Clinical Pediatric Emergency Medicine最新文献

Surgical disease has gained increased attention in recent years as contributing to the substantial global burden of disease. Congenital anomalies and surgically correctable ailments of newborns, such as those affecting the chest and abdomen, often require initial intervention with potential for long-term, disease-free survival. The true prevalence of these conditions, however, and the available resources for their management in low- and middle-income countries are unclear. This chapter provides an overview of congenital abdominal anomalies within the context of low- and middle-income countries, and a practical guide to recognition and initial management of those who present for care.

Significant progress has been made in reducing global child mortality rates over the past 2 decades, with the improvements in survival primarily occurring among children between 1 month and 5 years of age. As a result, neonatal mortality now accounts for almost half of all deaths in children less than 5 years of age. Helping Babies Breathe is a neonatal resuscitation program developed by the American Academy of Pediatrics for use in low-resource settings and aims to teach basic resuscitation skills to providers who are present at deliveries. Using a train-the-trainer curricular model and low-cost simulator and equipment, Helping Babies Breathe has been implemented in more than 80 countries to train 500 000 providers and has resulted in a marked decline in early neonatal deaths and fresh stillbirths. Ongoing research is being done to optimize strategies to maintain resuscitation skills and knowledge over time, as well as to develop additional methods to improve neonatal resuscitation in low-resource settings, with hopes of achieving the United Nations Sustainable Development Goals for neonatal mortality rates by 2030 worldwide.

Healthcare providers are critical to disaster response throughout the world. Increasingly, there are government and nongovernment sponsored opportunities for providers to participate in disaster response as members of disaster response teams. Training regarding principles and practices of disaster response should begin long before ever deploying for a disaster. Training opportunities on-line and in-person are readily available, but not usually for a specific disaster at the time it occurs. Just-in-time disaster specific training prepares providers for imminent deployment for a real-time disaster. Particularly for disaster response in an austere environment, just-in-time disaster specific training optimizes preparation and response. This manuscript offers topics, strategies, and modalities for just-in-time pediatric-focused disaster training regarding situational awareness, personal preparation and resiliency, and delivery of patient care for austere environments.

Procedural sedation has become a routine pediatric practice in high-income countries with a goal to decrease procedural time and error rates while increasing patient, parent, and provider satisfaction. Unfortunately, procedural sedation is not commonly performed in resource-limited settings due to lack of training, provider availability, medication availability, monitoring and resuscitation equipment, and clinical practice guidelines specific for use in resource-limited settings. This article outlines the development of a pediatric sedation curriculum tailored specifically for use in low- and middle-income countries. This curriculum was piloted in Liberia for pediatric and surgical residents in 2016, and the challenges and next steps for broader implementation of such a curriculum are detailed here. Globally available pediatric procedural sedation is necessary to improve the health care and outcomes of children living in low- and middle-income countries.

Emergency medicine is a relatively new field of practice in sub-Saharan Africa, and the first specialty training in Tanzania started in 2010. Despite this, the majority of emergency care for children is done by providers with little formal emergency medicine or pediatric emergency training. A low-fidelity, in situ simulation curriculum was held at Bugando Medical Center in Western Tanzania in 2018. There were 11 simulation cases that covered core topics in pediatric emergency care, and these were done on an ad hoc basis during available education time in a busy emergency department using available resources. These cases were well received and represent an opportunity for using external specialists to assist with provider education.

Suicide is a leading cause of death among our young patients. Healthcare providers in acute care settings like the emergency department have an opportunity to identify and intervene with those at risk in order to prevent death from suicide, future psychiatric emergencies, and the considerable morbidity that patients with unmet behavioral health needs experience. This article describes the current state of depression and suicide among young people and the strategies for implementing and improving screening in the emergency department. Finally, the article will articulate how to prepare for the challenges that emergency care providers face, as we work to reduce barriers for all patients to access behavioral health resources and receive needed care.

Adolescent patients comprise up to 16% of all emergency department (ED) visits in the United States. Although an exact prevalence is difficult to determine, an estimated 4-17% of youth identify as lesbian, gay, bisexual, transgender, and questioning. Health care providers need to understand gender identity and sexual orientation to provide competent medical care within a clinical setting that is safe for minority youth. Despite the ED presence of lesbian, gay, bisexual, transgender, and questioning teens, many ED providers report a lack of comfort with understanding the health care needs of this patient population. In this article, we aim to review the topics of gender identity, gender presentation, sexual orientation, and pronoun use, and provide practical guidelines for eliciting important information in the care of sexual and gender minority youth.

Illicit drug use by adolescents is an old problem with new clinical challenges, as teens access synthetic drugs in schools, on the street, and through internet purchase. Detection of synthetic drugs and unknown adulterants is often impossible using standard drug screens, but may be identified with the assistance of regional poison centers and the forensic laboratories of local universities and law enforcement, including the Drug Enforcement Agency. While clinical care for most intoxication and overdose cases is still largely supportive, critical interventions may be necessary for some. Toxicology experts at poison centers not only provide management advice contemporaneous to care, but compile data to identify local dangerous drug activity. This article reviews current knowledge of synthetic cannabinoids, amphetamines, and opioids, as well as the increasing teen use of “vaping” devices for delivery of tobacco and other substances.

Firearm violence is a serious threat to the safety of children and adolescents. Older adolescents, minorities, and boys are at increased risk, as are children who have been victims of firearm violence or violent crime in the past. Meaningful change to prevent firearm violence must incorporate principles of public health. Emergency physicians are uniquely poised to advocate for and participate in preventive efforts. This article discusses the state of firearm violence among adolescents as well as primary, secondary, and tertiary prevention efforts that have demonstrated effectiveness. This includes hospital-based programs that take a multi-disciplinary, comprehensive approach to the care of at-risk patients.

Rates of chlamydia and gonorrhea infection are at an all-time high among adolescents. Because many infections are asymptomatic, the Centers for Disease Control and Prevention recommend at least yearly screening in sexually active female adolescents and all sexually active male adolescents if in high-prevalence clinical settings or in populations with high burden of infection. Adolescents often access the emergency department for care, many of whom are at high risk, making the emergency department a strategic setting to screen for sexually transmitted infections. Nucleic acid amplification testing is the Centers for Disease Control and Prevention–recommended test for chlamydia and gonorrhea. Empiric treatment should be considered carefully and initiated if indicated. Partner treatment is also important, and expedited partner therapy may be an option.