Focused Evaluation of the Emergent Pediatric Patient

Chapter 91 Focused Evaluation of the Emergent Pediatric Patient


An Introduction for the Student



R. Jason Adams, MD , Magdy W. Attia, MD


The pediatric emergency department is a relatively new subspecialty. With the unfortunate inaccessibility of primary care and the readily available medical information of the Internet stirring the anxiety of parents, concerns and chief complaints of short duration may present to the emergency department (ED) rather than to the primary care physician. There has been an exponential increase in ED visits throughout the country, resulting in increased utilization of resources and increased wait times for care. Patients with a wide variety of chief complaints and diagnoses are evaluated and treated routinely. The ability to perform a rapid but focused evaluation, while considering the possibility of a serious underlying disease state, is an essential skill required to efficiently triage the child with severe illness or trauma who needs immediate treatment.




Medical Knowledge and Patient Care


When first assessing a child in the ED, the physician should immediately determine whether the patient is ill-appearing or toxic. In the case of an unresponsive patient in shock, resuscitative measures to stabilize the airway, breathing, and circulation (ABCs) should be promptly initiated. For trauma cases, a rapid assessment using the primary survey should be carried out to identify and treat life-threatening injuries.


The history will be focused on:


• Chief complaint: The chief complaint will steer the physician in the direction of an organ system. Further questioning in a non-leading manner typically refines the chief complaint(s) and could redirect the physician to other organ systems that could be involved.

• Onset of symptoms: Insidious versus sudden. For instance, sudden onset of abdominal pain is more concerning than pain developing over weeks.

• Duration of symptoms: The ED physician can be challenged by a convoluted or protracted history of the present illness, but must remain focused on recent changes in symptoms in order to address the emergent needs.

• Associated symptoms: Symptoms such as pain, rash, respiratory symptoms, nausea and vomiting, though nonspecific, could be diagnostic clues and should be elicited in the review of systems.

• Past medical history: This is an integral part of the history. For example, patients with a chronic underlying medical condition such as chronic lung disease with episodic acute illness may require a more thorough evaluation than a child who is perfectly healthy with the same complaints of a fever and cough. Similarly, the child with previous intra-abdominal surgery who presents with abdominal pain may be more worrisome and may present a greater diagnostic challenge than a patient without a history of prior surgery.
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Jul 18, 2016 | Posted by in PEDIATRICS | Comments Off on Focused Evaluation of the Emergent Pediatric Patient

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