Pediatric Emergency Care

Aka: Pediatric Emergency Care, Emergency Care of Children, Pediatric Acute Care, Emergency Pediatrics, Emergencies in Children

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II. Precautions

  1. Parental concern for serious illness is highly correlated with actual serious illness
    1. Positive Likelihood Ratio >8
    2. Van den Bruel (2007) Br J Gen Pract 57(540):538-46 +PMID:17727746 [PubMed]
    3. Thompson (2012) Health Technol Assess 16(15): 1-100 +PMID:22452986 [PubMed]
  2. Child behavior change after emergency department visits is common
    1. See Childlife Specialist Measures to Calm Children
    2. Behavior changes include anxiety including Separation Anxiety, apathy and withdrawal
    3. Occurs in 20% of children undergoing procedures with or without sedation
      1. Brodzinski (2013) Pediatr Emerg Care 29(10): 1098-101 +PMID:24076612 [PubMed]
      2. McQueen (2009) Ann Emerg Med 54(2): 191-7 +PMID:19464072 [PubMed]
      3. Pearce (2018) Acad Emerg Med 25(3): 267-74 +PMID:28992364 [PubMed]

III. Approach: Preparation

  1. Consent for Treating Minors
  2. Childlife Specialist Measures to Calm Children

IV. Exam

  1. Pediatric Vital Signs
  2. Pediatric Glasgow Coma Scale
  3. Pediatric Early Warning Score
  4. Pediatric Assessment Triangle

V. Imaging

  1. Cancer Risk due to Diagnostic Radiology
  2. CT Head Indications in Pediatric Head Injury

VI. Procedures

  1. Emergency
    1. Emergency Pediatric Dosing (e.g. Broselow Tape)
      1. Avoid calculating doses in your head (using a chart minimizes errors in emergency situations)
    2. Difficult Intravenous Access in Children
      1. Do not delay Intraosseous Access in critically ill children if two failed peripheral access attempts
    3. Clinic Crash Cart
    4. Bag Valve Mask
    5. High Flow Nasal Cannula
    6. Advanced Airway in Children
    7. Pediatric Resuscitation
    8. Advanced Life Support for Newborns
  2. Pain
    1. Procedural Sedation and Analgesia
    2. Pediatric Analgesics
  3. Miscellaneous
    1. Laceration

VII. Management: Serious Conditions

  1. Abuse
    1. Pediatric Non-Accidental Trauma
    2. Sexual Abuse in Children
  2. Dehydration
    1. Pediatric Dehydration Management
  3. Endocrine conditions
    1. Diabetic Ketoacidosis Management in Children
  4. Infectious
    1. Pediatric Sepsis
  5. Neurologic condition
    1. Status Epilepticus
  6. Respiratory
    1. Status Asthmaticus
    2. Anaphylaxis
  7. Resuscitation
    1. See procedures above
    2. Apparent Life-Threatening Events In Children (ALTE)
    3. Sudden Infant Death Syndrome (SIDS)
  8. Trauma
    1. Pediatric Trauma
    2. Pediatric Cervical Spine Injury
    3. Pediatric Abdominal Trauma

VIII. Management: Common Conditions

  1. Cardiovascular conditions
    1. Pediatric Murmur
  2. Gastrointestinal conditions
    1. Pediatric Abdominal Pain
    2. Pediatric Diarrhea
    3. Pediatric Constipation
    4. Pediatric Vomiting
    5. Pediatric Dehydration Management
  3. Psychiatric Conditions
    1. Pediatric Depression
    2. Adolescent Drug Abuse
    3. Anorexia Nervosa
    4. Pediatric Autoimmune Neuropsychiatric Disorders (PANDAS)
  4. Neurologic Conditions
    1. Pediatric Headache
    2. Pediatric Tremor
    3. Pediatric Spell
    4. Concussion
  5. Genitourinary Conditions
    1. Dysuria in Children
    2. Pediatric UTI
    3. Pediatric Hematuria
    4. Pediatric Proteinuria
  6. Infectious Conditions
    1. Fever Evaluation in Children
    2. Fever and Rash
  7. Respiratory Conditions
    1. Pediatric Acute Cough
    2. Pediatric Pneumonia
  8. Muscloskeletal Conditions
    1. Pediatric Low Back Pain
    2. Pediatric Limp
    3. Joint Pain in Children
    4. Pediatric Fractures
  9. Eye Conditions
    1. Pediatric Red Eye
    2. Viral Conjunctivitis

IX. Management: Newborns and Infants

  1. See broader pediatric approaches above
  2. Emergency Conditions
    1. Newborn Resuscitation
    2. Neonatal Respiratory Distress
    3. Crashing Newborn
    4. Floppy Infant
    5. Neonatal Sepsis
    6. Neonatal Hypoglycemia
    7. Newborn Injury
  3. Common newborn presentations
    1. Neonatal Jaundice
    2. Inconsolable Infant
    3. Dermatologic Conditions in Infants
    4. Diaper Rash
    5. Conjunctivitis in Newborns

X. Management: Miscellaneous conditions

  1. Cardiovascular Conditions
    1. Congenital Heart Disease
    2. Pediatric Congestive Heart Failure
  2. Neurologic Conditions
    1. Autism
    2. Pediatric Brain Tumor
    3. Ventriculoperitoneal Shunt (VP Shunt)
    4. Intellectual Disability
  3. Gastrointestinal Conditions
    1. Enterostomy
  4. Infectious Conditions
    1. Pediatric HIV
  5. Respiratory Conditions
    1. Tracheostomy
  6. Cancer
    1. Pediatric Cancer
  7. Cohorts at risk
    1. Immigrant Child
    2. Adolescent Health

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