Clinical Pediatric Emergency Medicine最新文献

With an increasing number of pediatric heart transplant patients, it is inevitable that they will seek medical care at an emergency department for cardiac or noncardiac complaints. Given the special issues associated with transplant (some of which are similar to other organ transplants and some of which are unique to cardiac transplantation), the emergency care provider should have an understanding of what care can be independently provided, concerns which may require additional testing or expertise, and when to call the cardiac consultant. The goal of this review is to address these issues.

Point-of-care ultrasound is increasingly being used throughout clinical medicine, especially in the emergency department and intensive care units. A more focused area within point-of-care ultrasound is in echocardiography. In this review, the use of point-of-care cardiac ultrasound, specifically for rapid cardiac evaluation in the pediatric emergency department, is examined to highlights its benefits and utility.

Electrocardiograms can be useful in the emergency department setting when dealing with patients presenting with cardiac symptoms and signs. These include chest pain, syncope, palpitations, cyanosis, heart failure symptoms, and ingestions. Although the electrocardiogram may be helpful in identifying an underlying diagnosis, it may be normal in many cases and should be used as an adjunct diagnostic tool, not to be relied upon solely. Important diagnoses that can be made by electrocardiogram alone include supraventricular and ventricular arrhythmias, conduction system abnormalities such as heart block, and some channelopathies, such as long QT syndrome and Brugada syndrome. Caution must be taken in that, often, these diagnoses cannot be excluded even in the presence of a normal electrocardiogram (differing sensitivity for different diseases) and, often, incidental findings may occur in the absence of heart disease (nonspecific findings). Therefore, it is important to synthesize all data prior to coming to any conclusions.

Chest pain, palpitations and syncope are amongst the most common symptoms presenting to the emergency department (ED). A finding of a murmur, although rare to present as primary cause for ED visit, can often be an associated finding noted during the evaluation. Although these symptoms can be very alarming to patients and parents, they are infrequently associated with significant cardiac disease. Although the cardiac etiologies for these common symptoms are rare, these cardiac conditions can sometimes be life threatening. This review examines these presenting symptoms of chest pain, syncope and palpitations or the finding of murmur for possible differential diagnoses.

It is well recognized that adult survivors with congenital heart disease are at risk for several cardiac and noncardiac complications that can impact their long-term outcomes. Emergency departments are increasingly being used for the evaluation and management of acute complications in these patients. However, there are several issues that are unique to adults with congenital heart disease related to the complexity of their cardiac anatomy, previous surgical intervention, and residual hemodynamic lesions that can complicate their presentation and management. This review examines the many challenges faced in caring for adults with congenital heart disease presenting to the emergency department, including the issues related to underlying cardiac lesion, access to care, and the evaluation and management of common clinical presentations.

Coronary artery issues are rare in children, leading to challenges for the pediatric emergency medicine practitioner. The differential diagnosis can be grouped into congenital or acquired coronary abnormalities. Congenital coronary anomalies leading to myocardial ischemia or aborted sudden cardiac death are most often due to an anomalous origin of a coronary artery. Acquired coronary artery disease is most commonly related to the sequelae of Kawasaki disease. Lastly, rare, specific patient populations are at higher risk for early coronary disease. This review discusses the most common pediatric causes of coronary artery events, providing an overview of the evaluation and management in an emergency department setting.

Value-based health care is finding increasing importance in medical care. This manuscript reviews the concept of value-based health care and its application to pediatric patients with cardiac complaints in the emergency department.

The National Pediatric Readiness Project is a national quality initiative sponsored by the American College of Emergency Physicians, the American Academy of Pediatrics, and the Emergency Nurses Association. Multiple efforts across numerous states are in process to optimize pediatric readiness of emergency departments. This article describes past, current, and future efforts to ensure pediatric readiness of our nations' emergency departments and to understand the relationship between pediatric readiness and quality of pediatric emergency care.

In the aftermath of a disaster, families may become separated. With greater than 60 million children being apart from their families during the day, one could imagine a disaster resulting in great difficulties in reuniting these children with their families. History has shown us that widespread events can prove particularly challenging as was shown during Hurricane Katrina when it took up to 6 months to reunite all displaced children with their families. This article will discuss the history of pediatric disaster preparedness efforts, highlighting some of the available resources in the development of a family reunification plan. Next will be a discussion of basic features of a well-thought-out family reunification plan, including critical areas to establish as part of an institution's plan. Key partners necessary to engage will be discussed, as well as the importance of testing any plan through drills. Finally, future work will be highlighted.

Nurses, particularly emergency nurses, have long been involved with Emergency Medical Services for Children (EMSC) at the local, state, and national level. Partnerships with several professional nursing associations, including the Emergency Nurses Association, have championed the mission of EMSC. These partnerships have been essential to ensuring pediatric emergency readiness, disaster preparedness, and education across the Health Resources and Services EMSC program. Emergency nurses are actively engaged in quality improvement work with the Facility Recognition Collaborative and the Pediatric Readiness Quality Collaborative with their EMSC partners, as well as research through the Pediatric Emergency Care Applied Research Network. In the future, continuing to leverage and expand partnerships with professional nurses and nursing organizations is an important component to the success and growth of EMSC.