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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.
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Influenza takes an enormous toll on humanity with respect to mortality, hospitalization, and medically attended illness. Despite the licensure of antiviral medications, immunization is the best control measure of influenza. Because patients eligible for influenza vaccine frequent EDs, health care providers working in this arena should offer the vaccine or appropriately recommend and refer patients following current guidelines to sites where the vaccine is obtainable.
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In recent years, the analysis of complex system errors, such as medical errors occurring in the ED, has changed from simply labeling and punishing individuals to understanding the underlying systems that contribute to medical error. In this issue of Emergency Medicine Specialty Reports, error in the ED and its contributing factors will be discussed, as well as steps to develop a culture of safety.
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