The purpose of this article is to review procedures and therapies used in the difficult, life-threatening clinical circumstances. The authors review five procedures that are rarely used in extreme situations.
Skin rashes are a common chief complaint in any pediatric emergency department (ED). In 2008, skin rash was among the top 10 principal reasons for ED visits in the United States in patients younger than the age of 15 years.
Clinical syndromes due to altitude can manifest in susceptible individuals with elevations as low as 1500 meters (5000 feet) above sea level. For otherwise healthy adults, altitudes of 2350 meters (8000 feet) are considered the arbitrary cutoff for placing one at risk for more serious syndromes, such as acute mountain sickness (AMS). While decreased ambient oxygen pressure is the most evident change at high altitude and presumably is responsible for most of the pathophysiologic derangements, other factors may have medical implications as well, such as decreased ambient temperature, increased exposure to ultraviolet radiation, and lower humidity.
Spinal trauma is a rare yet important category of injury. Children account for 10% of spinal injuries, but account for 25% of the mortality. Pediatric patients who present with possible spinal injury pose several unique challenges to the emergency department provider. Unique anatomic and developmental features place pediatric patients at risk for spinal injuries that are not typically seen in the adult population. In addition, unlike adult patients, there is little consensus on the most appropriate workup for potentially injured patients. When evaluating pediatric patients, practitioners must balance the limited available clinical data with the risks and benefits of various imaging modalities. The authors review the spectrum of pediatric spinal injury.