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Children who present with a history of foreign body ingestion frequently offer both a diagnostic and management challenge to the emergency medicine physician. Esophageal foreign bodies can result in significant injury to or the death of a child. What follows is a review of the literature on the subject of esophageal foreign bodies in children.
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The daily practice of emergency medicine involves life and death decisions. While training in emergency medicine focuses on life-saving procedures and medications, dying patients often seek care in the ED for symptom relief, psychosocial support, or a variety of other reasons. Education, experience, communication, and compassion can improve the emergency physicians ability to deliver medical care near the end of life that will serve to relieve suffering, improve communication of the patients preferences and goals of medical treatment, and improve overall care of the patient and family.
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A standardized withdrawal-of-life-support order form was viewed as helpful by physicians and nurses and changed medication delivery in a positive manner.
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In a randomized, clinical trial involving patients with ALI/ARDS from non-sepsis etiologies, inhaled nitric oxide at 5 ppm failed to improve any of the clinically meaningful outcomes.
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With the media currently focused on vaccine shortages, the emergency physician must be prepared to rationally and scientifically explain diagnostic and therapeutic approaches in children with influenza. The author of this article prepares the ED physician to confidently face the 2004-2005 influenza season.
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This months issue of ED Legal Letter will discuss the medicolegal risks to the physician, nurse, and hospitals associated with a patient leaving against medical advice and provide strategies to prevent patients from leaving.
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Although diabetes mellitus is second only to asthma as the most prevalent chronic disease of childhood, the literature has very few comprehensive reviews of diabetic ketoacidosis (DKA), the most frequent cause of death in children with diabetes. The importance of an early diagnosis and appropriate management should not be underestimated. The authors provide a focused review for the ED physician for recognition and management of a child with DKA, with special attention to potentially serious complications.
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The authors review the classic course of common pediatric diseases associated with rashes, including varicella-zoster virus, herpes simplex virus (HSV), roseola, and rubella. Understanding the classic patterns, disease progression, high-risk populations, and potential complications allow the ED physician to avoid unnecessary testing in low-risk patients with a classic presentation, and aggressively approach potentially significant rashes in high-risk populations (e.g., neonatal HSV). This article also is designed to increase ED physicians awareness of treatment strategies associated with common viral exanthems.
