Abdominal pain is a common reason for pediatric patients to present to the emergency department. Pain assessment is especially challenging when patients are unable to communicate due to their developmental stage or medical conditions. Preverbal and nonverbal children are at increased risk for complications of delayed or missed diagnosis. Inadequate pain control is also a concern in this vulnerable population. This review provides guidance for assessment of abdominal pain in preverbal and nonverbal children, focusing on behavioral measures, which are more applicable and reliable in these patients, and on the effective use of parental input. Recommendations are given for a graduated approach to pain management, including nonpharmacologic and pharmacologic options.
Tranexamic acid (TXA) is an antifibrinolytic medication with multiple routes of topical and systemic administration that can be used to treat acute hemorrhage across a broad range of clinical scenarios. Pediatric data are more limited than the adult literature, which benefits from larger, higher-quality studies; however, TXA remains a potentially effective, safe, and versatile option for temporizing bleeding and limiting blood loss in children. This review discusses the evidence on TXA use in traumatic hemorrhage, traumatic brain injury, posttonsillectomy bleeding, epistaxis, oral and gingival bleeding, lower airway bleeding, and traumatic hyphema.
Although they are rare, pediatric cervical spine injuries can be severe and life-threatening. To detect these injuries while avoiding further harm, emergency clinicians must recognize high-risk signs and mechanisms and consider physiology based on patient age. This review presents evidence-based recommendations for prehospital management, imaging decisions, and emergency department management of pediatric cervical spine injuries.
Pediatric penile problems range from congenital anomalies to acquired and emergent conditions. Acquired conditions can result from various causes, including infectious and inflammatory conditions, hematologic conditions, strangulation conditions, trauma, and surgical injuries. This review provides an overview of the presentation, diagnosis, and management of pediatric penile problems that may present to the emergency department. Recommendations are given for evaluation and management, with emphasis on pain relief, restoration of normal anatomy, and timely treatment. Guidance is also provided on indications for emergent urologic consultation. Optimizing outcomes for pediatric patients with penile conditions requires addressing key challenges, including effective pain and anxiety management, thoughtful use of imaging, and careful evaluation for possible abuse.
While indications and techniques for thoracostomy are well studied in adults, pediatric-specific evidence remains limited for emergency department-based thoracostomy and especially thoracotomy. The ability to perform urgent interventions for life-threatening pleural space pathologies is essential for all emergency clinicians. This issue reviews the clinical indications for thoracostomy and thoracotomy in pediatric patients, outlines procedural considerations for these techniques, and discusses potential complications in the emergency department. Advancements in the field are also highlighted, including emerging approaches to reduce procedural delays and improve patient outcomes.
