Clinical Pediatric Emergency Medicine最新文献

A 52-day-old infant presented to the emergency department with newly discovered fractures of the left arm, including fractures of the distal humerus and distal radius and an ulnar metaphyseal corner fracture. Initial presentation was concerning for nonaccidental trauma. Review of systems and physical examination findings suggested an alternative etiology. Further radiographic studies and laboratory results revealed the ultimate diagnosis.

A female adolescent presented to the emergency department with altered level of consciousness, fever, and hypotension. Initial management was focused on acute resuscitation. Shortly after arrival, the search for the cause of the patient's shock became acutely focused due to the finding of a positive urine pregnancy test result, but the ultimate etiology of her decompensation was not fully determined until days later in the intensive care unit.

A 3-year-old boy presented to the emergency department with a chief complaint of “lethargy” and was found to have ptosis with eventual respiratory failure and need for emergent intubation. There is a broad differential for a patient with respiratory failure, and careful physical examination and history are imperative to reduce morbidity and prevent mortality. After further evaluation and workup, the diagnosis is ultimately revealed.

An 8-month-old presented to a community hospital with respiratory distress, progressive abdominal distension, and emesis in the setting of fever and significant irritability. His illness course eventually progressed to requiring intubation and bedside exploratory laparotomy. He was subsequently diagnosed with abdominal compartment syndrome secondary to methicillin-resistant Staphylococcus aureus sepsis. The differential for abdominal distension in this age group is extensive, and the eventual diagnosis offers valuable teaching points in the management of the sick infant with abdominal distension.

Emergency departments are a primary site for evaluation of pediatric patients presenting with fever. Part of this evaluation may include the collection of blood cultures to rule out infection from a bacterial pathogen. Many of these samples, however, yield results that are not representative of a true bacterial infection, causing undue burden on patients and their families and adding considerable costs for the health care system. Reducing the rate of false-positive blood cultures may be achieved through quality improvement methodology. Strategies for the reduction of blood culture contamination, including process improvement and targeted education, are discussed in this review.

Medication error is the most common medical error and disproportionately affects pediatric patients. Physicians have a responsibility to understand root causes for medication error and common prevention strategies. Further research in this field is imperative to prevent medication errors resulting in adverse patient events. This article uses a case of potential clonidine toxicity that presented to the emergency department to illustrate and review these concepts. Given that clonidine is being prescribed to both pediatric and adult patients for expanding clinical indications, children are at higher risk for potential overdose. Therefore, a brief review of clonidine toxicity and its management is also provided.

The Ann & Robert H. Children's Hospital of Chicago identified dissatisfaction with communication, expectations, and care during evaluation for suspected child abuse, which requires coordination among emergency department (ED) providers, child abuse pediatricians (CAPs), and social workers. The aim of this project was to develop and implement standard care and communication in the evaluation of suspected child abuse. A multi-disciplinary project team was convened and utilized quality improvement methodology to complete a barriers assessment and gap analysis. The project team developed a guideline with clear criteria and decision points. A scripting tool was also designed to standardize communication and increase transparency with families. The ED implemented this guideline for suspected child abuse in December 2018. Employing a quality improvement approach to streamlining communication and care for children presenting to the ED for suspected child abuse was effective for ensuring buy-in from team members.