When performing a procedure, attempts should be
made to minimize pain and suffering in children through
the use of anesthetic, sedative, and/or pain medications.
Not only will the patient be happier, but the parents will be
more satisfied with their child's care. Use of topical
anesthetics during laceration repair, suprapubic bladder
reduction, consider using procedural sedation. These pro
In most pediatric cases, your history and physical exam
are sufficient to rule out serious pathology. However, if
more ominous diagnoses are suggested by the history and/
or physical, testing should move into laboratory, imaging,
and possibly procedures as necessary (Figure 47-2).
Once treatment strategies are chosen or narrowed down to
a few alternatives, it is a good time to review the options or
plan with the parent(s). The parents can be very helpful in
supporting the clinician in explaining the plan to the
patient. If multiple alternatives are presented, the parents
can help choose an option most in line with their wishes,
preferences, and/or child's comfort.
Medication dosages and emergency equipment must be
appropriate for the patient's weight. Getting an accurate
weight as part of the initial vital signs can help speed
medication calculations at this stage of the ED visit. If a
directly measured weight is unavailable in an emergent
situation, using a resuscitation tape (previously called
Broselow tape) can be extremely helpful. The red arrow on
the tape is placed at the patient's head and the tape is
extended to his/her feet to measure length. There is an
average weight listed on the tape for this length. It is this
weight that is used for medication dosing, etc. All
medication dosages must be calculated on a milligram per
kilogram basis. All treatment should be performed as
quickly and as gently as possible.
Indications for admission in pediatric patients include
suspected or confirmed acute surgical diagnoses ( eg,
appendicitis), any medical condition requiring further
monitoring and treatment ( eg, asthma, dehydration with
intractable vomiting), and uncertain diagnoses requiring
further work-up. Also, patients with certain social issues,
including suspected abuse, neglect, and failure to thrive,
should be considered for admission pending social services
Stable patients with good social supports and medical
follow-up are appropriate for discharge after medical
conditions have been diagnosed and treatment plans
initiated and/or completed. Chronic conditions and related
all pediatric patients have regular primary care providers,
patients will benefit from contact between the emergency
medicine physician and the primary care provider to have
appropriate continuity of care after discharge from the ED.
The treatment of the pediatric patient presents unique
challenges and requires specialized training but is easily
achievable by maintaining good rapport and communica
tion and showing patience and empathy. These skills will
decrease the amount of anxiety for the patient and parent,
facilitate care, and improve compliance.
American Academy of Pediatrics Committee on Pediatric
Emergency Medicine, American College of Emergency
Physicians Pediatric Emergency Medicine Committee, O'Malley
P, Brown K, Mace SE. Patient- and family-centered care and the
role of the emergency physician providing care to a chlld in the
emergency department. Pediatrics. 2006;118:2242-2244.
Corrales 1\Y, Starr M. Assessment of the unwell chlld. Aust Pam
Cydulka RK, Meckler GD. Tintinalli's Emergency Medicine: A
Comprehensive Study Guide. 7th ed. New York, NY: McGrawHill, 20 1 1, pp. 73 1-733.
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