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The ED is a common setting for the initial evaluation of emotional and behavioral disorders, including suicidal behavior or attempts. In the United States, approximately 2 million adolescents attempt suicide each year. As the number of visits by adolescents to the ED rises and the availability of outpatient mental health services diminishes, the ED physician must be not only able to stabilize the patient medically, but also should be comfortable with differentiating organic from psychiatric disease, performing a targeted psychosocial interview, initiating treatment, and arranging for disposition.
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Pediatric wrist and hand injuries are very common in the emergency department (ED). Early recognition and appropriate management are critical to maximize the chances of an optimal functional outcome. This article reviews five key injuries of the pediatric wrist and hand: scaphoid fracture, proximal thumb metacarpal fractures, skier's thumb/gamekeeper's thumb, phalanx injuries, and boxer's fractures/fight bites.
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A 12-year-old boy with an unremarkable familial and medical history presents with global aphasia and right hemiplegia 14 days after a streptococcal pharyngeal infection. A neurological examination performed three hours after symptom onset reveals a conjugate gaze deviation to the left, right hemiplegia, hemihypesthesia, and extensor plantar sign. The NIHSS score is 22. Laboratory examinations are normal. A cerebral CT shows a hyperdense left MCA and early signs of infarction in that area.
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Children with diabetes, especially type 1, remain at risk for developing diabetic ketoacidosis (DKA). This may seem confounding in a modern society with such advanced medical care, but the fact remains that children who are type 1 diabetics have an incidence of DKA of 8 per 100 patient years.
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Complete upper airway obstruction is a rare complication of disease entities in the pediatric patient population; however, it needs to remain high on the differential diagnosis because it can abruptly become a life or death scenario. Respiratory compromise has long been known to be the leading cause of cardiac arrest in children.
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