors for serious infection or other complications in order to make appropriate treatment decisions. This review provides evidence-based recommendations for the evaluation and treatment of mammalian bite wounds in children in the emergency department, including guidelines for empiric antibiotic therapy, wound management, and prophylaxis for infectious disease and bloodborne pathogens. The unique considerations in the management of human bite wounds are also discussed.

Although the cause of macrocephaly is found to be benign in many cases, the large differential diagnosis includes conditions that can be life-threatening. Prompt recognition and timely diagnosis can lead to a better prognosis in many cases. This issue summarizes the available literature on macrocephaly and provides recommendations for the evaluation, diagnosis, and appropriate disposition of children with macrocephaly in the acute setting. Developmental milestones, "red flags," and neurologic examination by age are reviewed to help narrow the differential diagnosis and identify underlying etiologies. Guidance is provided for which imaging studies are indicated, and recommendations are given for which children need transfer or admission.

Asthma is the most common chronic disease of childhood. Although home action plans and the use of maintenance medications have improved daily management and control of asthma, many children still require emergency department care at least once per year. Emergency clinicians must be able to manage patients with acute asthma exacerbations and determine their safe disposition. This issue reviews the current evidence-based emergency department management recommendations for moderate to severe acute asthma in pediatric patients. Timely use of bronchodilators and systemic corticosteroids, as well as adjunct modalities, are discussed. Current challenges in asthma management related to vaping and COVID-19 are also addressed.

Pediatric cardiac arrest presents an infrequent but high-stakes event for emergency clinicians, who need to maintain expertise in this area. Evidence regarding pediatric resuscitations has been accumulating substantially over the past decade and highlights the unique considerations and challenges when resuscitating children. This issue reviews resuscitation principles of children in cardiac arrest while addressing the newest evidence-based and best-practice recommendations by the American Heart Association.

This supplement reviews the evidence and applications for Pediatric NIH Stroke Scale, which quantifies stroke severity using a child-specific version of the National Institutes of Health Stroke Score.

Headache is a common complaint in pediatric patients presenting to the emergency department. Diagnosis of life-threatening pathology can be difficult due to the nonspecific symptoms for many of these conditions. Emergency clinicians must have a high index of suspicion, obtain a detailed history, and conduct a thorough physical examination to accurately identify life-threatening causes of headache. This issue reviews the general approach, differential diagnosis, and initial workup and management of the most common dangerous causes of secondary headaches in pediatric patients.