Update in Pediatric Emergency Medicine: Pediatric Resuscitation, Pediatric Sepsis, Interfacility Transport of the Pediatric Patient, Pain and sedation in the Emergency Department, Pediatric Trauma

This chapter summarizes the state-of-the-art approach to several critical aspects of pediatric emergency care. While the field of pediatric emergency medicine is much broader, we have chosen some key topics which are essential for every physician providing care to children. The resuscitation section highlights the challenges and the particularities of pediatric airway management as well as the correct technique for effective cardiopulmonary resuscitation, defibrillation and vascular access. The sepsis section stresses that the key to a successful outcome is early recognition; it outlines the clinical spectrum of sepsis, the systemic inflammatory response and the pathophysiology of septic shock, with emphasis on early clinical signs, airway management, volume resuscitation, vasoactive support and antibiotic therapy. In the last decade, attention to pediatric pain management has resulted in increasing awareness of assessment tools and pharmacologic as well as non-pharmacologic strategies for pain control and anxiolysis. The pain section updates these important aspects of pediatric care and includes management of procedural sedation. Although the general principles of trauma care in children are similar to those of adults, the trauma section highlights the key differences, with respect to anatomy and physiology, and how these impact on early recognition of hemorrhagic shock, susceptibility to specific injuries, indications for imaging (no pan-CTs!) and the more prevalent non-surgical management. Healthcare providers must also know how to safely transport a child who requires additional resources or an escalation in level of care. The regionalization of pediatric intensive care units and trauma services has made it imperative for pediatricians to understand the general principles of transport medicine outlined in this chapter. The overview of pediatric inter-facility transport discusses choice of transport team and modality, emphasizes patient stabilization prior to transport and outlines required medications and supplies.