Management of pediatric toxic ingestions in the emergency department.

Pediatric ingestions present a common challenge for emergency clinicians. While findings and information from the physical examination, electrocardiographic, laboratory, and radiologic testing may suggest a specific ingestion, timely identification of many substances is not always possible. In addition to diagnostic challenges, the management of many ingested substances is controversial and recommendations are evolving. This issue reviews the initial resuscitation, diagnosis, and treatment of common pediatric ingestions. Also discussed are current recommendations for decontamination and administration of antidotes for specific toxins.

Prediction of clinical deterioration after admission from the pediatric emergency department.

BACKGROUND: An ongoing threat to hospitalized patients is delayed recognition of clinical deterioration and its association with increased morbidity and mortality. OBJECTIVE: This study evaluated the ability of Pediatric Emergency Medicine (PEM) clinicians to predict clinical deterioration of patients admitted from the Pediatric Emergency Department (PED). Clinical deterioration was defined as unanticipated transfer to an Intensive Care Unit (ICU) within 12 h of PED-to-ward admission. METHODS: This prospective study was conducted in the PED of an urban, academic, tertiary-care children's hospital. Nurses, attending physicians, fellows, and residents completed surveys about their predicted risk of clinical deterioration for each patient admitted to the pediatric ward using a visual analog scale (VAS), and their level of certainty in their prediction using a Likert scale. Additional data included clinician years of experience, and continuity of care versus patient hand-off between clinicians. RESULTS: 4482 surveys were completed by clinicians for 2892 unique admissions over ten months. Twenty-two patients required transfer to an ICU within 12 h of PED-to-ward admission. Nurses' predictions of deterioration risk were higher for patients who went on to require ICU transfer than for patients who did not. Level of certainty correlated with years of clinician experience and with continuity of care, and was higher for patients predicted to have a low risk of deterioration. CONCLUSIONS: Clinicians are more certain of their predictions with increasing experience, continuity of care, and when predicted risk is low.