Clinical Pediatric Emergency Medicine最新文献

There has been increased public awareness, research, and legislation regarding to concussion or mild traumatic brain injury (mTBI) in young athletes. Along with this, there has been an increase in the number of annual emergency department (ED) visits for the evaluation of sports- and non-sports-related head injuries. Several medical organizations have published recommendations regarding the management of concussion and subsequent return to activities. The purpose of this article is to: (1) summarize these guidelines and provide up-to-date recommendations regarding concussion treatment, and (2) provide this author's approach to the concussion management in both the ED and sports medicine clinic settings.

Teen dating violence (TDV) is an underrecognized and significant public health problem that affects millions of adolescents each year. Many teens seek care in the emergency department (ED) for their injuries due to TDV, and are at risk for negative short- and long-term outcomes. With a better understanding by ED clinicians of normal adolescent development, as well as the impact of TDV on the health and safety of teen patients, the ED setting can serve as an effective site for both intervention and violence prevention. This article provides an overview of the importance of this issue, the impact of technology and social media on TDV, and best practices for ED screening, documentation, and referral.

The emergency department (ED) is a frequent and important site for gynecologic care, and many women present to the ED for reproductive health concerns such as abnormal menses. Due to early menstrual age and increased incidence of sexually transmitted infections, adolescents are particularly prone to abnormal menses, but are also disproportionately affected by unintended pregnancy. While EDs have long been used for the evaluation and initial management of abnormal uterine bleeding, general contraceptive provision in the ED is a novel approach to addressing unmet contraceptive needs among adolescent women. We review normal menstruation and the evaluation and management of abnormal uterine bleeding in adolescents, including the use of combined oral contraceptives. Expanding on this established indication for contraceptive use in the ED, we present attitudes, barriers, and approaches to ED provision of contraceptives for adolescent pregnancy prevention.

Since the Institute of Medicine's initial report on medical error was published in 1999, understanding of the magnitude of this problem within health care continues to grow. Although medical error is a broad category that includes both system and human factors, diagnostic error, with significant consequences for patients and their families, bias is a common and often overlooked contributor. This type of error is complex, as it is rooted in clinicians' use of heuristics and their inherent or cognitive biases. The objective of this review is to define medical error and to explore the methods that can be used to reduce error in clinical practice. Using a case-based discussion, cognitive bias resulting in diagnostic error will be reviewed.

Neonatal cardiac emergencies, as reviewed in this journal, are frequently ductal-dependent structural heart lesions. Although there is slight overlap (less so in older infants), cardiac emergencies outside the neonatal period typically result in shock as a common denominator rather than hypercyanosis. Aborted sudden cardiac death is usually an arrhythmia-related problem—as also reviewed in this journal—although there can be overlap between sudden cardiac death, arrhythmias, and shock. The goal of this review is to make the emergency care provider more aware in the cardiac causes of shock and to review the latest evaluation and management strategies as well as triage decisions and the timely involvement of the cardiology consultant.

Congenital heart disease is a relatively common birth defect that can be associated with significant morbidity and mortality. Although many emergency department visits have potential cardiac complaints, some of these signify critical cardiac disease (ie, cardiac emergencies) requiring urgent triage and management. Neonatal cardiac emergencies represent a unique subset of cardiac emergencies that can be difficult to distinguish from other critical neonatal pathologies such as sepsis and metabolic crisis. In this article, we review current approaches to the neonate with a potential cardiac emergency, highlighting common modes of presentation and providing strategies to distinguish cardiac from noncardiac etiologies. Rapid identification of a potential neonatal cardiac emergency allows for the most efficient and appropriate use of resources in this patient population while ensuring that life-threatening cardiac disease is aggressively managed to ensure the best possible outcome. Unique to the neonate is the “ductal dependent circulation” and a common feature of the cardiac lesions reviewed below. Although there is overlap, other lesions that can result in shock (and are not ductal dependent) are reviewed elsewhere in this issue of Clinical Pediatric Emergency Medicine.

There are a few very rare pediatric cardiac problems not clearly related to the heart in which the cardiologist is usually called to make the diagnosis and help in management. Aortic dissection and pulmonary embolism are so rare in children that many providers have not encountered these problems. Pulmonary hypertension shares pathophysiology with pulmonary embolism, although emergency presentations are also extremely rare. In this review, we describe the presentation and latest practices in the evaluation, triage, and emergency department management strategies.

The challenge for the pediatric emergency medicine provider is to identify cardiac emergencies even when the chief complaint is not clearly cardiac. An additional challenge is to consider whether subspecialty consultation is required and, if so, to determine in what capacity and with what urgency. In this article, we review guiding principles surrounding subspecialty consultation in pediatrics and examine factors in all phases of a consultation from the perspective of both the pediatric emergency medicine provider and the pediatric cardiologist. In the Preliminary Phase, we discuss considerations surrounding whether a consult should be called and introduce the categories of “FYI” and “Curbside” calls. In the Action Phase, we review different circumstances appropriate for traditional (in-person) and telemedicine consultations. In the Aftercare Phase, we summarize the responsibilities of each party, emphasizing the need to ascertain appropriate access to effective follow-up care. We conclude by recommending that future efforts should be focused on collaboration between EDs and local pediatric cardiology groups to devise guidelines or clinical reference documents in regard to consultation expectations and parameters, with a suggested starting point included.