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Mammalian bites in children carry risk for infection, adverse cosmetic outcomes, and emotional distress. Emergency clinicians must carefully assess bite wounds and consider any risk factors for serious infection or other complications in order to make appropriate treatment decisions. This review provides evidence-based recommendations for the evaluation and treatment of mammalian bite wounds in children in the emergency department, including guidelines for empiric antibiotic therapy, wound management, and prophylaxis for infectious disease and bloodborne pathogens. The unique considerations in the management of human bite wounds are also discussed.
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When patients who have experienced intimate partner violence (IPV) present to the ED for medical care, the immediate priority for the emergency clinician is the stabilization of the patient and the treatment of acute traumatic injuries. However, there are unique considerations associated with the evaluation and management of these patients. Emergent medical needs must be balanced with concerns for the patient’s emotional well-being; the need for advocacy and social services; issues of privacy and consent; and protocols for forensic evidence collection.
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Emergency clinicians must have a high index of suspicion and a judicious approach to evaluating the chief complaint (ie, headache) of patients with suspected subarachnoid hemorrhage, as accurate initial diagnosis and management are critical to optimizing outcomes. Emergency clinicians must be able to identify SAH and determine the etiology quickly and accurately, and they should be aware of the secondary complications that affect both the central nervous system and other major organs. The diagnosis is challenging and has devastating consequences if missed. This review evaluates the literature and current evidence, including controversies and recent guidelines, to support a best-practice approach to the diagnosis and treatment of patients with spontaneous subarachnoid hemorrhage.
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Acute ischemic stroke is a leading cause of morbidity and mortality in the United States, and a majority of acute ischemic stroke patients are evaluated for the first time by a clinician in the emergency department. Given the time-dependent nature of the treatments that have been proven to improve outcomes significantly in patients presenting with AIS, it is important for emergency clinicians to be able to evaluate these patients rapidly for appropriate treatment. This issue presents evidence-based guidelines for the diagnosis and treatment of acute ischemic stroke in patients who present more than 3 hours after last known well time.
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When making imaging decisions in children with thoracic and abdominal injuries, clinicians must balance the need to reduce unnecessary radiation exposure in these patients with the need to quickly identify serious and potentially life-threatening injuries. Consideration of the location and mechanism of injury and the physical examination findings are required to make appropriate imaging decisions. This supplement reviews evidence-based recommendations for imaging decisions and interpretations in pediatric patients with thoracic and abdominal injuries and provides examples of imaging modalities and findings
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Drowning and submersion injuries are highly prevalent, yet preventable, causes of pediatric mortality and morbidity. Prehospital care should focus on restoring normal ventilation and circulation as quickly as possible to limit the extent of hypoxic insult. In this review, passive external, active external, and active internal rewarming techniques for treatment of hypothermic patients are discussed. A systematic approach to treatment and disposition of pediatric drowning victims is provided, and risk factors, caveats in pediatric care, and factors affecting prognosis are also discussed.
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Pneumothorax, or air in the pleural space, is common in trauma, and has been found in up to 50% of severe polytrauma patients with chest injury. Although pneumothorax is traditionally diagnosed on plain film and confirmed with CT, the advent of portable ultrasonography has provided a way to rapidly diagnose pneumothorax, with a higher sensitivity than plain film. Patients with traumatic pneumothorax are typically treated with needle decompression or tube thoracostomy. However, recent literature has found that many patients can be managed conservatively via observation, or with a smaller thoracostomy such as a percutaneous pigtail catheter rather than a larger chest tube.
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Your subscription to Emergency Medicine Practice provides you with new issues every month, each focusing on the practical application of the evidence for topics like trauma, cardiovascular emergencies, drugs & procedures, airway management, and more.
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Your subscription to Pediatric Emergency Medicine Practice provides you with new issues every month, each focusing on the practical application of the evidence for topics like trauma, cardiovascular emergencies, drugs & procedures, airway management, and more.
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Your bundled subscription to Emergency Medicine Practice and Pediatric Emergency Medicine Practice provides you with two new courses every month, each focusing on the practical application of the evidence for topics like trauma, cardiovascular emergencies, drugs & procedures, airway management, and more.
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Credit Designation: EB Medicine designates this enduring material for a maximum of 4 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
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