Clin Pediatr Emerg Med
· 2020 Jun · PMID 32922213
·
Full text
In the United States, 1 in 4 children lives in an immigrant family. State and national policies have historically precluded equitable access to health care among children in immigrant families. More recently, increasingl...In the United States, 1 in 4 children lives in an immigrant family. State and national policies have historically precluded equitable access to health care among children in immigrant families. More recently, increasingly restrictive policies, political rhetoric, and xenophobic stances have made immigrant families less able to access health care and less comfortable in attempting to do so, thus increasing the likelihood that patients will present to the emergency department. Once in the emergency department, language, cultural, and health literacy barriers make providing high-quality care potentially challenging for some families. Emergency care professionals can therefore glean critical insight regarding inequities from clinical work to inform advocacy and policy changes at institutional, community, regional, and national levels.
Clin Pediatr Emerg Med
· 2020 Jun · PMID 32901200
·
Full text
Firearms remain a common cause of injury in children. Advocacy is a tool that can be useful in effecting systemic change. Yet for firearm injury prevention, traditional methods of effecting change face unique barriers no...Firearms remain a common cause of injury in children. Advocacy is a tool that can be useful in effecting systemic change. Yet for firearm injury prevention, traditional methods of effecting change face unique barriers not experienced in other areas of pediatric injury prevention. As pediatric emergency medicine physicians, we are on the front lines, and as part of the receiving end of the trauma inflicted on our communities by firearms, ours is a powerful voice well suited to overcome these barriers. Current firearm advocacy efforts include raising awareness via social media or editorials, organizing larger advocacy groups for support, challenging legislation, and implementing hospital-based violence intervention programs. Future advocacy directions should include collaborating with unique partners, teleadvocacy, direct action, and finding common ground with gun regulation opposition. Physician advocacy is essential to firearm injury prevention. Continuing to innovate around our advocacy efforts will be vital to the health and safety of our patients.
Clin Pediatr Emerg Med
· 2020 Sep · PMID 36570485
·
Full text
The COVID-19 pandemic has created conditions which heighten risk for child abuse. As key players in times of crisis, pediatric emergency medicine providers must be equipped with the tools to recognize, respond to, and mi...The COVID-19 pandemic has created conditions which heighten risk for child abuse. As key players in times of crisis, pediatric emergency medicine providers must be equipped with the tools to recognize, respond to, and mitigate risk of child abuse. An exploration of the scientific literature, stakeholder organization reports and lay press was undertaken to understand the impact of large-scale U.S. crises, including infectious disease, financial downturn, natural disaster, and violence, on child abuse risk and inform prevention strategies. Review of the literature suggests a relationship between crises and child abuse risk, though gaps in the research remain. We outline the role of pediatric emergency medicine providers in partnering with communities in organizing and advocating for systems that better protect children and strengthen families.
Clin Pediatr Emerg Med
· 2019 Dec · PMID 32288647
·
Full text
A 3-year-old boy presented to the emergency department with a chief complaint of "lethargy" and was found to have ptosis with eventual respiratory failure and need for emergent intubation. There is a broad differential f...A 3-year-old boy presented to the emergency department with a chief complaint of "lethargy" and was found to have ptosis with eventual respiratory failure and need for emergent intubation. There is a broad differential for a patient with respiratory failure, and careful physical examination and history are imperative to reduce morbidity and prevent mortality. After further evaluation and workup, the diagnosis is ultimately revealed.
Clin Pediatr Emerg Med
· 2018 Mar · PMID 32288646
·
Full text
Bronchiolitis is the number one cause of hospitalization in infants during the first year of life. Clinical guidelines recommend primarily supportive care and discourage use of pharmacotherapies and diagnostics. However,...Bronchiolitis is the number one cause of hospitalization in infants during the first year of life. Clinical guidelines recommend primarily supportive care and discourage use of pharmacotherapies and diagnostics. However, there continues to be widespread use of non-recommended therapies and variation in the use of therapeutic interventions among hospitals in the United States. Here we review evidence-based management of this common disease in order to optimize resource utilization, decrease healthcare costs, and decrease unnecessary hospitalization. Current evidence does not support the routine use of chest radiographs, viral testing or laboratory evaluation in children with bronchiolitis. In addition, routine administration of bronchodilators, including albuterol and nebulized epinephrine, corticosteroids and hypertonic saline are not recommended for infants and children with bronchiolitis. Intravenous or nasogastric hydration and nutritional support, supplemental oxygen, and respiratory support are recommended. Standardization of bronchiolitis care with evidence based institutional clinical pathways spanning ED to inpatient care can help optimize resource utilization while simultaneously improving care of bronchiolitis and reducing hospital length of stays and costs.
Clin Pediatr Emerg Med
· 2017 Sep · PMID 29056870
·
Full text
Childhood lead poisoning is a multi-faceted, complex condition, which affects not only the child's health and well-being, but also the family's housing security, economic status, job security, and stress level. This revi...Childhood lead poisoning is a multi-faceted, complex condition, which affects not only the child's health and well-being, but also the family's housing security, economic status, job security, and stress level. This review updates the emergency department clinician on the management of childhood lead poisoning. Infants and children are at higher risk than adults for lead exposure due to their smaller size and proportionately larger dose of ingested toxins, their proximity to ground dirt and indoor dust, their energy and curiosity, their oral exploratory and pica behaviors, their proportionately larger daily water and milk intake, and dietary preferences that differ markedly from those of adults. Pediatric health care providers working in the emergency department can provide medical management, as well as preventive counseling and guidance, to parents of children presenting with evidence of acute or chronic lead poisoning.
Clin Pediatr Emerg Med
· 2016 Sep · PMID 32288645
·
Full text
The pediatric emergency medicine (PEM) environment is well suited for simulation-based activities, be they educational interventions for PEM learners, evaluations of the interface between health providers and the environ...The pediatric emergency medicine (PEM) environment is well suited for simulation-based activities, be they educational interventions for PEM learners, evaluations of the interface between health providers and the environment that they work in, or research investigations using simulation as a tool to answer specific clinical questions. As such, PEM has been among the leaders in the integration of this modality for clinical training. Traditionally, simulation has been used extensively for the dissemination of clinical training in the areas of clinical knowledge and its application, and the clinical, technical, and teamwork skills involved in PEM care. Increasingly, simulation is being used in novel applications, including breaking bad news, disclosure of error, family-centered care, quality and patient safety education, and system-level integration. The future will look to further identify, measure, and inform the integration of simulation with new and innovative adjuncts in the clinical environment, as well as to determine the optimal timing and use of simulation-based education to enhance the quality of care delivered to patients by the interprofessional and multidisciplinary team.
Clin Pediatr Emerg Med
· 2015 Sep · PMID 32288644
·
Full text
We present a 6-month-old boy with failure to thrive who was referred to the emergency department by his primary care doctor for leukocytosis and was found to be hypoxic with diffuse infiltrates on chest radiograph. Our p...We present a 6-month-old boy with failure to thrive who was referred to the emergency department by his primary care doctor for leukocytosis and was found to be hypoxic with diffuse infiltrates on chest radiograph. Our patient was admitted and eventually diagnosed with pneumonia secondary to hyper immunoglobulin M syndrome. Even though pneumonia is an uncommon cause of hypoxia in infants, this case illustrates the need for pediatric emergency physicians to be cognizant of this rare but life threatening cause of hypoxia.
Clin Pediatr Emerg Med
· 2015 Jun · PMID 26273230
·
Full text
Diagnosis and treatment of acute pelvic pain in the adolescent female requires differentiating among a broad differential diagnosis that includes potentially serious illness across several organ systems. The case present...Diagnosis and treatment of acute pelvic pain in the adolescent female requires differentiating among a broad differential diagnosis that includes potentially serious illness across several organ systems. The case presented provides an illustration of the assessment and management of acute pelvic pain, and key teaching points about important potential causes.
Clin Pediatr Emerg Med
· 2014 Dec · PMID 25587241
·
Full text
Children are the members of our population who are most vulnerable to the effects of a chemical, biological, radiological, nuclear or explosive (CBRNE) attack. It has been over 12 years since 9/11 and the majority of cli...Children are the members of our population who are most vulnerable to the effects of a chemical, biological, radiological, nuclear or explosive (CBRNE) attack. It has been over 12 years since 9/11 and the majority of clinicians who would be providing care to children in the event of another attack still lack the requisite disaster preparedness training. The purpose of this report is to provide an overview of the recent developments that will enable the affordable creation of key CBRNE educational and just in time material. In 2011, the National Center for Disaster Medicine and Public Health (NCDMPH) convened a pediatric disaster preparedness conference. Much of the initial groundwork for development of a pediatric disaster preparedness curriculum, including the identification of target audiences and requisite role specific CBRNE curriculum content, was the product of this conference. Much of the needed pediatric education and training content for the diagnosis and treatment of the injurious effects of CBRNE has recently been both developed and well vetted. Bringing together these efforts in an educational program will result in a workforce that is better trained and prepared to address the needs of children impacted by these types of disasters.
Stanley IH, Snyder D, Westen S
… +8 more, Ballard ED, Teach SJ, Kapetanovic S, Wharff EA, Bridge JA, Ginnis K, Pao M, Horowitz LM
Clin Pediatr Emerg Med
· 2013 Mar · PMID 23908600
·
Full text
Emergency departments (EDs) are important venues for detecting youth at risk for suicide. Children and adolescents who present to the ED and report a recent life stressor, such as stressors related to interpersonal relat...Emergency departments (EDs) are important venues for detecting youth at risk for suicide. Children and adolescents who present to the ED and report a recent life stressor, such as stressors related to interpersonal relationships, may be at elevated risk for suicide. Utilizing data from three large, urban pediatric EDs, we examined the relationship between reported recent life stressors and suicide risk, as measured by the Suicidal Ideation Questionnaire. Overall, youth who reported a recent life stressor were at elevated risk of suicide [adjOR = 5.43 (95% CI, 3.18-9.26)]. Importantly, however, this finding was tempered by the fact that 20% of youth who screened positive for suicide risk did not report a stressor. Thus, while the knowledge of stressors may provide useful supplementary information to a suicide risk assessment, the presence or absence of a reported stressor is not sufficient to determine one's risk of suicide. ED clinicians are advised to include direct questions about suicidal thoughts and behaviors.
Ballard ED, Stanley IH, Horowitz LM
… +3 more, Pao M, Cannon EA, Bridge JA
Clin Pediatr Emerg Med
· 2013 Mar · PMID 23908599
·
Full text
The emergency department (ED) is a promising setting to screen youth for suicide risk. Patient reactions to questions about suicidal thoughts and behaviors during their ED visit have implications for how screening is int...The emergency department (ED) is a promising setting to screen youth for suicide risk. Patient reactions to questions about suicidal thoughts and behaviors during their ED visit have implications for how screening is introduced, developed, and implemented. The current study is a qualitative investigation into patient opinions about screening for suicide risk in the pediatric ED. As part of a subset of a multisite study, 165 participants, 10 to 21 years old, were included in this sub-analysis. Ninety percent (148/165) of participants supported suicide risk screening. Reasons youth support screening included prevention of suicide, detection of at-risk youth, and a lack of other social support. Overall, pediatric patients agreed with suicide risk screening in the ED, citing similar reasons as in a previous investigation, further demonstrating acceptability of suicide risk screening in this setting. A small subset of youth (10%; 17/165) did not support screening for reasons that included a desire to focus on their chief (i.e., nonpsychiatric) presenting concern and fear of iatrogenic risk. Understanding patient opinions, including those in support of and in opposition to screening, can inform implementation practices. Further education about the importance of suicide risk assessment may be a helpful first step in instituting universal screening efforts.
Clin Pediatr Emerg Med
· 2013 Jun · PMID 32336958
·
Full text
Healthy infants and toddlers who attend day care centers are at increased risk for contracting common childhood illnesses such as viral upper and lower respiratory illnesses, viral gastrointestinal infections, and acute...Healthy infants and toddlers who attend day care centers are at increased risk for contracting common childhood illnesses such as viral upper and lower respiratory illnesses, viral gastrointestinal infections, and acute and chronic otitis media. The author proposes that this high frequency of common infections be termed . Daycaritis imposes significant social and economic burdens on both the family and the health care system. This review describes the most common infections seen in day care attendees, preventative measures to decrease the rates of illness, and a practical approach to diagnosis and management in the emergency department.
Clin Pediatr Emerg Med
· 2013 Jun · PMID 32288643
·
Full text
In modern pediatric emergency medicine, biomarker-based assays that enable quick bedside diagnostics and subsequent disease management can be valuable. There is a growing need for novel, disease-specific biomarkers that...In modern pediatric emergency medicine, biomarker-based assays that enable quick bedside diagnostics and subsequent disease management can be valuable. There is a growing need for novel, disease-specific biomarkers that can improve the outcome of pediatric infectious diseases commonly encountered in the emergency department (ED). Viral respiratory infections, central nervous system infections, sepsis, and septic shock are acute disease states frequently encountered in the ED. In this review, we describe a host of novel biomarkers, including a diverse set of cytokines, chemokines, and nitric oxide-based metabolites. Based on disease pathophysiology, a rationale is provided for a molecular- or biomarker-based approach in the ED. Throughout this review, emphasis is placed on diagnostic rapidity because this relates directly to timeliness and quality of care in a busy ED. Once the biomarkers become more clinically available, in a rapid ED setting as bedside point-of-care assays, quality of care will be enhanced, not only by means of diagnostics but also in prognosticating severity of illness.
Clin Pediatr Emerg Med
· 2013 Mar · PMID 23682241
·
Full text
Mental health problems are a significant cause of morbidity and mortality among pediatric populations. Screening for these problems can result in earlier identification and increase treatment and improve outcomes for the...Mental health problems are a significant cause of morbidity and mortality among pediatric populations. Screening for these problems can result in earlier identification and increase treatment and improve outcomes for these children and adolescents. The emergency department (ED) is an ideal site for such screening. Pediatric ED patients are known to be at higher risk for mental health problems. For many, an ED visit is one of the few opportunities to identify and intervene with these children and adolescents. A number of brief, efficient screening instruments have been developed for the ED setting. Screening for mental health problems is both feasible and acceptable to ED patients, parents, and caregivers.
Clin Pediatr Emerg Med
· 2012 Dec · PMID 23471213
·
Full text
Medications are being used with greater frequency to address pediatric mental health problems, and in recent years atypical antipsychotic (AAP) prescriptions have increased more than any other class. Acute care practitio...Medications are being used with greater frequency to address pediatric mental health problems, and in recent years atypical antipsychotic (AAP) prescriptions have increased more than any other class. Acute care practitioners must be aware of the pharmacology of AAPs and the conditions, on- and off-label, for which they are prescribed. This involves identifying and managing side effects that manifest both mentally and physically. Although "atypicality" confers a lower risk of movement side effects compared to conventional agents, children are more sensitive than adults to extrapyramidal reactions. Like adults, they also may present with toxic sedation, confusion, cardiovascular dysfunction, and metabolic derangements. Evaluation and management of these toxicities requires an index of suspicion, a careful symptom and medication history, physical examination, and targeted interventions. This review is designed to orient the emergency practitioner to the challenging task of recognizing and treating adverse effects related to acute and chronic atypical antipsychotic exposure in children.
Clin Pediatr Emerg Med
· 2013 Mar · PMID 25904825
·
Full text
Suicide is the third leading cause of death in adolescents, and often youths with suicidal behavior or ideation present to the emergency department (ED) for care. Many suicidal youths do not receive mental health care af...Suicide is the third leading cause of death in adolescents, and often youths with suicidal behavior or ideation present to the emergency department (ED) for care. Many suicidal youths do not receive mental health care after discharge from the ED, and interventions are needed to enhance linkage to outpatient intervention. This paper describes the Family Intervention for Suicide Prevention (FISP). Designed for use in emergency settings, the FISP is a family-based cognitive-behavior therapy session designed to increase motivation for follow-up treatment, support, coping, and safety, augmented by care linkage telephone contacts after discharge. In a randomized trial of the intervention, the FISP was shown to significantly increase the likelihood of youths receiving outpatient treatment, including psychotherapy and combined medication and psychotherapy. The FISP is a brief, focused, efficacious treatment that can be delivered in the ED to improve the probability of follow-up treatment for suicidal youths.
Clin Pediatr Emerg Med
· 2011 Sep · PMID 21927581
·
Full text
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, an...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 they are unrecognized. Detailed discussion of these "atypical" sickle cell disease complications, organized by organ system involved, will be the focus of this article.
Clin Pediatr Emerg Med
· 2011 Sep · PMID 25411564
·
Full text
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 posttra...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.