Pediatric emergency medicine practice最新文献

Imaging is a critical tool for the diagnosis and management of thoracic and abdominal injuries in pediatric patients. The location and mechanism of injury, the physical examination, and other clinical findings should guide emergency clinicians in the selection of the most appropriate imaging modality for the pediatric trauma patient. This supplement reviews the evidence for imaging decisions in the setting of pleural space, lung parenchyma, chest wall, cardiac, diaphragm, solid-organ, and hollow-viscus injuries in pediatric patients. Examples demonstrating imaging modalities, interpretations, and specific findings are provided. Considerations for imaging in suspected nonaccidental abdominal trauma are also discussed.

Ocular injuries are the most common cause of preventable blindness in children. A detailed and systematic evaluation of patients with ocular trauma will reduce morbidity and improve long-term vision outcomes. This issue reviews the critical aspects of the pediatric ocular examination for accurate diagnosis of vision-threatening injuries. It also provides recommendations for immediate emergency department treatment, and indications for urgent versus emergent ophthalmology referral.

Firearm injuries are a leading cause of pediatric mortality in the United States. The frequency of pediatric extremity firearm injuries and the high repeat incidence in high-risk patients make it important for emergency clinicians to understand how to manage these injuries. This issue focuses on the acute management of firearm injuries to the extremities of pediatric patients, drawing from the pediatric literature or extrapolated from adult literature where pediatric evidence is scarce. Current trends, novel management, and controversies are also discussed.

Labor and sex trafficking impact children of all ages, genders, and nationalities. Trafficked patients present to the emergency department for illnesses and injuries both related and unrelated to their trafficking experiences. Emergency clinicians are not meant to be experts in labor and sex trafficking, but they must know enough to be able to identify patients at risk for trafficking and ensure that these patients have the opportunity to be connected to relevant services and support. This issue reviews the ways in which youth are trafficked, the indicators of trafficking, and the evidence-based and best-practice recommendations for addressing suspected or confirmed trafficking in the pediatric and adolescent patient populations.

Drowning and submersion injuries are highly prevalent, yet preventable, causes of pediatric mortality and morbidity. Prehospital care should focus on restoring normal ventilation and circulation as quickly as possible to limit the extent of hypoxic insult. Diagnostic testing for symptomatic patients may include blood glucose level, arterial blood gas level, complete blood count, electrolyte 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 of pediatric drowning victims is provided, and risk factors, caveats in pediatric care, and factors affecting prognosis are also discussed.

A review of the uses and evidence for the Bacterial Meningitis Score, which rules out bacterial meningitis in pediatric patients.

A review of the uses and evidence for the Local Anesthetic Dosing Calculator, which is used to help avoid toxic doses local anesthetics.

Millions of children continue to be at risk for lead exposure despite a dramatic decline over the past 4 decades, and hundreds present annually to emergency departments with lead poisoning. These patients can be challenging to identify due to their nonspecific presentation and frequent lack of known exposure. This issue will prepare the emergency clinician to identify and care for the lead-poisoned patient, focusing on: (1) identifying key historical features, signs, and symptoms at presentation; (2) the medical management of lead poisoning; and (3) formulation of a safe discharge plan.

Specific biomarker levels can help differentiate children who require emergent medical interventions, such as procedures, surgeries, or antibiotics, from those who may not. Appropriate application of biomarkers after a thorough history and physical examination can potentially improve cost-effective management by minimizing unnecessary procedures and tests without sacrificing patient safety. This issue reviews the literature regarding 4 biomarkers: lactate, C-reactive protein, ferritin, and procalcitonin. Evidence-based recommendations are made for the clinical evaluation of bacterial meningitis, common infections, and appendicitis.

A review of the uses and evidence for the Step-by-Step approach, which identifies febrile infants aged ≤90 days who are at low risk of invasive bacterial infections.