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Working in the environment of the emergency department, we experienced a plethora of clinical pathology that enhanced and finely tuned our visual diagnosis skills. Armed with a digital camera and a consent form, we were able to build a library of educational material in the form of clinical pictures, radiographic images, and fascinating stories. With these assets we prepared the first edition of the Atlas of Pediatric Emergency Medicine and have been humbled and pleased at the enthusiastic response of our audience. Based upon that response we have prepared this second edition.

The pressures of clinical practice continue to increase with demands of increasing productivity, decreasing reimbursement, and increasing numbers of patients, all leading to the potential to spend more time ordering tests than observing and examining patients. Thus, the art of visual diagnosis remains an endangered species. Where the bedside experience was once the highlight of our clinical day, the “art” has been replaced by mechanics. Our trainees are being schooled in processing flow and survival mode ideation.

Sir William Osler once wrote: “Avoid the common and fatal facility of reaching conclusions from superficial observations and being constantly misled by the ease with which our minds fall into the ruts of one or two experiences.” The more patients one sees and examines, the better one becomes at forming a concise differential diagnosis prior to ordering an expensive, time-consuming, and often invasive work-up. The student of visual diagnosis is not only more likely to make the right diagnosis, but is also more likely to avoid the costly error. We urge our fellow physicians to hold on to this art. By perfecting the tools we were born with and supplementing them with those that we developed, we will continue to have pride in what we do, love our patients, and enjoy our careers.

We have made an attempt to make this second edition even more user friendly than the first. The Atlas features a consistent format with concise text regarding Clinical Summary, Emergency Department Treatment and Disposition, and Pearls. Side by side with this concise, easy-to-read text is a wealth of images illustrating what these clinical problems look like in real life in an emergency setting. By making the text higher yield, we have been fortunate to be able to double the number of images in this new edition, greatly enhancing the work. Not only have we doubled the amount of images, but we have updated the book with the newest imaging techniques available to all who work in the emergency setting. A new section on Emergency Ultrasound is also added; however, as the medical and lay communities have become “radiation conscious and cautious,” ultrasound and plain radiography still remain the workhorses of pediatric imaging.

This Atlas is intended to assist the busy clinician in diagnosis, work-up, and disposition. It is written for anyone who has the privilege of taking care of acutely ill and injured children. We hope our experience and images will aid those in practice at continuing to hone their visual diagnostic and differential diagnosis skills, and also that it will stimulate clinicians who are starting their careers to never stop asking questions, always strive to improve the art of visual diagnosis, work on eliminating any fear of patient contact, and never stop learning from your patients.

Ars longa vita brevis (art is long while life is short). With this quote, Hippocrates reminds us how much there is to learn in a short period and thereby (hopefully) inspire us to be humble, scholarly, and better doctors.

Binita R. Shah, MD, FAAP
Michael Lucchesi, MD, FACEP
John Amodio, MD
Mark Silverberg, MD, MMB, FACEP

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