Pediatric emergency medicine practice最新文献

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.

Pediatric chest pain is a relatively common presenting complaint, but identifying serious pathologies without overtesting patients with less-serious pathologies can be a challenge for emergency clinicians. This issue reviews the available literature to provide evidence-based recommendations to support a more standardized approach to the evaluation and management of pediatric patients with chest pain. This issue will help the emergency clinician identify red flags associated with cardiac causes of pediatric chest pain, recognize life-threatening causes of cardiac and non- cardiac chest pain, clinically diagnose the most common causes of non-cardiac chest pain, and appropriately utilize diagnostic tests in the evaluation of chest pain patients.

A review of the uses and evidence for the Hour-specific Risk for Neonatal Hyperbilirubinemia tool, which predicts risk of hyperbilirubinemia in neonates.

Hyperbilirubinemia is one the most common reasons for emergency department visits for the neonate. Most cases of unconjugated hyperbilirubinemia are benign. Although rare, unrecognized or untreated pathologic unconjugated hyperbilirubinemia can lead to the development of acute bilirubin encephalopathy and, ultimately, kernicterus. This issue reviews the emergency department evaluation and management of neonatal hyperbilirubinemia and discusses how to recognize acute bilirubin encephalopathy, with the goal of preventing kernicterus. Recommendations are provided for risk stratification and determining the need for phototherapy or exchange transfusion, using nomograms to plot total serum bilirubin levels and taking into consideration hyperbilirubinemia and neurotoxicity risk factors.

Electrical injuries in pediatric patients are uncommon but can be life-threatening and require efficient and effective identification and management. Injury severity is based on the characteristics of the electricity, the duration of contact with the electrical source, and the current's pathway through the body. This issue discusses the specific threats posed by high-voltage, low-voltage, and lightning injuries. The various presentations are described, including burns, arrhythmias, respiratory arrest, cardiac arrest, blunt trauma from falls or blast events, rhabdomyolysis, tympanic membrane rupture, and altered mental status, among others. The most current literature is reviewed, and an evidence-based approach is provided for the diagnosis and management of electrical injuries in pediatric patients presenting to the emergency department.

Global travel has made travel-associated infectious diseases (TAIDs) a more frequent consideration in the pediatric emergency department. Studies show that physicians may either omit a travel history or, even with a positive travel history, do not consider potentially serious illnesses, such as dengue and malaria. A thorough travel history including the purpose, location, activities, diet, and exposures can help the emergency clinician develop and narrow the differential diagnosis. This issue reviews the epidemiology, clinical presentation, diagnosis, and management of various TAIDs, with the goal of early recognition and disease-specific treatment.

Transplant patients are at risk for illnesses and complications days, months, or years after transplantation, and they can present complex challenges for emergency clinicians. This review discusses the general approach to the management of pediatric transplant patients in the emergency department, with a focus on general complications and organ-specific complications after solid organ transplantation. Hematopoietic stem cell transplantation and its common complications will also be discussed. A key step in the management of all transplant patients includes consultation with the patient's transplant team to ensure appropriate testing, treatment, and disposition for these patients.

The majority of bites and stings from terrestrial animals are not dangerous. However, due to their smaller size, children may be more susceptible to the effects of venom, and they may experience more-severe envenomation effects than adults. This issue reviews the basic epidemiology and underlying pathophysiology of the bites and stings of spiders, bees and wasps, fire ants, scorpions, snakes, and lizards. Clinical presentations are reviewed, and evidence-based recommendations are provided for management of the envenomated patient. While the pathophysiology and much of the presentation and treatment are similar for both children and adults, there can be subtle differences, which will be highlighted in this review.

Trauma is the leading cause of death in the pediatric population and is among the most common reasons for ED visits by children. Imaging is an important tool for the diagnosis and management of pediatric trauma, but there are risks associated with exposure to ionizing radiation. In pediatric head and neck injuries, clinical findings and clinical decision tools can help inform selection of the most appropriate imaging modalities for the trauma patient, while also reducing unnecessary radiation exposure. This supplement reviews evidence-based recommendations for imaging decisions and interpretations in skull fractures, traumatic brain injuries, abusive head trauma, cervical spine injuries, and facial bone fractures. Examples demonstrating imaging modalities and specific findings for the types of injuries are also provided.

A review of the uses and evidence for the Shock Index, Pediatric Age-Adjusted (SIPA), which predicts mortality in children with blunt trauma.