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Child abuse can be difficult to recognize, especially in the often chaotic environment of the emergency department. As the leaders of the community and medical safety net that is the ED, emergency physicians play a unique role in detecting, treating, and preventing child abuse. This issue of Emergency Medicine Specialty Reports provides an update on the patterns, diagnosis, and treatment of physical child abuse injuries.
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This article completes a four-part series on abdominal pain that began with the January issue of ED Legal Letter. The first two parts outlined risk management strategies for dealing with adult abdominal pain. The third part detailed obstetric emergencies and the difficulty in caring for both mother and unborn child. This concluding segment will review the evaluation and management of pediatric abdominal pain.
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Although cervical spine injuries are uncommon in children, a missed or delayed diagnosis may have devastating consequences for the patient. A thorough understanding of normal pediatric anatomy, injury patterns, and children who are at increased risk for injury is critical for the physician caring for the acutely injured child.
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Whether a bite or sting results in an anaphylactic reaction, impressive
local effects, or a life-threatening systemic reaction, the emergency
physician must be able to institute appropriate and effective
treatment. Emergency physicians also must be able to recognize clinical
envenomation patterns, since some critically ill patients may not be
able to convey the details of the attack. Since all areas of the
country are represented in the envenomation statistics, all emergency
physicians should be familiar with identification and stabilization of
envenomated patients and know what resources are available locally for
further management of these often complicated patients.
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Medication errors have been publicized as among the most dangerous risks to emergency department and hospitalized patients. Newspaper and magazine articles have leaped on the issue. While physicians and hospitals would like to believe this is just news propaganda to increase sales, they are wrong. Studies have shown that patients are dying from preventable adverse drug events (ADEs). Although hospitals, physicians, nurses, risk managers, and pharmacists have made attempts to reduce risks and prevent ADEs, there is much more that must be done. This months ED Legal Letter describes different types of ADEs and develops risk management strategies to reduce the chance of medication error. Adopting the guidelines provided in this issue will create a safer environment for our patients.
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Newbornsinfants younger than 28 days of ageare particularly challenging to emergency medicine physicians. The most important tool for recognizing a newborn with a problem or potential problem is a strong foundation of knowledge about normal infant rashes, feeding patterns, and expected variations. The authors review common newborn problems with an emphasis on normal variations and deviations that require a more thorough evaluation.
