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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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Infants younger than 28 days are challenging to the emergency department physician, who must be familiar with the normal variants and the subtle findings that may indicate a more serious underlying problem. The amazing physiologic changes that the newborn accomplishes following delivery may precipitate disaster if an underlying congenital problem exists. The astute ED physician is also familiar with particular high-risk times when critical diseases may present, such as cyanotic congenital heart disease, and has a heightened suspicion for these disease processes. This article provides a comprehensive overview of critical diseases that may present in the newborn period and strategies for their early detection and appropriate management.
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With advances in diagnostic modalities and shunting procedures, children with hydrocephalus now do amazingly well. Unfortunately, not only do these children get common childhood illnesses, but they also may develop life-threatening complications from their shunting devices that have very similar clinical presentations to common childhood diseases. To effectively and efficiently manage these children, the emergency physician must have a clear understanding of the technology used and of the potential risks and complications that may develop.
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The fifth vital sign, pulse oximetry, routinely is used in every emergency department throughout the country to determine the baseline oxygenation of a patient in respiratory distress, to assess a patients response to therapeutic decisions, and to monitor a child during a conscious sedation or resuscitation. It is important to understand how the device functions and the limitations of this routinely used technology.
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Infants with an apparent life-threatening event (ALTE) present for medical attention because an acute and unexpected incident has alarmed the caregivers. These frightening episodes of apnea and color change in infants have generated considerable concern in both professional and lay groups. This article reviews the presentation, recognition, diagnosis and ED management for children who present with an ALTE.
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Applications particularly useful in the pediatric and adolescent patient populations will continue to gain wider recognition and acceptance by the physician community. Most ultrasound examinations are quick and simple to perform, and ED physicians can gain comfort and facility in performing these focused applications.
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