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General Considerations
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Children constitute one of the most diverse and challenging patient populations facing the emergency physician. While comprising almost 30% of emergency department patients, critical illness and injury are present in only approximately 5%. The majority of pediatric emergency visits are evaluated not in pediatric hospitals, but community emergency departments. Early recognition and aggressive management of illnesses and injuries effecting pediatric patients is of utmost importance.
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The epidemiology of pediatric emergency medicine changes with the clinical setting. In the prehospital environment, the common presenting complaints are trauma, seizures, respiratory distress, and toxicologic emergencies. In the emergency department, the most common complaints are fever, trauma, injury, respiratory distress, vomiting, diarrhea, or upper respiratory tract infection.
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Assessment of the pediatric patient in the emergency department requires an age-specific approach. A calm, reassuring, and gentle manner on the physician's part will facilitate information collection and encourage patient cooperation in examining and testing.
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Knowledge of the child's growth and development often is required for the diagnosis, management, and disposition of the pediatric patient. Severity of acute pediatric illness and injury is often difficult to discern. Recognition of anatomic and physiologic differences remind the examiner of large surface area to weight ratio leading to heat loss and trauma to internal organs may exist with little signs of external injury. Airway differences are important to understand in order to manage respiratory distress and failure. Observational methods of assessment may be more sensitive to illness and injury acuity in children taking into account such variables as quality of cry, reaction to parent stimulation, state variation, skin color, hydration status, and response social overtures such as talking and smiling. Such observations appear to be more predictive of serious illness than anatomic physical examination using standard palpation, percussion, and auscultation techniques.
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Assessment and management of the distressed pediatric patient requires appropriately sized equipment. Table 50–1 provides equipment sizes for invasive procedures in children of different age groups.
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