Fleisher & Ludwig's Textbook of Pediatric Emergency Medicine

Name: Fleisher & Ludwig's Textbook of Pediatric Emergency Medicine
Brand: Wolters Kluwer Health
Price: 453.99 EUR
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Richard G. Bachur Kathy N. Shaw James Chamberlain Jane Lavelle Joshua Nagler Joan Shook(Autor*in)

Wolters Kluwer Health (Verlag)

1. Auflage

Erschienen am 18. August 2020

1528 Seiten

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Inhalt

Cover
Title Page
Copyright
Dedication
CONTRIBUTING AUTHORS
ACKNOWLEDGMENTS
CONTENTS
SECTION I: Core Principles of Quality and Safety
CHAPTER 1: INTRODUCTION: HIGH-QUALITY EMERGENCY CARE FOR CHILDREN
GOALS OF EMERGENCY CARE
QUALITY AND ITS MEASUREMENT IN PEDIATRIC EMERGENCY MEDICINE
Current Evidence and Practice
High Reliability and Patient Safety
Teamwork and Communication
Cognitive Error
CONCLUSION
CHAPTER 2: INTRODUCTION TO CLINICAL PATHWAYS
BACKGROUND
QUALITY IMPROVEMENT THEORY
APPROACH TO CLINICAL PATHWAY DEVELOPMENT
MEASURING IMPROVEMENT
CHAPTER 3: CLINICAL DECISION SUPPORT
PEOPLE, PROCESS, THEN TECHNOLOGY
CDS OPPORTUNITIES ACROSS A HEALTHCARE ENCOUNTER
Pre-Visit
Assessment and Plan Formulation
Plan Execution
Response to Events
Disposition and Post-Visit
CHAPTER 4: MULTIDISCIPLINARY TEAMWORK
INTRODUCTION
WHY TEAMWORK IS IMPORTANT TO QUALITY AND SAFETY
What Is a Team?
Who Is on a Team?
Team Core Competencies
Facilitating Teamwork
Strategies to Enhance Teamwork
CONCLUSION
CHAPTER 5: HUMANISM IN THE EMERGENCY DEPARTMENT
WHAT IS PROFESSIONALISM?
WHAT IS HUMANISM?
WHAT IS THE RELATIONSHIP OF HUMANISM TO PROFESSIONALISM?
WHY IS BALANCE IMPORTANT? TO THE PATIENT? TO THE DOCTOR?
HOW DO WE MAINTAIN AND PROJECT OUR HUMANISM?
INTRODUCTION AND JOINING
DETAILED SOCIAL HISTORY
PERSONAL INFORMATION
ADDRESSING FEARS
FREQUENT TOUCH POINTS
PARENTAL PRESENCE
SETTING REALISTIC EXPECTATIONS
CHECKING ON COMMUNICATION (FOLLOW-UP)
HUMANISM WITH COLLEAGUES AND STAFF (DEBRIEFINGS-TEAMWORK)
HUMANISM VIA SELF-CARE
SUMMARY
SECTION II: Resuscitation and Stabilization
CHAPTER 6: A GENERAL APPROACH TO TRIAGE
INTRODUCTION
HISTORY OF TRIAGE
CURRENT TRIAGE SYSTEMS
PEDIATRIC TRIAGE CONSIDERATIONS
Triage Process
Pediatric Assessment Triangle
Primary Survey
Secondary Survey
Triage Decision
Triage Documentation
Reassessment
EMTALA
TRENDS IN TRIAGE
Pivot Roles
Split Flow
Immediate Bedding
Provider in Triage
CONCLUSION
CHAPTER 7: A GENERAL APPROACH TO THE ILL OR INJURED CHILD
BACKGROUND AND EPIDEMIOLOGY
PEDIATRIC DIFFERENCES
PRINCIPLES OF CRITICAL ILLNESS AND INJURY IN CHILDREN
Triage
VITAL SIGNS
TEAM COMPOSITION
RAPID ASSESSMENT
PRIMARY SURVEY
Airway
Breathing
Circulation
Disability
Exposure/Environment
IV Access
Fluid Resuscitation
SECONDARY SURVEY
FAMILY PRESENCE
QUALITY AND COMPETENCY
CHAPTER 8: AIRWAY
GOALS OF EMERGENCY THERAPY
Quality and Safety
ALTERNATIVES TO ENDOTRACHEAL INTUBATION
High-Flow Nasal Cannula
Noninvasive Ventilation
APPROACH TO ENDOTRACHEAL INTUBATION
EQUIPMENT
Endotracheal Tubes
Direct Laryngoscopes
Video Laryngoscopes
PREOXYGENATION
PATIENT POSITIONING
MEDICATIONS
Sedatives
Neuromuscular-Blocking Agent (Paralyzing Agent)
Adjunctive Agents
POSTPROCEDURE MANAGEMENT
Maintenance of Sedation Following Tracheal Intubation
RESCUE DEVICES IN PEDIATRIC AIRWAY MANAGEMENT
When to Use
Supraglottic Airways
Other Supraglottic Devices
CHAPTER 9: CARDIOPULMONARY RESUSCITATION
GOALS OF EMERGENCY THERAPY
INCIDENCE
PATIENT CHARACTERISTICS
Age
Etiology
Demographics
TREATMENT OVERVIEW
PROGNOSIS
CLINICAL MANIFESTATIONS
MANAGEMENT
Management Sequence
AIRWAY
Evaluation
MANAGEMENT
Airway Positioning
Artificial Airways
BREATHING
Evaluation
MANAGEMENT
Spontaneous Ventilation
Oxygen Delivery Devices
Assisted Ventilation
Expired Air Techniques
Masks
CIRCULATION
Evaluation
Management
EXTERNAL CARDIAC COMPRESSION
INTRAVENOUS ACCESS
DRUGS OF RESUSCITATION
Estimating Body Weight
Alternative Routes of Medication Administration
FLUID RESUSCITATION
DEFIBRILLATION AND CARDIOVERSION
SPECIFIC RESUSCITATION SCENARIOS
Bradycardia With a Pulse and Poor Perfusion
Pulseless Arrest
Tachydysrhythmias With a Pulse and Poor Perfusion
EXTRACORPOREAL CARDIOPULMONARY RESUSCITATION
NEWLY BORN INFANT RESUSCITATION
EMERGENCY DEPARTMENT READINESS
PATHOPHYSIOLOGY
MANAGEMENT
INITIAL STEPS OF NEWBORN RESUSCITATION
Thermoregulation
Stimulation
Airway
Assessment of Heart Rate
Assessment of Need for Supplemental Oxygen
UMBILICAL CORD MANAGEMENT
INTERVENTIONS
Oxygenation and Ventilation
Supporting Circulation
Other Medications
POSTRESUSCITATION CARE
SPECIAL SITUATIONS
Withholding Resuscitation
Discontinuing Resuscitative Efforts
Induced Therapeutic Hypothermia
Pneumothorax
Congenital Diaphragmatic Hernia
TEAMWORK IN RESUSCITATION FOR ALL PEDIATRIC PATIENTS
DISCONTINUATION OF LIFE SUPPORT IN CHILDREN
CEREBRAL RESUSCITATION
Hypothermia
QUALITY IMPROVEMENT
ETHICAL ISSUES IN PEDIATRIC CARDIOPULMONARY RESUSCITATION
CHAPTER 10: SHOCK
DEFINITION OF SHOCK
GOALS OF EMERGENCY THERAPY
CLINICAL AND PATHOPHYSIOLOGIC CONSIDERATIONS
TYPES OF SHOCK
Hypovolemic Shock
Cardiogenic Shock
Obstructive Shock
Distributive Shock
Neurogenic Shock
Dissociative Shock
CLINICAL CONSIDERATIONS IN SHOCK RECOGNITION
Vital Signs
History and Physical Examination Findings
PRINCIPLES OF SHOCK MANAGEMENT
Vascular Access
Volume Resuscitation
Vasoactive Agents
Electrolyte Abnormalities
Airway Management
Source Control
PROTOCOL-BASED CARE FOR SEPTIC SHOCK
Timely Antimicrobial and Fluid Resuscitation Therapy
Global Considerations
American College of Critical Care Medicine and Surviving Sepsis Campaign Recommendations
Quality Metrics in Pediatric Sepsis
CLINICAL PARAMETERS OF SHOCK REVERSAL
FLUID-REFRACTORY AND CATECHOLAMINE-RESISTANT SHOCK
CONSIDERATIONS FOR INTENSIVE CARE AND TRANSPORT
OUTCOMES
CHAPTER 11: INTERFACILITY TRANSPORT AND STABILIZATION
INTRODUCTION TO PEDIATRIC INTERFACILITY TRANSPORT
TRANSPORT CONSIDERATIONS
MODES OF TRANSPORT
MEDICAL OVERSIGHT
Direct Medical Control
Indirect Medical Control
PEDIATRIC TRANSPORT TEAM STRUCTURE AND LOGISTICS
Education and Training
Quality Improvement
Communication
Patient and Team Safety
Air Transport and Safety
Vehicle Safety
Lights and Siren Use
STABILIZATION FOR TRANSPORT
ALTITUDE PHYSIOLOGY AND THE AIR MEDICAL ENVIRONMENT
MEDICAL-LEGAL ISSUES
SECTION III: Signs and Symptoms
CHAPTER 12: ABDOMINAL DISTENSION
INTRODUCTION
DIFFERENTIAL DIAGNOSIS
EVALUATION AND DECISION
History
Physical Examination
Laboratory
Management
CHAPTER 13: AGITATED CHILD
INTRODUCTION
DIFFERENTIAL DIAGNOSIS
Medical Conditions
Psychiatric Conditions
EVALUATION AND DECISION
General Approach/Initial Stabilization
Medical Conditions
Psychiatric Evaluation
Evaluation of Support Systems
Disposition
CHAPTER 14: APNEA
INTRODUCTION
PATHOPHYSIOLOGY
DIFFERENTIAL DIAGNOSIS
EVALUATION AND DECISION
Initial Stabilization
Has a Significant Apneic Episode Occurred?
Is There an Underlying Cause?
CHAPTER 15: ACUTE ATAXIA
INTRODUCTION
HOW TO DIAGNOSE ATAXIA ON NEUROLOGIC EXAMINATION
DIFFERENTIAL DIAGNOSIS AND ROLE OF IMAGING AND LABORATORY TESTS
MANAGEMENT CONSIDERATIONS
CHAPTER 16: BREAST LESIONS
INTRODUCTION
DIFFERENTIAL DIAGNOSIS
Breast Infections
Benign Cysts and Masses
Malignant Masses
Abnormal Secretions (Nipple Discharge)
Lesions Associated With Pregnancy and Lactation
Miscellaneous Breast Lesions
EVALUATION AND DECISION
History and Physical Examination
Diagnostic Testing
APPROACH
Prepubertal Child
Pubertal/Postpubertal Male
Pubertal/Postpubertal Female
CHAPTER 17: COMA
INTRODUCTION
PATHOPHYSIOLOGY
DIFFERENTIAL DIAGNOSIS
Primary Central Nervous System Disorders
Systemic Abnormalities
EVALUATION AND DECISION
History and Physical Examination
Neurologic Examination and Scoring
Laboratory and Radiologic Studies
Vital Sign Abnormalities
History of Head Trauma
History of Seizures
History of Toxic Ingestions
Increased Intracranial Pressure or Focal Neurologic Defect
Fever
Metabolic Abnormalities
Coma of Unknown Origin
CHAPTER 18: CONSTIPATION
INTRODUCTION
DEFINITION
PHYSIOLOGY
EVALUATION AND DECISION
Acute Constipation
Chronic Constipation
TREATMENT
Approach to the Patient With Severe Chronic Constipation
CHAPTER 19: COUGH
INTRODUCTION
PATHOPHYSIOLOGY
DIFFERENTIAL DIAGNOSIS
EVALUATION AND DECISION
History
Physical Examination
Ancillary Studies
Approach
TREATMENT
CHAPTER 20: CRYING
INTRODUCTION
PATHOPHYSIOLOGY
EVALUATION AND DECISION
ACKNOWLEDGMENTS
CHAPTER 21: CYANOSIS
INTRODUCTION
PATHOPHYSIOLOGY
DIFFERENTIAL DIAGNOSIS
EVALUATION AND DECISION
CHAPTER 22: DEHYDRATION
PATHOPHYSIOLOGY
DIFFERENTIAL DIAGNOSIS
EVALUATION AND DECISION
History
Physical Examination
Laboratory
Diagnostic Approach
Initial Management
Oral Rehydration Therapy
Parenteral Rehydration
CONCLUSION
CHAPTER 23: DIARRHEA
INTRODUCTION
DIFFERENTIAL DIAGNOSIS
EVALUATION AND DECISION
TREATMENT
CHAPTER 24: DIZZINESS AND VERTIGO
INTRODUCTION
PATHOPHYSIOLOGY
DIFFERENTIAL DIAGNOSIS
Infections
Migraine
Benign Paroxysmal Vertigo of Childhood
Ototoxic Drugs
Trauma
Seizures
Motion Sickness
Ménière Disease
Miscellaneous Causes
EVALUATION AND DECISION
Differentiation of True Vertigo and Pseudovertigo
True Vertigo
MANAGEMENT
Pseudovertigo
CHAPTER 25: EDEMA
INTRODUCTION
PATHOPHYSIOLOGY
DIFFERENTIAL DIAGNOSIS
EVALUATION
LOCALIZED EDEMA
GENERALIZED EDEMA
CHAPTER 26: EPISTAXIS
INTRODUCTION
PATHOPHYSIOLOGY
DIFFERENTIAL DIAGNOSIS
Local Causes
Systemic Causes
EVALUATION AND DECISION
CHAPTER 27: EYE: RED EYE
INTRODUCTION
PATHOPHYSIOLOGY
EVALUATION AND DECISION
CHAPTER 28: EYE: STRABISMUS
INTRODUCTION
PATHOPHYSIOLOGY
Nerve Palsies
Muscle Restriction
Strabismus With Intact Eye Muscle Function
EVALUATION AND DECISION
ESOTROPIA EMERGENCIES
EXOTROPIA EMERGENCIES
HYPERTROPIA/HYPOTROPIA EMERGENCIES
CHAPTER 29: EYE: UNEQUAL PUPILS
INTRODUCTION
PATHOPHYSIOLOGY
EVALUATION AND DECISION
ANISOCORIA
MIOSIS
Local Factors
Neurologic Factors
MYDRIASIS
Local Factors
Neurologic Factors
CORECTOPIA AND IRREGULAR PUPILS
UNEQUAL PUPILLARY REACTIVITY
CHAPTER 30: EYE: VISUAL DISTURBANCES
INTRODUCTION
PATHOPHYSIOLOGY
DIFFERENTIAL DIAGNOSIS
EVALUATION AND DECISION
Severe Visual Loss Associated With Trauma
Severe Visual Loss Not Associated With Trauma
Mild Visual Loss With Trauma
Mild Visual Loss Without Trauma
CHAPTER 31: FEVER
INTRODUCTION
PATHOPHYSIOLOGY
EVALUATION AND DECISION
SYMPTOMATIC TREATMENT, DISPOSITION, AND PARENTAL GUIDANCE
DISPOSITION AND DISCHARGE CONSIDERATIONS
CHAPTER 32: FOREIGN BODY: INGESTION AND ASPIRATION
PATHOPHYSIOLOGY
DIFFERENTIAL DIAGNOSIS
Gastrointestinal Foreign Body
Respiratory Foreign Body
EVALUATION AND DECISION
Unknown Location
Gastrointestinal Foreign Body
Respiratory Foreign Body
ACKNOWLEDGMENTS
CHAPTER 33: GASTROINTESTINAL BLEEDING
INTRODUCTION
INITIAL ASSESSMENT
GI Bleed Imitators
Severity of Bleeding
Establishing the Level of Bleeding
UPPER GASTROINTESTINAL BLEEDING
Differential Diagnosis
Neonatal Period (0 to 1 Month)
Infancy (1 Month to 2 Years)
Preschool Period (2 to 5 Years)
School Age Through Adolescence Period
Evaluation and Decision: Upper Gastrointestinal Bleeding
LOWER GASTROINTESTINAL BLEEDING
Differential Diagnosis
Evaluation and Decision: Lower Gastrointestinal Bleeding
Summary
ACKNOWLEDGMENT
CHAPTER 34: HEARING LOSS
PATHOPHYSIOLOGY
DIFFERENTIAL DIAGNOSIS
Conductive Hearing Loss
Congenital Sensorineural Hearing Loss
Acquired Sensorineural Hearing Loss
EVALUATION AND DECISION
CHAPTER 35: HEART MURMURS
DIFFERENTIAL DIAGNOSIS
History
Examination
EVALUATION AND DECISION
Infants With Cardiac Murmur
Cyanotic Infants
Infants Who Are Not Cyanotic
Children Greater Than 1 Year of Age With Murmur
SUMMARY
CHAPTER 36: HEMATURIA
INTRODUCTION
PATHOPHYSIOLOGY
DIFFERENTIAL DIAGNOSIS
Evaluation and Decision
CHAPTER 37: HYPERTENSION
INTRODUCTION
PATHOPHYSIOLOGY/DIFFERENTIAL DIAGNOSIS
EVALUATION AND DECISION
MANAGEMENT
SPECIFIC THERAPY
Intravenous Antihypertensive Medications
Oral Antihypertensive Medications
SUMMARY
CHAPTER 38: IMMOBILE ARM
DIFFERENTIAL DIAGNOSIS
EVALUATION AND DECISION
CHAPTER 39: INGUINAL MASSES
INTRODUCTION
GENERAL APPROACH
DIFFERENTIAL DIAGNOSIS
Lymphadenopathy and Lymphadenitis
Inguinal Hernias
Retractile, Undescended, Ectopic, and Traumatically Dislocated Testes
EVALUATION AND DECISION
CHAPTER 40: INJURY: ANKLE
INTRODUCTION
DIFFERENTIAL DIAGNOSIS
ANKLE FRACTURES
ANKLE SPRAINS
Classification of Ankle Sprains
Injuries Associated With Ankle Sprains
EVALUATION AND DECISION
History
Physical Examination
Radiographic Imaging
Approach
TREATMENT
Fractures
Sprains
Splinting
Rehabilitation
Orthopedic Referral
CHAPTER 41: INJURY: HEAD
PEDIATRIC HEAD TRAUMA
PATHOPHYSIOLOGY
DIFFERENTIAL DIAGNOSIS
Scalp
Skull
Traumatic Brain Injury
Concussion
Posttraumatic Seizure
Cerebral Contusion
Epidural Hematoma
Subdural Hematoma
Intracerebral Hematoma
Subarachnoid Hemorrhage
Diffuse Axonal Injury
Cerebral Edema
Penetrating Injuries
EVALUATION AND DECISION (SEE CHAPTER 113 NEUROTRAUMA)
CLINICAL ASSESSMENT
History
Physical Examination
Radiographic Investigation
Approach
CHAPTER 42: INJURY: KNEE
INTRODUCTION
DIFFERENTIAL DIAGNOSIS
Acute Injuries
Subacute Injuries
EVALUATION AND DECISION
CHAPTER 43: Injury: Shoulder
INTRODUCTION
DIFFERENTIAL DIAGNOSIS
EVALUATION AND DECISION
CHAPTER 44: JAUNDICE: CONJUGATED HYPERBILIRUBINEMIA
INTRODUCTION
NORMAL BILIRUBIN PHYSIOLOGY
DEFINITION
ETIOLOGIES
HISTORY AND PHYSICAL EXAMINATION
EVALUATION
EVALUATION OF THE NEONATE
EVALUATION OF THE OLDER CHILD
LIFE-THREATENING CAUSES NOT TO MISS
Acute Liver Failure
Congenital TORCHS Infections and Sepsis
Biliary Atresia
Metabolic Abnormalities
Obstructive Etiologies: Gallstones, Cysts
Acetaminophen Toxicity
CHAPTER 45: JAUNDICE: UNCONJUGATED HYPERBILIRUBINEMIA
INTRODUCTION
PATHOPHYSIOLOGY
DIFFERENTIAL DIAGNOSIS
Excess Bilirubin Production
Decreased Bilirubin Conjugation
Impaired Bilirubin Excretion
EVALUATION
History
Physical Examination
Additional Studies
MANAGEMENT
Phototherapy
Exchange Transfusion
Hydration
Discharge
APPROACH
Clinical Pathway for Neonates
Beyond the Neonatal Period
CHAPTER 46: LIMP
INTRODUCTION
DIFFERENTIAL DIAGNOSIS
EVALUATION AND DECISION
History
Physical Examination
Laboratory and Imaging
CHAPTER 47: LYMPHADENOPATHY
INTRODUCTION
MECHANISM OF LYMPHADENOPATHY
DIFFERENTIAL DIAGNOSIS
CAUSES OF LYMPHADENOPATHY BY REGION
Cervical
Other Lymphadenopathy of the Head and Neck
Axillary and Epitrochlear
Inguinal
Iliac
GENERALIZED LYMPHADENOPATHY
LIFE-THREATENING LYMPHADENOPATHY
EVALUATION AND DECISION
CHAPTER 48: NECK MASS
INTRODUCTION
INITIAL EVALUATION AND DECISION MAKING
Child With Neck Mass and Respiratory Distress or Systemic Toxicity
Child With Neck Mass and No Distress
DIFFERENTIAL DIAGNOSIS
Congenital Masses
Inflammatory Masses
Neoplasms
GENERAL DIAGNOSTIC APPROACH
DISPOSITION
CHAPTER 49: NECK STIFFNESS
INTRODUCTION
DIFFERENTIAL DIAGNOSIS
Neck Stiffness Associated With Trauma
Neck Stiffness Associated With Infectious/Inflammatory Conditions
Neck Stiffness Associated With Tumors, Vascular Lesions of the Central Nervous System, or Other Space-Occupying Lesions
Congenital Causes of Neck Stiffness
Miscellaneous Causes of Neck Stiffness
EVALUATION AND DECISION
CHAPTER 50: ODOR: UNUSUAL
INTRODUCTION
PATHOPHYSIOLOGY
DIFFERENTIAL DIAGNOSIS
Metabolic Disorders
Toxicologic Considerations
Infectious Diseases
Dermatologic Conditions
Foreign Bodies
Orifice Odors
Systemic Diseases
EVALUATION AND DECISION
CHAPTER 51: OLIGOMENORRHEA
INTRODUCTION
DEFINITIONS
DIFFERENTIAL DIAGNOSIS
EVALUATION AND DECISION
History
Examination
Pregnancy
Evaluation of Nonpregnant Patients
ENDOCRINE ABNORMALITIES
Hyperandrogenism
HYPOTHALAMIC-PITUITARY AXIS DISORDERS
Caloric Insufficiency
Hyperprolactinemia
Ovarian Disorders
Thyroid Disorders
Miscellaneous
APPROACH TO DIAGNOSIS
ACKNOWLEDGMENTS
CHAPTER 52: ORAL LESIONS
INTRODUCTION
PATHOPHYSIOLOGY
DIFFERENTIAL DIAGNOSIS
Congenital Oral Lesions
Infectious Oral Lesions
Tumorous Oral Lesions
Oral Lesions Associated With Systemic Disease
Miscellaneous Oral Lesions
EVALUATION AND DECISION
CHAPTER 53: PAIN: ABDOMEN
INTRODUCTION
PATHOPHYSIOLOGY
DIFFERENTIAL DIAGNOSIS
EVALUATION AND DECISION
Abdominal Pain in the Setting of Trauma
Considerations Among Children With Abdominal Distention or Prior Abdominal Surgery
Abdominal Pain Associated With Peritoneal Signs
Extra-abdominal Conditions Associated With Acute Abdominal Pain
Palpable Mass
Focal Tenderness
Colicky Pain
Fever
Chronic or Recurrent Pattern
Additional Considerations in the Postpubertal Female With Acute Abdominal Pain
SUMMARY
CHAPTER 54: PAIN: BACK
INTRODUCTION
DIFFERENTIAL DIAGNOSIS
EVALUATION AND DECISION
CHAPTER 55: PAIN: CHEST
INTRODUCTION
PATHOPHYSIOLOGY
DIFFERENTIAL DIAGNOSIS
EVALUATION AND DECISION
Child With Thoracic Trauma
Child With No Thoracic Trauma
SUMMARY
CHAPTER 56: PAIN: DYSPHAGIA
INTRODUCTION
PATHOPHYSIOLOGY
DIFFERENTIAL DIAGNOSIS
EVALUATION AND DECISION
CHAPTER 57: PAIN: DYSURIA
INTRODUCTION
EVALUATION AND DECISION
SYMPTOMATIC MANAGEMENT
CHAPTER 58: PAIN: EARACHE
INTRODUCTION
DIFFERENTIAL DIAGNOSIS
OTITIS EXTERNA
ACUTE OTITIS MEDIA
OTORRHEA
COMPLICATIONS OF ACUTE OTITIS MEDIA
TRAUMATIC TM PERFORATION
REFERRED EAR PAIN
CHAPTER 59: PAIN: HEADACHE
INTRODUCTION
PATHOPHYSIOLOGY
DIFFERENTIAL DIAGNOSIS
Vascular
Muscle Contraction
Inflammation
Traction/Compression
Psychogenic
EVALUATION AND DECISION
Clinical Assessment
Laboratory and Radiographic Testing
Treatment and Disposition
CHAPTER 60: PAIN: JOINTS
INTRODUCTION
DIFFERENTIAL DIAGNOSIS
EVALUATION AND DECISION
Trauma
Monoarthritis
Polyarthritis
CHAPTER 61: PAIN: SCROTAL
INTRODUCTION
PATHOPHYSIOLOGY
DIFFERENTIAL DIAGNOSIS
CAUSES OF PAINFUL SCROTAL SWELLING
Torsion of the Testis
Torsion of Testicular Appendage
Epididymitis/Orchitis
Orchitis
Trauma/Hematocele
Incarcerated Inguinal Hernia
Henoch-Schönlein Purpura
Other Causes of a Painful Scrotum
CAUSES OF PAINLESS SCROTAL SWELLING
Hydrocele
Hernia
Varicocele
Spermatocele
Idiopathic Scrotal Edema
Kawasaki Disease
Testis Tumor
Antenatal Torsion Testis (Newborn)
EVALUATION AND DECISION
Initial Approach
History
Physical Examination
Imaging Modalities
CHAPTER 62: PALLOR
INTRODUCTION
DIFFERENTIAL DIAGNOSIS
Decreased Production of Hemoglobin and Red Cells
Hypoplastic and Aplastic Anemias
Disorders of Heme and Globin Production
Systemic Disease
Increased Red Cell Destruction
Membrane Disorders
Enzyme Disorders
Hemoglobinopathies
Immune Hemolytic Anemia
Microangiopathic Anemia
Blood Loss
EVALUATION AND DECISION
SUMMARY
CHAPTER 63: PALPITATIONS
INTRODUCTION
PATHOPHYSIOLOGY
DIFFERENTIAL DIAGNOSIS
Hyperdynamic Cardiac Activity
Sinus Bradycardia
True Cardiac Arrhythmias
EVALUATION AND DECISION
CHAPTER 64: POLYDIPSIA
INTRODUCTION
PATHOPHYSIOLOGY
DIFFERENTIAL DIAGNOSIS
EVALUATION AND DECISION
CHAPTER 65: RASH: ATOPIC/CONTACT DERMATITIS AND PHOTOSENSITIVITY
DERMATITIS
Atopic Dermatitis
Nummular Eczema
Asteatotic Eczema
Dyshidrotic Eczema
Lichen Simplex Chronicus
Contact Dermatitis
Allergic Contact Dermatitis
Irritant Contact Dermatitis
Autoeczematization
PHOTOSENSITIVITY
Polymorphous Light Eruption
Phytophotodermatitis
CHAPTER 66: RASH: BACTERIAL AND FUNGAL INFECTIONS/RASH: MACULOPAPULAR
BACTERIAL INFECTIONS
Pustular Eruptions
Other Pathogens
FUNGAL INFECTIONS
Dermatophytes
CHAPTER 67: RASH: VESICULOBULLOUS
INTRODUCTION
ACQUIRED BLISTERING ERUPTIONS
Infestations
Acropustulosis of Infancy
MASTOCYTOSIS
INHERITED BLISTERING DISEASES
Epidermolysis Bullosa
Incontinentia Pigmenti
AUTOIMMUNE BULLOUS DISORDERS
Linear IgA Disease
Bullous Pemphigoid
Dermatitis Herpetiformis
Systemic Lupus Erythematosus
OTHER BULLOUS ERUPTIONS THAT MAY BE CONFUSED WITH AUTOIMMUNE BLISTERING DISEASES
Friction Blisters
Frostbite
LABORATORY EVALUATION
Gram Stain
Tzanck Smear
Rapid Slide Test for Direct Immunofluorescence
Bacterial or Viral Cultures
Polymerase Chain Reaction
Skin Biopsy
CONCLUSION
CHAPTER 68: RASH: DRUG ERUPTIONS
DRUG ERUPTIONS
URTICARIA
MORBILLIFORM
DRUG HYPERSENSITIVITY REACTION (DHR)/DRUG REACTION WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS)
PUSTULAR
VESICULOBULLOUS
Fixed Drug
Erythema Multiforme
Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis
CHAPTER 69: RASH: NEONATAL
INTRODUCTION
PUSTULAR ERUPTIONS
Neonatal Acne
Erythema Toxicum Neonatorum
Transient Neonatal Pustular Melanosis
Staphylococcal Pustulosis
Neonatal Candida
Candidal Diaper Dermatitis
Infantile Acropustulosis
VESICULAR ERUPTIONS
Neonatal Herpes Simplex Virus Infections
Incontinentia Pigmenti
PATCHES AND PLAQUES
Annular Rash
Scaly Red Patches and Plaques
Atrophic Patches
Indurated Plaques
Vascular Patches/Plaques and Hamartomas
DARKER AND LIGHTER SKIN LESIONS
CHAPTER 70: RASH: PAPULOSQUAMOUS ERUPTIONS AND VIRAL EXANTHEMS
PAPULOSQUAMOUS ERUPTIONS
Psoriasis
Seborrheic Dermatitis
Pityriasis rosea
Pityriasis rubra pilaris
Pityriasis lichenoides
Lichen nitidus
Lichen planus
Lichen striatus
VIRAL SYNDROMES
Kaposi Varicelliform Eruption
Papular-Purpuric Gloves-and-Socks Eruption
Unilateral Laterothoracic Exanthem
GIANOTTI-CROSTI SYNDROME (PAPULAR ACRODERMATITIS OF CHILDHOOD, PAPULOVESICULAR ACROLOCATED SYNDROME)
CONCLUSION
CHAPTER 71: RESPIRATORY DISTRESS
INTRODUCTION
PATHOPHYSIOLOGY
DIFFERENTIAL DIAGNOSIS
Respiratory System
Nervous System
Chest Wall/Thoracic Cavity
Cardiovascular
Gastrointestinal
Metabolic and Endocrine Disturbances
Hematologic
EVALUATION AND DECISION
Triage and Stabilization
History
Physical Examination
Approach
Treatment
SUMMARY
CHAPTER 72: SEIZURES
BACKGROUND
PATHOPHYSIOLOGY
ETIOLOGY
DIFFERENTIAL DIAGNOSIS
INITIAL STABILIZATION
EVALUATION AND DECISION
History
Planning for an Active Seizure
Physical Examination
DIAGNOSTIC APPROACH
EMERGENCY TREATMENT OF AN ACTIVE SEIZURE
Prevention and Preparation
Medical Management of an Active Seizure Beyond the Neonatal Period
SPECIAL CONSIDERATIONS
Febrile Seizures
CHAPTER 73: SEPTIC-APPEARING INFANT
INTRODUCTION
DIFFERENTIAL DIAGNOSIS
Sepsis
Other Infectious Diseases
Cardiac Diseases (See Chapter 86 Cardiac Emergencies)
Endocrine Disorders (See Chapter 89 Endocrine Emergencies)
Metabolic Disorders
Renal Disorders (See Chapter 100 Renal and Electrolyte Emergencies)
Hematologic Disorders
Gastrointestinal Disorders (See Chapter 91 Gastrointestinal Emergencies)
Neurologic Diseases
Child Abuse
EVALUATION AND DECISION
CHAPTER 74: SORE THROAT
INTRODUCTION
DIFFERENTIAL DIAGNOSIS
Infectious Pharyngitis
Irritative Pharyngitis/Foreign Body
Herpetic Stomatitis
Peritonsillar Abscess
Retropharyngeal and Lateral Pharyngeal Abscesses
Epiglottitis
Kawasaki Disease
Stevens-Johnson Syndrome
Chemical Exposure
Referred Pain
Psychogenic Pharyngitis
Pharyngitis in the Immunosuppressed Host
EVALUATION AND DECISION
CHAPTER 75: STRIDOR
INTRODUCTION
PATHOPHYSIOLOGY
DIFFERENTIAL DIAGNOSIS
Stridor With Acute Onset in the Febrile Child
Stridor With Acute Onset in the Afebrile Child
Chronic Stridor
EVALUATION AND DECISION
Febrile Child
Afebrile Child
CHAPTER 76: SYNCOPE
INTRODUCTION
AUTONOMIC (VASOVAGAL OR NEUROCARDIOGENIC) SYNCOPE
CARDIAC SYNCOPE
Long QT Syndrome (LQTS)
Brugada Syndrome
Structural Heart Disease
Other Arrhythmias
OTHER CONDITIONS AND THOSE THAT MIMIC SYNCOPE
Hypoglycemia
Epilepsy
Narcolepsy
Vertebrobasilar Migraine or Transient Ischemic Attacks
Psychogenic Causes of Syncope
Orthostatic Intolerance
Dysautonomia
Drugs and Toxins
CLINICAL EVALUATION
Electrocardiogram (ECG)
Other Tests
TREATMENT
SUMMARY POINTS
CHAPTER 77: TACHYCARDIA
INTRODUCTION
PATHOPHYSIOLOGY
DIFFERENTIAL DIAGNOSIS
Sinus Tachycardia
Tachyarrhythmias
EVALUATION AND DECISION
CHAPTER 78: URINARY FREQUENCY
INTRODUCTION
PATHOPHYSIOLOGY
DIFFERENTIAL DIAGNOSIS
Renal and Urinary System
Extraurinary System
EVALUATION AND DECISION
CHAPTER 79: VAGINAL BLEEDING
INTRODUCTION
VAGINAL BLEEDING IN THE PREPUBERTAL PATIENT
Evaluation and Decision
Vulvar Bleeding
Vaginal Bleeding
Urethral Bleeding
BLEEDING IN THE NONPREGNANT ADOLESCENT PATIENT
Normal Menstrual Cycle
Evaluation and Decision in the Nonpregnant Adolescent
Causes of Uterine Bleeding in the Adolescent Patient
Treatment Options
BLEEDING IN THE PREGNANT PATIENT
Bleeding During Early Pregnancy
Bleeding During an Ectopic Pregnancy
Bleeding During Late Pregnancy
Bleeding With Shock
CHAPTER 80: VAGINAL DISCHARGE
INTRODUCTION
EVALUATION OF VAGINAL DISCHARGE IN THE PREPUBERTAL CHILD
Differential Diagnosis
Examination
Diagnostic Testing and Treatment
EVALUATION OF VAGINAL DISCHARGE IN THE ADOLESCENT
Differential Diagnosis
Examination
Diagnostic Testing and Treatment
CHAPTER 81: VOMITING
INTRODUCTION
EVALUATION AND DECISION
General Approach
History
Physical Examination
APPROACH TO CHILDREN BY AGE GROUPS
Neonates
Older Infants
Older Child
CHAPTER 82: WEAKNESS
INTRODUCTION
PATHOPHYSIOLOGY
DIFFERENTIAL DIAGNOSIS
EVALUATION AND DECISION
CHAPTER 83: WEIGHT LOSS
INTRODUCTION
PATHOPHYSIOLOGY
EVALUATION AND DECISION MAKING
General Approach
DIFFERENTIAL DIAGNOSIS BY AGE
Infants
Toddlers Through Preadolescents
Adolescents
Disposition
SUMMARY
CHAPTER 84: WHEEZING
INTRODUCTION
PATHOPHYSIOLOGY
DIFFERENTIAL DIAGNOSIS
Common Conditions
Less Common Conditions
Rare Conditions
EVALUATION
History
Physical Examination
DIAGNOSTIC TESTS
APPROACH
CHILDREN YOUNGER THAN 1 YEAR OLD
CHILD 1 YEAR OR OLDER
SECTION IV: Medical Emergencies
CHAPTER 85: ALLERGIC EMERGENCIES
GOALS OF EMERGENCY THERAPY
ANAPHYLAXIS
Goals of Treatment
Current Evidence
Clinical Considerations
HEREDITARY ANGIOEDEMA
Current Evidence
Goals of Treatment
Clinical Considerations
SERUM SICKNESS
Current Evidence
Goals of Treatment
Clinical Considerations
ALLERGIC RHINITIS AND CONJUNCTIVITIS
Current Evidence
Goals of Treatment
Clinical Considerations
CHAPTER 86: CARDIAC EMERGENCIES
GOALS OF EMERGENCY THERAPY
CONGENITAL HEART DISEASE
Goals of Treatment
Current Evidence
Clinical Considerations
Ductal Dependent Lesions
Ductal Dependent Pulmonary Blood Flow
Ductal Dependent Systemic Blood Flow
Shunt Lesions
Adults With Congenital Heart Disease
ARRHYTHMIC EMERGENCIES
Goal of Treatment
Current Evidence
Clinical Considerations
SUDDEN CARDIAC DEATH
ACUTE HEART FAILURE SYNDROMES
Current Evidence
Goal of Treatment
Clinical Considerations
ACQUIRED HEART DISEASE
Goals of Treatment
CARDIOMYOPATHIES
MYOCARDITIS
PERICARDITIS
CARDIAC TAMPONADE
BACTERIAL ENDOCARDITIS
ACUTE RHEUMATIC FEVER
KAWASAKI DISEASE
MYOCARDIAL INFARCTION
CARDIAC TRAUMA
Goals of Treatment
Current Evidence
Clinical Considerations
Blunt
Penetrating
Electrical
EVALUATION OF THE PATIENT WITH A CARDIAC DEVICE
Goals of Treatment
Current Evidence
Clinical Considerations
CHAPTER 87: CHILD ABUSE/ASSAULT
GOALS OF EMERGENCY CARE
INJURIES FROM PHYSICAL ABUSE: GENERAL
Clinical Considerations
CUTANEOUS MANIFESTATIONS OF ABUSE: BRUISES, BURNS, AND BITES
Goals of Treatment
Current Evidence
Clinical Considerations
OROPHARYNGEAL INJURIES FROM ABUSE
Goals of Treatment
Current Evidence
Clinical Considerations
ABUSIVE FRACTURES
Goals of Treatment
Current Evidence
Clinical Considerations
ABUSIVE HEAD TRAUMA
Goals of Treatment
Current Evidence
Clinical Considerations
ABUSIVE ABDOMINAL TRAUMA
Goals of Treatment
Current Evidence
Clinical Considerations
CHAPTER 88: DERMATOLOGIC URGENCIES AND EMERGENCIES
GOALS OF EMERGENCY CARE
PAPULES
Papules With a Characteristic Appearance
Milia
Molluscum Contagiosum
Warts
Xanthomas
Insect Bites
Tick Bites
Spider Bites
Scabies Infestation
Louse Infestation
Vascular Papules and Nodules
Yellow, Tan, or Brown Papules
Skin-Colored Papules
PLAQUES
Annular Plaques
NODULES
Panniculitis
Generalized Macules and Papules/Morbilliform Eruptions
EVALUATION AND DECISION
DIFFERENTIAL DIAGNOSIS
Presence of Fever
Potentially Life-threatening Illnesses
Causes of Other Widespread Rashes Associated With Fever
Nonspecific Viral Exanthems
Generalized Eruptions Without Fever
Vesicles/Bullae
Localized Eruptions Without Fever
Chronic Eruptions Without Fever
PAPULOSQUAMOUS ERUPTIONS/SCALY RED PATCHES AND PLAQUES
Conditions That Lack Pruritus
Pruritic Papulosquamous Disorders
VASCULAR LESIONS
Pyogenic Granulomas
Hemangioma
URTICARIA/WHEALS
Clinical Manifestations
Management
CHAPTER 89: ENDOCRINE EMERGENCIES
DIABETIC KETOACIDOSIS
Goals of Treatment
Current Evidence
Clinical Considerations
MILD KETOACIDOSIS/HYPERGLYCEMIA
Goals of Treatment
Current Evidence
Clinical Considerations
HYPOGLYCEMIA
Goal of Treatment
Current Evidence
Clinical Considerations
HYPOPITUITARISM
Goal of Treatment
Current Evidence
Clinical Considerations
ACUTE ADRENAL INSUFFICIENCY
Goal of Treatment
Current Evidence
Clinical Considerations
CONGENITAL ADRENAL HYPERPLASIA
Goal of Treatment
Current Evidence
Clinical Considerations
PHEOCHROMOCYTOMA
Goal of Treatment
Current Evidence
Clinical Considerations
DIABETES INSIPIDUS
Goal of Treatment
Current Evidence
Clinical Considerations
SYNDROME OF INAPPROPRIATE ANTIDIURETIC HORMONE SECRETION
Goals of Treatment
Current Evidence
Clinical Considerations
HYPERPARATHYROIDISM
Goal of Treatment
Current Evidence
Clinical Considerations
HYPOPARATHYROIDISM
Goal of Treatment
Current Evidence
Clinical Considerations
RICKETS
Goals of Treatment
Current Evidence
Clinical Considerations
THYROID STORM
Goals of Treatment
Current Evidence
Clinical Considerations
NEONATAL THYROTOXICOSIS
Goals of Treatment
Current Evidence
Clinical Considerations
CONGENITAL HYPOTHYROIDISM
Goal of Treatment
Current Evidence
Clinical Considerations
CHAPTER 90: ENVIRONMENTAL EMERGENCIES, RADIOLOGICAL EMERGENCIES, BITES AND STINGS
DROWNING
Goals of Treatment
Current Evidence
Clinical Recognition
Triage Considerations
Initial Assessment
Management and Diagnostic Testing
Indications for Discharge or Admission
SMOKE INHALATION
Goals of Treatment
Current Evidence
Clinical Recognition
Triage Considerations
Clinical Assessment
Management and Diagnostic Studies
Indications for Discharge or Admission
CARBON MONOXIDE POISONING
Goals of Treatment
Current Evidence
Clinical Recognition
Triage Considerations
Clinical Assessment
Management and Diagnostic Studies
Indications for Discharge or Admission
ENVIRONMENTAL AND EXERTIONAL HEAT ILLNESS
Goals of Treatment
Current Evidence
Clinical Recognition
Management and Diagnostic Studies
Indications for Admission and Discharge
ACCIDENTAL HYPOTHERMIA
Goals of Treatment
Current Evidence
Clinical Recognition
Triage Considerations
Initial Assessment
Management and Diagnostic Studies
Indications for Admission and Discharge
FROSTBITE INJURY
Clinical Recognition
HIGH-ALTITUDE ILLNESS
Goals of Treatment
Current Evidence
Clinical Recognition
Triage and Initial Assessment
Management and Diagnostic Studies
Prevention
ELECTRICAL INJURIES
Goals of Treatment
Current Evidence
Clinical Recognition
Management and Diagnostic Studies
Indications for Discharge and Admission
RADIATION INJURIES
Goals of Treatment
Current Evidence
Triage Considerations
Management and Diagnostic Studies
BITES AND STINGS
Goals of Treatment
MARINE INVERTEBRATES
Phylum Coelenterata (Cnidaria)
Phylum Echinodermata
MARINE VERTEBRATES
Stingrays
Sharks
Scorpaenidae
Catfish
TERRESTRIAL INVERTEBRATES
Phylum Arthropoda
TERRESTRIAL VERTEBRATES
Venomous Reptiles
MAMMALIAN BITES
Goals of Treatment
Current Evidence
Clinical Considerations
Clinical Assessment
Management
CHAPTER 91: GASTROINTESTINAL EMERGENCIES
GOALS OF EMERGENCY CARE
GASTROINTESTINAL BLEEDING
Goals of Treatment
UPPER GASTROINTESTINAL BLEEDING
Esophageal Varices
PEPTIC ULCER DISEASE
Goals of Treatment
Clinical Evidence
Clinical Considerations
MALLORY-WEISS TEARS/PROLAPSE GASTROPATHY
LOWER GI BLEEDING
Inflammatory Bowel Disease
DIETARY PROTEIN GASTROINTESTINAL DISORDERS
Goals of Treatment
Current Evidence
Clinical Considerations
ADDITIONAL CAUSES OF GASTROINTESTINAL BLEEDING
Hemolytic Uremic Syndrome
Henoch-Schönlein Purpura
Gastrointestinal Vascular Malformations
Foreign Bodies
PANCREATITIS
Goals of Treatment
Current Evidence
Clinical Considerations
BILIARY TRACT DISEASE
Biliary Atresia
CHOLELITHIASIS/CHOLECYSTITIS
ALAGILLE SYNDROME
LIVER DISEASE
Acute Liver Failure
PORTAL HYPERTENSION
ACUTE VIRAL HEPATITIS
Goals of Emergency Therapy
Current Evidence
Clinical Considerations
POSTEXPOSURE PROPHYLAXIS
Hepatitis A
Hepatitis B
MISCELLANEOUS ABDOMINAL EMERGENCIES
Gastroesophageal Reflux Disease
Celiac Disease
Mesenteric Lymphadenitis
Reye Syndrome
CHAPTER 92: GYNECOLOGY EMERGENCIES
GOALS OF EMERGENCY CARE
PREGNANCY
Goals of Treatment
Current Evidence
Clinical Considerations
EMERGENCY CONTRACEPTION
VAGINITIS
Goals of Treatment
Current Evidence
TRICHOMONAL VAGINITIS
Clinical Considerations
SHIGELLA VAGINITIS
Clinical Considerations
STREPTOCOCCAL VAGINITIS
Clinical Considerations
CANDIDAL VAGINITIS
Clinical Considerations
BACTERIAL VAGINOSIS
Clinical Considerations
NONSPECIFIC VAGINITIS
Clinical Considerations
CERVICITIS
Goals of Treatment
Current Evidence
Clinical Considerations
PELVIC INFLAMMATORY DISEASE
Goals of Treatment
Current Evidence
Clinical Considerations
ADNEXAL TORSION
Goals of Treatment
Current Evidence
Clinical Considerations
DISEASES THAT PRODUCE EXTERNAL GENITOURINARY LESIONS
Herpes Simplex Virus Infection
HPV
DISORDERS OF MENSTRUATION
Dysmenorrhea
ABNORMAL UTERINE BLEEDING
Goals of Treatment
Background
Clinical Manifestations
Management
LICHEN SCLEROSIS
CONGENITAL VAGINAL OBSTRUCTION
LABIAL ADHESIONS
URETHRAL PROLAPSE
Clinical Manifestations
Management
Contraceptive Devices
INTRAUTERINE DEVICES
Clinical Manifestations
Management
SUBDERMAL HORMONAL IMPLANT
Clinical Manifestations
Management
CHAPTER 93: HEMATOLOGIC EMERGENCIES
GOALS OF EMERGENCY THERAPY
ANEMIA
Goals of Treatment
Current Evidence
BLOOD LOSS
Clinical Considerations
HEMOLYTIC ANEMIA
Current Evidence
Goals of Treatment
Clinical Considerations
METHEMOGLOBINEMIA
Goals of Treatment
Clinical Considerations
INEFFECTIVE OR DECREASED RED BLOOD CELL PRODUCTION
Current Evidence
Clinical Considerations
SICKLE CELL DISEASE
Goals of Treatment
Clinical Considerations
Vasoocclusive Pain Episodes
Visceral Pain Crises and Hepatobiliary Disease
Priapism
Infection/Sepsis
Acute Chest Syndrome
Stroke
Anemia
Splenic Sequestration
Papillary Necrosis
Avascular Necrosis
Transfusions
NEUTROPENIA
Goals of Treatment
Current Evidence
Clinical Considerations
DISORDERS OF NEUTROPHIL FUNCTION
PLATELET DISORDERS
Goals of Treatment
IMMUNE THROMBOCYTOPENIA
Current Evidence
Clinical Considerations
OTHER DISORDERS ASSOCIATED WITH THROMBOCYTOPENIA
Neonatal Thrombocytopenia
Heparin-Induced Thrombocytopenia
Nonimmune Thrombocytopenia
THROMBOCYTOSIS
Goals of Treatment
Clinical Considerations
DISORDERS OF HEMOSTASIS
Goals of Treatment
Current Evidence
Clinical Considerations
Diagnostic Testing
Management
Clinical Indications for Discharge or Admission
HEMOPHILIA
Goals of Treatment
Current Evidence
Clinical Considerations
VON Willebrand Disease
Current Evidence
Clinical Considerations
HYPERCOAGULABILITY
Goals of Treatment
Current Evidence
Clinical Considerations
TRANSFUSION REACTIONS
Clinical Recognition
Management
CHAPTER 94: INFECTIOUS DISEASE EMERGENCIES
GOALS OF EMERGENCY CARE
BACTEREMIA AND SEPSIS
Current Evidence
Goals of Treatment
Clinical Considerations
OTHER SYSTEMIC INFECTIOUS EMERGENCIES
Goals of Treatment
Toxic Shock Syndrome
Rickettsial Diseases
Babesiosis
CNS INFECTIOUS EMERGENCIES
Meningitis, Bacterial
Herpes Simplex Virus, Neonatal
Meningitis, Aseptic
Encephalitis and Meningoencephalitis
Other CNS Infections
Acute Flaccid Paralysis
NECK INFECTIOUS EMERGENCIES
Cervical Lymphadenitis
Other Neck Infectious Emergencies
RESPIRATORY TRACT INFECTIOUS EMERGENCIES
Upper Respiratory Tract Infectious Emergencies
LOWER RESPIRATORY TRACT INFECTIOUS EMERGENCIES
Pneumonia
Other Respiratory Tract Infectious Emergencies
CARDIAC INFECTIOUS EMERGENCIES
Kawasaki Disease
Other Cardiac Infectious Emergencies
GASTROINTESTINAL INFECTIOUS EMERGENCIES
Gastroenteritis-Viral
Gastroenteritis-Bacterial
Hemolytic Uremic Syndrome
Nontyphi Salmonella
Shigella
Antibiotic-Associated Colitis
Intra-Abdominal Abscesses
GENITOURINARY INFECTIOUS EMERGENCIES
Urinary Tract Infections
SKIN AND SOFT TISSUE INFECTIOUS EMERGENCIES
Impetigo
Cellulitis
Mastitis, Neonatal
Omphalitis
Septic Arthritis
Lyme Disease Arthritis
Osteomyelitis
INFECTIONS IN RETURNED TRAVELERS
Introduction
Malaria
Tuberculosis
Typhoid
Dengue
Chikungunya
Zika
Diarrheal Diseases
SYSTEMIC INFECTIONS IN THE RETURNED TRAVELER
Yellow Fever
Leptospirosis
Tick-borne Diseases
Plague
CENTRAL/PERIPHERAL NERVOUS SYSTEM
Neurocysticercosis
Rabies
African Trypanosomiasis
CARDIAC INFECTIONS
Chagas Disease
RESPIRATORY TRACT INFECTIONS
Coronaviruses (SARS, MERS)
Diphtheria
Hantavirus
Lymphadenopathy
Measles
Mumps
Brucella
GASTROINTESTINAL/GENITOURINARY
Amebiasis
Giardia
Cryptosporidium
Gram-negative Enterics: Vibrio, E. coli, Campylobacter, Shigella
Schistosomiasis
Soil Helminthic Infections
SKIN/SOFT TISSUE INFECTIONS
Leishmaniasis
Cutaneous Larva Migrans
Filariasis
SEXUALLY TRANSMITTED INFECTIONS
Chlamydia, Neonatal
Gonorrhea, Neonatal
Gonorrhea, Disseminated
Herpes Simplex Virus, Nonneonatal
Human Immunodeficiency Virus
Syphilis, Congenital
Syphilis, Acquired
CHAPTER 95: METABOLIC EMERGENCIES
GOALS OF EMERGENCY THERAPY
UNKNOWN SUSPECTED IEM
Goals of Treatment
Current Understanding
Clinical Considerations
KNOWN IEM
Goals of Treatment
Current Understanding
Clinical Considerations
AMINO ACID DISORDERS
Goals of Treatment
Current Understanding
Clinical Considerations
ORGANIC ACIDEMIAS
Goals of Treatment
Current Understanding
Clinical Considerations
UREA CYCLE DEFECTS
Goals of Treatment
Current Understanding
Clinical Considerations
FATTY ACID OXIDATION DEFECTS
Goals of Treatment
Clinical Understanding
Current Considerations
CARBOHYDRATE DISORDERS
Disorders of Carbohydrate Intolerance
Goals of Treatment
Clinical Considerations
Disorders of Carbohydrate Production or Utilization
NEONATE WITH POSITIVE NEWBORN SCREEN
Goals of Treatment
Current Understanding
Clinical Considerations
SUMMARY
CHAPTER 96: NEONATAL EMERGENCIES
INTRODUCTION AND INITIAL ASSESSMENT
Goals of Emergency Care
Current Evidence
Goals of Treatment
Clinical Considerations
COLOR CHANGES AND DERMATOLOGIC FINDINGS
Goals of Emergency Care
Color Changes
Dermatologic Findings
Benign Rashes
Significant Neonatal Rashes (See Chapter 69 Rash: Neonatal)
NEONATAL HEAD AND NECK EMERGENCIES
Disorders of Head Size, Shape, and Symmetry
Abnormalities of Head Shape
Perinatal Birth Injuries to Head and Neck
Neonatal Eye Disorders
Disorders of the Neonatal Nose and Mouth
NEONATAL CARDIAC EMERGENCIES
Current Evidence
Goals of Treatment
Clinical Considerations
NEONATAL RESPIRATORY AND AIRWAY PROBLEMS
Goals of Emergency Care
Diseases That Cause Stridor in a Neonate
Other Disorders That Produce Neonatal Respiratory Distress
ABDOMINAL, GASTROINTESTINAL, AND GENITOURINARY EMERGENCIES
Goals of Treatment
Malrotation and Volvulus
Other Causes of Intestinal Obstruction
Necrotizing Enterocolitis
Hernias
Umbilical Cord Anomalies
Abnormal Stool
Abdominal Masses
Genitourinary Anomalies
NEONATAL NEUROLOGIC EMERGENCIES
Goals of Treatment
Seizures
Neonatal Encephalopathy
Neonatal Abstinence Syndrome
Abnormal Tone
NEONATAL INFECTIONS
Goals of Treatment
Neonatal Sepsis
Pneumonia in the Newborn
Urinary Tract Infections in the Newborn
Other Viral Infections of the Newborn
Neonatal Herpes Simplex Virus Infection
Neonatal Enteroviral Infection
Special Considerations
CHAPTER 97: NEUROLOGIC EMERGENCIES
GOALS OF EMERGENCY CARE
SEIZURES (SEE ALSO CHAPTER 72 SEIZURES)
Goals of Treatment
Current Evidence
Clinical Considerations
DISORDERS THAT PRESENT WITH HEADACHE (SEE ALSO CHAPTER 59 PAIN: HEADACHE)
Migraine
Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)
STROKE/CEREBROVASCULAR ACCIDENT
Goals of Treatment
Current Evidence
Clinical Considerations
DISORDERS THAT PRESENT WITH ENCEPHALOPATHY (SEE ALSO CHAPTER 17 COMA)
Goals of Treatment
DISORDERS OF MOTOR FUNCTION (SEE ALSO CHAPTER 82 WEAKNESS)
Goals of Treatment
DISORDERS OF BALANCE (SEE CHAPTERS 15 ACUTE ATAXIA AND 24 DIZZINESS AND VERTIGO)
Goals of Treatment
MOVEMENT DISORDERS
Goals of Treatment
DISORDERS OF CRANIAL NERVE FUNCTION
Goals of Treatment
CHAPTER 98: ONCOLOGIC EMERGENCIES
GOALS OF EMERGENCY THERAPY
SECTION I: INITIAL CARE OF THE CHILD WITH NEW OR RECURRENT CANCER
LEUKEMIA
Goals of Treatment
Current Evidence
Clinical Considerations
HISTIOCYTIC DISEASES
Goal of Treatment
Current Evidence
Clinical Considerations
TUMORS OF THE CENTRAL NERVOUS SYSTEM
Goals of Treatment
Current Evidence
Clinical Considerations
TUMORS OF THE HEAD AND NECK
Goals of Treatment
Current Evidence
Clinical Considerations
TUMORS OF THE THORAX
Goals of Treatment
Current Evidence
Clinical Considerations
TUMORS OF THE HEPATOBILIARY TREE
Goals of Treatment
Current Evidence
Clinical Considerations
Tumors of the Pancreas
Tumors of the Gastrointestinal Tract
NEUROBLASTOMA
Goals of Treatment
Current Evidence
Clinical Considerations
TUMORS OF THE KIDNEY
Goals of Treatment
Current Evidence
Clinical Considerations
TUMORS OF THE LOWER GENITOURINARY TRACT
GONADAL TUMORS
TUMORS IN AND AROUND THE SPINAL CORD
TUMORS OF BONE
Goal of Treatment
Current Evidence
Clinical Considerations
TUMORS OF THE SOFT TISSUES
CANCERS OF THE SKIN
SECTION II: MANAGEMENT OF COMPLICATIONS ASSOCIATED WITH CANCER AND CANCER THERAPY
HEMATOLOGIC COMPLICATIONS OF CANCER TREATMENT
Goals of Treatment
Current Evidence
Clinical Considerations
INFECTIOUS COMPLICATIONS OF CANCER TREATMENT
Goals of Treatment
Current Evidence
Clinical Considerations
COMPLICATIONS OF CAR-T CELL THERAPY
Goals of Treatment
Current Evidence
Clinical Considerations
METABOLIC COMPLICATIONS OF CANCER TREATMENT
PAIN
Goals of Treatment
Current Evidence
Clinical Considerations
NEUROLOGIC COMPLICATIONS OF CANCER TREATMENT
CARDIOVASCULAR COMPLICATIONS
HEPATIC AND GASTROINTESTINAL COMPLICATIONS OF CANCER TREATMENT
RENAL COMPLICATIONS OF CANCER THERAPY
GENITOURINARY COMPLICATIONS OF CANCER TREATMENT
SKIN COMPLICATIONS OF CANCER TREATMENT
COMPLICATIONS OF HEMATOPOIETIC STEM CELL TRANSPLANTATION
CARE OF PATIENTS WITH ADVANCED CANCER
CHAPTER 99: PULMONARY EMERGENCIES
GOALS OF EMERGENCY THERAPY
ACUTE RESPIRATORY FAILURE
Current Evidence
Goals of Treatment
Clinical Considerations
ASTHMA
Current Evidence
Goals of Treatment
Clinical Considerations
ASPIRATION PNEUMONIA
Current Evidence
Goal of Treatment
Clinical Considerations
BRONCHOPULMONARY DYSPLASIA
Current Evidence
Goals of Treatment
Clinical Considerations
CYSTIC FIBROSIS
Current Evidence
Goals of Treatment
Clinical Considerations
PULMONARY HEMORRHAGE
Current Evidence
Goals of Treatment
Clinical Considerations
PULMONARY EMBOLISM
Current Evidence
Goals of Treatment
Clinical Considerations
PULMONARY EDEMA
Current Evidence
Goals of Treatment
Clinical Considerations
PLEURITIS/PLEURAL EFFUSION
Current Evidence
Goals of Treatment
Clinical Considerations
SARCOIDOSIS
Current Evidence
Goals of Treatment
Clinical Considerations
OBSTRUCTIVE SLEEP APNEA
Current Evidence
Goals of Treatment
Clinical Considerations
INTERSTITIAL LUNG DISEASE
CHAPTER 100: RENAL AND ELECTROLYTE EMERGENCIES
GOALS OF EMERGENCY CARE
DEHYDRATION/HYPOVOLEMIA
Current Evidence
Goals of Treatment
Clinical Considerations
DISORDERS OF SODIUM HOMEOSTASIS
Goals of Treatment
Hyponatremia
Hypernatremia
DISORDERS OF POTASSIUM HOMEOSTASIS
Goals of Treatment
Hypokalemia
Hyperkalemia
DISORDERS OF CALCIUM HOMEOSTASIS
Goals of Treatment
Hypocalcemia
Hypercalcemia
DISORDERS OF ACID-BASE HOMEOSTASIS
Goals of Treatment
Metabolic Acidosis
Metabolic Alkalosis
ACUTE KIDNEY INJURY
Current Evidence
Goals of Treatment
Clinical Considerations
INTRINSIC CAUSES OF AKI
Hemolytic Uremic Syndrome
Postinfectious Glomerulonephritis
Henoch-Schönlein Purpura
Acute Interstitial Nephritis
Rhabdomyolysis
NEPHROTIC SYNDROME
Current Evidence
Goals of Treatment
Clinical Considerations
CHRONIC KIDNEY DISEASE
Current Evidence
Goals of Treatment
Clinical Considerations
CHAPTER 101: RHEUMATOLOGIC EMERGENCIES
GOALS OF EMERGENCY CARE
SYSTEMIC LUPUS ERYTHEMATOSUS
Current Evidence
Goals of Treatment
Clinical Considerations
OTHER SYSTEMIC CONNECTIVE TISSUE DISEASES
Scleroderma and Mixed Connective Tissue Disease
Scleroderma
Mixed Connective Tissue Disease
VASCULITIS
Current Evidence
Goals of Treatment
Clinical Considerations
POLYARTERITIS NODOSA
Current Evidence
Clinical Considerations
JUVENILE DERMATOMYOSITIS
Current Evidence
Clinical Considerations
Management
BEHÇET DISEASE
Clinical Considerations
Management
ARTHRITIS
JUVENILE IDIOPATHIC ARTHRITIS
Current Evidence
Clinical Considerations
Laboratory and Radiologic Features
Management
HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS AND MACROPHAGE ACTIVATION SYNDROME
Current Evidence
Clinical Considerations
Management
KAWASAKI DISEASE
Current Evidence
Goals of Treatment
Clinical Considerations
Management
LYME DISEASE
CHAPTER 102: TOXICOLOGIC EMERGENCIES
PEDIATRIC POISONINGS
Current Evidence
CLINICAL CONSIDERATIONS
Initial Life Support Phase
Evaluation and Detoxification Phase
NONTOXIC INGESTION
PHARMACEUTICALS
Acetaminophen
Cardiac Drugs
Iron
Psychotropic Medications
Salicylates
Miscellaneous Toxins
Drugs Dangerous in Small Doses
NONPHARMACEUTICALS
Alcohols and Glycols
Foods/Fish
HOUSEHOLD CLEANING PRODUCTS AND CAUSTICS
Household Cleaning Products
Pesticides
Rodenticides
PLANTS/MUSHROOMS
Plant Toxicity
Mushrooms
SUBSTANCE USE
Current Evidence
Clinical Considerations
Clinical Indications for Discharge or Admission
SPECIFIC DRUGS
Psychoactives, Including Novel Psychoactives
Cannabis and Synthetic Cannabinoid Receptor Antagonists
STIMULANTS
Amphetamines
Cocaine
Central Anticholinergics
Central Nervous System Sedative-Hypnotics
Opioids
?-Hydroxybutyrate, ?-Hydroxybutyrolactone, and 1,4-Butanediol
Inhalants
OTHER EMERGING DRUGS OF ABUSE
Current Evidence
Cathinones
SECTION V: Trauma
CHAPTER 103: ABDOMINAL TRAUMA
GOALS OF EMERGENCY CARE
THE APPROACH TO THE PEDIATRIC PATIENT WITH ABDOMINAL TRAUMA
Current Evidence
Goals of Treatment
Clinical Considerations
FOCUSED ABDOMINAL SONOGRAPHY FOR TRAUMA
Goals of Treatment
DIAGNOSTIC IMAGING FOR ABDOMINAL TRAUMA
Goals of Treatment
EMERGENT VERSUS SELECTIVE LAPAROSCOPY OR LAPAROTOMY
Goals of Treatment
BLUNT ABDOMINAL TRAUMA
Goals of Treatment
Abdominal Wall Contusions
Solid Organ Injuries
Pancreatic Injuries
Hollow Abdominal Viscera Injuries
Late Presentations of Intra-Abdominal Trauma
PENETRATING ABDOMINAL TRAUMA
Goals of Treatment
Gunshot Wounds
Stab Wounds
ABDOMINAL INJURIES-THE LAP BELT COMPLEX AND CHILD ABUSE
Goals of Treatment
LAP AND SHOULDER BELT AND AIR BAG INJURIES
Child Abuse
CHAPTER 104: BURNS
GOALS OF EMERGENCY CARE
INITIAL ASSESSMENT AND RESUSCITATION
Current Evidence
Goals of Treatment
Clinical Considerations
MAJOR BURNS
Current Evidence
Goals of Treatment
Clinical Considerations
MINOR BURNS
Goals of Treatment
Clinical Considerations
SPECIAL CIRCUMSTANCES
Goals of Treatment
Inflicted Burns
Electrical Burns
Chemical Burns
CHAPTER 105: DENTAL TRAUMA
GOALS OF EMERGENCY CARE
ASSESSMENT OF TRAUMATIC DENTAL EMERGENCIES
Current Evidence
Goals of Treatment
Clinical Considerations
SOFT TISSUE INJURY
Current Evidence
Goals of Treatment
Clinical Considerations
TRAUMATIC DENTAL INJURIES
Current Evidence
Goals of Treatment
Clinical Considerations
JAW FRACTURES
Current Evidence
Goals of Treatment
Mandibular Fractures/Dislocations
Maxillary Fractures
CHAPTER 106: ENT TRAUMA
GOALS OF EMERGENCY THERAPY
General Goals
TRAUMA TO THE EAR
Ear Foreign Body
Current Evidence
Clinical Considerations
Ear Trauma
EXTERNAL EAR
Current Evidence
Clinical Considerations
MIDDLE EAR
Current Evidence
Clinical Considerations
INNER EAR
Current Evidence
Clinical Considerations
OTHER INJURIES ASSOCIATED WITH EAR TRAUMA
Temporal Bone Fracture
CSF Otorrhea
TRAUMA TO THE NOSE AND SINUSES
Nasal Foreign Body
Current Evidence
Clinical Considerations
Trauma to the Nose and Sinuses
Current Evidence
Clinical Considerations
Sinus Barotrauma
TRAUMA TO THE ORAL CAVITY AND PHARYNX
Goals of Treatment
Current Evidence
Clinical Considerations
Caustic Injuries
TRAUMA TO THE LARYNX AND TRACHEA
Foreign Body
Current Evidence
Clinical Considerations
LARYNGEAL AND TRACHEAL TRAUMA
Goals of Treatment
Current Evidence
Clinical Considerations
CHAPTER 107: FACIAL TRAUMA
GOALS OF EMERGENCY THERAPY
Stabilization of the Airway
Cervical Spine Protection
Identification of Specific Bony Injuries and Facial Neurologic Deficits
Determination of Appropriate Imaging Modality
Obtain Subspecialty Consultation When Indicated
FACIAL FRACTURES
Mandible Fracture
Orbital Fracture
Nasal Fracture
Zygoma and Maxilla Fractures
Frontal Bone Fractures
SOFT TISSUE INJURIES
Lacerations
Regional Nerve Blocks
Guidelines for Subspecialty Consultation
CHAPTER 108: GENITOURINARY TRAUMA
INTRODUCTION
GOALS OF EMERGENCY THERAPY
KIDNEY
Goal of Treatment
Current Evidence
Clinical Considerations
Initial Assessment
Management/Diagnostic Testing
Clinical Indications for Discharge or Admission
URETER
Goal of Treatment
Current Evidence
Clinical Considerations
Management/Diagnostic Testing
Clinical Indications for Discharge or Admission
BLADDER
Goal of Treatment
Current Evidence
Clinical Considerations
Initial Assessment/Diagnostic Testing
Management
Clinical Indications for Discharge or Admission
URETHRA
Goal of Treatment
Current Evidence
Clinical Considerations
Management
Clinical Indications for Discharge or Admission
SCROTUM
Goal of Treatment
Clinical Considerations
Initial Assessment, Management, and Diagnostic Testing
PENIS
Clinical Recognition
PERINEUM
SEXUAL ABUSE
CHAPTER 109: HAND TRAUMA
GOALS OF EMERGENCY CARE
FINGERTIP INJURIES
Clinical Considerations
HAND LACERATIONS
Clinical Considerations
PHALANGES
Clinical Considerations
DISLOCATIONS
Clinical Considerations
METACARPALS
Clinical Considerations
CARPALS
Clinical Considerations
CHAPTER 110: MINOR TRAUMA
GOALS OF EMERGENCY CARE
GENERAL PRINCIPLES OF MINOR WOUND REPAIR
Obtaining Hemostasis
Prevention of Infection
Cosmesis and Wound Healing
Parental Satisfaction
Rate of Wound Infection After Repair
Current Evidence
Clinical Considerations
Painless Alternatives to Sutures
Wound Care
Wound Aftercare
MANAGEMENT OF SPECIFIC WOUNDS
Facial and Oral Wounds
Forehead Lacerations
Eyebrow Lacerations
Eyelid Lacerations
External Ear Blunt Trauma and Lacerations
Nasal Lacerations
Lip Lacerations
Cheek Lacerations
Tongue Lacerations
Buccal Mucosa Lacerations
FINGERTIP
Fingertip Avulsion
Nail Bed Lacerations
Subungual Hematoma
GENITOURINARY LACERATIONS
VASCULAR INJURIES
LACERATIONS IN PROXIMITY TO JOINTS
CHAPTER 111: MUSCULOSKELETAL TRAUMA
GENERAL PRINCIPLES OF PEDIATRIC ORTHOPEDICS
Goals of Emergency Therapy
GENERAL PRINCIPLES AND PROPERTIES OF PEDIATRIC FRACTURES
Goals of Treatment
Anatomy and Physiology of Pediatric Bone
Physeal Fractures
Torus Fractures
Greenstick Fractures
Bowing Fractures
Avulsion Fractures
GENERAL PRINCIPLES OF ACUTE ORTHOPEDIC CARE
Current Evidence
Goals of Treatment
Clinical Considerations
COMPLICATIONS OF FRACTURES: OPEN FRACTURES AND COMPARTMENT SYNDROME
Goals of Treatment
Current Evidence
Clinical Considerations
MULTIPLE TRAUMA
PHYSICAL ABUSE
PATHOLOGIC FRACTURES
INJURIES OF THE UPPER EXTREMITIES
Injuries of the Shoulder and Humerus
Shoulder Dislocation
Injuries of the Scapula
Injuries of the Humerus
Injuries of the Elbow
Lateral Condyle Fractures
Medial Epicondyle Fractures
Distal Humerus Physeal Fractures
Olecranon Fractures
Radial Head and Neck Fractures
Elbow Dislocations
Radial Head Subluxation
Injuries of the Forearm
Fractures of the Distal Radius and Ulna
INJURIES OF THE LOWER EXTREMITIES
Injuries of the Pelvis and Hip
Injuries of the Hip and Proximal Femur
Injuries of the Femur and Knee
Injuries of the Knee
Injuries of the Proximal Tibia and Fibula and Shaft
Injuries of the Ankle and Foot
Injuries of the Foot
INJURIES OF THE THORACOLUMBAR SPINE
Goals of Treatment
Current Evidence
Clinical Considerations
CHAPTER 112: NECK TRAUMA
GOALS OF EMERGENCY CARE
PENETRATING TRAUMA
Goals of Treatment
Current Evidence
Clinical Considerations
BLUNT TRAUMA
Goals of Treatment
Current Evidence
Clinical Considerations
CERVICAL SPINE TRAUMA
Goals of Treatment
Current Evidence
Clinical Considerations
SPECIFIC INJURIES
Jefferson Fracture
Hangman's Fracture
Atlantoaxial Subluxation
Cervical Distraction Injuries
Vertebral Compression Injuries
Spinal Cord Injury Without Radiographic Abnormality
Torticollis (Wry Neck)
Spinal Cord Syndromes
CHAPTER 113: NEUROTRAUMA
GOALS OF EMERGENCY THERAPY
NEUROTRAUMA
Blunt Head Injury
CONCUSSION
Current Evidence
SKULL FRACTURES
Goal of Treatment
Clinical Considerations
CHAPTER 114: OCULAR TRAUMA
GOALS OF EMERGENCY CARE
HISTORY
Assessment of Prior Eye Pathology and Relevant Medical History
Assessment of Injury Mechanism
PHYSICAL EXAMINATION
Assess Visual Acuity
Inspect the Periorbital Tissues and Eyelids Thoroughly
Open the Eyelids
Check the Red Reflex
Evaluate the Pupils and the Extraocular Movements
Evaluate the Anterior Surface of the Eye
Perform Direct Ophthalmoscopy to Evaluate for Papilledema or Retinal Hemorrhages
Consider Bedside Ultrasound
OPEN-GLOBE INJURY
Current Evidence
Goals of Treatment
Clinical Considerations
BLOW-OUT FRACTURE
Current Evidence
Goals of Treatment
Clinical Considerations
EYELID LACERATIONS
Current Evidence
Goals of Treatment
Clinical Considerations
CORNEAL AND CONJUNCTIVAL INJURY
Current Evidence
Goals of Treatment
Clinical Considerations
HYPHEMA
Current Evidence
Goals of Treatment
Clinical Considerations
TRAUMATIC IRITIS
Clinical Manifestations
Management
Traumatic Versus Nonorganic Visual Loss
Child Abuse
CHAPTER 115: THORACIC TRAUMA
GOALS OF EMERGENCY THERAPY
PNEUMOTHORAX AND HEMOTHORAX
Current Evidence
Goals of Treatment
Clinical Considerations
Diagnostic Testing
Management
Disposition
PULMONARY CONTUSIONS
Current Evidence
Clinical Considerations
Disposition
BLUNT CARDIAC INJURIES
Current Evidence
Clinical Considerations
INJURIES OF THE AORTA AND GREAT VESSELS
Current Evidence
Clinical Considerations
CHEST WALL INJURIES
Goals of Treatment
RIB FRACTURES
RIB FRACTURES AND CHILD ABUSE
FLAIL CHEST
STERNAL, SCAPULAR, AND MEDIAL CLAVICLE FRACTURES
PENETRATING TRAUMA AND ED THORACOTOMY
Goals of Treatment
Emergency Thoracotomy
OTHER INTRATHORACIC INJURIES
Goals of Treatment
Tracheobronchial Injuries
ESOPHAGEAL INJURIES
DIAPHRAGMATIC INJURIES
TRAUMATIC ASPHYXIA
SECTION VI: Surgical Emergencies
CHAPTER 116: ABDOMINAL EMERGENCIES
GOALS OF EMERGENCY CARE
ACUTE NONPERFORATED APPENDICITIS
Current Evidence
Goals of Treatment
Clinical Considerations
PERFORATED APPENDICITIS
Goals of Treatment
Clinical Considerations
ACUTE INTESTINAL OBSTRUCTION
Goals of Treatment
Current Evidence
Intussusception
Incarcerated Inguinal Hernia
Incarcerated Umbilical Hernia
Malrotation of the Bowel With Volvulus
Sigmoid Volvulus
Pyloric Stenosis
Postoperative Adhesions
Chronic Partial Intestinal Obstruction
Chronic Constipation
Aganglionic Megacolon (Hirschsprung Disease)
Duplications
Inflammatory Bowel Disease
DISEASES THAT PRODUCE RECTAL BLEEDING
Goals of Treatment
Fissures
Juvenile Polyps
Meckel Diverticulum
INTRA-ABDOMINAL MASSES
Current Evidence
Sacrococcygeal Teratoma
Nonmalignant Intra-Abdominal Masses
Malignant Intra-Abdominal Masses
ABDOMINAL WALL DEFECTS
Inguinal Hernias and Hydroceles
Epiploceles (Epigastric Hernias)
Umbilical Hernias
Other Umbilical Defects
CHAPTER 117: DENTAL EMERGENCIES
GOALS OF THERAPY
Odontalgia-Simple Toothache
Dentoalveolar Infection and Abscess
POSTEXTRACTION COMPLICATIONS
Goals of Treatment
Hemorrhage
Infection
Alveolar Osteitis
PERIODONTAL SOFT TISSUE PATHOLOGY
Goals of Treatment
Pericoronitis
Acute Necrotizing Ulcerative Gingivitis, Trench Mouth
Primary Herpetic Gingivostomatitis or Herpes Simplex Virus Type 1
ORAL MUCOSAL SOFT TISSUE PATHOLOGY
Goals of Treatment
Eruption Cysts
Aphthous Stomatitis
Mucocele
Pyogenic Granuloma
Neonatal Cysts
Riga-Fede Disease/Natal or Neonatal Teeth
CHAPTER 118: ENT EMERGENCIES
GOALS OF EMERGENCY CARE
ACUTE OTITIS MEDIA
Goals of Treatment
Current Evidence
Clinical Considerations
SINUSITIS
Goals of Treatment
Current Evidence
Clinical Considerations
TONSILLITIS AND PERITONSILLAR ABSCESS/CELLULITIS
Goals of Treatment
Current Evidence
Clinical Considerations
RETROPHARYNGEAL AND PARAPHARYNGEAL INFECTIONS
Goals of Treatment
Current Evidence
Clinical Considerations
CERVICAL ADENITIS AND NECK ABSCESSES
Goals of Treatment
Current Evidence
Clinical Considerations
POSTTONSILLECTOMY HEMORRHAGE
Goals of Treatment
Current Evidence
Clinical Considerations
VERTIGO
Goals of Treatment
OTHER CONDITIONS OF THE EXTERNAL EAR
Goals of Treatment
EPISTAXIS
Goals of Treatment
CONDITIONS OF THE LARYNX AND TRACHEA
Goals of Treatment
CHAPTER 119: GENITOURINARY EMERGENCIES
GOALS OF EMERGENCY CARE
PENILE PROBLEMS
Penile Care in the Uncircumcised Male Infant
Post Circumcision Concerns
Phimosis and Paraphimosis
Meatal Stenosis
Balanoposthitis
Priapism
TESTICULAR PROBLEMS
Background
Testicular Torsion
Testicular Mass
Torsion of the Appendix Testis
Epididymitis
Hydrocele
Undescended Testis
Varicocele
FEMALE UROLOGIC EMERGENCIES
Goals of Treatment
Clinical Recognition
Clinical Assessment
Management
RENAL COLIC/NEPHROLITHIASIS
Goals of Treatment
Clinical Recognition
Triage Considerations
Management
ACUTE URINARY RETENTION
Background
Goals of Treatment
Clinical Recognition
Triage Considerations
Clinical Assessment
Management
CHAPTER 120: MINOR LESIONS
GOALS OF EMERGENCY CARE
HAND AND FOOT LESIONS
Eponychia and Paronychia
Herpetic Whitlow
Felon
Subungual Hematoma
Subungual Foreign Body
Hair Tourniquet
Ganglion
FACE AND SCALP LESIONS
Epidermal Inclusion Cyst
Dermoid Cyst
Nasal Bridge Lesions
Preauricular Lesions
NECK LESIONS
Midline Neck Lesions
Lateral Neck Lesions
SURFACE LESIONS
Vascular Malformations
CHAPTER 121: MUSCULOSKELETAL EMERGENCIES
GOALS OF EMERGENCY CARE
OSTEOMYELITIS
Current Evidence
Goals of Treatment
Clinical Considerations
SEPTIC ARTHRITIS
Goals of Treatment
Current Evidence
Clinical Considerations
Lyme Arthritis
Transient Synovitis
Penetrating Intra-Articular Wounds
OVERUSE SYNDROMES
Goals of Treatment
Current Evidence
Osgood-Schlatter Disease
Sinding-Larsen-Johansson Disease
Little Leaguer Elbow
Sever Disease
Bursitis
OSTEOCHONDRITIS DISSECANS
Current Evidence
Clinical Considerations
SLIPPED CAPITAL FEMORAL EPIPHYSIS
Goals of Treatment
Current Evidence
Clinical Considerations
PATELLOFEMORAL PAIN SYNDROME AND CHONDROMALACIA PATELLAE
Current Evidence
Clinical Considerations
LEGG-CALVé-PERTHES DISEASE
Current Evidence
Clinical Considerations
ANNULAR LIGAMENT DISPLACEMENT (RADIAL HEAD SUBLUXATION)
Current Evidence
Clinical Considerations
Shoulder (Glenohumeral) Subluxation/Dislocation
DISORDERS OF THE BACK
Discitis (Diskitis)
Spondylolysis and Spondylolisthesis
COMPARTMENT SYNDROME
Current Evidence
Clinical Considerations
COMPLEX REGIONAL PAIN SYNDROME TYPE 1 (REFLEX SYMPATHETIC DYSTROPHY)
Current Evidence
Clinical Considerations
CHAPTER 122: NEUROSURGICAL EMERGENCIES
GOALS OF EMERGENCY THERAPY
SPONTANEOUS (NONTRAUMATIC) INTRACEREBRAL HEMORRHAGE
Goals of Treatment
Clinical Considerations
ACUTE HYDROCEPHALUS
Goals of Treatment
Clinical Considerations
SHUNT FAILURE
Goals of Treatment
Clinical Considerations
SPINAL HEMORRHAGE
CENTRAL NERVOUS SYSTEM INFECTION
Meningitis
Discitis/Osteomyelitis
POSTOPERATIVE COMPLICATIONS
Mass Lesions
Hydrocephalus
CHAPTER 123: OPHTHALMIC EMERGENCIES
GOALS OF EMERGENCY CARE
EXAMINATION
Assessment of Ocular Positioning and Movement
Visual Acuity Testing
Examining the Swollen Eye
Instillation of Eye Drops
COMMON EYE EMERGENCIES
Periorbital and Orbital Cellulitis
Conjunctivitis
Ocular Chemical Injury
Hordeolums and Chalazions
Nasolacrimal Duct Obstruction and Infection
CHAPTER 124: THORACIC EMERGENCIES
INTRODUCTION
GOALS OF EMERGENCY THERAPY
CLINICAL MANIFESTATIONS
Physical Examination
Evaluation
AIRWAY COMPROMISE
Tracheal Obstruction
Tracheomalacia
Vascular Rings
BRONCHIAL LESIONS
Bronchial Atresia
Primary Tracheobronchial Tumors
Right Middle Lobe Syndrome
ESOPHAGUS-RELATED CAUSES OF AIRWAY DIFFICULTIES
Goal of Treatment
Esophageal Atresia and Tracheoesophageal Fistula
Esophageal Web
Caustic Ingestion
PLEURAL DISEASES
Pneumothorax
Pneumomediastinum
Pleural Effusion
Empyema
Solid Lung and Pleural Lesions
LUNG LESIONS
Current Evidence
Goal of Treatment
Cystic Lung Disorders-CPAM and BPS
Bronchogenic Cyst
Congenital Lobar Emphysema
Congenital Pulmonary Arteriovenous Fistula
Rare Lesions
MEDIASTINAL TUMORS
Current Evidence
Goal of Treatment
Clinical Considerations
Solid Mediastinal Masses
Cystic Mediastinal Lesions
DIAPHRAGMATIC PROBLEMS
Current Evidence
Goal of Treatment
Congenital Diaphragmatic Hernia
Foramen of Morgagni Hernias
Diaphragmatic Eventration
Paraesophageal Hernia
CHEST WALL TUMORS
Current Evidence
Goals of Treatment
Clinical Considerations
CHAPTER 125: TRANSPLANTATION EMERGENCIES
GOALS OF EMERGENCY CARE
POSTTRANSPLANT INFECTIOUS COMPLICATIONS
Current Evidence
Goals of Treatment
Clinical Considerations
GRAFT REJECTION
Current Evidence
Goals of Treatment
Clinical Considerations
POSTTRANSPLANT LYMPHOPROLIFERATIVE DISORDER
Goals of Treatment
Current Evidence
Clinical Considerations
VASCULAR COMPLICATIONS
LIVER TRANSPLANTATION
Hepatic Artery Thrombosis
Portal Vein Complications
Hepatic Vein Obstruction
Cardiac Vascular Complications
SURGICAL COMPLICATIONS
IMMUNOSUPPRESSANT MEDICATION-RELATED COMPLICATIONS
OTHER EMERGENCIES
BILIARY COMPLICATIONS
RECURRENCE OF PRIMARY DISEASE
ACKNOWLEDGMENT
SECTION VII: Behavioral Health Emergencies
CHAPTER 126: BEHAVIORAL AND PSYCHIATRIC EMERGENCIES
INTRODUCTION
GOALS OF EMERGENCY MENTAL HEALTH ASSESSMENT AND CRISIS INTERVENTION
REQUIREMENTS OF THE EMERGENCY DEPARTMENT
EVALUATION
Medical History and Physical Examination
Mental Status of the Child
Family Evaluation
Using Social Support
Resources for ED Clinicians
GOALS OF TREATMENT FOR AGITATED OR VIOLENT BEHAVIOR
Clinical Considerations
SUICIDE ATTEMPTS
Goals of Emergency Evaluation and Treatment
Clinical Considerations
Clinical Recognition
DEPRESSION
Goals of Treatment
Clinical Considerations
MANIA/BIPOLAR DISORDER
Goals of Emergency Treatment
Initial Assessment
Management
PSYCHOSIS
Goals of Emergency Treatment
Clinical Considerations
SOMATIC SYMPTOM AND RELATED DISORDERS
Goals of Treatment
Clinical Considerations
Initial Assessment
Management
POSTTRAUMATIC STRESS DISORDERS
PANIC ATTACKS
CARING FOR CHILDREN WITH AUTISM SPECTRUM DISORDERS IN THE EMERGENCY DEPARTMENT
Clinical Considerations
Management
Challenges in Healthcare Environment
SCREENING FOR MENTAL HEALTH PROBLEMS IN THE EMERGENCY DEPARTMENT
CHAPTER 127: SEXUAL ASSAULT: CHILD AND ADOLESCENT
GOALS OF EMERGENCY CARE
OVERVIEW OF APPROACH
Team Composition
Training
Assessing and Maintaining Competency
Assessing and Maintaining Quality
CURRENT EVIDENCE
CLINICAL CONSIDERATIONS
Clinical Recognition
Triage
Initial Assessment
Management/Diagnostic Testing
Clinical Indications for Discharge or Admission
NONACUTE SEXUAL ABUSE
SECTION VIII: Procedures and Appendices
CHAPTER 128: EQUIPMENT
EMERGENCY DEPARTMENT
OFFICE OR CLINIC
CHAPTER 129: PROCEDURAL SEDATION
INTRODUCTION
BACKGROUND
Barriers to Treatment of Pain in Children
Impact of Pain and Importance of Successful Pain Management
Assessment of Pain in Children
PROCEDURAL SEDATION AND ANALGESIA
Definitions
Decision to Perform PSA
Evaluation and Preparation of Patient Prior to Sedation
Sedation Protocols
Choice of Technique and Medications
METHODS OF DELIVERY
SEDATIVES
Benzodiazepines
Chloral Hydrate
Barbiturates
Etomidate
Propofol
Nitrous Oxide (N2O)
Ketamine
Dexmedetomidine
ANALGESICS
Sucrose
Opioids
Local Agents
Specific Uses of Local Agents
NONPHARMACOLOGIC METHODS FOR PAIN CONTROL
SPECIAL SITUATIONS
The Emotionally Labile Child
COMPLICATIONS AND ERRORS
Medication Errors
Documentation
DISCHARGE MEDICATIONS
Acetaminophen
NSAIDs
Opioids
SUMMARY
CHAPTER 130: PROCEDURES
PREPARATION AND ASSESSMENT OF THE CHILD
POSITIONING AND RESTRAINTS
Indications
Complications
Procedure
Positional Support by Caregiver
Restraint by Personnel
EXTERNAL JUGULAR VENIPUNCTURE OR PERIPHERAL CANNULATION
Indications
Complications
Equipment
Procedure
RADIAL ARTERY PUNCTURE OR CANNULATION
Indications
Complications
Caution
Equipment
Procedure
FEMORAL ARTERY/VEIN PUNCTURE
Indications
Contraindications
Complications
Equipment
Procedure
PERCUTANEOUS FEMORAL VEIN CATHETERIZATION
Indications
Complications
Equipment
Procedure
PERCUTANEOUS INTERNAL JUGULAR VEIN CATHETERIZATION
Indications
Complications
Equipment
Procedure
SCALP VEIN CATHETERIZATION
Indications
Complications
Equipment
Procedure
UMBILICAL ARTERY CATHETERIZATION
Indications
Complications
Equipment
Procedure
UMBILICAL VEIN CATHETERIZATION
Indications
Complications
INTRAOSSEOUS INFUSION
Indications
Complications
Equipment
Procedure
ACCESSING CENTRAL VENOUS CATHETERS
Types
Indications
Complications
Equipment
Procedure
LUMBAR PUNCTURE
Indications
Complications
Equipment
Procedure
PNEUMATIC OTOSCOPIC EXAMINATION
Indications
Complications
Procedure
REMOVAL OF A FOREIGN BODY FROM THE EAR
Indications
Complications
Procedure
ASPIRATION OF AN AURICULAR HEMATOMA
Indications
Complications
Procedure
EVERSION OF THE EYELIDS
Indications
Complications
Procedure
IRRIGATION OF THE CONJUNCTIVA
Indications
Complications
Procedure
EYELID RETRACTION
Indications
Complications
Procedure
CONTACT LENS REMOVAL
Indications
Complications
Procedure
Soft Contact Lens
NASAL CAUTERIZATION
Indications
Contraindications
Complications
Procedure
NASAL PACKING-ANTERIOR AND POSTERIOR
Indications
Complications
Procedure
REMOVAL OF A NASAL FOREIGN BODY
Indications
Complications
Procedure
REIMPLANTATION OF AN AVULSED PERMANENT TOOTH
Indications
Contraindications
Complications
Equipment
Procedure
REPLACEMENT OF A TRACHEOSTOMY CANNULA
Indications
Complications
Procedure
NEEDLE THORACOSTOMY
Indications
Complications
Equipment
Procedure
INSERTION OF A CHEST TUBE
Indications
Complications
Equipment
Procedure
INSERTION OF A THORACOSTOMY CATHETER-SELDINGER TECHNIQUE
Indications
Complications
Equipment
Procedure
PERICARDIOCENTESIS
Indications
Complications
Equipment
Procedure
NASOGASTRIC TUBE PLACEMENT
Indications
Complications
Procedure
REPLACEMENT OF A GASTROSTOMY TUBE
Indications
Contraindications
Complications
Equipment
Procedure
REDUCTION OF AN INCARCERATED INGUINAL HERNIA
Indications
Complications
Procedure
RECTAL PROLAPSE
Indications
Complications
Procedure
CATHETERIZATION OF THE BLADDER
Indications
Contraindications
Complications
Procedure
SUPRAPUBIC BLADDER ASPIRATION
Indications
Complications
Procedure
INCISION AND DRAINAGE OF AN ABSCESS
Indications
Complications
Contraindications
Procedure
CLOSED REDUCTION OF DISLOCATIONS
Finger/Toe Joint Dislocation
Procedure
Shoulder (Glenohumeral) Joint Dislocation
Patella Dislocation
Elbow Joint Dislocation
DRAINAGE OF A SUBUNGUAL HEMATOMA
Indications
Complications
Procedure
INCISION AND DRAINAGE OF A FELON
Indications
Complications
Procedure
INCISION AND DRAINAGE OF A PARONYCHIA
Indications
Complications
Procedure
INGROWN TOENAIL REPAIR
Indications
Complications
Procedure
REMOVAL OF A SUBUNGUAL SPLINTER OR FOREIGN BODY
Indications
Complications
Procedure
REMOVAL OF RINGS
Indications
Complications
Procedure
REMOVAL OF A BODY PIERCING
Indications
Complications
Procedure
REMOVAL OF FISH HOOKS
Indications
Complications
Equipment
Procedure
HAIR TOURNIQUET REMOVAL
Indications
Complications
Equipment
Procedure
ARTHROCENTESIS-GENERAL CONSIDERATIONS
Indications
Complications
Contraindications (Relative)
Equipment
Knee Joint
TOPICAL ANESTHESIA AND DIRECT WOUND INFILTRATION
Indications
Complications
Equipment
Procedure
FIELD BLOCK
Indications
Complications
Equipment
Procedure
PERIPHERAL NERVE BLOCKS
Complications
Equipment
Digital and Metacarpal Nerve Block
Supraorbital Nerve Block
Infraorbital Nerve Block (Intraoral Approach)
Mental (Infraoral) Nerve Block
SPLINTING OF MUSCULOSKELETAL INJURIES
General Splinting
Other Issues
Long Arm Posterior Splint
Posterior Splint-Below the Knee
Ankle Stirrup (Sugar Tong) Splint
Long Leg Posterior Splint
Ulnar Gutter Splint
Radial Gutter Splint
Sugar Tong Splint-Forearm
Thumb Spica Splint
Dorsal Extension Finger Splint
REDUCTION OF NURSEMAID'S ELBOW
Indications
Complications
Procedure
ACKNOWLEDGMENTS
CHAPTER 131: ULTRASOUND
INTRODUCTION
ADMINISTRATIVE ASPECTS
Starting a Point-of-Care Ultrasound Program
Equipment Considerations
ULTRASOUND BASICS
Ultrasound Physics
Basic Controls
General Scanning Techniques
DIAGNOSTIC APPLICATIONS
Focused Assessment With Sonography in Trauma
Cardiac
Chest
Hip
GENITOURINARY ULTRASOUND
First Trimester Ultrasound
Kidney Ultrasound
Bladder Ultrasound
Pediatric Abdomen
Hypertrophic Pyloric Stenosis
Intussusception
Appendicitis
PROCEDURAL APPLICATIONS
CENTRAL AND PERIPHERAL VENOUS CANNULATION
Central Venous Cannulation
Peripheral Venous Cannulation
Thoracentesis
Bladder Catheterization
Lumbar Puncture Guidance
SOFT TISSUE ULTRASOUND
Soft Tissue Infections
Foreign-Body Identification and Removal
OTHER USES OF ULTRASOUND
PARACENTESIS AND PERICARDIOCENTESIS
EVALUATION OF JOINTS
NERVE BLOCKS
CHAPTER 132: BIOLOGICAL AND CHEMICAL TERRORISM
GOALS OF EMERGENCY CARE
BIOLOGIC AGENTS
Current Evidence
GOALS OF TREATMENT
CLINICAL CONSIDERATIONS
Clinical Recognition
Triage Considerations: Minimizing Spread of Infection
CLINICAL ASSESSMENT AND MANAGEMENT
Specific Agents
VIRAL HEMORRHAGIC FEVERS
Ricin
OTHER AGENTS
CHEMICAL AGENTS
Current Evidence
Goals of Treatment
Clinical Considerations
CLINICAL ASSESSMENT AND MANAGEMENT
Specific Agents
Vesicants
Pulmonary Agents
Cyanide
Riot-Control Agents
Miscellaneous Chemicals
Emergency Department Preparedness
CONCLUSION
CHAPTER 133: INSTRUCTIONS FOR PARENTS
DISCHARGE INSTRUCTIONS
LEGAL AND REGULATORY CONSIDERATIONS
Meaningful Use
Legal Considerations
GENERAL PRINCIPLES OF DISCHARGE INSTRUCTIONS
Organization
DISCHARGE INSTRUCTION FORMATS
Verbal Instructions
Written Instructions
Multimedia Technology
Combination Method: The Preferred Method
OBSTACLES TO COMPREHENSION AND RETENTION OF DISCHARGE INSTRUCTIONS
LITERACY AND LANGUAGE COMPREHENSION
NONNATIVE ENGLISH-SPEAKING PATIENTS
MEDICATIONS AND MEDICATION RECONCILIATION
FOLLOW-UP
SUMMARY
CHAPTER 134: PREHOSPITAL CARE
EMS SYSTEMS
History of EMS Systems
Epidemiology
Governance of EMS Systems
Components of Prehospital Care Systems
EMS Providers
Medical Oversight of EMS
EMERGENCY MEDICAL DISPATCHERS AND DISPATCH PRINCIPLES
EQUIPMENT AND MODES OF TRANSPORT
COMMUNICATION
Equipment
EMS Reports to Hospital Personnel
Medical Records
Telemedicine in EMS
ISSUES IN EMS CARE
Culture of Safety
MEDICAL-LEGAL ISSUES
REGIONALIZATION
PEDIATRIC PREHOSPITAL AIRWAY MANAGEMENT
CHILDREN WITH SPECIAL HEALTHCARE NEEDS
EMERGENCY PREPAREDNESS
EMS FOR CHILDREN PROGRAM
History of EMS for Children
ROLE OF THE PEDIATRICIAN/PEDIATRIC EM PROVIDER IN EMS FOR CHILDREN
IOM REPORTS
EMS RESEARCH
EVIDENCE-BASED GUIDELINES
SUMMARY
CHAPTER 135: TECHNOLOGY-ASSISTED CHILDREN
INTRODUCTION
APPROACH TO THE CARE OF THE TECHNOLOGY-ASSISTED CHILD
TRACHEOSTOMY CARE
Background
Pathophysiology
Equipment
Clinical Findings/Management
CEREBROSPINAL FLUID SHUNTS
Background
Pathophysiology
Equipment
Clinical Findings/Management
INDWELLING VENOUS ACCESS DEVICES
Background
Pathophysiology
Equipment
Clinical Findings/Management
ENTERAL FEEDING TUBES
Background
Pathophysiology
Equipment
Clinical Findings/Management
GASTROINTESTINAL AND GENITOURINARY DIVERSION
Background
Pathophysiology
Equipment
Clinical Findings/Management
Urinary Diversions
Index

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