Bleeding as a chief complaint in the pediatric emergency department is something that many healthcare providers will come across. Some of these children may have inherited bleeding disorders that we must be aware of in order to provide the best care possible. Below is a basic review of hemophilia and what we should know and do in the emergency department.
A 6-year-old male is brought to the emergency department (ED) after falling from the monkey bars at a local playground. Physical examination reveals no scalp hematoma, and the child appears alert and well oriented. You decide to observe him over the next 30 minutes hours to determine if he develops any disconcerting symptoms. After 15 minutes of observation within the ED the patient has an episode of vomiting witnessed by the nurses. The patient’s mother wants to know if this means he has failed his observation period and needs to receive a head CT. Your answer? (more…)
“We need to debrief” said the nurse manager after the medical team walked out of the critical care room after pronouncing a child who died after a traumatic accident. The social worker pointed at me (I am a Child Life Specialist) and looked at her and said “It’s our code blue now. We have to wait. We have a job to do”. Which was her way of saying we still had a lot of work to do with the family. At that point I walked in a room with the social worker and devastated parents, where the patient’s brother waited. He looked at me with big eyes and wanted to know if his sibling was ok. Not a conversation I would wish upon my worst enemy.
A 3-year-old male presents to the emergency department (ED) complaining of vomiting and diarrhea that has been occurring for 2 days. The mother states that the child has had fewer wet diapers today but has made tears when crying. On physical examination you note no rebound or guarding of the abdomen and determine that the child is moderately dehydrated. Your initial plan is to administer ondansetron and rehydrate the child orally. This is what you have been taught but is it actually efficacious? A just published 2014 JAMA Pediatrics article attempted to answer this question.
A 6-month-old male presents to the emergency department with diarrhea and vomiting. Despite antiemetic therapy, the the child is unable to tolerate oral intake in the ED and so you opt to admit him to the hospital for IV fluids. The pediatric hospitalist requests that you write maintenance fluids prior to admission to the floor. Utilizing the 4-2-1 rule you calculate maintenance needs and choose D5 ½NS as your fluid. This is what you had been taught to utilize in children. It seems appropriate… but is it?
Intracranial injury is the leading cause of death and disability in children. It can arise after severe, moderate, or minor head injury. Children with minor head injury present the greatest diagnostic dilemma for emergency physicians, as they appear well but a small number will develop intracranial injuries. The question that often arises in the ED is:
To CT or not to CT?