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One of the most common manifestations of disease, fever in children remains controversial, misunderstood, and often is thought to be mysterious. The clinician always should realize that fever is not a disease itself, but a manifestation of a number of different disease processes. Because there are substantial differences in the cause and outcome of fever-generating illnesses in children of different ages, the discussion must consider age. Not surprisingly, there is a diversity of approaches to fever.
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As medical practitioners mature with experience, many discover that what was taught in medical school — History is the most important part of the patient encounter — is actually true. Yet, taking a history is a practiced skill even for the examiner who speaks the same language as the patient. The problems encountered with taking a history from a patient are compounded exponentially when the examiner and the patient are not skilled in speaking the same language. In this issue, the author explores numerous facets of caring for patients who speak a language other than the physician’s language.
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The emergency department physician is continually challenged to identify children who may have sustained an injury secondary to abuse. Reaching a balance between protecting a child from possible harm and putting a family through the ordeal of an unwarranted investigation is challenging. This article reviews the common patterns of injury that should raise concern for abuse.
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Acute renal failure, characterized by sudden loss of the ability of the kidneys to excrete waste, concentrate urine, conserve electrolytes, and maintain fluid balance, is a frequent clinical problem.
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In the past few years, new strategies in the management of sepsis have shown significant mortality benefits. This article addresses aspects regarding the management of sepsis, including appropriate fluid administration, medications, and other evidence-based strategies necessary for the treatment of septic patients in the emergency department. With the incorporation of these new practice strategies in addition to the guidelines published by the Surviving Sepsis Campaign, emergency physicians can contribute to a significant decrease in sepsis mortality in the years to come.
