Objective: The coronavirus disease (COVID-19) pandemic has presented unique challenges to pediatric emergency medicine (PEM) departments. The purpose of this study was to identify these challenges and ascertain how centers overcame barriers in creating solutions to continue to provide high-quality care and keep their workforce safe during the early pandemic. Methods: This is a qualitative study based on semi-structured interviews with physicians in leadership positions who have disaster or emergency management experience. Participants were identified through purposive sampling. Interviews were recorded and transcribed electronically. Themes and codes were extracted from the transcripts by 2 independent coders. Constant comparison analysis was performed until thematic saturation was achieved. Member-checking was completed to ensure trustworthiness. Results: Fourteen PEM-trained physicians participated in this study. Communication, leadership and planning, clinical practice, and personal adaptations were the principal themes identified. Recommendations elicited include improving communication strategies; increasing emergency department (ED) representation within hospital-wide incident command; preparing for a surge and accepting adult patients; personal protective equipment supply and usage; developing testing strategies; and adaptations individuals made to their practice to keep themselves and their families safe. Conclusions: By sharing COVID-19 experiences and offering solutions to commonly encountered problems, pediatric EDs may be better prepared for future pandemics.

In the December 2002 issue of Clinical Pediatric Emergency Medicine, Andrew Kienstra and the author addressed the evaluation and management of children exposed to or infected with biological agents of terrorism. This topic had become particularly relevant to pediatricians, emergency physicians, and other front-line health care workers in the United States the previous year, when a child contracted cutaneous anthrax as part of the distribution of anthrax spores to prominent political and media figures via the US Postal Service. The ensuing 11 years have seen an enormous increase in bioterrorism research. This article reviews updates in the detection, diagnosis, and management of the organisms and toxins considered to be at highest risk for bioterrorist use.

Pneumothorax (PTX) is defined as the presence of gas in the potential space betweenthe visceral and parietal pleura. It can be classified into two causal categories.The first, spontaneous PTX, occurs in the absence of trauma. These pneumothora-ces (PTXs) can be further broken down into primary and secondary classifications. Aprimary spontaneous PTX occurs in a patient with either no or subclinical underlyinglung disease. Often attributed to ruptured apical blebs, primary spontaneous PTX isoften associated with smoking in adults, but can also be seen in healthy children. Asecondary spontaneous PTX occurs as a complication of a chronic or acute under-lying pulmonary disease process.The second, traumatic PTX, occurs via blunt or penetrating mechanisms. Rib frac-tures may or may not be present. Traumatic PTX takes place when air enters thepleural space from pulmonary, esophageal, chest wall, or tracheobronchial treeinjuries.

This article discusses pneumothorax, pneumomediastinum, and pulmonary embolism in pediatric practice. Although children appear to have better outcomes than adults, the risk factors are substantial. Topics covered include the pathophysiology incidence, presentation, diagnosis, and management of these diseases.

Children com-monly present to the emergency department with some form of skin infection. Over the last decade, the emergence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has forced emergency physicians to rethink our approach to cutaneous infections. These types of infections appear to be increasing. Knowledge of community patterns of antibiotic sensitivity is imperative in management.

Tropical Storm Allison was the deadliest and most-costly tropical or subtropical storm in recorded United States history. The world-renowned Texas Medical Center sustained approximately $2 billion in damage, more than that experienced by any other medical community. In addition, decades of research performed by hundreds of scientists was destroyed. This article traces the unprecedented damage caused by this storm, focusing primarily on its direct and indirect effects on Texas Medical Center and its surrounding medical infrastructure. It also examines the storm's impact on Texas Children's Hospital, the only free-standing pediatric hospital in the city and one of only three tertiary-care hospitals in the city of Houston to remain open in the days following the storm.

With the recent anthrax attacks, bioterrorism has become a reality in the United States. These attacks have changed our understanding of anthrax and the use of bioweapons (BWs). Emergency department staff will be the first line of defense against probable future attacks. It is therefore critical that medical personnel are trained to recognize, respond to, and manage BW attacks. Recognizing a BW attack requires an understanding of the specific signals indicating a possible outbreak, as well as knowledge of the agents that constitute the most likely threat. Responding to an attack involves the proper notification of public health and law enforcement officials, surveillance tools to alert the medical community, and appropriate communication with the public to prevent panic. Managing an attack, in addition to direct treatment of victims, involves hospital defensive actions and effective utilization of resources and staff. Fundamental to the entire process is appropriate education and training of medical staff. Current data indicates a need for more BWs training to ensure preparedness.

Computers are becoming an increasingly important tool in the management of emergency departments across the United States. Many emergency physicians are unfamiliar with computer systems and are uncomfortable with the idea of implementing computer technology into their departments. This article summarizes the benefits of computerized patient tracking systems and outlines the process by which such a program can be selected and incorporated into an emergency center.

We estimate the impact of prenatal stress on early childhood development outcomes known as “middle years” or intermediate outcomes, which has not been studied previously. Using a unique measure of actual maternal stress induced by a large earthquake, we find that relative to children that were not exposed, in utero maternal stress reduces children’s cognitive skills and socio-emotional problems by age 3, and that the effects are heterogeneous. The negative impacts on cognitive skills occur during the first trimester of pregnancy and are found among both low and high-income children, and boys and girls. The harmful effects on socio-emotional behaviors occur when stress is experienced in the last trimester of pregnancy.