BOOK
Pediatric Emergencies, An Issue of Pediatric Clinics, E-Book
Richard Lichtenstein | Getachew Teshome
(2013)
Additional Information
Book Details
Abstract
The care of children with acute medical problems is evolving as knowledge of new conditions develops. In addition, technology also changes to provide solutions to optimize care. This issue of PCNA highlights the important populations, disease states, and technological advancements in pediatric emergency medicine. Although concussion and head injury are common occurrences for the practicing pediatrician, we now better understand how to evaluate and manage these children and to use CT scans appropriately. Pediatric offices need to be incorporated in any emergency plan for both acute emergencies and common injuries. Analgesia and sedation must always be considered to provide comfort for children. Technologically assisted children and children with acute psychiatric and behavioral problems are now more commonplace in the Emergency Department as well as the office setting, and the practicing pediatrician needs to have a clear plan in understanding these medical conditions and appropriate management and referral. New drugs of abuse and foreign body ingestions are prevalent and have unique diagnostic and treatment challenges. Skin infections and abscesses have always been common but our knowledge of resistance patterns and best practices for treatment is changing. Finally, whether it is the pediatric office practitioner or the Emergency medicine physician, we need to continue our important efforts in injury prevention for the future of our children.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| PEDIATRIC CLINICSOF NORTH AMERICA | i | ||
| Copyright\r | ii | ||
| PROGRAM OBJECTIVE | iii | ||
| TARGET AUDIENCE | iii | ||
| LEARNING OBJECTIVES | iii | ||
| ACCREDITATION | iii | ||
| DISCLOSURE OF CONFLICTS OF INTEREST | iii | ||
| UNAPPROVED/OFF-LABEL USE DISCLOSURE | iii | ||
| TO ENROLL | iv | ||
| METHOD OF PARTICIPATION | iv | ||
| CME INQUIRIES/SPECIAL NEEDS | iv | ||
| Contributors | v | ||
| EDITORS | v | ||
| AUTHORS | v | ||
| Contents | ix | ||
| Preface: Pediatric Emergencies\r | ix | ||
| Acute Bronchiolitis\r | ix | ||
| Asthma Update\r | ix | ||
| Evaluation of Child with Fever Without Source: Review of Literature and Update\r | ix | ||
| Skin and Soft Tissue Infections\r | x | ||
| Approach to Syncope and Altered Mental Status\r | x | ||
| Updates in the General Approach to Pediatric Head Trauma and Concussion\r | x | ||
| Cervical Spine Injury\r | x | ||
| Emerging Concepts in Pediatric Emergency Radiology\r | xi | ||
| Pediatric Office Emergencies\r | xi | ||
| Common Office Procedures and Analgesia Considerations\r | xi | ||
| Pediatric Mental Health Emergencies and Special Health Care Needs\r | xi | ||
| Updates in the General Approach to the Pediatric Poisoned Patient\r | xi | ||
| Updates in Pediatric Gastrointestinal Foreign Bodies\r | xii | ||
| Injury Prevention: Opportunities in the Emergency Department\r | xii | ||
| PEDIATRIC CLINICS OF\rNORTH AMERICA\r | xiii | ||
| FORTHCOMING ISSUES | xiii | ||
| December 2013 | xiii | ||
| February 2014 | xiii | ||
| April 2014 | xiii | ||
| RECENT ISSUES | xiii | ||
| August 2013 | xiii | ||
| June 2013 | xiii | ||
| April 2013 | xiii | ||
| Preface:\rPediatric Emergencies | xv | ||
| Acute Bronchiolitis | 1019 | ||
| Key points | 1019 | ||
| INTRODUCTION | 1019 | ||
| PUBLIC HEALTH BURDEN | 1019 | ||
| PATHOGENESIS | 1020 | ||
| ETIOLOGY | 1021 | ||
| CLINICAL FEATURES | 1021 | ||
| DIFFERENTIAL DIAGNOSIS | 1022 | ||
| Viral-Triggered Wheezing or Asthma | 1022 | ||
| Gastroesophageal Reflux and Aspiration Pneumonia | 1022 | ||
| Foreign-Body Aspiration | 1023 | ||
| Pneumonia | 1023 | ||
| Congestive Heart Failure | 1023 | ||
| ASSESSMENT AND RISK STRATIFICATION | 1023 | ||
| Apnea | 1023 | ||
| Respiratory Failure | 1024 | ||
| DIAGNOSIS | 1024 | ||
| TREATMENT | 1025 | ||
| Pharmacologic Therapy | 1025 | ||
| Bronchodilators | 1025 | ||
| Corticosteroids/anti-inflammatory agents | 1026 | ||
| Antibiotics | 1027 | ||
| Antiviral/ribavirin | 1027 | ||
| Other therapies | 1027 | ||
| Heliox | 1027 | ||
| High-dose systemic steroids | 1027 | ||
| Inhaled glucocorticoids | 1027 | ||
| Surfactant | 1027 | ||
| Combination therapies | 1028 | ||
| Nonpharmacologic Treatment | 1028 | ||
| Chest physiotherapy | 1028 | ||
| Hypertonic saline | 1028 | ||
| High-flow nasal cannula | 1028 | ||
| Prophylaxis | 1028 | ||
| SUMMARY | 1029 | ||
| REFERENCES | 1029 | ||
| Asthma Update | 1035 | ||
| Key points | 1035 | ||
| INTRODUCTION | 1035 | ||
| EPIDEMIOLOGY | 1036 | ||
| DIFFERENTIAL DIAGNOSIS | 1036 | ||
| SEVERITY ASSESSMENT | 1036 | ||
| INITIAL STANDARD THERAPY | 1037 | ||
| Short-acting β-Agonist | 1037 | ||
| Albuterol or levalbuterol | 1037 | ||
| Delivery device | 1037 | ||
| Continuous nebulized SABA treatment | 1038 | ||
| Ipratropium Bromide | 1039 | ||
| Corticosteroids | 1040 | ||
| Route, dosing, duration | 1040 | ||
| Inhaled corticosteroid | 1040 | ||
| REASSESSMENT | 1040 | ||
| ADJUNCTIVE THERAPIES | 1041 | ||
| Magnesium Sulfate | 1041 | ||
| Helium-oxygen–Delivered SABA | 1041 | ||
| Systemic (Injected) β-Agonists | 1041 | ||
| Noninvasive Ventilatory Support | 1042 | ||
| Other Medications | 1042 | ||
| CHEST RADIOGRAPHS | 1042 | ||
| CLINICAL PRACTICE GUIDELINES | 1042 | ||
| POST–EMERGENCY DEPARTMENT CARE | 1042 | ||
| Improving Preventive Therapy | 1042 | ||
| Written Asthma Care Plans | 1043 | ||
| Follow-up After an Acute Visit | 1043 | ||
| SUMMARY | 1043 | ||
| REFERENCES | 1043 | ||
| Evaluation of Child with Fever Without Source | 1049 | ||
| Key points | 1049 | ||
| INTRODUCTION | 1049 | ||
| OCCULT BACTEREMIA | 1050 | ||
| URINARY TRACT INFECTION | 1051 | ||
| MENINGITIS | 1051 | ||
| PNEUMONIA | 1052 | ||
| FEBRILE CHILDREN WITH CONFIRMED VIRAL ILLNESS | 1052 | ||
| ROLE OF SCREENING TESTS | 1053 | ||
| ROLE OF PREDICTION RULES | 1053 | ||
| CULTURES AS REFERENCE STANDARDS: TIME TO REEVALUATE OUR APPROACH? | 1054 | ||
| MANAGEMENT OF THE FEBRILE CHILD WITH FWS | 1057 | ||
| Management of Febrile Child 3 to 36 Months Old | 1057 | ||
| Management of Febrile Infant 3 Months and Younger | 1058 | ||
| Febrile neonate (28 days or 4 weeks and younger) | 1058 | ||
| Febrile infant between 4 weeks and 12 weeks old | 1058 | ||
| SUMMARY | 1058 | ||
| REFERENCES | 1059 | ||
| Skin and Soft Tissue Infections | 1063 | ||
| Key points | 1063 | ||
| INTRODUCTION | 1063 | ||
| Microbiology | 1064 | ||
| Epidemiology and Emergence of CA-MRSA | 1064 | ||
| CLINICAL AND DIAGNOSTIC APPROACH | 1065 | ||
| Clinical Evaluation | 1065 | ||
| Microbiologic Diagnosis | 1066 | ||
| SURGICAL THERAPY | 1067 | ||
| Sedation and Analgesia | 1067 | ||
| Method of Incision and Drainage | 1067 | ||
| Wound Management | 1069 | ||
| Alternatives to Incision and Drainage | 1070 | ||
| ANTIMICROBIAL THERAPY AND NONSURGICAL MANAGEMENT | 1070 | ||
| Antibiotics and Skin Abscesses | 1071 | ||
| Antibiotics and Cellulitis | 1071 | ||
| Topical Therapy | 1074 | ||
| Hospitalization for SSTI | 1074 | ||
| COMPLICATIONS | 1074 | ||
| Treatment Failure and Recurrence | 1074 | ||
| CA-MRSA Colonization | 1075 | ||
| SUMMARY | 1076 | ||
| REFERENCES | 1076 | ||
| Approach to Syncope and Altered Mental Status | 1083 | ||
| Key points | 1083 | ||
| INTRODUCTION: NATURE OF THE PROBLEM | 1083 | ||
| CAUSES FOR T-AMS | 1085 | ||
| Apparent Life-Threatening Event | 1085 | ||
| Breath Holding | 1085 | ||
| Seizure | 1085 | ||
| Syncope | 1086 | ||
| Reflex Syncope | 1089 | ||
| Cardiac Syncope | 1089 | ||
| Syncope and Sudden Cardiac Death in Athletes | 1089 | ||
| HCM | 1089 | ||
| Coronary Artery Anomalies | 1090 | ||
| Long QT Syndrome | 1090 | ||
| Brugada Syndrome | 1091 | ||
| Catecholaminergic Polymorphic VT | 1092 | ||
| Arrhythmogenic Right Ventricular Dysplasia or Cardiomyopathy | 1092 | ||
| Myocarditis | 1092 | ||
| Wolff-Parkinson-White Syndrome | 1093 | ||
| Postoperative Arrhythmias in the Setting of Repaired Congenital Heart Defects | 1093 | ||
| Migraine | 1094 | ||
| Conversion | 1095 | ||
| CAUSES FOR P-AMS | 1096 | ||
| Infants and Young Children | 1096 | ||
| Sepsis | 1096 | ||
| Inborn errors of metabolism | 1096 | ||
| Nonaccidental trauma | 1097 | ||
| Intussusception | 1097 | ||
| Infections (shigellosis) | 1097 | ||
| Encephalitis | 1097 | ||
| Seizure | 1098 | ||
| Metabolic derangement (glucose, sodium) | 1098 | ||
| Intracranial tumor/mass | 1098 | ||
| Posterior reversible encephalopathy syndrome | 1099 | ||
| APPROACH TO THE PATIENT WITH TRANSIENT AMS | 1099 | ||
| Patient History | 1099 | ||
| Physical Examination | 1099 | ||
| Imaging and Additional Testing | 1101 | ||
| APPROACH TO THE PATIENT WITH P-AMS | 1102 | ||
| Patient History | 1102 | ||
| Physical Examination | 1103 | ||
| Imaging and Additional Testing | 1103 | ||
| SUMMARY | 1104 | ||
| REFERENCES | 1104 | ||
| Updates in the General Approach to Pediatric Head Trauma and Concussion | 1107 | ||
| Key points | 1107 | ||
| INTRODUCTION | 1107 | ||
| CONCUSSION/MILD TBI | 1108 | ||
| Description | 1108 | ||
| Evaluation | 1108 | ||
| Sports Concussion | 1109 | ||
| Legislation and Return-to-Play | 1109 | ||
| Subconcussive Injury | 1110 | ||
| Changes in Sports Regulation and Techniques | 1111 | ||
| Chronic Traumatic Encephalopathy | 1111 | ||
| Imaging | 1111 | ||
| Prediction Rules for Cranial CT after Head Trauma | 1112 | ||
| Hospitalization | 1114 | ||
| MODERATE AND SEVERE TBI | 1114 | ||
| Prophylaxis of Posttraumatic Seizure | 1117 | ||
| Intraventricular Hemorrhage | 1117 | ||
| Skull Fractures | 1117 | ||
| Basilar Skull Fracture | 1117 | ||
| SUMMARY | 1118 | ||
| REFERENCES | 1118 | ||
| Cervical Spine Injury | 1123 | ||
| Key points | 1123 | ||
| EPIDEMIOLOGY | 1123 | ||
| DEVELOPMENTAL ANATOMY | 1124 | ||
| CLINICAL PRESENTATION | 1124 | ||
| CLINICAL SCREENING CRITERIA | 1126 | ||
| INITIAL MANAGEMENT | 1126 | ||
| DIAGNOSTIC TESTING | 1126 | ||
| INJURY PATTERNS | 1129 | ||
| SUMMARY | 1136 | ||
| REFERENCES | 1136 | ||
| Emerging Concepts in Pediatric Emergency Radiology | 1139 | ||
| Key points | 1139 | ||
| INTRODUCTION | 1139 | ||
| IMAGING MODALITIES | 1140 | ||
| Plain-Film Radiograph (X-Ray) | 1140 | ||
| Ultrasound | 1140 | ||
| Computed Tomography | 1140 | ||
| Magnetic Resonance Imaging | 1140 | ||
| THE AGE OF ALARA | 1141 | ||
| Clinical Decision Rules | 1142 | ||
| HEAD TRAUMA | 1142 | ||
| BLUNT ABDOMINAL TRAUMA | 1143 | ||
| Which Child Does Not Need an Abdominal CT? | 1144 | ||
| Focused Assessment with Sonography for Trauma | 1144 | ||
| APPENDICITIS | 1145 | ||
| BEDSIDE US | 1145 | ||
| Skin and Soft Tissue Infections | 1146 | ||
| Peritonsillar Abscess | 1146 | ||
| Long-Bone Fractures | 1148 | ||
| Echocardiography | 1148 | ||
| THE FUTURE OF PEDIATRIC IMAGING | 1148 | ||
| REFERENCES | 1149 | ||
| Pediatric Office Emergencies | 1153 | ||
| Key points | 1153 | ||
| OFFICE SELF-ASSESSMENT | 1154 | ||
| OFFICE PERSONNEL AND SKILLS | 1154 | ||
| OFFICE EQUIPMENT | 1155 | ||
| MEDICATIONS | 1156 | ||
| EMS RESPONSE AND EIF | 1156 | ||
| MOCK CODES/SKILL DRILLS | 1158 | ||
| WHEN DISASTER STRIKES | 1159 | ||
| SUMMARY | 1159 | ||
| REFERENCES | 1160 | ||
| Common Office Procedures and Analgesia Considerations | 1163 | ||
| Key points | 1163 | ||
| INTRODUCTION | 1163 | ||
| RATIONALE FOR PEDIATRIC PAIN MANAGEMENT | 1163 | ||
| COMMON OBJECTIONS TO PAIN MANAGEMENT | 1164 | ||
| NATURE OF PEDIATRIC PROCEDURAL DISTRESS | 1164 | ||
| Fear | 1164 | ||
| Preparation | 1165 | ||
| Restraint | 1166 | ||
| Focus of Attention–Active and Passive Distraction, Environment, One Voice | 1169 | ||
| Passive distraction | 1169 | ||
| Active distraction | 1169 | ||
| Environment | 1169 | ||
| PHARMACOLOGIC ANXIOLYSIS | 1170 | ||
| Paradoxic Reactions | 1171 | ||
| ENTERAL PHARMACOLOGIC PAIN MANAGEMENT | 1172 | ||
| Over-the-Counter Treatment | 1172 | ||
| Oral Opioids | 1172 | ||
| Intranasal Fentanyl | 1172 | ||
| TOPICAL ANESTHETICS | 1172 | ||
| PHYSIOLOGIC PAIN MANAGEMENT—GATE CONTROL AND DESCENDING NOXIOUS INHIBITORY CONTROL | 1173 | ||
| Sucrose Analgesia | 1173 | ||
| IV and Phlebotomy | 1173 | ||
| Preparation | 1173 | ||
| Pediatric Mental Health Emergencies and Special Health Care Needs | 1185 | ||
| Key points | 1185 | ||
| INTRODUCTION | 1185 | ||
| SUICIDAL IDEATION AND SUICIDE ATTEMPTS | 1185 | ||
| Introduction | 1186 | ||
| Risk factors | 1186 | ||
| Evaluation | 1186 | ||
| Identifying at-risk patients | 1186 | ||
| Ensuring safety | 1187 | ||
| Confidentiality | 1187 | ||
| Interview | 1187 | ||
| Family interview | 1188 | ||
| Physical Examination | 1188 | ||
| Laboratory Testing | 1189 | ||
| Pharmacologic Considerations | 1189 | ||
| Nonpharmacologic Strategies | 1189 | ||
| Determining the Level of Care | 1189 | ||
| Safety Planning | 1190 | ||
| Instill Hope | 1191 | ||
| HOMICIDAL IDEATION, AGGRESSION, AND RESTRAINT | 1191 | ||
| Introduction | 1191 | ||
| Risk factors | 1191 | ||
| Evaluation | 1191 | ||
| Management Goals | 1192 | ||
| Nonpharmacologic Strategies | 1192 | ||
| Pharmacologic Strategies | 1193 | ||
| CARE OF CHILDREN WITH AUTISM AND DEVELOPMENTAL DISORDERS | 1195 | ||
| Introduction | 1195 | ||
| Evaluation | 1195 | ||
| Transition Planning | 1196 | ||
| Sensory/Environmental Modification and Distraction | 1196 | ||
| Communication Adjuncts | 1196 | ||
| REFERENCES | 1197 | ||
| Updates in the General Approach to the Pediatric Poisoned Patient | 1203 | ||
| Key points | 1203 | ||
| INTRODUCTION | 1203 | ||
| GI DECONTAMINATION | 1204 | ||
| Syrup of Ipecac | 1204 | ||
| Activated Charcoal | 1204 | ||
| Whole-bowel Irrigation | 1204 | ||
| New Interventions: Enhanced Elimination | 1205 | ||
| Neonatal Abstinence Syndrome | 1206 | ||
| Prescription Drug Abuse | 1206 | ||
| SINGLE-PILL/SINGLE-DOSE KILLERS | 1207 | ||
| Sulfonylurea | 1208 | ||
| CCBs and β-Blockers | 1209 | ||
| Opioids | 1209 | ||
| Methylsalicylate (Oil of Wintergreen) | 1210 | ||
| DESIGNER DRUGS | 1211 | ||
| Synthetic Marijuana | 1211 | ||
| Bath Salts (Synthetic Cathinones) | 1212 | ||
| Energy Drinks | 1212 | ||
| Internet Phenomena, OTC Products, and Topical Patches | 1213 | ||
| SUMMARY | 1215 | ||
| REFERENCES | 1215 | ||
| Updates in Pediatric Gastrointestinal Foreign Bodies | 1221 | ||
| Key points | 1221 | ||
| INTRODUCTION | 1221 | ||
| AGE-APPROPRIATE BEHAVIORS | 1221 | ||
| CAUSE | 1222 | ||
| CLINICAL MANIFESTATIONS | 1222 | ||
| DIAGNOSTIC EVALUATION | 1223 | ||
| Special Radiographic Considerations | 1225 | ||
| MANAGEMENT | 1226 | ||
| Removal Techniques | 1227 | ||
| SPECIFIC TYPES OF FOREIGN BODIES | 1228 | ||
| Coins | 1228 | ||
| Sharp Objects | 1229 | ||
| Long Objects | 1229 | ||
| Food Bolus | 1229 | ||
| Caustic Liquids | 1230 | ||
| Batteries | 1231 | ||
| Magnets | 1233 | ||
| COMPLICATIONS | 1234 | ||
| SUMMARY | 1235 | ||
| REFERENCES | 1235 | ||
| Injury Prevention | 1241 | ||
| Key points | 1241 | ||
| INTRODUCTION | 1241 | ||
| HISTORY OF INJURY PREVENTION | 1242 | ||
| SETTING FOR INJURY-PREVENTION EDUCATION: PRIMARY CARE OFFICE VERSUS THE ED | 1242 | ||
| MODELS FOR EDUCATION ON BEHAVIORAL CHANGE | 1244 | ||
| Health Belief Model | 1244 | ||
| Social Cognitive Theory | 1245 | ||
| Stages of Change Model | 1245 | ||
| Teachable Moment | 1245 | ||
| SUCCESSFUL ED INTERVENTIONS | 1245 | ||
| LINKING THE ED TO THE COMMUNITY | 1247 | ||
| PREPARING THE ED FOR INJURY-PREVENTION INTERVENTIONS | 1248 | ||
| HEALTH SYSTEMS AND HOSPITAL PARTNERS | 1248 | ||
| Injury-Prevention Programs | 1248 | ||
| Trauma Programs | 1249 | ||
| Primary Care Setting | 1250 | ||
| Newborn Nurseries and Care Units | 1250 | ||
| SUMMARY | 1250 | ||
| REFERENCES | 1250 | ||
| Index | 1255 |