Richard Lichenstein, MD, Editor

Getachew Teshome, MD, MPH, Editor

These issues are amplified in the hotbed of the emergency department. Emergency physicians face the dilemma of being expected to apply practices based on best evidence, with access to all manner of laboratory and radiologic resources, and to do it as efficiently as possible for all types of medical and traumatic conditions. Emergency physicians must juggle the clinical needs of patients and parents as well as the administrative issues of time and cost. Practicing pediatricians are challenged even more so by the same problems and demands.

This issue of Pediatric Clinics of North America highlights diseases, injuries, populations, and emerging conditions in pediatric emergency medicine. Bronchiolitis, asthma, and fever will always be pediatricians’ bread and butter. The latest developments in these illnesses are reviewed in this issue, with implications for their assessment and management. Skin infections and abscesses are likewise common, but our knowledge of resistance patterns and the new best practices for treatment is changing. Appropriate use of antibiotics and judicious use of incision and drainage are discussed. The evaluation of altered mental status is always challenging. We present a framework for a rational approach to evaluation and management of these patients. Concussion and head injury are frequent presentations for the practicing pediatrician. We now better understand how to evaluate and manage children with these injuries, and we know how to use CT scans more appropriately. New research has shed light on the risk of cervical spine injury after trauma, helping us understand the common practice of clearing the c-spine better. Moreover, the practical use of all types of radiologic examinations is reviewed as they pertain to acute pediatric illness and injury. Pediatric offices have evolved with a greater scope of practice and extended hours of availability, to the point that they can be seen as mini emergency departments. These clinical care sites need to be ready to assess and manage acute emergencies and common injuries by knowing simple procedures as well as lifesaving skills, because these sites will surely be incorporated in community emergency plans.

At every site of care, children need to be made comfortable when they are ill or injured. Analgesia and procedural sedation must always be considered to provide comfort for children. A child’s first experience in a medical setting can leave lasting physical and psychological impressions. A comprehensive approach to pain relief and anxiolysis is the first step toward ensuring a rewarding medical encounter for patient and practitioner. Children assisted by technologic devices and others with acute psychiatric and behavioral problems are coming to emergency departments and office settings in increasing numbers. The practicing pediatrician needs to have a true appreciation of these patient groups and a clear plan for interacting with them and providing appropriate management and referral.

New drugs of abuse and foreign body ingestions pose unique diagnostic and treatment challenges. Clinicians are on the forefront for uncovering patterns of injury, ingestion, and illness that are likely to be encountered in any office setting. The magnet and bath salt ingestion stories told in this issue are the types of encounters that lead to research and innovation and ultimately improved children’s health.

Finally, prevention efforts initiated and encouraged by pediatric office practitioners and emergency medicine physicians are critical for the safety and wellness of children. Injury prevention efforts are one of the true success stories in pediatrics. This issue reviews some evidence-based interventions that have been used successfully in emergency departments.

We would like to thank all our authors for their time and effort in preparing the manuscripts. Their expertise and enthusiasm were very much appreciated in this undertaking.

Our experience with the Pediatric Emergency Care Applied Research Network was integral for the planning and compilation of this Pediatric Clinics of North America issue. From this interaction, we have developed an intense respect for the process of research and evidenced-based medicine. Moreover, we have benefited from collaboration with members of the Section of Pediatric Emergency Medicine, Council on Injury, Violence, and Poison Prevention of the American Academy of Pediatrics, and at the University of Maryland School of Medicine. We are privileged to consider these people as colleagues, mentors, and friends.

We are forever grateful for our family and friends, but are especially thankful to our wives, Maura and Tsigie, and our children, Sarah, Mike, Eden, and Daniel. These are the people who inspire us daily to tackle challenges thoughtfully and with empathy and compassion.