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Vaccine-Preventable Diseases In Pediatric Patients: A Review Of Measles, Mumps, Rubella, And Varicella
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Vaccine-Preventable Diseases In Pediatric Patients: A Review Of Measles, Mumps, Rubella, And Varicella - $39.00

Publication Date: November 2016 (Volume 13, Number 12)

CME: This issue includes 4 AMA PRA Category 1 CreditsTM, 4 ACEP Category I credits, 4 AAP Prescribed credits, 4 AOA Category 2A or 2B credits, and 4 ABIM MOC points.

Authors
 
Deborah A. Levine, MD
Clinical Associate Professor of Emergency Medicine and Pediatrics, New York University School of Medicine, Bellevue Hospital Center, New York, NY
 
Peer Reviewers
 
Joshua Rocker, MD
Associate Chief, Division of Pediatric Emergency Medicine; Assistant Professor of Emergency Medicine and Pediatrics,
Hofstra Northwell School of Medicine, Cohen Children's Medical Center, New Hyde Park, NY
 
Lara Zibners, MD, FAAP, FACP
Honorary Consultant, Paediatric Emergency Medicine, St. Mary's Hospital Imperial College Trust, London, UK; Nonclinical Instructor of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
 
Abstract
 
Sickle cell disease is a chronic hematologic disease with a variety of acute, and often recurring, complications. Vaso-occlusive crisis, a unique but common presentation in sickle cell disease, can be challenging to manage. Acute chest syndrome is the leading cause of death in patients with sickle cell disease, occurring in more than half of patients who are hospitalized with a vaso-occlusive crisis. Uncommon diagnoses in children, such as stroke, priapism, and transient red cell aplasia, occur more frequently in patients with sickle cell disease and necessitate a degree of familiarity with the disease process and its management. Patients with sickle cell trait generally have a benign course, but are also subject to serious complications. This issue provides a current review of evidence-based management of the most common acute complications of sickle cell disease seen in pediatric patients in the emergency department.
 

Excerpt From This Issue

A mother reports that her 3-month-old son is fussy and has had a runny nose and fever for the past 5 days. She also notes that the infant developed a red, raised rash initially on his face, which spread to his abdomen and extremities over the course of a day. The mother reports that her son is eating less and has been breathing rapidly. The boy was born full-term in the United States and has no past medical history. He has had 1 vaccination at his primary care physician, at 2 months of age. The family just returned from a trip to London a week ago, and there are no other sick contacts in the family. The infant’s vital signs are: heart rate, 175 beats/min; respiratory rate, 45 breaths/min; rectal temperature, 38.3oC (101oF); and oxygen saturation, 91% on room air. The physical examination findings demonstrate bilateral conjunctival injection with no purulent drainage, rhinorrhea, and slightly dry lips and oral mucosa. The infant has a blanching maculopapular exanthem to his face, trunk, extremities, palms, and soles. Upon auscultation, he has rales at both lung bases.

A 6-month-old girl, who was born full-term, is brought into the ED by her mother. The mother states that her daughter has had a fever and a rash for 3 days; the rash began on the infant’s face as “water blisters." The mother also states that her daughter has not felt well for the last 2 days, has had decreased urine output, decreased activity, and has been irritable. According to the mother, the girl is up to date with recommended vaccinations for her age. There are no sick contacts in the family; however, the patient’s grandmother has a painful rash on her back. The infant’s vital signs are: heart rate, 170 beats/ min; respiratory rate, 25 breaths/min; rectal temperature, 38.5oC (101.4oF); and oxygen saturation, 98% on room air. The physical examination is significant for vesicles on an erythematous base on the girl’s face, trunk, extremities, and back, as well as many excoriated and scabbed lesions. There are erythematous papules on the anterior buccal mucosa and the posterior pharynx. The infant’s mucous membranes are dry, her lungs are clear, and her skin is warm. The infant is crying and her mother is having difficulty consoling her.

 

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