Survey science in pediatric emergency medicine

Surveys conveniently acquire and summarize valuable information from a target population. The specific aims, design, target sample, mode of distribution, data analysis, and inherent limitations of the survey methodology should be carefully considered to maximize the validity of the results. This review provides guidance on the methods and standards necessary to complete sound survey science.     

Bedside ultrasound in pediatric emergency medicine

Bedside emergency ultrasound has been used by emergency physicians for >20 years for a variety of conditions. In adult centers, emergency ultrasound is routinely used in the management of victims of blunt abdominal trauma, in patients with abdominal aortic aneurysm and biliary disease, and in women with first-trimester pregnancy complications. Although its use has grown dramatically in the last decade in adult emergency departments, only recently has this tool been embraced by pediatric emergency physicians. As the modality advances and becomes more available, it will be important for primary care pediatricians to understand its uses and limitations and to ensure that pediatric emergency physicians have access to the proper training, equipment, and experience. This article is meant to review the current literature relating to emergency ultrasound in pediatric emergency medicine, as well as to describe potential pediatric applications.     

Trends and challenges in international pediatric emergency medicine

PURPOSE OF REVIEW: Pediatric emergency care internationally is practiced in a wide variety of local contexts, and the quality of care varies. International pediatric emergency medicine refers to the spectrum of care provided to children with serious illnesses and injuries globally. This article serves as the first of its kind to characterize current trends and challenges in this area. RECENT FINDINGS: Current trends in international pediatric emergency medicine include international dissemination of pediatric emergency medicine guidelines, pediatric-specific disaster relief training, increasing numbers of pediatric emergency medicine research collaboratives, interest groups and training programs, and increasing numbers of spaces dedicated to pediatric emergency care. Current challenges to the field include inequalities in access to medical research and information, various nonmedical barriers and lack of reports describing approaches to the delivery of pediatric emergency care. SUMMARY: While there are many recent advances in the state of pediatric emergency medicine internationally, there still exist many barriers to the improvement in its quality. Many of these obstacles are not specific to pediatric emergency medicine, but reflect overall disparities between the developing and developed worlds. One first step to overcoming pediatric emergency medicine practiced in isolation is a formal organization of the field of international pediatric emergency medicine.     

Radiation injuries and illnesses in pediatric emergency medicine

Radiation illnesses and injuries are rare, and because they typically involve occupational exposures, they are even more rare in children. Nonetheless, radiation is widely used in medicine, industry, and research, and radioactive materials are commonly transported. Even without the specters of nuclear reactor accidents or terrorist releases of low-yield nuclear explosives, radiation exposures are events for which pediatric emergency departments need to prepare. We review basic raidation biology and physics, sources of radiation exposure, the pathophysiology of radiation injury and illness, the diagnosis of radiation exposure, the clinical presentation and natural history of radiation injury and illness, the treatment of radiation exposure, and emergency department preparedness for handling radiation injury and illness. Having a radiation disaster plan in place, knowing its elements and practicing them, and prepositioning the right supplies are the keys to successfully treating exposed patients.     

Conducting ethical research in pediatric emergency medicine

As investigators design and implement research protocols, they should be aware of the ethical and legal requirements that govern research with human participants. This is especially true of research that involves children and other vulnerable groups. The purpose of this paper is to provide a brief overview of the regulatory and ethical requirements that relate to research involving children in the emergency department (ED) setting. For research in the ED to satisfy ethical and legal requirements, it must be scientifically sound and significant, subject selection must be fair, approaching families for enrollment must avoid pressure, the risks to participants cannot be excessive and must be minimized, risks must be justified by the benefits of the research, informed consent and assent must be obtained where appropriate, enrolled subjects must be respected, and the protocol must have obtained approval of an independent ethical review board.     

Ocular irrigant alternatives in pediatric emergency medicine

Minimizing pain and discomfort is an important consideration in pediatric ocular decontamination. The pH of an irrigant solution plays a significant role in its tolerability, because a solution with a pH that is too low or too high may cause edema and discomfort to the conjunctiva. We reviewed several available ocular irrigation solutions with respect to their chemical composition, pH, and cost efficiency. Currently, the irrigation solution of first choice for most ocular decontaminations in the pediatric emergency department (ED) is 0.9 % saline solution or normal saline (NS), which has a pH range between 4.5 and 6.0. Alternative ocular irrigant solutions available include Lactated Ringers solution (LR), which has a pH range between 6.2 and 7.5, buffered NS with pH adjusted to 7.4 with sodium bicarbonate, and Balanced Salt Solution Plus (BSS Plus), which has a pH of 7.4. Of these alternative solutions, all except BSS Plus are comparable in cost efficiency to NS. The use of more pH neutral solutions such as LR, NS with bicarbonate buffer, or BSS Plus may decrease ocular pain and irritation associated with copious irrigation, and may improve tolerance of ocular decontamination by a child.     

Integrative medicine and pediatric emergency medicine: Can they be complementary?

The IM approach emphasizes the concept of the body’s innate ability to heal. This can be illustrated by the child who presents with fever and is found to have a blood culture positive for Streptococcus pneumoniae. The child is frequently prescribed an antibiotic and in most cases recovers without problems. Did the antibiotic eradicate the bacteria and eliminate the infection? Did the patient’s immune system, assisted by the antibiotic reducing the bacterial load, promote recovery? Did the immune system resolve the infection and the antibiotic was unnecessary? CAM would support the belief that the body’s immune system combating the infection with the assistance of the antibiotic healed the infection. The CAM focus on the individual patient and prevention for health and well-being lends itself to the study and use of many techniques not all of which are common or accepted in mainstream allopathic medical care. This represents a fertile area for research. One such plan for health services and outcome research on CAM practices was described by Kathi Kemper.120Whether you choose to use CAM therapies for yourself, your patients, or your family, or just want to be better informed about what is happening in the consumer market, there are an abundance of resources for education. As with many areas of medicine, the quality of CAM research varies and studies must be critically appraised before wholesale incorporation into PEM practice. The EP is urged to keep an open mind and understand the concepts of IM and the therapies available. A last thought for closing is a quote from Voltaire, the 18th century French philosopher, “The art in medicine consists of amusing the patient while nature cures the disease.”Table 5