MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Clinical Pediatric Emergency Medicine' source. Sun, 29 Jan 2012 14:39:07 +0100 http://www.medworm.com/index.php?rid=5469428&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840111000590%2Fabstract%3Frss%3Dyes The electrocardiogram (ECG) is a useful screening and diagnostic tool in the emergency department (ED) for dysrhythmias and other cardiac emergencies. In conjunction with a thorough history and physical examination, the ECG is an important part of the evaluation of many presenting complaints. The ED physician should be familiar with the most common cardiac diagnoses as well as those associated with sudden cardiac death. Knowledge of pediatric normal variants is also essential for correct ECG analysis and interpretation. We will review and discuss ECGs for several acute cardiac presentations to illustrate the usefulness of the ECG in the ED. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5469428 Thu, 01 Dec 2011 05:00:00 +0100 5469428 http://www.medworm.com/index.php?rid=5469427&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840111000577%2Fabstract%3Frss%3Dyes Cardiac trauma, though rare in children, is associated with a variety of clinical syndromes and found most often in cases of multisystem injury. Blunt chest trauma may manifest as cardiac contusion, though complications including cardiac tamponade, aortic injury, or structural cardiac damage may result. Commotio cordis may result if the impact occurs at a specific time in the cardiac cycle. Diagnosis of cardiac injury may be complicated and necessitate a high index of suspicion, involving the consideration of cardiac enzymes, electrocardiogram, echocardiography, computed tomography, or angiography. Children, particularly, may present without classic signs and symptoms making the diagnosis more challenging. Penetrating cardiac traumas are far rarer, but often require rapid, aggressive resus... Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5469427 Thu, 01 Dec 2011 05:00:00 +0100 5469427 http://www.medworm.com/index.php?rid=5469426&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840111000619%2Fabstract%3Frss%3Dyes This article focuses on common surgeries in neonates with congenital heart disease as well as postoperative complications that may be encountered in the emergency department. The recognition and management of hemodynamic, infectious, and intrathoracic derangements as well as common postoperative dysrhythmias will be discussed. Approaches to airway management, vascular access, and procedural sedation in this patient population will also be addressed. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5469426 Thu, 01 Dec 2011 05:00:00 +0100 5469426 http://www.medworm.com/index.php?rid=5469425&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840111000607%2Fabstract%3Frss%3Dyes The approach to the infant with a cardiac emergency begins with identification of the unstable or critically ill child and proceeds rapidly into stabilization and provision of immediate therapies. Support of oxygenation, ventilation, and circulation will precede identification of specific cardiac lesions. The emergency clinician can use clinical findings, chest x-ray, and electrocardiographic information to plan emergent intervention. Infants in the first days of life who present with circulatory collapse secondary to obstruction of pulmonary or systemic blood flow (ductus dependent) conditions can be stabilized with prostaglandin E infusion. The more common presentation of cardiac disease in the first month of life is congestive heart failure. Infants with congestive heart failure require... Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5469425 Thu, 01 Dec 2011 05:00:00 +0100 5469425 http://www.medworm.com/index.php?rid=5469424&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840111000656%2Fabstract%3Frss%3Dyes Adolescents frequently present to the emergency department with chest pain. Unlike adult patients with chest pain, most studies have shown that adolescents with this complaint rarely have serious organic pathology. For many adolescents, the symptom of chest pain is not acute in nature, and it is uncommon for an adolescent with this complaint to present with significant distress or require immediate resuscitation. However, an adolescent with chest pain should still be approached carefully and promptly because serious medical conditions can be present. The emergency physician should consider important cardiac causes of chest pain in adolescents, such as hypertrophic cardiomyopathy, drug abuse (cocaine and others), myocarditis, and pericarditis. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5469424 Thu, 01 Dec 2011 05:00:00 +0100 5469424 http://www.medworm.com/index.php?rid=5469423&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840111000589%2Fabstract%3Frss%3Dyes This article will specifically address the symptom of palpitations in pediatric patients, isolating it from the more frequently reviewed subject of chest pain. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5469423 Thu, 01 Dec 2011 05:00:00 +0100 5469423 http://www.medworm.com/index.php?rid=5469422&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840111000620%2Fabstract%3Frss%3Dyes Syncope is a common presentation for children in the emergency department (ED). Cardiac causes of pediatric syncope are rare but may be life threatening and have the highest risk of morbidity and mortality. An extensive workup for syncope is usually unnecessary. All children presenting to the ED with syncope should have a detailed history, physical examination, and electrocardiogram performed. These components should be used to guide further diagnostic studies and subspecialty referrals. Cardiology consultation or referral should be considered if a cardiac etiology is suspected due to “red flags” identified during the history, physical examination, or electrocardiogram. An algorithmic approach to the evaluation of pediatric syncope in the ED is recommended. (Source: Clinical Pediatric ... Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5469422 Thu, 01 Dec 2011 05:00:00 +0100 5469422 http://www.medworm.com/index.php?rid=5469421&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840111000632%2Fabstract%3Frss%3Dyes Important changes were introduced in the 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Cardiac arrest remains a leading cause of death in many parts of the world, and despite important advances in medical science, the outcome of cardiopulmonary arrest is poor. The fundamental changes in the American Heart Association 2010 guidelines include the new recommendation to begin resuscitation with chest compression, airway, and breathing. We will review and discuss how to approach a successful pediatric resuscitation with the maintenance of adequate coronary artery and cerebral artery perfusion and, ultimately, how to improve outcomes in infants and children. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5469421 Thu, 01 Dec 2011 05:00:00 +0100 5469421 http://www.medworm.com/index.php?rid=5469420&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840111000644%2Fabstract%3Frss%3Dyes For the heart will leadFor the head will explainBut the final common pathway is the heartWhatever kingdom may come- John Stone (cardiologist and poet) In emergency medicine, counter to most other subspecialties, the focus of care is usually centered on management as opposed to diagnosis. The emergency department (ED) provider must ultimately decide on a course of action (treat or not treat; discharge home or admit to the hospital) regardless of whether a diagnosis is made. To help guide this decision-making process, the ED provider often considers 2 different groups of etiologies. First, what are the most common conditions that present with the patient's particular constellation of symptoms, considering a variety of factors including patient age, duration of symptoms, and time of year? At... Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5469420 Thu, 01 Dec 2011 05:00:00 +0100 5469420 http://www.medworm.com/index.php?rid=5469419&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840111000693%2Fabstract%3Frss%3Dyes (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5469419 Thu, 01 Dec 2011 05:00:00 +0100 5469419 http://www.medworm.com/index.php?rid=5469418&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840111000681%2Fabstract%3Frss%3Dyes (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5469418 Thu, 01 Dec 2011 05:00:00 +0100 5469418 http://www.medworm.com/index.php?rid=5144520&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840111000371%2Fabstract%3Frss%3Dyes Children who present with immune thrombocytopenic purpura or autoimmune hemolytic anemia require emergent recognition and treatment in close consultation with a pediatric hematologist and blood bank. Treatment decisions need to be individualized to the patient and their clinical condition rather than based on a certain platelet or hemoglobin value. Severe bleeding, including intracranial hemorrhage, is rare in immune thrombocytopenic purpura. Primary treatment options include observation only, corticosteroids, or intravenous immunoglobulin. Platelet transfusions are reserved for life-threatening emergencies. Patients with autoimmune hemolytic anemia may present with profound anemia, for which corticosteroids are the mainstay of therapy. Involving the blood bank early is crucial because fin... Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5144520 Sat, 20 Aug 2011 16:10:54 +0100 5144520 http://www.medworm.com/index.php?rid=5144519&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840111000383%2Fabstract%3Frss%3Dyes Hematopoietic cell transplantation is the only potentially curative option for a variety of pediatric malignant and nonmalignant disorders. Despite advances in transplantation biology and immunology as well as in posttransplant management that have contributed to improved survival and decreased transplant-related mortality, hematopoietic cell transplantation does not come without significant risk of complications. When patients who have undergone hematopoietic cell transplantation present to the emergency department, it is important to consider a variety of therapy-related complications to optimize management and outcome. In this article, we use clinical cases to highlight some of the more common emergent complications after hematopoietic cell transplantation. (Source: Clinical Pediatric E... Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5144519 Sat, 20 Aug 2011 16:10:54 +0100 5144519 http://www.medworm.com/index.php?rid=5144518&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840111000413%2Fabstract%3Frss%3Dyes Hemophilia is a congenital bleeding disorder characterized by episodic hemorrhages that can be spontaneous or trauma related and can pose challenges in the emergency department both in diagnosis and management. Timely infusions of hemostatic clotting factors can control bleeding in most circumstances and significantly minimize sequelae. Hemorrhages in some anatomical areas such as the central nervous system, within the abdomen, or into restricted spaces in extremities require a high index of suspicion for early detection. Patients with hemophilia with inhibitors against specific clotting factors can be particularly challenging to treat. Patients with acquired hemophilia can present with severe spontaneous bleeding. Prompt correction of factor deficiencies by infusing an appropriately dosed... Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5144518 Sat, 20 Aug 2011 16:10:54 +0100 5144518 http://www.medworm.com/index.php?rid=5144517&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840111000358%2Fabstract%3Frss%3Dyes Central nervous system (CNS) tumors are the most common solid tumors in childhood and adolescence. Evaluation and management of patients with CNS tumors by emergency medicine practitioners are critically important at the time of initial diagnosis as well as during emergency department visits for treatment-related complications. Increased intracranial pressure, hydrocephalus, spinal cord compression, or seizures may occur as a result of direct tumor disruption of normal CNS structures. For those patients who require radiation therapy and/or chemotherapy, recognition of common adverse events from these treatment modalities is important for accurate diagnoses and management in the emergency department. Emergencies in survivors of childhood CNS tumors are also reviewed. (Source: Clinical Pedia... Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5144517 Sat, 20 Aug 2011 16:10:54 +0100 5144517 http://www.medworm.com/index.php?rid=5144516&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS152284011100036X%2Fabstract%3Frss%3Dyes Sickle cell disease is the most common inherited blood disorder in the United States. This disorder of hemoglobin structure leads to a chronic hemolytic anemia and complex chronic disease manifested by sudden, severe, and life-threatening complications. These acute complications can occur in any organ system beginning in early childhood and lasting throughout life. The intermittent nature and acuity of these complications lend the emergency department to be an important site of care. The hallmark of sickle cell disease is the vasoocclusive painful event. Other more “typical” complications include fever, acute chest syndrome, priapism, and ischemic stroke. Children with sickle cell disease can also present with other “atypical” complications that can have devastating consequences if... Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5144516 Sat, 20 Aug 2011 16:10:53 +0100 5144516 http://www.medworm.com/index.php?rid=5144515&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840111000401%2Fabstract%3Frss%3Dyes Acute leukemia is the most common malignancy in children. Children with acute lymphoblastic leukemia and acute myeloid leukemia are frequently diagnosed, evaluated, and treated in emergency departments. Children with acute leukemia may develop multiple life-threatening electrolyte abnormalities, either at the time of diagnosis or after initiation of therapy. Children with acute lymphoblastic leukemia or hyperleukocytosis are at high risk for developing tumor lysis syndrome, which includes hyperuricemia, hyperkalemia, hyperphosphatemia, or hypocalcemia. Clinical complications of tumor lysis syndrome include renal insufficiency or acute renal failure, seizures, altered mental status or coma, cardiac arrhythmias, and sudden death. Rarely, children with acute leukemia will present with hyperca... Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5144515 Sat, 20 Aug 2011 16:10:53 +0100 5144515 http://www.medworm.com/index.php?rid=5144514&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840111000346%2Fabstract%3Frss%3Dyes This article discusses the signs and symptoms of VTE, which can often be subtle in pediatric patients, and radiographic and laboratory approaches in the evaluation of patients with suspected VTE. Initial treatment strategies for acute VTE are reviewed, as well as the recommended approach to managing patients already receiving anticoagulation when they present to the emergency department for care. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5144514 Sat, 20 Aug 2011 16:10:53 +0100 5144514 http://www.medworm.com/index.php?rid=5144513&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840111000395%2Fabstract%3Frss%3Dyes This article reviews some guiding principles of initial management of febrile neutropenic children with cancer with a focus on risk-stratified treatment approaches, including the use of inflammatory markers to discern risk. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5144513 Sat, 20 Aug 2011 16:10:53 +0100 5144513 http://www.medworm.com/index.php?rid=5144512&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840111000425%2Fabstract%3Frss%3Dyes Children and adolescents afflicted by hematologic and oncological conditions constitute some of the most complicated patients faced by care providers in the emergency department (ED). The spectrum of disease in this patient population ranges from malignant conditions such as leukemia to “benign” conditions such as immune thrombocytopenic purpura, both of which commonly present initially to the ED. In these situations, providers require a high index of suspicion for making the appropriate diagnosis and must anticipate potential complications and emergencies, some of which may be life threatening, associated with these disorders. Children with a history of hematologic or oncological disease may use the ED for other reasons. They may present with complications of the treatment that they r... Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5144512 Sat, 20 Aug 2011 16:10:53 +0100 5144512 http://www.medworm.com/index.php?rid=5144511&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840111000462%2Fabstract%3Frss%3Dyes (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5144511 Sat, 20 Aug 2011 16:10:53 +0100 5144511 http://www.medworm.com/index.php?rid=5144510&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840111000450%2Fabstract%3Frss%3Dyes (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5144510 Sat, 20 Aug 2011 16:10:53 +0100 5144510 http://www.medworm.com/index.php?rid=4999645&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840111000206%2Fabstract%3Frss%3Dyes A 13-year-old female presented to the emergency department after a syncopal episode. This episode was preceded by a 3-day viral prodrome consisting of a subjective fever, upper respiratory symptoms, and fatigue. She was found to have severe bradycardia secondary to complete heart block and cardiogenic shock resulting in multisystem organ failure. The patient required transthoracic pacing in the emergency department with emergent transvenous pacing in the pediatric intensive care unit. A comprehensive evaluation for the underlying etiology of her heart block, cardiogenic shock, and multisystem organ failure revealed viral myocarditis. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4999645 Tue, 31 May 2011 23:00:00 +0100 4999645 http://www.medworm.com/index.php?rid=4999644&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS152284011100019X%2Fabstract%3Frss%3Dyes A 3-month-old infant presented to the emergency department with vomiting and dehydration during an acute gastrointestinal illness. Her evaluation revealed hypoglycemia and diabetes insipidus, indicating the presence of hypopituitarism. Nystagmus was present on physical examination, suggesting an underlying diagnosis of septo-optic dysplasia. Brain magnetic resonance imaging confirmed the presence of this disorder, which is characterized by visual abnormalities, hypopituitarism, and midline brain defects. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4999644 Tue, 31 May 2011 23:00:00 +0100 4999644 http://www.medworm.com/index.php?rid=4999643&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840111000188%2Fabstract%3Frss%3Dyes Although reliable processes are the foundation for improving health care, individual provider performance plays an important role in those processes. A strategic well-thought approach for maximizing staff performance is necessary. This strategy begins by developing and communicating a vision for clinical care. Emergency department leadership can then specifically characterize the content of 3 skill sets necessary for success: cognitive, technical, and patient experience. The content of these skill sets will then define provider expectations and performance measures. After communicating expectations and performance measures with the physician staff, it is critical to provide feedback, motivate staff through incentives and rewards, and hold them appropriately accountable for the care they pr... Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4999643 Tue, 31 May 2011 23:00:00 +0100 4999643 http://www.medworm.com/index.php?rid=4999642&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840111000139%2Fabstract%3Frss%3Dyes We describe a systematic and comprehensive effort to decrease ED length of stay using lean manufacturing techniques derived from the Toyota Production System. Through a combination of projects, we describe how we were able to meet a hospital goal to reduce the length of time that admitted patients remain in the ED. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4999642 Tue, 31 May 2011 23:00:00 +0100 4999642 http://www.medworm.com/index.php?rid=4999641&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840111000231%2Fabstract%3Frss%3Dyes This article will describe the OE model used at the Children's Hospital of Michigan to change an existing system in a tertiary pediatric ED. Our work resulted in reducing ED admission time by 83%, the left without being seen rate by 91%, and the ED length of stay by 48%; improved the door-to-doctor time; and eliminated waiting room deaths. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4999641 Tue, 31 May 2011 23:00:00 +0100 4999641 http://www.medworm.com/index.php?rid=4999640&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840111000152%2Fabstract%3Frss%3Dyes Children often present to the emergency department with undifferentiated complaints, such as abdominal pain. The role of the emergency physician is to make an accurate and efficient assessment leading to diagnosis and management. Physician risk tolerance and decision methods have led to variations in practice and quality of care within the pediatric emergency department (PED). The use of evidence-based clinical algorithms to standardize and improve the quality of care delivered in the PED has increased significantly over the last decade. Using an example of a care map for children with suspected appendicitis, this article will demonstrate the incorporation of clinical prediction rules into clinical practice as a model for quality improvement in the PED. (Source: Clinical Pediatric Emergenc... Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4999640 Tue, 31 May 2011 23:00:00 +0100 4999640 http://www.medworm.com/index.php?rid=4999639&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840111000164%2Fabstract%3Frss%3Dyes Evidence-based guidelines are increasingly used within health care delivery systems to improve the quality of care delivered within local institutions. When created systematically through a transparent process by multidisciplinary teams, guidelines can serve as a means to improve diagnostic accuracy and therapeutic reliability. This review summarizes the justification for the development of evidence-based guidelines, the process of guideline development and implementation, and the tracking of outcomes to reduce variation in care and standardized practice. The development and implementation of such guidelines in pediatric emergency medicine have demonstrated several improvements in quality of care, and the outcomes derived are delineated within this review. (Source: Clinical Pediatric Emerg... Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4999639 Tue, 31 May 2011 23:00:00 +0100 4999639 http://www.medworm.com/index.php?rid=4999638&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840111000176%2Fabstract%3Frss%3Dyes This article discusses measuring quality in PEC, focusing on a measurement framework that includes the Institute of Medicine quality domains and Donabedian structure-process-outcome formulation for quality and disease frequency and severity. Adoption of this framework will allow PEC practitioners and administrators to assess quality of care in a balanced way. The article also addresses sources of data and responsibility for measurement as well as the integration of prehospital and hospital-based measures. The authors conclude that a lead agency, recognized as a single point of contact for stakeholders and the public, could result in consolidated and effective reporting of measures to greatly benefit the quality of emergency care for children. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4999638 Tue, 31 May 2011 23:00:00 +0100 4999638 http://www.medworm.com/index.php?rid=4999637&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840111000140%2Fabstract%3Frss%3Dyes There is an urgent need to improve the quality of health care delivery in emergency department (ED) settings. Given that nearly 27% of ED patients are children, 92% of which are seen in non–children's hospitals; the responsibility to improve the quality of emergency care for children applies to all systems, hospitals, EDs, and providers. In this article, we present an acute care model to frame quality improvement work in emergency care. This model will allow all EDs, not just children's hospital EDs, to adopt a common language and improve 4 integrated components of acute care: segmentation, diagnostic accuracy, therapeutic reliability, and disposition. Importantly for EDs, the acute care model can be used to improve ED flow. Furthermore, the model is supported by 4 critical competencies ... Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4999637 Tue, 31 May 2011 23:00:00 +0100 4999637 http://www.medworm.com/index.php?rid=4999636&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840111000218%2Fabstract%3Frss%3Dyes This article attempts to provide a glossary of commonly used quality frameworks, terms, and tools (the “learning curve”) followed by a couple of examples of clinical issues that are being addressed by formal/informal QI techniques (the “curveball”). (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4999636 Tue, 31 May 2011 23:00:00 +0100 4999636 http://www.medworm.com/index.php?rid=4999635&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS152284011100022X%2Fabstract%3Frss%3Dyes Concerns about rising costs, coupled with variable care provided, has fueled quality improvement (QI) efforts in health care. QI tools borrowed from the manufacturing industry, such as six sigma and lean methods, are being used to address variation, waste, and sometimes inappropriate or even dangerous health care practices. The emergency department (ED) is an integral component of the health care system and, in some instances, represents the only means of access to care. There are substantial challenges to delivering high quality care in the ED including overcrowding, undifferentiated illness, lack of resources, and liability concerns, just to name a few. Experts have recognized that delivery of emergency medical services is highly fragmented and have underscored the need for performance o... Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4999635 Tue, 31 May 2011 23:00:00 +0100 4999635 http://www.medworm.com/index.php?rid=4999634&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840111000292%2Fabstract%3Frss%3Dyes (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4999634 Tue, 31 May 2011 23:00:00 +0100 4999634 http://www.medworm.com/index.php?rid=4999633&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840111000280%2Fabstract%3Frss%3Dyes (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4999633 Tue, 31 May 2011 23:00:00 +0100 4999633 http://www.medworm.com/index.php?rid=4595685&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000923%2Fabstract%3Frss%3Dyes This article addresses issues surrounding credentialing and reimbursement for point-of-care emergency ultrasound. Specifically, certification, privileging, and accreditation in emergency ultrasound are defined, and examples of how these concepts are typically used in the United States are given. Methods of reimbursement are discussed, including the impact of point-of-care ultrasound use on evaluation and management codes and basic structure of current procedure and terminology codes including technical and professional components. Key requirements for reimbursement including documentation of medical necessity, findings, and image archival are covered. Future directions in point-of-care ultrasound credentialing and reimbursement are discussed. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4595685 Tue, 01 Mar 2011 00:00:00 +0100 4595685 http://www.medworm.com/index.php?rid=4595684&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000959%2Fabstract%3Frss%3Dyes In contrast to adult emergency medicine, bedside ultrasound has not been widely used in pediatric emergency medicine. Recent literature suggests that bedside ultrasound may have multiple uses for pediatric emergency care. This review will provide an overview on how to implement this tool into a pediatric emergency department and the integration of ultrasonography into a fellowship curriculum. In addition, this article will highlight evidence derived from the technology and business literature regarding the development of this technology for pediatric emergency medicine. Special emphasis will be placed on practical evidence to identify barriers to adoption as well as strategies to overcome these barriers. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4595684 Tue, 01 Mar 2011 00:00:00 +0100 4595684 http://www.medworm.com/index.php?rid=4595683&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000972%2Fabstract%3Frss%3Dyes New indications for bedside emergency ultrasound are consistently being described in the literature. In recent years, emergency ultrasound has been used in the diagnosis of ocular trauma, the measurement of optic nerve sheath diameter as a surrogate for intracranial pressure, the confirmation of endotracheal tube placement, the diagnosis of hip effusions, the identification of landmarks during lumbar puncture, procedural guidance during peripheral nerve blocks, and the diagnosis of skull fractures. Many of these applications have not been rigorously studied in pediatric patients; however, this article offers a summary of the latest applications of this diagnostic tool in emergency care. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4595683 Tue, 01 Mar 2011 00:00:00 +0100 4595683 http://www.medworm.com/index.php?rid=4595682&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000947%2Fabstract%3Frss%3Dyes Bedside emergency ultrasound (EUS) has been used for decades by emergency physicians and has recently begun to gain widespread acceptance in the pediatric emergency medicine arena. The use of bedside EUS for procedural assistance is a rapidly growing trend in pediatric emergency care. Its use for procedural purposes is aimed at not only improving the success rates of the procedure itself but also reducing complications and, thus, maximizing patient safety. The need to limit these unfavorable consequences resulting from necessary procedures is a powerful force, driving placement of EUS in the pediatric emergency department. Researchers continue to identify new applications for this exciting technology as practitioners are gaining expertise with proper training and education. As the range of... Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4595682 Tue, 01 Mar 2011 00:00:00 +0100 4595682 http://www.medworm.com/index.php?rid=4595681&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000960%2Fabstract%3Frss%3Dyes Point-of-care echocardiography is a goal-directed bedside ultrasound that can aid clinical decision making, enhance diagnostic confidence, and facilitate judicious consultation in the hemodynamically unstable or critically ill or injured child in the emergency department. Similar to other applications of ultrasound in the emergency department, it is designed to answer a binary (yes/no) question: Is there a pericardial effusion with tamponade? Is the left ventricular function normal or depressed or hyperdynamic? Is the cardiac preload decreased or normal or increased? The scope of this review is to introduce the reader to the technique, normal anatomy, and standard transthoracic echocardiographic views and understand how point-of-care echocardiography can be integrated into bedside assessme... Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4595681 Tue, 01 Mar 2011 00:00:00 +0100 4595681 http://www.medworm.com/index.php?rid=4595680&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000935%2Fabstract%3Frss%3Dyes Long bone fractures are common pediatric injuries. Their diagnosis and management have traditionally relied on radiography and fluoroscopy. However, these modalities expose patients and providers to radiation, increase the cost of care, and consume emergency department time and resources. An emerging imaging alternative is bedside ultrasound (US). This review summarizes the current state of medical evidence regarding the use of bedside US to diagnose and manage suspected pediatric long bone fractures. Growing evidence suggests that US may replace radiography for many patients. Furthermore, providers not already proficient in bedside US should consider expanding their skills using these methods. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4595680 Tue, 01 Mar 2011 00:00:00 +0100 4595680 http://www.medworm.com/index.php?rid=4595679&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000996%2Fabstract%3Frss%3Dyes This article will review the evidence base for point-of-care pelvic ultrasound. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4595679 Tue, 01 Mar 2011 00:00:00 +0100 4595679 http://www.medworm.com/index.php?rid=4595678&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000984%2Fabstract%3Frss%3Dyes This article will review the evidence base for the FAST and extended FAST examinations as applied to pediatric trauma patients. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4595678 Tue, 01 Mar 2011 00:00:00 +0100 4595678 http://www.medworm.com/index.php?rid=4595677&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS152284011000100X%2Fabstract%3Frss%3Dyes This issue of Clinical Pediatric Emergency Medicine features review articles that address the role of bedside ultrasound in pediatric emergency medicine. During the past decade, great strides have been made in bringing technology to the patient's bedside with a goal to improve the efficiency, quality, safety, and comfort of medical care. This issue is designed to bring the emergency care practitioner up-to-date with recent advances in the application of bedside ultrasonography in children. The articles can be divided into 3 categories: (1) those that deal with diagnostic indications, (2) those that review the use of ultrasound to facilitate invasive procedures, and (3) those that speak to the administrative issues relevant to the implementation of this modality. (Source: Clinical Pediatric... Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4595677 Tue, 01 Mar 2011 00:00:00 +0100 4595677 http://www.medworm.com/index.php?rid=4595676&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS152284011100005X%2Fabstract%3Frss%3Dyes (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4595676 Tue, 01 Mar 2011 00:00:00 +0100 4595676 http://www.medworm.com/index.php?rid=4595675&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840111000048%2Fabstract%3Frss%3Dyes (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4595675 Tue, 01 Mar 2011 00:00:00 +0100 4595675 http://www.medworm.com/index.php?rid=4208999&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000728%2Fabstract%3Frss%3Dyes Neonatal seizures are the most common neurologic emergency in the newborn period. Given that there is a broad differential diagnosis, emergency evaluation should first focus on identifying treatable causes. The following case describes a neonate who presented to the emergency department with seizures. The seizures were provoked by electrolyte abnormalities secondary to dehydration and renal failure from intestinal obstruction secondary to congenital duodenal atresia. This case illustrates a unique and potentially treatable etiology of neonatal seizures. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4208999 Tue, 30 Nov 2010 07:44:16 +0100 4208999 http://www.medworm.com/index.php?rid=4208998&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000716%2Fabstract%3Frss%3Dyes We report a case of a previously healthy 18-year-old female who presented to the pediatric emergency department with altered mental status, multi-system organ failure, and fulminant sepsis from pneumococcal meningitis. Further work-up of this patient confirmed a new diagnosis of SLE. This case highlights the potential degree of immune dysfunction in patients with SLE by opportunistic agents and common pathogens. A high index of suspicion for SLE in childhood is important as delays in diagnosis can lead to life-threatening complications and long-term sequelae. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4208998 Tue, 30 Nov 2010 07:44:16 +0100 4208998 http://www.medworm.com/index.php?rid=4208997&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS152284011000073X%2Fabstract%3Frss%3Dyes There are many misconceptions with billing for sedation services. It is not the setting or the type of provider or medication used, but the depth of sedation provided, that determines the type of sedation service that should be reported. Any qualified physician or nonphysician provider may report anesthesia services for deep sedation. Advanced negotiation with the hospital and third-party payers is the key to successful reimbursement for a sedation service. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4208997 Tue, 30 Nov 2010 07:44:16 +0100 4208997 http://www.medworm.com/index.php?rid=4208996&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000662%2Fabstract%3Frss%3Dyes This article reviews notable recent trends in research as reported in peer-reviewed journals, including large prospective database studies that have improved our understanding of the incidence and nature of adverse events in pediatric sedation. Along with this effort has come an attempt to better develop a new lexicon to describe “adverse events” or complications. In addition to these descriptive demographic articles, investigators continue to add to the cumulative experience with new drugs such as dexmedetomidine and older sedatives/analgesics such as ketamine and nitrous oxide in children. Finally, evaluation of the workload and trends in sedation utilization in children have been reported and will be reviewed; and future needs for pediatric sedation research are suggested. (Source: ... Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4208996 Tue, 30 Nov 2010 07:44:16 +0100 4208996 http://www.medworm.com/index.php?rid=4208995&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000686%2Fabstract%3Frss%3Dyes Practitioners of procedural sedation and analgesia for children in an emergency department setting must balance the needs of individual patients, including safety and efficacy, with the needs of the department as a whole, including efficiency and appropriate use of resources. Individual patient needs will vary depending on the age and developmental stage of the patient, the anticipated level of pain and distress, the degree of immobility required, and the duration of the procedure. The ability to accurately predict the need for sedation, the level of sedation and degree of analgesia required for patient comfort, and the best sedative agent to accomplish these goals without undesirable consequences is a skill that requires knowledge and experience. This review presents 6 case scenarios illu... Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4208995 Tue, 30 Nov 2010 07:44:16 +0100 4208995 http://www.medworm.com/index.php?rid=4208994&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000704%2Fabstract%3Frss%3Dyes Pain is the hallmark of sickle cell disease in children and adolescents. Many children seek relief from their pain in the emergency department. These visits have historically been characterized by undertreatment, bias, and distrust. Through compassionate care, aggressive pain management, and the development of clinical pathways or care guidelines, better analgesia, and a better careexperience can be assured for the child with sickle cell disease in need of emergency services. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4208994 Tue, 30 Nov 2010 07:44:16 +0100 4208994 http://www.medworm.com/index.php?rid=4208993&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000753%2Fabstract%3Frss%3Dyes We describe the evolution of guidelines for procedural sedation monitoring in children and review monitoring principles, common adverse events, current monitoring modalities, future directions, and emerging monitoring technologies. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4208993 Tue, 30 Nov 2010 07:44:15 +0100 4208993 http://www.medworm.com/index.php?rid=4208992&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000698%2Fabstract%3Frss%3Dyes This article reviews some of the many non-pharmacological developmentally-based strategies that can be implemented in the emergency department to reduce a child’s distress. These techniques can help improve treatment and procedural success, and ultimately create a more satisfying experience for the patient, family and medical team. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4208992 Tue, 30 Nov 2010 07:44:15 +0100 4208992 http://www.medworm.com/index.php?rid=4208991&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000674%2Fabstract%3Frss%3Dyes The spectrum of sedative and analgesic agents available to those who provide pediatric sedation and analgesia in the emergency department has broadened considerably over the past 2 decades. Pharmacologic agents that can be used alone or in combination in this context include nitrous oxide, midazolam, chloral hydrate, pentobarbital, etomidate, dexmedetomidine, propofol, and ketamine. The pharmacology, common clinical uses, advantages, and disadvantages of each of these agents are reviewed. Pharmacokinetics of the agents is addressed in tabular form, whereas pharmacodynamic aspects of each agent are discussed in more detail. Clinical uses addressed include noninvasive as well as invasive procedures. Relevant studies involving comparison of various sedative regimens for common emergency depar... Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4208991 Tue, 30 Nov 2010 07:44:15 +0100 4208991 http://www.medworm.com/index.php?rid=4208990&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000741%2Fabstract%3Frss%3Dyes Children are often fearful of visits to the emergency department (ED) because it represents a potentially painful experience in a foreign environment. Over the past 2 decades, a greater appreciation of the need to maximize patient comfort and minimize anxiety for the entire pediatric age spectrum has led to an appreciation of the role played by anxiolytics, narcotics, and sedatives in reducing unnecessary discomfort during the performance of procedures and radiologic examinations in children. The spectrum of agents available for pediatric procedural sedation and analgesia in the ED has broadened considerably over the past 2 decades. The intramuscular narcotic-phenothiazine “cocktail” has been relegated to historical lore, and the present day practitioner can choose from over a dozen ph... Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4208990 Tue, 30 Nov 2010 07:44:14 +0100 4208990 http://www.medworm.com/index.php?rid=4208989&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000790%2Fabstract%3Frss%3Dyes (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4208989 Tue, 30 Nov 2010 07:44:14 +0100 4208989 http://www.medworm.com/index.php?rid=4208988&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000789%2Fabstract%3Frss%3Dyes (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4208988 Tue, 30 Nov 2010 07:44:14 +0100 4208988 http://www.medworm.com/index.php?rid=3995440&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000406%2Fabstract%3Frss%3Dyes Pediatric foreign body (FB) ingestion is a common problem throughout the world. The type of FB that is ingested, the anatomical location of the FB, and the time to medical presentation are all factors that determine how the child will be treated. Unfortunately, there is not a universally implemented algorithm on how to deal with this concern. We review the literature and discuss the different types of foreign bodies that are ingested as well as highlight the differences and similarities in their management plans. We also present a possible algorithm to the approach of the pediatric patient with a concern for FB ingestion. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3995440 Tue, 31 Aug 2010 23:00:00 +0100 3995440 http://www.medworm.com/index.php?rid=3995439&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000443%2Fabstract%3Frss%3Dyes This article focuses on the pediatric patient suffering from penetrating abdominal trauma, the importance of rapid diagnosis and treatment of shock, as well as the workup and definitive management of children with penetrating abdominal injuries. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3995439 Tue, 31 Aug 2010 23:00:00 +0100 3995439 http://www.medworm.com/index.php?rid=3995438&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000418%2Fabstract%3Frss%3Dyes Major upper gastrointestinal hemorrhage is an alarming clinical presentation in infants and children. Although the etiology varies according to age at presentation, the shared principles of diagnosis and management include prompt assessment, resuscitation, investigation and therapeutic intervention. Patients with portal hypertension and other significant medical comorbidities warrant special consideration and medical management. Data on the epidemiology and outcomes of children with major upper gastrointestinal hemorrhage are limited and further research to address these questions is keenly awaited. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3995438 Tue, 31 Aug 2010 23:00:00 +0100 3995438 http://www.medworm.com/index.php?rid=3995437&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000467%2Fabstract%3Frss%3Dyes Acute liver failure is a rare, life-threatening clinical syndrome marked by the sudden loss of hepatic function in a patient with no prior history of liver disease. Although emergency liver transplantation is often the only life-saving therapeutic option, children correctly diagnosed with well-characterized causes of pediatric acute liver failure may benefit from the early implementation of directed medical therapies. Vigilant intensive and supportive care is critical with specific attention to the development of a myriad of potential complications. The goal of this article is to enable the early recognition of the child presenting in acute liver failure and provide a focused approach to the interim diagnostic and management strategies leading to the timely referral to a pediatric liver tr... Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3995437 Tue, 31 Aug 2010 23:00:00 +0100 3995437 http://www.medworm.com/index.php?rid=3995436&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS152284011000042X%2Fabstract%3Frss%3Dyes Inflammatory bowel disease (IBD) is an increasingly common cause of morbidity in the pediatric population. Despite the establishment of dedicated multidisciplinary IBD teams in many centers, the care offered by emergency physicians is often crucial in the period before diagnosis and at times of relapses or acute complications. Crohn's disease and ulcerative colitis can present with a myriad of acute and chronic symptoms to the emergency department. Pediatric Crohn's disease encompasses a variety of phenotypic forms and often does not present with the classic triad of diarrhea, abdominal pain, and weight loss. Pediatric ulcerative colitis tends to be more extensive than adult-onset disease, with a greater predilection to acute severe exacerbations requiring urgent recognition. Disease- and ... Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3995436 Tue, 31 Aug 2010 23:00:00 +0100 3995436 http://www.medworm.com/index.php?rid=3995435&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000480%2Fabstract%3Frss%3Dyes This article reviews the causes, clinical presentation, and acute management of constipation in children presenting to the emergency department. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3995435 Tue, 31 Aug 2010 23:00:00 +0100 3995435 http://www.medworm.com/index.php?rid=3995434&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS152284011000039X%2Fabstract%3Frss%3Dyes Abdominal pain is a common reason for emergency department visits in the United States. Failure to treat children's pain has long been considered substandard and unethical. Within the emergency department setting, pain has been repeatedly shown to be undertreated. Analgesic medications are suboptimally used for children with abdominal pain because of a wide variety of causes. To our knowledge, there is no standard of care for the treatment of such pain. As such, several recent studies have set out to determine the most appropriate methods to address this gap in knowledge. The proceeding article will attempt to review the literature as it pertains to severe acute abdominal pain, biliary colic, renal colic, and dysmenorrhea. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3995434 Tue, 31 Aug 2010 23:00:00 +0100 3995434 http://www.medworm.com/index.php?rid=3995433&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000479%2Fabstract%3Frss%3Dyes Acute gastroenteritis remains a major cause of morbidity and mortality in children around the world, especially in children younger than 5 years. The severity of the disease varies widely depending on the volume of fluid loss the child experiences through vomiting and diarrhea. Preventing the development of dehydration and rehydration therapy are the mainstay of emergency department treatment. A variety of therapies have been proposed to achieve these aims in children with acute gastroenteritis by alleviating vomiting and diarrhea. This review will describe the most recent developments in the literature related to acute gastroenteritis. Special emphasis will be placed on the emerging evidence for innovative therapeutic interventions. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3995433 Tue, 31 Aug 2010 23:00:00 +0100 3995433 http://www.medworm.com/index.php?rid=3995432&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000455%2Fabstract%3Frss%3Dyes The clinical and epidemiological spectrum of acute gastroenteritis is likely to change dramatically in the face of rotavirus vaccination. Acute gastroenteritis will become less common and severe and other viruses may predominate, such as norovirus. Oral rehydration is generally underemployed in the management of gastroenteritis. A greater emphasis on “frontloaded” care in the waiting room, the use of newer antiemetics and more prescriptive oral fluid management will reduce the need for inpatient care. When this fails, nasogastric administration of fluids is a valuable but underutilized treatment. Nasogastric rehydration is as effective, quicker, and easier to employ than intravenous rehydration at the expense of a less pleasant but short procedural experience for the child. It should b... Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3995432 Tue, 31 Aug 2010 23:00:00 +0100 3995432 http://www.medworm.com/index.php?rid=3995431&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000431%2Fabstract%3Frss%3Dyes Gastrointestinal emergencies are important to clinicians and their patients. Some disease processes are extremely common, while others can be life threatening. Whereas acute gastroenteritis results in nearly 200 000 pediatric hospitalizations annually but very little mortality, other disease processes, such as major upper gastrointestinal hemorrhage and acute liver failure, are infrequent, yet can have dire consequences. Thus, the clinician has to identify the few true emergencies among a sea of patients presenting with more mundane gastrointestinal complaints. More importantly, emergency care providers need to be capable of minimizing morbidity in patients with non–life-threatening conditions while optimizing outcomes in patients with more significant disease processes. (Source: Clinic... Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3995431 Tue, 31 Aug 2010 23:00:00 +0100 3995431 http://www.medworm.com/index.php?rid=3995430&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000522%2Fabstract%3Frss%3Dyes (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3995430 Tue, 31 Aug 2010 23:00:00 +0100 3995430 http://www.medworm.com/index.php?rid=3995429&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000510%2Fabstract%3Frss%3Dyes (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3995429 Tue, 31 Aug 2010 23:00:00 +0100 3995429 http://www.medworm.com/index.php?rid=3818366&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS152284011000025X%2Fabstract%3Frss%3Dyes This is the case of a 13-year-old adolescent girl who presented to the emergency department and was diagnosed with severe pulmonary hypertension. In the intensive care unit, she underwent a comprehensive evaluation for the underlying etiology of her pulmonary hypertension and was determined to have pulmonary venoocclusive disease, a rare disorder of pulmonary venous fibrosis and thrombosis. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3818366 Mon, 31 May 2010 23:00:00 +0100 3818366 http://www.medworm.com/index.php?rid=3818365&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000200%2Fabstract%3Frss%3Dyes Sudden loss of vision is a very uncommon but extremely worrisome symptom. The management of children with acute vision loss in the emergency department requires timely recognition, a focused assessment, and referral to the appropriate subspecialty care provider for further evaluation and definitive care. In this article, we will review the clinical manifestations and early management of traumatic and nontraumatic causes of acute vision loss in children. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3818365 Mon, 31 May 2010 23:00:00 +0100 3818365 http://www.medworm.com/index.php?rid=3818364&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000194%2Fabstract%3Frss%3Dyes Postoperative complications in pediatric otolaryngology often present to the emergency department. Posttonsillectomy hemorrhage is a feared complication due to its lethal potential and should be managed in conjunction with an otolaryngologist. Physicians should possess and awareness of procedures that have been used in an emergent setting. Postoperative pain management options are discussed including acetaminophen, acetaminophen with codeine, and nonsteroidal anti-inflammatory drugs. Rare postadenoidectomy complications such as nasopharyngeal stenosis and Grisel syndrome are discussed. Tympanostomy tubes are the most common surgery in children, and the proper treatment of posttympanostomy tube otorrhea is discussed. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3818364 Mon, 31 May 2010 23:00:00 +0100 3818364 http://www.medworm.com/index.php?rid=3818363&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000169%2Fabstract%3Frss%3Dyes Tracheostomy is a life-saving tool readily available to modern physicians. This review describes tracheostomy complications in pediatric patients, with an emphasis on etiology, epidemiology, and management. Complications in pediatric tracheostomies range from intraoperative to late postoperative (chronic). We will separate them arbitrarily into early and late complications. The early complication period begins from when the tracheostomy is performed up until 1 month postoperatively. Late complications occur from 1 month postoperatively and beyond. We will cover some of the necessary steps to treat these complications. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3818363 Mon, 31 May 2010 23:00:00 +0100 3818363 http://www.medworm.com/index.php?rid=3818362&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000273%2Fabstract%3Frss%3Dyes This article reviews common oropharyngeal lesions that occur in children, including trauma, and the management of these conditions, including techniques for orofacial nerve blocks. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3818362 Mon, 31 May 2010 23:00:00 +0100 3818362 http://www.medworm.com/index.php?rid=3818361&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000224%2Fabstract%3Frss%3Dyes Tooth avulsion occurs commonly in pediatric practice. However, most caretakers either do not recognize the relative urgency of this injury or do not know emergent management when this does occur. Such injuries should be recognized and treated expeditiously because several studies support a more likely favorable prognosis with timely and appropriate initial management. This review highlights the essential steps in the initial diagnosis and management of this injury for both primary care practitioners and emergency medicine providers. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3818361 Mon, 31 May 2010 23:00:00 +0100 3818361 http://www.medworm.com/index.php?rid=3818360&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000212%2Fabstract%3Frss%3Dyes Maxillofacial fractures are relatively rare in the pediatric population. However, the consequences of such fractures can be very profound. Age-specific variations occur with regards to particular fracture types. We review these specific types of fractures, their etiologies, appropriate diagnostic studies, and early management. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3818360 Mon, 31 May 2010 23:00:00 +0100 3818360 http://www.medworm.com/index.php?rid=3818359&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000170%2Fabstract%3Frss%3Dyes A variety of conditions may result in maxillofacial swelling in children, prompting a visit to the emergency department. Some of these diagnoses are self-limiting, whereas others may be life-threatening. Furthermore, the pediatric population is at significant risk for problems that rarely occur in adults. Emergency medicine providers must be able to identify these conditions, especially if specialty consultation is required. Some of the most common and significant causes of maxillofacial swelling in children are reviewed to help familiarize the practitioner with their presentation, causes, and available treatment options. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3818359 Mon, 31 May 2010 23:00:00 +0100 3818359 http://www.medworm.com/index.php?rid=3818358&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000261%2Fabstract%3Frss%3Dyes A foreign body ingestion should be considered in the differential diagnosis when evaluating children with gastrointestinal and respiratory complaints. Delayed presentations of foreign body ingestion can range from severe respiratory distress to being completely asymptomatic. The patient's condition, the type and location of the foreign body, and the expertise of the available providers dictate the management of ingested foreign bodies. Emergent removal is necessary for children with symptoms of acute respiratory distress or intractable vomiting and for those with the following ingestions: food impaction; 2 or more magnets; sharp objects in the proximal bowel; and esophageal, aural, and otic button batteries. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3818358 Mon, 31 May 2010 23:00:00 +0100 3818358 http://www.medworm.com/index.php?rid=3818357&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000236%2Fabstract%3Frss%3Dyes Neck masses are a common presenting complaint for children in the emergency department. A detailed history and physical examination usually leads to a preliminary diagnosis. Imaging can sometimes assist in differentiating the type and extent of the lesion. This review will focus on congenital and inflammatory lesions, which make up the vast majority of neck masses in the pediatric population. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3818357 Mon, 31 May 2010 23:00:00 +0100 3818357 http://www.medworm.com/index.php?rid=3818356&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000182%2Fabstract%3Frss%3Dyes Foreign body aspiration occurs frequently and is a leading cause of pediatric morbidity. At the time of presentation for care, children may be asymptomatic. A high index of suspicion is therefore needed to make the diagnosis. Radiography may aid in establishing the diagnosis but cannot exclude a radiolucent airway foreign body. Bronchoscopy remains the definitive method for diagnosis and the therapy of choice for removal of airway foreign bodies. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3818356 Mon, 31 May 2010 23:00:00 +0100 3818356 http://www.medworm.com/index.php?rid=3818355&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000248%2Fabstract%3Frss%3Dyes Signs and symptoms involving the eye, ear, nose, mouth, face, and neck are common complaints in children presenting to the emergency department, representing a wide range of possible diagnoses, from the benign to life-threatening. In this issue of Clinical Pediatric Emergency Medicine, the authors discuss a broad range of conditions and identify those particular problems that require subspecialty assistance. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3818355 Mon, 31 May 2010 23:00:00 +0100 3818355 http://www.medworm.com/index.php?rid=3818354&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000339%2Fabstract%3Frss%3Dyes (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3818354 Mon, 31 May 2010 23:00:00 +0100 3818354 http://www.medworm.com/index.php?rid=3818353&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000327%2Fabstract%3Frss%3Dyes (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3818353 Mon, 31 May 2010 23:00:00 +0100 3818353 http://www.medworm.com/index.php?rid=3367542&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109001153%2Fabstract%3Frss%3Dyes This article offers suggestions for physicians and other acute care providers for ways to accomplish this task by relying on skills we already possess as we increase our level of understanding. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3367542 Mon, 01 Mar 2010 00:00:00 +0100 3367542 http://www.medworm.com/index.php?rid=3367541&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109001098%2Fabstract%3Frss%3Dyes Most pediatric trauma patients are cared for in non-children's hospitals by providers without pediatric specialty training and in facilities that may not be used to caring for children. Children have different physiologic and psychologic responses to injury than adults. Children have different service and evaluative needs. Several studies have shown that pediatric trauma patients have improved outcomes with lower mortality, fewer operations, and improved function when cared for in pediatric facilities or adult trauma centers with pediatric expertise. Differences between injured adults and injured children need to be understood, recognized, and acted upon by care providers to optimize treatment for injured children. Limitations in the availability of pediatric specialists require that all h... Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3367541 Mon, 01 Mar 2010 00:00:00 +0100 3367541 http://www.medworm.com/index.php?rid=3367540&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109001104%2Fabstract%3Frss%3Dyes This article reviews management principles of traumatic brain injury, mechanical ventilation, and shock in the pediatric trauma patient and is intended to guide ED management of these patients until they can be transferred to an appropriate level of inpatient care. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3367540 Mon, 01 Mar 2010 00:00:00 +0100 3367540 http://www.medworm.com/index.php?rid=3367539&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109001165%2Fabstract%3Frss%3Dyes This article will provide a review of pain in injured children with respect to its pathophysiology, clinical ramifications, and patterns of analgesia practices. Impediments to analgesia are examined regarding multiple providers of care for the acutely injured child including prehospital personnel, nurses, and physicians. Finally, the article will provide analgesia recommendations with an approach to pain relief and sedation for the injured pediatric patient. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3367539 Mon, 01 Mar 2010 00:00:00 +0100 3367539 http://www.medworm.com/index.php?rid=3367538&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109001128%2Fabstract%3Frss%3Dyes This article's objective is to review the relative risks and benefits associated with this radiographic modality. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3367538 Mon, 01 Mar 2010 00:00:00 +0100 3367538 http://www.medworm.com/index.php?rid=3367537&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109001141%2Fabstract%3Frss%3Dyes This article reviews the literature and makes recommendations for a simplified, cost-effective laboratory testing strategy. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3367537 Mon, 01 Mar 2010 00:00:00 +0100 3367537 http://www.medworm.com/index.php?rid=3367536&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109001116%2Fabstract%3Frss%3Dyes This article will review the literature regarding the risks and benefits of various aspects of pediatric trauma care in the prehospital setting. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3367536 Mon, 01 Mar 2010 00:00:00 +0100 3367536 http://www.medworm.com/index.php?rid=3367535&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS152284010900113X%2Fabstract%3Frss%3Dyes The concept of a “golden hour” is a fixture in trauma care. There is a dearth of scientific proof for this concept but an abundance of controversy around how this concept should be interpreted, especially for pediatric trauma patients. Health care providers should instead focus on the “golden opportunity,” different for each patient, to provide the best care in the most appropriate environment for all injured children. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3367535 Mon, 01 Mar 2010 00:00:00 +0100 3367535 http://www.medworm.com/index.php?rid=3367534&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109001177%2Fabstract%3Frss%3Dyes For children younger than 14 years, there has been a dramatic and steady decline over the past 2 decades in injury-related mortality from 9427 deaths in 1986 (age-adjusted rate of 18.04/100 000) to 6530 in 2006 (age-adjusted rate of 10.59/100 000). Many factors contribute to this improvement including injury prevention strategies as well as treatment and aftercare of trauma patients. Although tremendous strides have been made, injury remains a leading cause of morbidity and mortality in the United States and is especially concerning within the pediatric population where trauma can rob years of happiness and productivity. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3367534 Mon, 01 Mar 2010 00:00:00 +0100 3367534 http://www.medworm.com/index.php?rid=3367533&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000054%2Fabstract%3Frss%3Dyes (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3367533 Mon, 01 Mar 2010 00:00:00 +0100 3367533 http://www.medworm.com/index.php?rid=3367532&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840110000042%2Fabstract%3Frss%3Dyes (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3367532 Mon, 01 Mar 2010 00:00:00 +0100 3367532 http://www.medworm.com/index.php?rid=3064553&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000925%2Fabstract%3Frss%3Dyes A 5-year-old white boy was sent to the emergency department by his pediatrician for fever and abdominal distention. For 1 month, his parents had noted intermittent fevers, with daily fevers (maximum temperature, 38.5°C) for 1 week. He had an enlarging “bump” over the right upper quadrant of his abdomen for 2 weeks and vague intermittent abdominal pain for 2 days. There was no history of vomiting, and stools had been normal (1-2 per day, loose, malodorous, no blood). His parents reported decreased energy for the last month but a normal appetite. No recent weight loss, bone or joint pain, or rashes were noted. Review of systems was positive for seasonal allergies and 1 month of nonproductive cough, which was diagnosed as cough-variant asthma. The nocturnal component of the cough improve... Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3064553 Tue, 01 Dec 2009 00:00:00 +0100 3064553 http://www.medworm.com/index.php?rid=3064552&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000901%2Fabstract%3Frss%3Dyes The patient is a 12-month-old male infant with global developmental delay who presented to the emergency department with a history of refusal to eat. On presentation, his mother reported that for the 4 days before presentation, he had refused to take formula, been increasingly irritable, and developed abdominal distension. He has had several episodes of “spitting up,” which was slightly increased from his baseline. The mother noted 3 to 4 large, green, soft stools without blood or mucous and decreased urine output on the day of this visit. She denied the presence of fever but stated that he had been coughing and intermittently breathing “hard and fast.” Three months before this current episode, he had similar symptoms requiring hospital admission and treatment for dehydration. (Sou... Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3064552 Tue, 01 Dec 2009 00:00:00 +0100 3064552 http://www.medworm.com/index.php?rid=3064551&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000913%2Fabstract%3Frss%3Dyes An 11-week-old baby boy was sent to the emergency department by his pediatrician for failure to thrive and 3 days of weak cry. He had only gained 3 oz since his 2-month-old well-child checkup, despite feeds of 3 to 4 oz of Enfamil Lipil with iron every 4 hours. He had 6 to 8 wet diapers each day, without any recent changes, and he had nonbloody yellow bowel movements once every 3 days, for which his pediatrician has prescribed daily corn syrup. He had an occasional nonbilious, nonbloody emesis about every 3 to 4 days. In the office, the pediatrician had obtained a finger stick glucose, which was normal at 85 mg/dL. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3064551 Tue, 01 Dec 2009 00:00:00 +0100 3064551 http://www.medworm.com/index.php?rid=3064550&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000937%2Fabstract%3Frss%3Dyes Infants and children presenting to the emergency department with hypoglycemia are a diagnostic emergency and require urgent treatment. The metabolic adaptive patterns of fasting occur earlier in children compared to adults, most notably with the development of ketone bodies. Glucose is the preferred energy source for the brain; however, when deprived of glucose, ketone bodies are an alternative fuel that may cross the blood-brain barrier. As infants and children have a relatively larger brain to body size and their rates of glucose use are higher, they are at increased risk of hypoglycemia. Collection of the "critical sample" to assist in the diagnostic work-up and urgent treatment to stabilize blood glucose levels is of paramount importance to protect the developing brain from glucose dep... Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3064550 Tue, 01 Dec 2009 00:00:00 +0100 3064550 http://www.medworm.com/index.php?rid=3064549&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000883%2Fabstract%3Frss%3Dyes Hyperthyroidism may present to physicians in the emergency department in a variety of ways. Using a case-based approach, this article provides a review of 3 such presentations, Graves disease, thyroid storm, and the accidental ingestion of thyroid hormone. Each case will offer a review of the evaluation and management of children with disorders of hyperthyroidism and specific recommendations pertaining to each case. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3064549 Tue, 01 Dec 2009 00:00:00 +0100 3064549 http://www.medworm.com/index.php?rid=3064548&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000950%2Fabstract%3Frss%3Dyes This article will present 2 cases with sodium abnormalities and then review the epidemiology, pathophysiology, and current management practices for dysnatremias. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3064548 Tue, 01 Dec 2009 00:00:00 +0100 3064548 http://www.medworm.com/index.php?rid=3064547&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS152284010900086X%2Fabstract%3Frss%3Dyes Adrenal insufficiency is an important and potentially life-threatening condition that may present to the emergency department. Seven clinical scenarios of adrenal insufficiency that the emergency physician should be able to recognize and confidently manage are reviewed. Epidemiology and mortality, etiology, and pathophysiology are addressed. Clinical presentation, diagnosis, and management of acute and chronic adrenal disease are also covered. In particular, adrenal suppression due to exogenous steroid use, adrenal suppression in septic shock, and adrenal suppression associated with etomidate are reviewed. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3064547 Tue, 01 Dec 2009 00:00:00 +0100 3064547 http://www.medworm.com/index.php?rid=3064546&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000895%2Fabstract%3Frss%3Dyes Traumatic brain injury (TBI) is a major cause of morbidity and mortality in children. Subsequent endocrine changes have been illustrated in adults and have been recently investigated in children as well. Head injury occurs often in children, and TBI has accounted for many emergency department visits. The most common type of brain injury in children is diffuse brain injury caused by acceleration or deceleration forces. In adults, there is no relationship that has emerged between the occurrence of pituitary dysfunction and time after TBI, type or severity of initial injury, or later outcome. In pediatrics, studies have shown that a delay in diagnosing pituitary dysfunction was common. In children with TBI, a screening algorithm, starting with measurement of an early-morning cortisol, should ... Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3064546 Tue, 01 Dec 2009 00:00:00 +0100 3064546 http://www.medworm.com/index.php?rid=3064545&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000949%2Fabstract%3Frss%3Dyes Intercurrent illness may trigger hyperglycemia as a result of the secretion of stress hormones and cytokines. This condition is termed “stress hyperglycemia.” Patients with stress hyperglycemia (rather than diabetes mellitus) usually do not have a lengthy history of polyuria, polydipsia, or weight loss. They do not manifest symptoms or signs of ketoacidosis (hyperpnea, acetone smell of breath). In addition, biochemical evidence of ketoacidosis is absent. If hyperglycemia is associated with a serum glucose above the low 200s, inpatient evaluation is preferred. In the emergency department, hemoglobin A1c can help acutely in estimating chronicity, with high levels prompting admission. Levels of diabetes antibodies should be drawn, and follow-up should be arranged to ascertain normalcy of ... Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3064545 Tue, 01 Dec 2009 00:00:00 +0100 3064545 http://www.medworm.com/index.php?rid=3064544&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000871%2Fabstract%3Frss%3Dyes Diabetic ketoacidosis results from deficient insulin action and increased action of hormones such as catecholamines, glucagon, glucocorticoids, and growth hormone, which are produced during stress and which antagonize insulin's actions. Diabetic ketoacidosis is associated with a relatively high mortality rate. Treatment consists of appropriate fluid resuscitation, insulin infusion, adjustments of electrolytes and phosphate, and careful monitoring. The most common serious complication is cerebral edema. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3064544 Tue, 01 Dec 2009 00:00:00 +0100 3064544 http://www.medworm.com/index.php?rid=3064543&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000962%2Fabstract%3Frss%3Dyes This issue of Clinical Pediatric Emergency Medicine features endocrine disorders with which pediatric patients present to the emergency department. Dr Fogel discusses diagnosis and treatment of ketoacidosis. She points out that the diagnosis depends on the presence of hyperglycemia (typically glucose >200 mg/dL) in association with HCO3 levels of 15 mEq/L or lower and venous pH of 7.3 or less. Currently, the clinical practice is to limit the total volume of fluids administered to patients with ketoacidosis to 3500/mL/m2/day. Finally, the most frequent method of insulin administration is by continuous infusion, starting with 0.1/kg/hr. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3064543 Tue, 01 Dec 2009 00:00:00 +0100 3064543 http://www.medworm.com/index.php?rid=3064542&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109001001%2Fabstract%3Frss%3Dyes (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3064542 Tue, 01 Dec 2009 00:00:00 +0100 3064542 http://www.medworm.com/index.php?rid=3064541&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000998%2Fabstract%3Frss%3Dyes (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=3064541 Tue, 01 Dec 2009 00:00:00 +0100 3064541 http://www.medworm.com/index.php?rid=2763658&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS152284010900055X%2Fabstract%3Frss%3Dyes (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2763658 Mon, 31 Aug 2009 23:00:00 +0100 2763658 http://www.medworm.com/index.php?rid=2763657&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000561%2Fabstract%3Frss%3Dyes The most obvious deficiency in the current evaluation of disaster response is the lack of objective, quantifiable measures of performance. This frequently leads to assessments that are highly subjective depending on the evaluator, does not provide those who are planning with targets to achieve, and does not allow for measures that they have improved their preparedness. The goal of this article is to offer recommendations for government agencies at the federal, regional, and local levels, public health departments, and health care institutions to aid in the development of pediatric emergency management performance measures. This will be achieved through the application of traditional quality principles to the assessment of emergency management efforts and to the use of innovative analytic m... Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2763657 Mon, 31 Aug 2009 23:00:00 +0100 2763657 http://www.medworm.com/index.php?rid=2763656&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000494%2Fabstract%3Frss%3Dyes This article emphasizes key emergency response aspects of hospital preparedness for disasters involving children, in particular (1) hospital-based incident command, (2) strategies for operational continuity, (3) pediatric principles of surge capacity, (4) development of decontamination protocols, (5) infection control, (6) sheltering in place, and (7) evacuation strategies. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2763656 Mon, 31 Aug 2009 23:00:00 +0100 2763656 http://www.medworm.com/index.php?rid=2763655&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000500%2Fabstract%3Frss%3Dyes This article provides an overview of recent literature on disasters and mental health, covering children's stress reactions, mental health problems that may arise, and risk factors that affect these reactions. Practical guidance for pediatric emergency health care providers is emphasized, including psychological first aid, recommendations for screening questions to facilitate mental health triage, and an overview of effective mental health interventions. It concludes with a discussion of the impact of providing care in the aftermath of a disaster on the health care professional. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2763655 Mon, 31 Aug 2009 23:00:00 +0100 2763655 http://www.medworm.com/index.php?rid=2763654&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000512%2Fabstract%3Frss%3Dyes This article offers an outline for the components of disaster planning and response where considerations for family reunification should occur and describes the challenges and solutions within each. Challenges and solutions are described in 6 areas including practice and planning, clinical services, ancillary support, transportation and accommodations, communication and identification, and psychological support. Family reunification will be more successful if these challenges are understood and solutions are enacted. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2763654 Mon, 31 Aug 2009 23:00:00 +0100 2763654 http://www.medworm.com/index.php?rid=2763653&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000548%2Fabstract%3Frss%3Dyes This article provides an overview of the need for decontamination and the process of decontamination for hospitals. Practical guidance on decontamination methods for children of different ages is presented. Recommendations for training and communication during decontamination are also reviewed. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2763653 Mon, 31 Aug 2009 23:00:00 +0100 2763653 http://www.medworm.com/index.php?rid=2763652&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000524%2Fabstract%3Frss%3Dyes This article reviews the planning and triage considerations for prehospital providers caring for children in a mass casualty event. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2763652 Mon, 31 Aug 2009 23:00:00 +0100 2763652 http://www.medworm.com/index.php?rid=2763651&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000536%2Fabstract%3Frss%3Dyes This article will also discuss the H1N1 outbreak that started during the spring 2009. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2763651 Mon, 31 Aug 2009 23:00:00 +0100 2763651 http://www.medworm.com/index.php?rid=2763650&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000676%2Fabstract%3Frss%3Dyes This article is part of a collaborative effort by experts in the field of emergency preparedness to complete an overview begun by the late Michael Shannon, MD, MPH, on the current challenges and future directions in pediatric disaster readiness. This particular article, "The Future of Pediatric Preparedness," will offer a perspective on future directions in pediatric preparedness. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2763650 Mon, 31 Aug 2009 23:00:00 +0100 2763650 http://www.medworm.com/index.php?rid=2763649&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000688%2Fabstract%3Frss%3Dyes This article is part of a collaborative effort by experts in the field of emergency preparedness to complete an overview begun by the late Michael Shannon, MD, MPH, on the current challenges and future directions in pediatric disaster readiness. This particular article, "Challenges Facing Pediatric Preparedness," will review some of the major challenges facing current efforts to enhance pediatric readiness. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2763649 Mon, 31 Aug 2009 23:00:00 +0100 2763649 http://www.medworm.com/index.php?rid=2763648&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000664%2Fabstract%3Frss%3Dyes This article is part of a collaborative effort by experts in the field of emergency preparedness to complete an overview begun by the late Michael Shannon, MD, MPH, on the current challenges and future directions in pediatric disaster readiness. This particular article, "The Role of Pediatric Health Care Providers," will illustrate the important role of pediatric care experts at all levels of disaster planning, and as a vital resource for pediatric emergency preparedness in the community. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2763648 Mon, 31 Aug 2009 23:00:00 +0100 2763648 http://www.medworm.com/index.php?rid=2763647&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000652%2Fabstract%3Frss%3Dyes This article is part of a collaborative effort by experts in the field of emergency preparedness to complete an overview begun by the late Michael Shannon, MD, MPH, on the current challenges and future directions in pediatric disaster readiness. This particular article, "Mental Health Concerns," will address some of the unique developmental and psychological vulnerabilities of children as disaster victims (or as disaster witnesses) and strategies for timely identification and intervention for mental health concerns in children. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2763647 Mon, 31 Aug 2009 23:00:00 +0100 2763647 http://www.medworm.com/index.php?rid=2763646&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000640%2Fabstract%3Frss%3Dyes This article is part of a collaborative effort by experts in the field of emergency preparedness to complete an overview begun by the late Michael Shannon, MD, MPH, on the current challenges and future directions in pediatric disaster readiness. This particular article, "Lessons Learned From Disasters Affecting Children," will address pediatric-specific vulnerabilities to disasters and pediatric patient care considerations in various phases of disaster planning and response, as has been learned from recent experiences. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2763646 Mon, 31 Aug 2009 23:00:00 +0100 2763646 http://www.medworm.com/index.php?rid=2763645&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000639%2Fabstract%3Frss%3Dyes This article is part of a collaborative effort by experts in the field of emergency preparedness to complete an overview begun by the late Michael Shannon, MD, MPH, on the current challenges and future directions in pediatric disaster readiness. This particular article, "Preparing for Natural Disasters," will address pertinent clinical and disaster management issues relating to caring for children and families impacted by natural disasters. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2763645 Mon, 31 Aug 2009 23:00:00 +0100 2763645 http://www.medworm.com/index.php?rid=2763644&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000627%2Fabstract%3Frss%3Dyes This article is part of a collaborative effort by experts in the field of emergency preparedness to complete an overview begun by the late Michael Shannon, MD, MPH, on the current challenges and future directions in pediatric disaster readiness. This particular article, "Preparation for Terrorist Threats: Explosive Devices," will promote a greater awareness of explosive devices as significant terrorism threat and pertinent clinical considerations in caring for pediatric victims of explosive injury. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2763644 Mon, 31 Aug 2009 23:00:00 +0100 2763644 http://www.medworm.com/index.php?rid=2763643&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000615%2Fabstract%3Frss%3Dyes This article is part of a collaborative effort by experts in the field of emergency preparedness to complete an overview begun by the late Michael Shannon, MD, MPH, on the current challenges and future directions in pediatric disaster readiness. This particular article, "Preparation for Terrorist Threats: Radiation Injury," will address pertinent clinical management issues relating to radioactive agents and the unique vulnerabilities and care needs of children as potential victims of such terrorism. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2763643 Mon, 31 Aug 2009 23:00:00 +0100 2763643 http://www.medworm.com/index.php?rid=2763642&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000603%2Fabstract%3Frss%3Dyes This article is part of a collaborative effort by experts in the field of emergency preparedness to complete an overview begun by the late Michael Shannon, MD, MPH, on the current challenges and future directions in pediatric disaster readiness. This particular article, "Preparation for Terrorist Threats: Biologic and Chemical Agents," will address pertinent clinical management issues relating to biologic and chemical agents and the unique vulnerabilities and care needs of children as potential victims of such terrorism. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2763642 Mon, 31 Aug 2009 23:00:00 +0100 2763642 http://www.medworm.com/index.php?rid=2763641&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000597%2Fabstract%3Frss%3Dyes This article, and the nine that follow, represent a collaborative effort by experts in the field of emergency and disaster preparedness, many who were colleagues of the late Michael Shannon, MD, MPH, to complete this overview he had begun for this issue of Clinical Pediatric Emergency Medicine. Each article will address a specific topic area within the broad realm of pediatric disaster readiness, reviewing current challenges and future directions. This series of articles represents a tribute to Michael Shannon and his great legacy of excellence in patient care, teaching and research, and his outstanding leadership and advocacy for children and families. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2763641 Mon, 31 Aug 2009 23:00:00 +0100 2763641 http://www.medworm.com/index.php?rid=2763640&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000585%2Fabstract%3Frss%3Dyes I can no longer exactly recall how I learned of Michael Shannon's death on March 10th, the day will likely forever remain a blur. Although we had met many years earlier, I had the great fortune to partner with Michael as an external reviewer for the PEM program at the Hospital for Sick Children in 2005. Over those 2 days in Toronto, we got to know each other fairly well. I had previously been aware that Michael was a remarkable person, I just never knew until then how truly special he was. I remember musing on my journey home that I had met the “Renaissance Man.” (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2763640 Mon, 31 Aug 2009 23:00:00 +0100 2763640 http://www.medworm.com/index.php?rid=2763639&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000573%2Fabstract%3Frss%3Dyes Numerous events in the United States and abroad have demonstrated the vulnerabilities of children during and after disasters in the past decade. In 2002, an issue of Clinical Pediatric Emergency Medicine (CPEM) focused on pediatric disaster management and explored the consequences to children of a terrorist attack and natural disasters. Unfortunately, experiences continue to remind us that the inclusion of children in the preparation for disasters remains incomplete and results in tragic consequences. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2763639 Mon, 31 Aug 2009 23:00:00 +0100 2763639 http://www.medworm.com/index.php?rid=2763638&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000731%2Fabstract%3Frss%3Dyes (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2763638 Mon, 31 Aug 2009 23:00:00 +0100 2763638 http://www.medworm.com/index.php?rid=2763637&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS152284010900072X%2Fabstract%3Frss%3Dyes (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2763637 Mon, 31 Aug 2009 23:00:00 +0100 2763637 http://www.medworm.com/index.php?rid=2449367&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000305%2Fabstract%3Frss%3Dyes With a grant from the Robert Wood Johnson Foundation, we developed and evaluated an emergency department (ED) based intervention in which patients returned to the ED for a structured 90-minute appointment during the weeks after an acute asthma visit. The intervention, which emphasized disease management using national asthma guidelines, successfully reduced overdependence on EDs for episodic care of asthma while also improving asthma-related quality of life among a cohort of low-income, urban, and largely minority children with moderate to severe asthma and a history of ED recidivism. We have since sustained and grown this multifaceted approach to addressing the disparities in asthma care and outcomes among children in our community. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2449367 Mon, 01 Jun 2009 04:00:00 +0100 2449367 http://www.medworm.com/index.php?rid=2449366&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000342%2Fabstract%3Frss%3Dyes Current guidelines recommend that all children obtain follow-up within 1 to 4 weeks after an emergency department (ED) visit for acute asthma. Follow-up may be an important link to reestablish regular care with the primary care provider, review reasons for the ED visit, and update the home management plan. Obtaining follow-up from the ED can be challenging. Studies have reported baseline follow-up rates between 7% and 44% without intervention. Successful interventions report follow-up rates of 36% to 78%. Studies that demonstrated improved follow-up from the ED found methods to personalize care such as individualized education, assistance with follow-up, and/or providing medications or transportation free of charge. A few studies effectively used computer-based interventions in the ED. As ... Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2449366 Mon, 01 Jun 2009 04:00:00 +0100 2449366 http://www.medworm.com/index.php?rid=2449365&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000287%2Fabstract%3Frss%3Dyes Asthma is the most common chronic illness during childhood and significantly impacts all aspects of the health care system. Disconnects between the different facets of the health care system exist, leading to less than optimal quality of care. Improving the quality of care received by patients with asthma requires an understanding that systems-based changes are needed. Quality improvement efforts in pediatric asthma care delivery are described in 2 case examples: one involving hospital-wide metered dose inhaler use with phase out of nebulized mask treatment therapy and the second involving emergency department educational strategies. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2449365 Mon, 01 Jun 2009 04:00:00 +0100 2449365 http://www.medworm.com/index.php?rid=2449364&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000329%2Fabstract%3Frss%3Dyes Asthma is a complex heterozygous multifactorial condition with variability in clinical features and response to treatment, likely related to interactions between genetics and environmental exposures. Pharmacogenomic research seeks to identify and elucidate relationships between genetic variation and therapeutic response. Multiple studies have examined genetic variation in the β2-adrenergic receptor gene and association with asthma phenotypes. Results suggest that single-nucleotide polymorphisms in this gene are associated with greater bronchodilation acutely after albuterol, worse pulmonary function over time with daily albuterol use, and tachyphylaxis to albuterol with chronic use. Although these results are intriguing, there are limitations of individual studies and discrepancies among ... Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2449364 Mon, 01 Jun 2009 04:00:00 +0100 2449364 http://www.medworm.com/index.php?rid=2449363&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000299%2Fabstract%3Frss%3Dyes This article reviews the effects of NPPV on the pathophysiology of acute lower respiratory tract disease, evidence on the use of NPPV in acutely ill patients, and challenges and potential complications of the use of NPPV specific to children. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2449363 Mon, 01 Jun 2009 04:00:00 +0100 2449363 http://www.medworm.com/index.php?rid=2449362&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000317%2Fabstract%3Frss%3Dyes Children with respiratory diseases present commonly to the emergency department. As a continuous, dynamic measure of the ventilatory status, capnography can provide valuable information in the assessment and management of these patients. After a review of the relevant physiology and technology of carbon dioxide monitoring, clinical applications for the use of capnography in patients with respiratory illnesses are discussed. Characteristic waveforms are provided, and their interpretation and clinical significance are discussed. A focus on the current literature investigating the noninvasive monitoring of patients with obstructive lung disease is included. Practical tips for successfully using capnography are also presented. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2449362 Mon, 01 Jun 2009 04:00:00 +0100 2449362 http://www.medworm.com/index.php?rid=2449361&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000330%2Fabstract%3Frss%3Dyes Bronchiolitis is a common respiratory illness in infancy for which there is a great deal of clinical practice variation, leading to costly resource utilization without clear evidence for benefit. Recent literature has focused on developing a broad base of evidence through systematic reviews and meta-analyses. This review will focus on this literature as it relates to pharmacologic and nonpharmacologic therapies and other management decisions. In addition, it will highlight some emerging evidence regarding the management of bronchiolitis and innovative new therapies. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2449361 Mon, 01 Jun 2009 04:00:00 +0100 2449361 http://www.medworm.com/index.php?rid=2449360&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000354%2Fabstract%3Frss%3Dyes This article will primarily focus on heliox inhalation therapy and heliox-driven nebulizer therapy for acute asthma exacerbations. The emergence of heliox inhalation therapy for acute viral bronchiolitis will also be addressed. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2449360 Mon, 01 Jun 2009 04:00:00 +0100 2449360 http://www.medworm.com/index.php?rid=2449359&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000366%2Fabstract%3Frss%3Dyes Respiratory illness is a leading reason for children to receive emergency care. Given its clinical importance, efforts to improve respiratory therapy have played a key role in the development of pediatric emergency medicine as both a physician specialty and a broader system of care involving many disciplines and resources. Any attempt to review innovation in pediatric respiratory care is a risky business, given the nearly constant evolution of the literature; however, the articles included here represent a few common principles that are likely to endure. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2449359 Mon, 01 Jun 2009 04:00:00 +0100 2449359 http://www.medworm.com/index.php?rid=2449358&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000408%2Fabstract%3Frss%3Dyes (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2449358 Mon, 01 Jun 2009 04:00:00 +0100 2449358 http://www.medworm.com/index.php?rid=2449357&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000391%2Fabstract%3Frss%3Dyes (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2449357 Mon, 01 Jun 2009 04:00:00 +0100 2449357 http://www.medworm.com/index.php?rid=2350381&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS152284010900007X%2Fabstract%3Frss%3Dyes Adolescents are frequent visitors to the emergency department (ED), and many use the ED as their only source of care. They may choose to obtain treatment in the ED for the anonymity and privacy it affords and may be unaccompanied by a parent who can provide consent for treatment. The provision of sexual and reproductive health care to adolescents in the ED presents challenges to the medical provider specifically with regard to consent and confidentiality issues. This review discusses the various state and federal laws governing the provision of sexual and reproductive health care services to adolescents, including the diagnosis and treatment of sexually transmitted infections and HIV, contraceptive services, prenatal care, and abortion services. We review the circumstances under which an a... Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2350381 Sun, 01 Mar 2009 05:00:00 +0100 2350381 http://www.medworm.com/index.php?rid=2350380&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000123%2Fabstract%3Frss%3Dyes Conditions that affect the foreskin and glans penis that should be recognized by the emergency medicine practitioner include phimosis, paraphimosis, and inflammatory penile skin conditions, such as balanitis, posthitis, and balanoposthitis. Despite some difficulty in clearly defining phimosis and balanitis/balanoposthitis, paraphimosis remains a true urologic emergency that requires immediate identification and management. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2350380 Sun, 01 Mar 2009 05:00:00 +0100 2350380 http://www.medworm.com/index.php?rid=2350379&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000111%2Fabstract%3Frss%3Dyes This article reviews the anatomical considerations in the pediatric patient, which predispose to the development of scrotal masses. In addition, it reviews the diagnosis and treatment of common scrotal masses, including inguinal hernias and hydroceles, and provides tips to distinguish between simple, communicating, and cord hydroceles. More unusual pediatric diagnoses, such as varicoceles and scrotal and testicular tumors, are also discussed, along with indications for urgent or emergent referral to a pediatric surgeon or urologist. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2350379 Sun, 01 Mar 2009 05:00:00 +0100 2350379 http://www.medworm.com/index.php?rid=2350378&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000147%2Fabstract%3Frss%3Dyes This article discusses both blunt and penetrating injuries to the penis, urethra, and scrotum. The anatomy, epidemiology, pathophysiology, clinical symptoms, and evaluation of each type of injury are discussed. Testicular rupture, urethral disruption, and penile fracture and amputation are acute surgical emergencies that require emergent referral to and management by a qualified urologist. Most of the other conditions can be diagnosed and managed by an emergency physician with access to high-resolution ultrasonography. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2350378 Sun, 01 Mar 2009 05:00:00 +0100 2350378 http://www.medworm.com/index.php?rid=2350377&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000135%2Fabstract%3Frss%3Dyes This article reviews the differential diagnosis and management of the acute scrotal pain in the pediatric population, specifically focusing on testicular torsion, epididymitis, and torsion of the appendix testis. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2350377 Sun, 01 Mar 2009 05:00:00 +0100 2350377 http://www.medworm.com/index.php?rid=2350376&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000044%2Fabstract%3Frss%3Dyes Ovarian torsion is a rare occurrence, but it is frequently considered in the differential diagnosis of a female with abdominal pain. A thorough knowledge of the pathophysiology, clinical presentation, and imaging options will allow the emergency department (ED) provider to facilitate rapid diagnosis and thus improve outcomes. In addition to these topics, success rates of detorsion and the argument for ovarian-sparing surgery are reviewed. The ED provider is encouraged to educate patients regarding these options and to advocate for ovarian-preserving procedures. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2350376 Sun, 01 Mar 2009 05:00:00 +0100 2350376 http://www.medworm.com/index.php?rid=2350375&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000056%2Fabstract%3Frss%3Dyes Adolescent females presenting to the emergency department (ED) with acute pelvic pain may have diagnoses with significant morbidity and in some cases, mortality. An adolescent female with a complaint of acute pelvic pain can create a challenging clinical situation for busy ED providers. Differentiating between acute and chronic pain, and determining gynecologic vs other origins is an important first step. A thorough knowledge of adolescent development and the legal requirements of confidential care are helpful in sorting through these complicated complaints. Assessing for sexual activity and risk taking, pregnancy, and other sexual health components is critical to a thorough assessment and accurate diagnostic plan. Using an organ-specific approach to the reproductive system, this article w... Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2350375 Sun, 01 Mar 2009 05:00:00 +0100 2350375 http://www.medworm.com/index.php?rid=2350374&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS152284010900010X%2Fabstract%3Frss%3Dyes This article reviews the potential causes, clinical presentations, and management of vaginal bleeding in the prepubescent child. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2350374 Sun, 01 Mar 2009 05:00:00 +0100 2350374 http://www.medworm.com/index.php?rid=2350373&cid=s_38455_14_f&fid=38455&url=http%3A%2F%2Fwww.clinpedemergencymed.com%2Farticle%2FPIIS1522840109000068%2Fabstract%3Frss%3Dyes This article will also review management strategies of improved hygiene and sitz baths and the indications for antibiotics. (Source: Clinical Pediatric Emergency Medicine) Clinical Pediatric Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=2350373 Sun, 01 Mar 2009 05:00:00 +0100 2350373