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Current Issues

Identifying Emergency Department Patients With Chest Pain who are at Low Risk for Acute Coronary Syndromes

For trauma patients in the ED, life- and limb-threatening injuries take priority, but renal and genitourinary injury can have long-term consequences for patients, including chronic kidney disease, erectile dysfunction, incontinence, and other serious problems. This issue offers a review of the literature regarding treatment of renal and GU injuries, from diagnosis to management to disposition.

  • The mechanism of the trauma can be a clue to the injury sustained:
    • Rapid deceleration forces can injure the kidney, from contusions to shattering
    • Most injuries to the ureter are a result of penetrating trauma
    • Bladder injuries are often seen in pelvic fractures
    • Injuries to the external genitalia are more likely from sports or sexual intercourse
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Pediatric Heat-Related Illness: Recommendations for Prevention and Management

Morbidity and mortality are directly related to the duration and intensity of hyperthermia. Early recognition and rapid reduction of core body temperature are critical to survival and prevention of multiorgan failure. This issue offers an overview of thermoregulation and evidence-based recommendations for the management and prevention of heat-related illness in pediatric patients.

  • Monitor core temperatures continuously with a rectal or esophageal probe. Stop cooling measures once core temperature has decreased to 38°C-39°C (100.4°F-102°F).
  • Ice-water immersion (conductive cooling) cools quickly, but may be difficult to set up and monitor in the ED.
  • Spraying warm water over the patient’s skin and sitting them in front of a fan (evaporative cooling) may be as effective at cooling as ice-water immersion.
  • Due to the lack of evidence for the use of cooled IV or iced lavage fluids, it is not routinely recommended for heat-related illness.
  • Most at risk for hypothermia are children who are obese, taking certain medications, or have chronic diseases.
  • Emergency clinicians should advocate for modification of athletic training programs and raising awareness of the danger of leaving children in vehicles, even for short periods in moderate temperatures. 
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Last Modified: 08/16/2017
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