Fleisher and Ludwig’s 5-Minute Pediatric Emergency Medicine Consult PDF
Preview Fleisher and Ludwig’s 5-Minute Pediatric Emergency Medicine Consult
P1:OSO/OVY P2:OSO/OVY QC:OSO/OVY T1:OSO LWBK822-FM LWBK822-Hoffman April19,2011 8:53 Fleisher & Ludwig’s 5-Minute Pediatric Emergency Medicine Consult i P1:OSO/OVY P2:OSO/OVY QC:OSO/OVY T1:OSO LWBK822-FM LWBK822-Hoffman April22,2011 2:6 EDITORS ASSOCIATE EDITORS Robert J. Hoffman, MD, MS Sandip A. Godambe, MD, PhD, MBA AssociateProfessorofEmergencyMedicine AssociateProfessorofPediatrics AlbertEinsteinCollegeofMedicine UniversityofTennesseeHealthScienceCenter Bronx,NewYork MedicalDirector,MedicalStaffQualityand ResearchDirector QualityEducation DepartmentofEmergencyMedicine AssociateMedicalDirector-EDT,EmergencyServices BethIsraelMedicalCenter LeBonheurChildren’s Hospital NewYork,NewYork Memphis,Tennessee Director,MedicalToxicology EmergencyServicesInstitute Raymond Pitetti, MD, MPH SheikhKhalifaMedicalCity AssociateProfessorofPediatrics AbuDhabi,UnitedArabEmirates UniversityofPittsburghSchoolofMedicine MedicalDirector,SedationServices Vincent J. Wang, MD, MHA AssociateMedicalDirector,EmergencyDepartment AssociateProfessorofPediatrics Children’s HospitalofPittsburghofUPMC KeckSchoolofMedicineoftheUniversityof Pittsburgh,Pennsylvania SouthernCalifornia AssociateDivisionHead DivisionofEmergencyMedicine Children’s HospitalLosAngeles LosAngeles,California Richard J. Scarfone, MD AssociateProfessorofPediatrics UniversityofPennsylvaniaSchoolofMedicine MedicalDirector,EmergencyPreparedness TheChildren’s HospitalofPhiladelphia Philadelphia,Pennsylvania ii P1:OSO/OVY P2:OSO/OVY QC:OSO/OVY T1:OSO LWBK822-FM LWBK822-Hoffman April19,2011 8:53 Fleisher & Ludwig’s 5-Minute Pediatric Emergency Medicine Consult Editors RobertJ.Hoffman,MD,MS VincentJ.Wang,MD,MHA RichardJ.Scarfone,MD Associate Editors SandipA.Godambe,MD,PhD,MBA RaymondPitetti,MD,MPH iii P1:OSO/OVY P2:OSO/OVY QC:OSO/OVY T1:OSO LWBK822-FM LWBK822-Hoffman April19,2011 8:53 SeniorAcquisitionsEditor:FrancesDeStefano ProductDirector:JuliaSeto VendorManager:BridgettDougherty SeniorManufacturingManager:BenjaminRivera SeniorMarketingManager:AngelaPanetta DesignCoordinator:TeresaMallon ProductionService:Aptara,Inc. 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VisitLippincottWilliams&WilkinsontheInternet:atLWW.com.LippincottWilliams&Wilkinscustomer servicerepresentativesareavailablefrom8:30amto6pm,EST. 10 9 8 7 6 5 4 3 2 1 iv P1:OSO/OVY P2:OSO/OVY QC:OSO/OVY T1:OSO LWBK822-FM LWBK822-Hoffman April19,2011 8:53 PREFACE We have produced this first edition of The 5-Minute Pedi- oughbutveryconcise,succinctmannersothatallkeypointsabout atricEmergencyMedicineConsult with the specific goal clinical presentations, differential diagnoses, diagnostic investiga- ofprovidingaconcise,formattedresourcefortheclinical tions, therapeutic interventions including medications and doses, managementofpediatricemergenciesandcommonpediatriccom- and admission or discharge criteria are presented. This text has plaintsencounteredinemergencydepartmentsandothersettings. been authored by selected pediatric emergency physicians from Asacademicpediatricemergencyphysicians,ourgoalistoapply both emergency and pediatric medicine backgrounds to provide thebestevidence,publishedclinicalpracticeguidelines,andother truesubspecialtyexpertise. informationtooptimizepatientcare.Numerousconstraintsmayin- The5-MinutePediatricEmergencyMedicineConsultwillbeuse- terferewithone’sabilitytostayappraisedofthemostcurrentevi- fultotraineesaswellastocliniciansfarbeyondtraining.Thoughthe denceandguidelinesapplicabletopediatricemergencymedicine. editorsandauthorspracticepediatricemergencymedicinewithin We recognize this and present this book as a resource for those theconfinesofemergencydepartmentsinacademicmedicalcen- whoalsowishtopracticeevidence-basedmedicinebutrequirethe ters,werecognizethatmostpediatricemergenciesarenottreated information distilled in a single, easily accessible reference. This insuchsettings,andmanypediatricemergenciesaretreatedout- 5-MinutePediatricEmergencyMedicineConsult is exactly such a sideofanemergencydepartmentaltogether.Thus,wehavetaken reference book. Honorifically named for the Fleisher and Ludwig greatstridestoproduceareferencethatrepresentsoptimalman- Textbook of Pediatric Emergency Medicine, which is the seminal agement of emergent and urgent pediatric conditions as well as comprehensivetextbookofpediatricemergencymedicine,ourtext commonpediatriccomplaintsinallsuchlocations.Cliniciansprac- seekstoprovidearapidreferenceforuseintheclinicalworkplace ticing in a tertiary care academic medical center with extensive ratherthanthorough,extensivecoverageofthesubjectmatter.The subspecialty support or those in the community setting in which 5-MinutePediatricEmergencyMedicineConsult isintendedtobe littleornosubspecialtysupportwillfindthistexttobeaninvaluable accurate, pointed, and readily integrated into practice rather than resource. definitive. We hope this book will serve as a useful and frequently used Clinicians at all levels of training and all stages of career de- resourcetoassistinourcommongoalofprovidingthebestpossible velopment need references to facilitate the provision of optimal pediatricemergencycaretoourpatients. patientmanagement.Eachchapterpresentsinformationinathor- v P1:OSO/OVY P2:OSO/OVY QC:OSO/OVY T1:OSO LWBK822-FM LWBK822-Hoffman April19,2011 8:53 FOREWORD FiveMinutes–Whatcanyoudoin5minutes?Workinginthe portant overview. At other points, it will be used for a familiar or pediatricemergencydepartmentformorethan35yearshas commonclinicalsituationbuta5-minuterefresherwillprovideare- often been a humbling experience. Along the way, we have assuringdoublechecktomakesurenothinghasbeenoverlooked learned many lessons. One of the most important has been the orforgotten.Ineithercase,thatinitialorientationandpreparation valueoforientationandpreparation.Wehaveallprovidedcarefor willprovemostvaluable. children when they suddenly burst through the doors in the arms We are honored to have our names as part of the title of this ofapoliceofficerorparamedicwithmajormultisystemtraumaor book.WeviewitasaperfectcompaniontotheTextbookofPediatric cardiacarrest.Wehavebeeninthesamecriticalsituationwhenwe EmergencyMedicine,6thEditionwheremorein-depthinformation hadjust5minutestopreparefortheevent.Asmanyofthereaders canbelearned.Wethanktheeditorsandauthorsforallowingus ofthisbookknow,thatextra5minutesmakesaworldofdifference to share in this work. We see it as yet another important step in totheoutcomeandperceivedqualityofcareprovided.Evenwhen improvingtheemergencycaretoillandinjuredchildren,whichhas residentsareassignedtotheemergencydepartmentforarotation beenthefoundationofourlife’swork. itisourperceptionthatthosewhogetabrieforientationtothesite Fiveminutescanmeanalot,and5minutesofreadingoneof performmuchbetterthanthosewhodonot.Andthosewhotakea thetopicsthatfollowwillsetyouonapathwaytowardrewarding minutetopreparebeforegoingintoatreatmentroomalsoevolve clinicalcare. tobebetterphysicians. Thatbringsustothisbook,The5-MinutePediatricEmergency STEPHENLUDWIG,MD Philadelphia,Pennsylvania MedicineConsult.Weknowthatusingthisbookwillprovidephysi- cianswiththeorientationandpreparationneededtoaddressawide GARYR.FLEISHER,MD rangeofclinicalproblems.Sometimesitwillbeanewconditionthat Boston,Massachusetts the physician has not faced before, and the topic will give an im- February2011 vi P1:OSO/OVY P2:OSO/OVY QC:OSO/OVY T1:OSO LWBK822-FM LWBK822-Hoffman May4,2011 21:59 ACKNOWLEDGMENTS IthankmywifeMiyaforherunderstanding,support,andsacrifice Iwouldliketothankmypatients,colleagues,andmentorswhohave duringtheproductionofthistext. taught me so much in my career. Your collective inquisitiveness, IsincerelythankLewisGoldfrankandSteveDavidsonforgiving selflessness, and support have inspired me to become a clinician me the most formative academic opportunities of my career, and worthyofyourtrust.Iamgratefultothemanyauthorsofthisbook LewisNelsonandBobHoffmanforservingasidealmodelsofaca- who have worked so hard to create an outstanding resource for demicemergencyphysiciansandclinicianeducators.Tothemany patientcare.Thankyoutomywife,Karen,foryourloveandsupport, emergencymedicineresidencyclassesandnotablythechiefres- andthankyoutomywonderfulchildrenStevenandJulia—Iloveyou identsofBethIsraelMedicalCenter,Iextendthanksforyearsof andI’mproudoftheyoungpeoplethatyouhavebecome. rewardinginteractionandinspirationtoremaininacademics. R.J.S. Iacknowledgefriendsacrosstheglobepastandpresentwho haveassistedmyendeavorsbyhelpingmebalanceproductivework This book is the result of the hard work of countless dedicated withenjoyablerecreation.Lastly,Ithankthefamiliesandpatients authors.Ithasbeenapleasuretoworkwiththemandtheeditorial towhomI’veprovidedemergencycarefortheprivilegeoftreating andpublishingteamofthisbook.Iwanttoextendaspecialthanksto them. themanyresidentsandfellowspastandpresentwhosequestions R.J.H. andpursuitofknowledgehavemademeabetterclinician–educator. Iwouldalsoliketothankmymanymentorsthroughoutmytraining. Withanysignificantwork,thereareinevitablynumerousindividuals Finally,manythankstomylovingfamily,especiallymywife,Libby, whohavecontributedtobringthisprojecttofruition.Iwouldliketo andthreechildren,Maya,Samir,andRiya,whohavemadesacrifices, thanktheauthorsandeditors,whohavespentenormousamounts yethavebeentheretosupport,entertain,andinspireme. of their own personal time to produce this book. Thanks to the patients and my colleagues: my co-attendings, the residents and S.A.G. fellows,andthenurses,whohaveinspiredmetobeabetterclinician andteacher.IalsowanttoacknowledgeGaryFleisherandthelate Iwouldfirstliketothankmywife,Leslie,mysonsNoah,Benand MichaelShannonfortheirmentorshipandguidance.Finally,Ideeply Logan, and my daughter Lia, for all of their support and love. Ev- appreciatemywifeEsther,andmyparentsJawandJean,fortheir erything I am, I owe to them. I would also like to thank the au- continualsupport,patience,andsacrifice. thors that I have worked with, the editorial staff for their support, V.J.W. andmyco-editorswhohadtoputupwithme.Ithastrulybeena pleasure to work on this project, and I have learned a great deal fromall. R.P. vii P1:OSO/OVY P2:OSO/OVY QC:OSO/OVY T1:OSO LWBK822-FM LWBK822-Hoffman April19,2011 8:53 viii P1:OSO/OVY P2:OSO/OVY QC:OSO/OVY T1:OSO LWBK822-FM LWBK822-Hoffman April30,2011 8:45 CONTRIBUTORS TzviAaron,MD CarlaMariaP.Alcid,MD BhawanaArora,MD Fellow AssistantProfessor PediatricEmergencyMedicineFellow DepartmentofPediatricEmergency DepartmentofPediatrics DepartmentofEmergencyMedicine Medicine TulaneUniversitySchoolofMedicine Children’sHospitalofMichigan NewYork-PresbyterianHospital MedicalDirector Detroit,Michigan WeillCornellMedicalCenter DepartmentofPediatricEmergency DanaAronsonSchinasi,MD NewYork,NewYork TulaneUniversityHospitalandClinics Fellow JacoboAbadi,MD NewOrleans,Louisiana DepartmentofEmergencyMedicine AssociateProfessor MichelleJ.Alletag,MD TheChildren’sHospitalofPhiladelphia DepartmentofPediatrics Fellow Philadelphia,Pennsylvania AlbertEinsteinCollegeofMedicine PediatricEmergencyMedicine MagdyW.Attia,MD JacobiMedicalCenter YaleUniversity Bronx,NewYork NewHaven,Connecticut Professor DepartmentofPediatrics AlyssaAbo,MD NaharD.Alruwaili,MD JeffersonMedicalCollege AssistantClinicalProfessor,Pediatrics Toronto,Ontario,Canada Philadelphia,Pennsylvania UCDavisSchoolofMedicine FellowshipDirector Sacramento,California CarolineAltergott,MD AssociateDirector JenniferAdu-Frimpong,MD AttendingPhysician DivisionofEmergencyMedicine CooperUniversityHospital DivisionofEmergencyMedicine AlfredI.duPontHospitalforChildren Camden,NewJersey Children’sHospitalLosAngeles Wilmington,Delaware LosAngeles,California DeweshAgrawal,MD MarkA.Auerbach,MD AssociateProfessor RobinL.Altman,MD AssistantProfessorofPediatrics DepartmentofPediatricsandEmergency AssociateProfessor YaleUniversitySchoolofMedicine Medicine DepartmentofPediatrics AttendingPhysician GeorgeWashingtonUniversitySchool NewYorkMedicalCollege SectionofPediatricEmergencyMedicine ofMedicine Chief YaleNewHavenChildren’sHospital Director SectionofGeneralPediatrics NewHaven,Connecticut PediatricResidencyProgram MariaFareriChildren’sHospitalat Children’sNationalMedicalCenter Westchester JeffreyR.Avner,MD Washington,DC Valhalla,NewYork Professor FaizAhmad,MD DepartmentofPediatrics ChristopherS.Amato,MD AssistantClinicalProfessor AlbertEinsteinCollegeofMedicine DepartmentofEmergencyMedicine DepartmentofPediatrics Chief,Children’sEmergencyService MorristownHospital ColumbiaUniversityCollegeofPhysicians DepartmentofPediatrics Morristown,NewJersey andSurgeons Bronx,NewYork AttendingPhysician YasmeenAnsari,MD MichaelR.Baker,MBBS DivisionofPediatricEmergencyMedicine DepartmentofEmergencyMedicine MorganStanleyChildrenHospitalof NorthShoreUniversityHospital NewYorkPresbyterian Manhasset,NewYork NewYork,NewYork AlexandreArkader,MD SaraAhmed,MD AssistantProfessor AssistantProfessor DepartmentofOrthopaedicSurgery DepartmentofPediatricEmergency KeckSchoolofMedicineoftheUniversity Medicine ofSouthernCalifornia TheChildren’sHospitalofMichigan Director,BoneandSoftTissueTumor Detroit,Michigan Program KhalidAlansari,MD Children’sOrthopaedicCenter DepartmentofPediatrics Children’sHospitalLosAngeles PediatricEmergencyCenterAl-Sadd LosAngeles,California HamadMedicalCorporation Doha,Qatar ix P1:OSO/OVY P2:OSO/OVY QC:OSO/OVY T1:OSO LWBK822-FM LWBK822-Hoffman April30,2011 8:45 x (cid:2) (cid:2) (cid:2) Contributors MichaelD.Baldovsky,DO,MBA RobertA.Belfer,MD StuartA.Bradin,DO Fellow AttendingPhysician AssistantProfessorofPediatricsand DivisionofEmergencyServices DepartmentofPediatrics EmergencyMedicine LeBonheurChildren’sMedicalCenter Children’sHospitalofPhiladelphia TheUniversityofMichigan Memphis,Tennessee Philadelphia,Pennsylvania AttendingPhysician Director,PediatricEmergencyMedicine Children’sEmergencyServices NelsonH.Bansil,DO DepartmentofPediatrics DepartmentofEmergencyMedicine, Fellow VirtuaHospital DivisionofPediatricEMergency DepartmentofPediatricEmergency Voorhees,NewJersey Medicine Medicine TheUniversityofMichiganHelathSystem LomaLindaUniversityMedicalCenter BrendaJ.Bender,MD AnnArbor,Michigan LomaLinda,California AttendingPhysician KristenBreslin,MD BeshBarcega,MD DepartmentofEmergencyMedicine Fellow AssistantProfessor AlfredI.duPontHospitalforChildren DivisionofEmergencyMedicine DepartmentofEmergencyMedicineand Wilmington,Delaware Children’sNationalMedicalCenter Pediatrics EyalBen-Isaac,MD Washington,DC LomaLindaUniversitySchoolofMedicine andChildren’sHospital AssistantProfessor SethL.Brindis,MD MedicalDirector,Pediatric KeckSchoolofMedicineoftheUniversity ClinicalInstructor DepartmentofEmergencyMedicine ofSouthernCalifornia DepartmentofPediatrics LomaLindaUniversityMedicalCenter Director,PediatricResidencyProgram DavidGeffenSchoolofMedicineat LomaLinda,California DepartmentofPediatrics UniversityofCalifornia,LosAngeles Children’sHospitalLosAngeles AttendingPhysician PeterL.J.BarnettMBBS,MSc,MSpMed LosAngeles,California DepartmentofEmergencyMedicine AssociateClinicalProfessor Children’sHospitalofOrangeCounty DepartmentofPaediatrics SeemaBhatt,MD Orange,California UniversityofMelbourne AttendingPhysician,EmergencyMedicine DeputyDirector CincinnatiChildren’sHospitalMedical KevinD.Buckley,MD DepartmentofEmergencyMedicine Center Director,MedicalServices RoyalChildren’sHospital Cincinnati,Ohio EmergencyDepartment Parkville,Victoria,Australia NavalHospitalSigonella MercedesM.Blackstone,MD Sicily,Italy SylviaBaszak,MD AssistantProfessorofClinicalPediatrics AssistantProfessor CaseyW.Buitenhuys,MD UniversityofPennsylvaniaSchoolof DepartmentofPediatrics,Divisionof ClinicalInstructor Medicine EmergencyMedicine DepartmentofEmergencyMedicine AttendingPhysician RobertWoodJohnsonMedicalSchool, HarborUniversityofCaliforniaMedical DepartmentofEmergencyMedicine UniversityofMedicineandDentistryof Center TheChildren’sHospitalofPhiladelphia NewJersey Torrance,California Philadelphia,Pennsylvania MedicalStaff KristyBunagan,MD DepartmentofPediatrics,Divisionof KeithBlum,MD EmergencyCare UniversityofNevada,LasVegas RobertWoodJohnsonUniversityHospital SunriseHospitalMedicalCenter SeanE.Button,MD NewBrunswick,NewJersey LasVegas,Nevada Fellow JeffBeecher,DO DepartmentofPediatricEmergency DivisionofNeurosurgery RichardG.Boles,MD Medicine StateUniversityofNewYork,StonyBrook AssociateProfessorofPediatrics Children’sHospitalofPittsburghofUPMC StonyBrook,NewYork KeckSchoolofMedicineoftheUniversity Pittsburgh,Pennsylvania ofSouthernCalifornia SolomonBehar,MD DivisionofMedicalGenetics JamesM.Callahan,MD AssistantProfessor Children’sHospitalLosAngeles AssociateProfessorofClinicalPediatrics KeckSchoolofMedicineoftheUniversity LosAngeles,California DivisionofEmergencyMedicine, ofSouthernCalifornia DepartmentofPediatrics AttendingPhysician CaraBornstein,DO UniversityofPennsylvaniaSchoolof DepartmentofEmergencyMedicine AttendingPhysician Medicine LosAngelesCountyMedicalCenter DepartmentofPediatricEmergency AttendingPhysician DivisionofEmergencyMedicine Medicine EmergencyDepartment Children’sHospitalLosAngeles LongIslandJewishMedicalCenter TheChildren’sHospitalofPhiladelphia LosAngeles,California NewHydePark,NewYork Philadelphia,Pennsylvania
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