Emerg Med Clin North Am
· 2026 Feb · PMID 41260849
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Headache accounts for 2% to 3% of emergency department visits annually. While the vast majority of these patients have a primary, non-serious cause, a small proportion of these patients have a "cannot miss" secondary cau...Headache accounts for 2% to 3% of emergency department visits annually. While the vast majority of these patients have a primary, non-serious cause, a small proportion of these patients have a "cannot miss" secondary cause that if misdiagnosed or have a delay in diagnosis, result in poor patient outcomes. The majority of serious diagnoses include subarachnoid hemorrhage, other types of intracranial hemorrhage including subdural hematoma, strokes, meningitis, and other non-neurologic etiologies. It is important for emergency physicians to identify through a careful history, physical examination, and consideration of epidemiologic factors which patients require extensive testing.
Emerg Med Clin North Am
· 2026 Feb · PMID 41260848
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The article Blood Pressure Management in Neurologic Emergencies emphasizes the importance of timely and effective blood pressure management in neurologic emergencies. It highlights that elevated blood pressure is a signi...The article Blood Pressure Management in Neurologic Emergencies emphasizes the importance of timely and effective blood pressure management in neurologic emergencies. It highlights that elevated blood pressure is a significant prognostic factor in conditions such as stroke, traumatic brain injury, posterior reversible encephalopathy syndrome (PRES) and preeclampsia. The review provides a detailed examination of current recommendations and controversies, offering a practical resource for emergency physicians. This article aims to equip clinicians with the knowledge to balance rapid intervention with long-term risk mitigation, ultimately improving patient outcomes.
Emerg Med Clin North Am
· 2026 Feb · PMID 41260847
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The acute management of intracerebral hemorrhage (ICH) is critically time-sensitive to decrease risk of hematoma expansion. This requires processes to be in place for expedited imaging and laboratory studies, careful blo...The acute management of intracerebral hemorrhage (ICH) is critically time-sensitive to decrease risk of hematoma expansion. This requires processes to be in place for expedited imaging and laboratory studies, careful blood pressure management, anticoagulation reversal, and neurosurgical evaluation for select patients all within the first few hours of presentation. The aim of this article is to provide an updated review on ICH management in the emergency department.
Emerg Med Clin North Am
· 2026 Feb · PMID 41260846
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This article provides a guide to perform a focused and rapid neurologic examination in the emergency department. Though the components are discussed in detail, it is important to appreciate that not every component of th...This article provides a guide to perform a focused and rapid neurologic examination in the emergency department. Though the components are discussed in detail, it is important to appreciate that not every component of the examination will be necessary for every patient. This review provides guidance for the emergency clinician to perform a focused neurologic examination to accurately diagnose potentially life-threatening conditions.
Emerg Med Clin North Am
· 2025 Nov · PMID 41106882
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Challenges in pediatric resuscitation include infrequent occurrence, size-specific equipment, variable patient size, and anatomy. Preparation for the event is essential. Knowledge of airway positioning, interventions, av...Challenges in pediatric resuscitation include infrequent occurrence, size-specific equipment, variable patient size, and anatomy. Preparation for the event is essential. Knowledge of airway positioning, interventions, available equipment, and initiation settings for mechanical ventilation build a strong foundation. In a peri-arrest patient, crystalloid, vasopressors, and blood products can optimize hemodynamics. In cardiac arrest, high-quality cardiopulmonary resuscitation (CPR), minimal interruptions, and adequate bag valve mask ventilation remains the mainstay of care. Recall critically-ill pediatric patients are at higher risk for hypoglycemia, hypothermia, accidental overdose, and non-accidental trauma. This article summarizes up-to-date evidence and experiential pearls and pitfalls for pediatric resuscitation.
Emerg Med Clin North Am
· 2025 Nov · PMID 41106881
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Tonsillectomy and adenoidectomy are among the most frequent pediatric surgical procedures performed in the United States. Approximately 5% of patients will experience a post-tonsillectomy hemorrhage. Due to the risk of r...Tonsillectomy and adenoidectomy are among the most frequent pediatric surgical procedures performed in the United States. Approximately 5% of patients will experience a post-tonsillectomy hemorrhage. Due to the risk of recurrence, even resolved bleeds require otolaryngology consultation. Nearly 30% of patients will have a second bleed. Approximately 40% of second bleeding episodes occur the day following the initial bleed and 10% of all patients with minor bleeding develop severe bleeding. Patients presenting with active bleeding constitute a surgical emergency. Initial assessment and primary survey should prioritize airway management and hemodynamic stability.
Emerg Med Clin North Am
· 2025 Nov · PMID 41106880
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This article reviews the management of moderate to severe traumatic brain injury in children, focusing on acute care, imaging, and rehabilitation strategies to mitigate secondary injury and maximize recovery. Key approac...This article reviews the management of moderate to severe traumatic brain injury in children, focusing on acute care, imaging, and rehabilitation strategies to mitigate secondary injury and maximize recovery. Key approaches include using optimal imaging modalities, managing intracranial pressure, and employing targeted rehabilitation. Biomarkers and novel therapies are under investigation, while postacute support emphasizes cognitive, physical, and psychosocial rehabilitation to enhance long-term quality of life.
Emerg Med Clin North Am
· 2025 Nov · PMID 41106879
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Acquired heart disease in children can have both acute and long-term consequences. Common acquired heart diseases include endocarditis, myocarditis, pericarditis, pericardial effusion, Kawasaki disease, myocardial infarc...Acquired heart disease in children can have both acute and long-term consequences. Common acquired heart diseases include endocarditis, myocarditis, pericarditis, pericardial effusion, Kawasaki disease, myocardial infarction, multisystem inflammatory syndrome in children, and rheumatic heart disease. Typically, these conditions arise from infections, and patients present with fever, chest pain, and shortness of breath and may have signs of heart failure on examination. Diagnosis is usually made clinically in the emergency department using a combination of history and examination findings and laboratory testing, which includes markers of cardiac involvement, electrocardiography, and echocardiography. These patients usually require inpatient management.
Emerg Med Clin North Am
· 2025 Nov · PMID 41106878
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Anaphylaxis is a (frequently underdiagnosed) type 1 hypersensitivity reaction, and the astute clinician must remain vigilant to recognize it, especially in children. Myriad triggers may precipitate anaphylaxis. The multi...Anaphylaxis is a (frequently underdiagnosed) type 1 hypersensitivity reaction, and the astute clinician must remain vigilant to recognize it, especially in children. Myriad triggers may precipitate anaphylaxis. The multi-system manifestations are numerous and may be confused with other diagnoses. Timely treatment with appropriately dosed epinephrine is essential to prevent complications or recurrent symptoms. Clinicians may consider using antihistamines, steroids, beta-agonists, fluids, or even vasopressors. Once symptoms are mitigated, patients require epinephrine autoinjector prescriptions and education, and a clear anaphylaxis emergency plan. Close follow-up with primary care and/or an allergy specialist is prudent.
Emerg Med Clin North Am
· 2025 Nov · PMID 41106877
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Asthma is the most common respiratory disorder in children with a continued significant morbidity and mortality rate despite advancements made in the care of these patients. This review looks at the evidence-based litera...Asthma is the most common respiratory disorder in children with a continued significant morbidity and mortality rate despite advancements made in the care of these patients. This review looks at the evidence-based literature to provide those treatments which will provide the best possible response from these patients.
Emerg Med Clin North Am
· 2025 Nov · PMID 41106876
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Fever is one of the most common chief complaints for patients in the pediatric emergency department (ED). Most of the time, these patients are diagnosed with a virus and treated with supportive care; however, there are a...Fever is one of the most common chief complaints for patients in the pediatric emergency department (ED). Most of the time, these patients are diagnosed with a virus and treated with supportive care; however, there are a subset of patients with chronic conditions or special circumstances that require a more thorough approach when they enter the ED with a fever. This article will go into detail about why we must be on high alert when these children present with a fever and how we should approach them medically.
Emerg Med Clin North Am
· 2025 Nov · PMID 41106875
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Burns are a frequent cause of injury in children and adolescents. This article reviews the principles of initial burn evaluation and management in the emergency department. After determining the injury mechanism and asse...Burns are a frequent cause of injury in children and adolescents. This article reviews the principles of initial burn evaluation and management in the emergency department. After determining the injury mechanism and assessing the extent of injury (depth and proportion of the body's surface area involved), treatment priorities include determining the need for airway management and providing adequate pain control. Children with more extensive or complicated burns should be transferred to a pediatric burn center.
Emerg Med Clin North Am
· 2025 Nov · PMID 41106874
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Thoracic and abdominal trauma are leading causes of mortality in pediatric patients making their diagnosis and management of utmost importance in children who present to the emergency department for traumatic injuries. D...Thoracic and abdominal trauma are leading causes of mortality in pediatric patients making their diagnosis and management of utmost importance in children who present to the emergency department for traumatic injuries. Diagnostic errors can lead to increased morbidity and mortality in this already at-risk population. This article aims to identify these diagnostic errors and address ways to improve outcomes in pediatric patients presenting with thoracic and abdominal trauma.
Emerg Med Clin North Am
· 2025 Nov · PMID 41106873
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Spinal injuries in children are a clinical challenge for emergency medicine providers. On one hand, spinal injuries are relatively rare and children are at an increased risk for an oncologic process after radiation expos...Spinal injuries in children are a clinical challenge for emergency medicine providers. On one hand, spinal injuries are relatively rare and children are at an increased risk for an oncologic process after radiation exposure. On the other hand, spinal injuries can cause significant morbidity and mortality. A thorough history and physical examination can help risk-stratify imaging assessment to detect serious injury. This evidence-based, state-of-the art review will help clinicians understand best practices in imaging decision making for cervical and thoracolumbar spinal injuries in children.
Emerg Med Clin North Am
· 2025 Nov · PMID 41106872
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Several seemingly minor traumatic pediatric injuries have potentially serious sequelae. Topics include periorbital lacerations, facial lacerations, nasal fractures, posterior oropharyngeal injuries, penetrating neck inju...Several seemingly minor traumatic pediatric injuries have potentially serious sequelae. Topics include periorbital lacerations, facial lacerations, nasal fractures, posterior oropharyngeal injuries, penetrating neck injuries, Seymour fractures, and straddle injuries. The pearls and pitfalls of the presentation and management of these injuries are reviewed in this article.
Emerg Med Clin North Am
· 2025 Nov · PMID 41106871
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This is a guide on the approach to procedures in the emergency department. The focus includes attention to pain and comfort measures and evidence-based techniques to optimize success. Tongue lacerations do not always nee...This is a guide on the approach to procedures in the emergency department. The focus includes attention to pain and comfort measures and evidence-based techniques to optimize success. Tongue lacerations do not always need to be repaired, but when they are large or gaping, certain measures should be taken to ensure success. Several techniques for the reduction of emergent paraphimosis and removal of hair tourniquets are described. Loop drains are easy to place and have numerous advantages over traditional incision and drainage. Finally, a new ultrasound approach may be helpful in identifying landmarks prior to performing a neonatal lumbar puncture.
Emerg Med Clin North Am
· 2025 Nov · PMID 41106870
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Constipation is a common emergency department (ED) chief complaint encompassing various gastrointestinal concerns. A focused history and physical should screen for dangerous mimics, dangerous causes, and dangerous compli...Constipation is a common emergency department (ED) chief complaint encompassing various gastrointestinal concerns. A focused history and physical should screen for dangerous mimics, dangerous causes, and dangerous complications. If red flags are absent, laboratory studies and abdominal imaging are generally unnecessary as functional constipation is a clinical diagnosis. Disimpaction with oral or enema therapy may start in the ED but requires outpatient therapy for success. Oral and enema therapies are safe, but emergency physicians should be aware of specific contraindications and potential adverse events before initiating.
Emerg Med Clin North Am
· 2025 Nov · PMID 41106869
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Community-acquired pneumonia (CAP) is a common respiratory infection in children, with viral etiologies predominating. Bacterial pathogens such as Streptococcus pneumoniae and Mycoplasma pneumoniae also contribute signif...Community-acquired pneumonia (CAP) is a common respiratory infection in children, with viral etiologies predominating. Bacterial pathogens such as Streptococcus pneumoniae and Mycoplasma pneumoniae also contribute significantly. Diagnosis relies primarily on clinical findings, with imaging reserved for severe cases. Treatment depends on the etiology, with amoxicillin as the first-line antibiotic for bacterial CAP and macrolides for atypical pneumonia. Supportive care, including oxygen therapy, is crucial for severe cases. Vaccination has drastically reduced CAP-related mortality, but new epidemiologic trends necessitate continued research. This review provides an updated approach to diagnosing, managing, and preventing pediatric CAP.