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The evaluation and diagnosis of the child with a limp can be challenging for the emergency physician. The authors review common causes for the acutely limping child, with special attention to those etiologies that need emergent or urgent intervention and referral. Additionally, the authors offer clinical and historical clues to help decipher the cause.
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Although pediatric cardiac diseases infrequently are seen in the emergency department (ED), early diagnosis and aggressive management is critical. Most importantly, the clinician must include these diseases in their differential and have a thorough understanding of typical and atypical presentations for congenital heart disease, dysrhythmias, myocarditis and pericarditis. Any child who has a clinical presentation suggestive of cardiac disease, must receive appropriate diagnostic testing and timely referral to optimize the childs outcome. The authors provide a thorough, focused review of the most commonly encountered cardiac diseases in the ED and key aspects to stabilization.
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Although an increasingly uncommon scenario, pediatric patients continue to suffer fatal consequences of poisonings in the United States each year. Individuals providing care for the pediatric population continue in their efforts not only to find ways to treat exposed children, but also to avoid exposures from occurring at all. The goal of reducing morbidity and mortality from poisonings in ever-changing environments, both in the home and at the hospital, remains a challenge to all caregivers.
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With the media currently focused on vaccine shortages, the emergency physician must be prepared to rationally and scientifically explain diagnostic and therapeutic approaches in children with influenza. The author of this article prepares the ED physician to confidently face the 2004-2005 influenza season.
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Although diabetes mellitus is second only to asthma as the most prevalent chronic disease of childhood, the literature has very few comprehensive reviews of diabetic ketoacidosis (DKA), the most frequent cause of death in children with diabetes. The importance of an early diagnosis and appropriate management should not be underestimated. The authors provide a focused review for the ED physician for recognition and management of a child with DKA, with special attention to potentially serious complications.
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The authors review the classic course of common pediatric diseases associated with rashes, including varicella-zoster virus, herpes simplex virus (HSV), roseola, and rubella. Understanding the classic patterns, disease progression, high-risk populations, and potential complications allow the ED physician to avoid unnecessary testing in low-risk patients with a classic presentation, and aggressively approach potentially significant rashes in high-risk populations (e.g., neonatal HSV). This article also is designed to increase ED physicians awareness of treatment strategies associated with common viral exanthems.
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