Toxicology
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Diagnosing and Managing Pediatric Foreign Body Ingestions: Part II
The process of diagnosing and managing foreign bodies has changed over the last few years. In Part II, the authors discuss not only the process for managing the majority of foreign bodies, but also unique ingestions that require special care.
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Diagnosing and Managing Pediatric Foreign Body Ingestions: Part I
Pediatric foreign body ingestion comes with a dichotomous presentation to the ED — the child in extremis with a clear need for immediate intervention vs. the well-appearing child with unknown ingestion. This creates a challenge for the emergency medicine provider to use a combination of history, physical examination, different imaging modalities, and overall clinical picture to verify ingestion over aspiration and, furthermore, to determine whether there is any need for immediate intervention. The decision-making tree surrounding foreign body ingestion changes based on time course, type of object, location in the gastrointestinal tract, and size. Therefore, a regimented and practical approach to foreign body ingestions is warranted.
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Unexpected Gaps in Opioid Overdose Treatments
Patients presenting to EDs for opioid overdose should go home with a naloxone prescription or a naloxone take-home kit. Alternatively, these patients could start buprenorphine when it is clinically feasible, or they could be connected directly to outpatient treatment for opioid use disorder.
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Few EDs Screen Patients for Excessive Alcohol Use
The ED is where patients often go during their most vulnerable times. Emergency providers can help vulnerable patients prevent a future crisis if they can show patients that help is available and how to access it.
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ED Visits for Alcohol and Substance Use Disorders Surging Nationally
Presentations often are bundled with a host of comorbid conditions and chronic or acute traumatic events. Providers should suspect and expect an underlying potentially serious coexisting medical complication in each patient encountered until proven otherwise.
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A Critical Review of Potentially Deadly Pediatric Ingestions
It is imperative for the emergency provider to be aware of common agents that can cause life-threatening toxicity or death should accidental ingestions occur. This article focuses on substances that are potentially catastrophic if ingestions occur and how to manage them accordingly.
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Researchers: Emergency Providers Missing Chances to Avert Future Opioid Disasters
Investigators express concern about prescribing rates for medication-assisted treatment after ED visits for opioid overdoses recorded between late 2019 and early 2021.
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In ED, Medication Harms Often Caused by Nontherapeutic Use
Of the 96,925 cases included in an analysis, 69.1% involved therapeutic use. Medication-related misuse, abuse, or self-harm caused approximately 62% of ED visits for medication-related harms in patients age 15-24 years, but only 22% of visits for patients age 55-64 years. For patients younger than age 45 years, 52.5% of ED visits involved nontherapeutic use.
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An Approach to Household Toxicological Emergencies in the Pediatric Patient
Patients with toxic ingestions most often will present to the emergency department as either a well-appearing patient with a known ingestion or as an ill-appearing patient with an unknown or suspected ingestion. This article will present the approach to both of these circumstances, discussing treatment and monitoring of specific overdoses as well as the initial approach to an ill child with a suspected overdose. The focus will be on common and accidental ingestions of toxins by pediatric patients.
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Pediatric Skin Infections
The skin is a dynamic organ, accounting for 15-20% of total body weight, and exhibits many functions such as protection against thermal and mechanical insults and against pathogenic microorganisms.