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The ED physician and trauma surgeon must have evidence-based
information on indications for emergency department thoracotomy that
can be determined rapidly, easily accessible equipment, and the ability
to recognize situations in which EDT clearly is not in the patients
best interest.
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Children often present to the emergency department complaining of headaches. While most headaches in children are not signs of serious, underlying disorders, some headaches may be the first presentation of a migraine headache. Migraine is the most common cause of recurrent, intermittent headaches in children. However, migraine headaches often are underdiagnosed and undertreated in children.
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Although vasculitic diseases generally are uncommon in the pediatric population, early recognition of processes that do occur is important to prevent sequelae. The authors provide a comprehensive review of the most common vasculitic diseases in children, with an emphasis on diagnostic clinical features, key laboratory studies, and appropriate therapy.
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Although cervical spine injuries are uncommon in children, a missed or
delayed diagnosis may have devastating consequences for the patient. A
thorough understanding of normal pediatric anatomy, injury patterns,
and children who are at increased risk for injury is critical for the
physician caring for the acutely injured child.
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Pediatric athletic head injuries are a significant problem, especially for emergency medicine physicians. The dedication of many young athletes to performance and their avoidance of restrictions makes it imperative that ED physicians recognize and give appropriate recommendations to parents and coaches of young athletes. The cumulative damage that may result from repetitive minor head trauma is not recognized by the majority of athletes, and the ED physician has the burden of conveying these potential risks to the family. This article provides a comprehensive review of sports-related head injuries and recommendations on grading of concussions, imaging, and the safe return of the athlete to competition.
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Newbornsinfants younger than 28 days of ageare particularly challenging to emergency medicine physicians. The most important tool for recognizing a newborn with a problem or potential problem is a strong foundation of knowledge about normal infant rashes, feeding patterns, and expected variations. The authors review common newborn problems with an emphasis on normal variations and deviations that require a more thorough evaluation.
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Emergency department physicians must be vigilant to accurately assess,
rapidly stabilize, and appropriately transport a severely injured
patient to the level of trauma care the patient requires. Instead of
viewing missed injuries as occurrences that result from inexperience or
incompetence, strategies to minimize the occurrence of missed injuries
and the resulting consequences are needed. All aspects of a trauma
system must work together to improve patient care.
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The recognition of non-accidental injury is critical for a pediatric
trauma patient. In the year 2000, almost 3 million reports of child
abuse were made to social service agencies. Forty-four percent of the
fatalities were children younger than 1 year of age. Not only are these
statistics alarming, but they point out the need for emergency
department and trauma physicians and nurses to recognize non-accidental
injury and aggressively protect the children who seek our medical
expertise and protection.
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Although spinal injuries occur infrequently, a delay in the detection of thoracolumbar trauma may have devastating consequences for a child. It is critical that the emergency physican be familiar with injury patterns that may result in this type of injury.
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Burn injuries account for half a million visits to the emergency department each year and present numerous challenges in management. The spectrum of burn injuries is immense, ranging from simple first-degree burns with no sequela to third-degree burns with hypermetabolic response. In addition, pediatric patients add unique challenges to providing optimal care.
