Pediatric emergency medicine practice最新文献

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.

Back pain in the pediatric population remains an unusual and concerning complaint that may be an indicator of serious underlying pathology. This issue reviews rare but dangerous etiologies of pediatric back pain and highlights signs and symptoms that may raise a red flag for potentially dangerous etiologies of back pain among children and teens. The evaluation of these patients, including judicious and effective imaging recommendations, is also discussed. A data-driven algorithm for evaluating patients can save the majority of patients from the expense and anxiety of unnecessary testing while effectively identifying the most appropriate means (and locations) for working up pathologic pediatric back pain.

Pediatric ankle and foot injuries are common complaints in the emergency department, and proper identification and management of these injuries is critical for uninterrupted limb development. This issue reviews the presentation, systematic evaluation, and management of common pediatric orthopedic injuries of the ankle and foot. Recommendations are given for the disposition of pediatric patients with ankle and foot injuries, with a focus on which patients need immediate orthopedic evaluation and which patients can be discharged home with appropriate follow-up.

Early recognition and treatment of electrolyte abnormalities protect the patient from derangements in the renal, myocardiac, and central nervous systems. Correction of electrolyte derangements decreases both morbidity and mortality. This issue reviews sodium, potassium, calcium, magnesium, and phosphorus abnormalities and provides a systematic approach to the evaluation and management of the ill child with an electrolyte emergency.

Untreated pain in childhood may have ramifications well into adulthood. Opioid medications have an important role in care for moderate to severe pain that cannot be relieved by first-line interventions, but clinicians must approach opioid use in the emergency department in an evidence-based, socially responsible manner. This issue reviews evidence-based approaches to with a focus on optimizing nonopioid pain management as a first approach and using opioid medications safely, when appropriate. Recommendations are provided for safer opioid prescribing, including assessment of risk factors for opioid misuse, careful family counseling and education, and suggested prescribing limits. Prescription and use of naloxone in the emergency department and as take-home kits are also discussed.

The differential diagnosis for pediatric patients presenting to the emergency department with movement-based neurological complaints is wide. Clinicians must ensure these children receive an appropriate evaluation to recognize rare diseases. Early recognition of these diagnoses helps facilitate coordination with specialists, guides imaging, and ensures proper management and disposition. This issue reviews 3 less-common movement disorders: acute cerebellar ataxia, anti-N-methyl-D-aspartate receptor encephalitis, and acute disseminated encephalomyelitis. The common presentations, evaluation, and management of these conditions in the emergency department are discussed.

Sepsis is a leading cause of morbidity and mortality in children. Early recognition and timely initiation of empiric broadspectrum antibiotics and crystalloid fluid administration have been associated with better outcomes. Although evidence for diagnosis and treatment of septic shock was first generated in adult studies, it is clear that pediatric studies are needed for management of septic shock in children. This issue provides guidance for managing septic shock in children, with a focus on early recognition and appropriate resuscitation.

The advent of pneumococcal and Haemophilus influenzae vaccines has substantially reduced the risk for occult (unsuspected) serious bacterial infection or invasive bacterial infection in the febrile child. The challenge for emergency clinicians is to identify and treat children with serious illness while avoiding overtreatment. This issue reviews the epidemiology and management of fever in children aged 3 to 36 months, focusing primarily on previously healthy, well-appearing children without a source of fever whose evaluation and management are more ambiguous.