Pediatrics in Review
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(Pediatrics in Review. 1997;18:424-428.)
© 1997 American Academy of Pediatrics

In Pediatric Emergency Medicine

Jane F. Knapp, MD*
* Director, Division of Emergency Medical Services, Professor of Pediatrics, Children's Mercy Hospital, University of Missouri Kansas City School of Medicine, Kansas City, Mo

   Introduction
 
In the not-so-distant past, a pediatric resident's emergency medicine experience consisted of emergency room (ER) shifts with little or no faculty supervision, where education was provided largely by a dog-eared copy of a favorite general pediatrics textbook. How times have changed! The ER of old is today's emergency department (ED), staffed 24 hours a day by a subspecialist in pediatric emergency medicine (PEM). Nearly everything in PEM is new.

There are more than 50 PEM fellowships in North America, and more than 500 physicians are board certified in the subspecialty. Three comprehensive textbooks and many shorter manuals are devoted solely to the care of pediatric emergencies. Courses such as Pediatric Advanced Life Support (PALS) and Advanced Pediatric Life Support (APLS) have filled a sizable gap in medical education by focusing solely on the recognition and resuscitation of the sick or injured child. The development of emergency medical services for children has become a national, federally funded issue that extends well beyond the walls of the ED and into physicians' offices, in large and small communities. Most importantly, ED practice has changed with the times, applying new technologies and research-guided therapies where only unproved traditional dogmas once existed.


   Resuscitation
 
The fundamentals of resuscitation stress airway assessment and management as the initial priority. Because children are much more likely to suffer respiratory rather than cardiac compromise, airway skills are critical. The pediatric airway differs from that of the adult in several important ways that can make the procedure of intubation more difficult. These anatomic differences, coupled with the difficulties of dealing with a child who is critically ill or injured, have made safe and effective airway management an emergency medicine priority.

The process of rapid sequence induction used by anesthesiologists for children undergoing general anesthesia for operative procedures has evolved into rapid sequence . . . [Full Text of this Article]






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Copyright © 1997 by the American Academy of Pediatrics.