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The emergency department physician is the critical link between the patient and the diagnostic tests, including radiographs, that are ordered. This article provides information on common radiographic errors to help clinicians improve their accuracy, confidence and subsequent patient care.
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New drugs are constantly added to the market, many of them legal. Many new drugs with abuse potential are often called “legal highs,” as they are not banned by the federal government or states. Also, products may be labeled “not for human consumption” to avoid the label of illegal. The European Monitoring Center for Drugs and Addiction Europol says 41 new drugs entered the market in 2010. The legal status of the more familiar recreational substances has encouraged users to seek newer options that offer the advantages of being legal, less expensive, less contaminated with adulterants, more readily available, or with more desirable pharmacological effects.
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While rhythm disturbance may be a common presenting complaint among adult emergency department (ED) patients, the incidence of cardiac dysrhythmia among pediatric patients is relatively low. In one retrospective review, primary cardiac arrhythmias were identified in 13.9 per 100,000 pediatric ED visits.1 The incidence of these dysrhythmias peaked during infancy and then again in adolescence.1 Cardiac dysrhythmias in children may be due to primary conduction abnormalities or may occur in the setting of structural heart disease, metabolic derangements from toxic ingestions, or infections. Supraventricular tachycardias (SVT) represent the most common pediatric dysrhythmias in adolescents (an estimated 63% of all documented tachycardias).1 After a brief review of initial emergency management of dysrhythmia, the authors will emphasize important pediatric ECG parameters and how they differ from adults.
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Abnormal movements, outside of seizure and ataxia, are an uncommon chief complaint among children presenting to the emergency department. A working knowledge of movement disorder phenomenology, etiology, differential diagnosis, and associated potentially life-threatening conditions is essential for emergency physicians. Each movement disorder and its clinical considerations will be discussed in detail in the article.
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Classically, pneumonia is defined as an infection of the lung parenchyma. However, worldwide, a variety of definitions exist, including fever, hypoxia, a constellation of other clinical symptoms, and radiologic findings. In pediatric and adolescent populations, early diagnosis will assist emergency department (ED) physicians with correctly managing and subsequently avoiding potential morbidity and mortality of this common infectious disease.
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Foreign body ingestion is a common problem, especially in children younger than 3 years of age. Fortunately, most cases have uneventful outcomes, but the potential for a devastating complication exists. Button batteries are particularly dangerous, and timely and appropriate management is critical. This article comprehensively reviews pediatric foreign body ingestions.
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Approximately one in five of children evaluated in the emergency department (ED) are physically abused. Emergency physicians (EPs) have a responsibility to consider abuse in the differential of every injured child.
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Pediatric advanced airway management is a critical skill for the emergency medicine practitioner. Safe, effective, emergent intubation can be completed with the use of rapid sequence intubation (RSI). A multitude of alternatives are available with a variety of advantages and disadvantages based on the individual clinical scenario. This article provides a comprehensive review of the process and alternatives associated with pediatric RSI.
