Pneumothorax In Pediatric Patients: Management Strategies To Improve Patient Outcomes -

Pneumothorax In Pediatric Patients: Management Strategies To Improve Patient Outcomes
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Publication Date: March 2017 (Volume 14, Number 3)


Matthew Harris, MD
Fellow in EMS and Disaster Medicine, Newark Beth Israel, Newark, NJ, RWJ/Barnabas Health; Attending Physician, Division of Pediatric Emergency Medicine, Cohen Children's Medical Center, New Hyde Park, NY
Joshua Rocker, MD
Associate Chief, Division of Pediatric Emergency Medicine, Cohen Children's Medical Center; Assistant Professor of Emergency Medicine and Pediatrics, Hofstra Northwell School of Medicine, New Hyde Park, NY
Peer Reviewers
Steven Choi, MD
Assistant Vice President, Montefiore Network Performance Improvement; Director, Montefiore Institute for Performance Improvement; Assistant Professor of Pediatrics, Albert Einstein College of Medicine, Bronx, NY
Michelle K. Hughes, DO, FAAP
Children’s Hospital of the King's Daughters, Pediatric Emergency Medicine Attending Physician, Associate Medical Director for Trauma, Chair of Resuscitation Outcomes Committee, Assistant Professor of Pediatrics, Eastern Virginia Medical School Department of Pediatrics, Norfolk, VA
Steven Yung, MD
Medical Director of Pediatric Quality and Safety Services, Assistant Professor, Pediatric Critical Care Medicine, Kravis Children’s Hospital at Mount Sinai, New York, NY

Diphtheria, pertussis, and tetanus are potentially deadly bacterial infections that are largely preventable through vaccination, though they remain in the population. This issue reviews the epidemiology, pathophysiology, diagnosis, and current recommended emergency management of these conditions. Disease-specific medications, as well as treatment of the secondary complications, are examined in light of the best current evidence. Resources include obtaining diphtheria antitoxin from the United States Centers for Disease Control and Prevention and best-practice recommendations with regard to testing, involvement of government health agencies, isolation of the patient, and identification and treatment of close contacts. Most importantly, issues regarding vaccination and prevention are highlighted.

Excerpt From This Issue

A panicked mother rushes into the emergency department, screaming that her baby is not breathing. Taking the apneic infant from her, you hurry to the resuscitation bay. Within seconds, the infant begins to breathe spontaneously. You provide supplemental oxygen by face mask as the team attaches leads and obtains vital signs. The monitor shows a respiratory rate of 30 breaths/min, heart rate of 140 beats/ min, and oxygen saturation of 98% on room air. As you note a rather unremarkable physical examination, apart from occasional gagging, his school-age sibling begins coughing. Does this sibling’s apparent upper respiratory illness have anything to do with your patient’s condition? You consider the infectious processes that could present with apnea and the key historical questions you should ask the mother, and you begin to plan your next step in the assessment and management of this baby.

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