Pediatric

Emergency
Medicine
Pediatric
Emergency
Medicine
Jill M. Baren, MD, MBE, FACEP, FAAP
Associate Professor of Emergency Medicine and Pediatrics
University of Pennsylvania School of Medicine
Department of Emergency Medicine
Hospital of the University of Pennsylvania
Department of Pediatrics
Division of Emergency Medicine
The Children’s Hospital of Philadelphia
Philadelphia, Pennsylvania

Steven G. Rothrock, MD, FACEP, FAAP

Professor of Emergency Medicine
University of Florida
Associate Professor of Clinical Sciences
Florida State University
Orlando Regional Healthcare System
Orlando, Florida

John A. Brennan, MD, FACEP, FAAP

Executive Director, Newark Beth Israel Medical Center
and the Children’s Hospital of New Jersey
Newark, New Jersey
Senior Vice President for Clinical and Emergency Services
Director, Pediatric Emergency Medicine
Saint Barnabas Health Care System
West Orange, New Jersey

Lance Brown, MD, MPH, FACEP, FAAP

Chief, Division of Pediatric Emergency Medicine
Associate Professor of Emergency Medicine and Pediatrics
Loma Linda University Medical Center and Children’s Hospital
Loma Linda, California

Pharmacology Editor
Ran D. Goldman, MD
Division Head and Medical Director, Division of Pediatric Emergency Medicine
British Columbia Children’s Hospital
Associate Professor, Department of Pediatrics
University of British Columbia
Senior Associate Clinician Scientist
Child & Family Research Institute (CFRI)
Vancouver, British Columbia, Canada
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899

PEDIATRIC EMERGENCY MEDICINE ISBN: 978-1-4160-0087-7

Copyright © 2008 by Saunders, an imprint of Elsevier Inc.

All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any
means, electronic or mechanical, including photocopying, recording, or any information storage and
retrieval system, without permission in writing from the publisher. Permissions may be sought directly
from Elsevier’s Health Sciences Rights Department in Philadelphia, PA, USA: phone: (+1) 215 239 3804, fax:
(+1) 215 239 3805, e-mail: healthpermissions@elsevier.com. You may also complete your request on-line via
the Elsevier homepage (http://www.elsevier.com), by selecting ‘Customer Support’ and then ‘Obtaining
Permissions’.

Notice

Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our knowledge, changes in practice, treatment and drug therapy may become necessary or
appropriate. Readers are advised to check the most current information provided (i) on procedures
featured or (ii) by the manufacturer of each product to be administered, to verify the recommended
dose or formula, the method and duration of administration, and contraindications. It is the
responsibility of the practitioner, relying on their own experience and knowledge of the patient, to make
diagnoses, to determine dosages and the best treatment for each individual patient, and to take all
appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the Editors
assumes any liability for any injury and/or damage to persons or property arising out or related to any
use of the material contained in this book.
The Publisher

Library of Congress Cataloging-in-Publication Data

Pediatric emergency medicine / [edited by] Jill M. Baren . . . [et al.].
p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-1-4160-0087-7
ISBN-10: 1-4160-0087-9
1. Pediatric emergencies. I. Baren, Jill M.
[DNLM: 1. Emergencies. 2. Child. 3. Critical Care—methods. 4. Infant. WS
205 P3712 2007]
RJ370.P45153 2007
618.92′0025—dc22 2007018571

Acquisitions Editor: Maria Lorusso

Developmental Editor: Joanie Milnes
Project Manager: David Saltzberg
Design Direction: Steven Stave

Working together to grow

libraries in developing countries
Printed in China www.elsevier.com | www.bookaid.org | www.sabre.org

Last digit is the print number: 9 8 7 6 5 4 3 2 1

To my husband Kenneth—I am truly grateful for your endless love, support of our family
life, and pride in my career, for without those things, this book and all of my work would
not exist.

To my sons Noah and Andrew—I am continually amazed by your gifts of love, patience, and
wisdom beyond your years. You have made every minute of my life worthwhile.

To my parents—you gave me the right start and never stopped encouraging me to be what I
wanted to be.

To an extraordinary mentor, James S. Seidel, MD, PhD, who opened many doors in the world
of pediatric emergency medicine and encouraged me to go through them.

To my co-editors John, Lance, and Steve—thank you for your friendship, creativity, humor,
persistence, high standards, and the countless hours you spent making this a reality.

Jill Baren

I dedicate this work to the two loves of my life—my wife Angela, and my daughter Ava. It is
my hope that this text serves to help protect, repair and sustain the health and lives of chil-
dren and parents everywhere.

Steve Rothrock

To my wife, Mary Beth, and our children, Kelly, Matthew and Colleen for all their help, love
and patience. To my friends and colleagues for all the support and mentoring they have given
me over the past 25 years. Especially to all the children and parents who, in a time of crisis,
put their faith and confidence in our care.

John A. Brennan

To acutely ill and injured children and the professionals who care for them.

Lance Brown

v
 Contributors
Fredrick M. Abrahamian, DO, FACEP
Assistant Professor of Medicine, UCLA School of Medicine,
Los Angeles; Director of Education, Department of
Emergency Medicine, Olive View-UCLA Medical Center,
Sylmar, California
Tetanus Prophylaxis; Rabies Postexposure Prophylaxis
Thomas J. Abramo, MD, FAAP, FACEP
Professor of Emergency Medicine and Pediatrics, Director,
Pediatric Emergency Department, Medical Director of
Pediatric Transport, and Pediatric Emergency
Phyisician-in-Chief, Department of Emergency
Medicine, Vanderbilt University Medical Center,
Monroe Carell Jr. Children’s Hospital at Vanderbilt,
Nashville, Tennessee
Monitoring in Critically Ill Children
Robert Acosta, MD
Assistant Professor, Department of Pediatrics, Albert
Einstein College of Medicine; Attending Physician,
Department of Pediatric Emergency Medicine, Jacobi
Medical Center, Bronx, New York
Rhinosinusitis
Paula Agosto, RN, MHA
Director of Nursing, Emergency, Critical Care, and
Transport, The Children’s Hospital of Philadelphia,
Philadelphia, Pennsylvania
Burns
Coburn Allen, MD
Assistant Professor of Pediatrics, Baylor College of
Medicine; Attending Physician, Texas Children’s
Hospital, Houston, Texas
Bone, Joint, and Spine Infections
Elizabeth R. Alpern, MD, MSCE
Assistant Professor, Department of Pediatrics, University of
Pennsylvania School of Medicine; Attending Physician,
Division of Emergency Medicine, Department of
Pediatrics, The Children’s Hospital of Philadelphia,
Philadelphia, Pennsylvania
Bacteremia
Jesus M. Arroyo, MD
Assistant Professor of Emergency Medicine, Department of
Emergency Medicine, University of Texas Medical
School at Houston, Houston, Texas
Sepsis
Miriam Aschkenasy, MD, MPH
Assistant Professor, Boston University School of Medicine;
Attending Physician, Boston Medical Center, Boston,
Massachusetts
Ear Diseases
Peter S. Auerbach, MD, FAAEM, FAAP
Attending Physician, Department of Emergency Medicine,
Inova Fairfax Hospital and Inova Fairfax Hospital for
Children, Falls Church, Virginia
Pelvic and Genitourinary Trauma
Franz E. Babl, MD, MPH
Clinical Associate Professor, University of Melbourne;
Pediatric Emergency Physician, Royal Children’s
Hospital, Melbourne, Victoria, Australia
Central Nervous System Vascular Disorders; Vaccination-
Related Complaints and Side Effects
Michael C. Bachman, MD, MBA
Assistant Medical Director, Department of Pediatric
Emergency Medicine, and Pediatric Emergency
Medicine Fellowship Director, Newark Beth Israel
Medical Center, Newark, New Jersey
Eye Disorders
Megan H. Bair-Merritt, MD, MSCE
Assistant Professor, Division of General Pediatrics and
Adolescent Medicine, Johns Hopkins School of
Medicine, Baltimore, Maryland
Interpersonal and Intimate Partner Violence
Roger A. Band, MD
Department of Emergency Medicine, Hospital of the
University of Pennsylvania, Philadelphia, Pennsylvania
Penile and Testicular Disorders
Isabel Barata, MD
Assistant Professor of Pediatrics, New York University
Medical School, New York; Director of Pediatric
Emergency Medicine, North Shore University Hospital,
Manhasset, New York
Neurovascular Injuries
Besh Barcega, MD, MBA
Assistant Professor, Emergency Medicine and Pediatrics,
Loma Linda University School of Medicine; Medical
Director, Pediatric Emergency Department, Loma Linda
University Children’s Hospital and Medical Center,
Loma Linda, California
Lower Extremity Trauma
vii
viii Contributors
Jill M. Baren, MD, MBE, FACEP, FAAP
Associate Professor of Emergency Medicine and Pediatrics,
University of Pennsylvania School of Medicine;
Department of Emergency Medicine, Hospital of the
University of Pennsylvania; Division of Emergency
Medicine, Department of Pediatrics, The Children’s
Hospital of Philadelphia, Philadelphia, Pennsylvania
End-of-Life Issues
Beverly H. Bauman, MD
Department of Emergency Medicine, Oregon Health and
Sciences University, Portland, Oregon
Ovarian Disorders; Vaginal and Urethral Disorders
Lee S. Benjamin, MD
Assistant Professor, Division of Emergency Medicine,
Department of Surgery, and Division of Pediatric
Emergency Medicine, Department of Pediatrics, Duke
University School of Medicine; Interim Associate
Medical Director of Pediatric Emergency Medicine,
Duke University Medical Center, Durham, North
Carolina
Serum Sickness
Suzanne M. Beno, MD
Assistant Professor, Faculty of Medicine and Dentistry,
University of Alberta; Faculty, Division of Pediatric
Emergency Medicine, The Stollery Children’s Hospital,
Edmonton, Alberta, Canada; Formerly Clinical
Instructor, University of Pennsylvania School of
Medicine; Fellow, Pediatric Emergency Medicine, The
Children’s Hospital of Philadelphia, Philadelphia,
Pennsylvania
Anaphylaxis; Renal Disorders
Deena Berkowitz, MD, MPH
Adjunct Professor, Department of Pediatrics, George
Washington University of Medicine; Attending,
Emergency Department, Children’s National Medical
Center, Washington, DC
Lumbar Puncture
Jason E. Bernad, MD
Attending Physician—Emergency Medicine, Saratoga
Hospital, Saratoga Springs, New York
Wound Management
Daan Biesbroeck, MD
Attending Emergency Department Staff, OLVG Hospital,
Amsterdam, The Netherlands
Urinary Tract Infections in Children and Adolescents
Jeffrey S. Blake, MD
Pediatric Emergency Medicine Fellow, Division of
Emergency Medicine, Children’s National Medical
Center, Washington, DC
Gastrointestinal Bleeding
Frederick C. Blum, MD, FACEP
Associate Professor of Emergency Medicine and Pediatrics,
West Virginia University School of Medicine,
Department of Emergency Medicine, Ruby Memorial
Hospital, Morgantown, West Virginia
Abdominal Trauma
Boura’a Bou Aram, MD
Department of Pediatrics, State University of New York
Upstate Medical University, Syracuse, New York
Hemolytic-Uremic Syndrome; Utilizing Blood Bank
Resources/Transfusion Reactions and Complications
John C. Brancato, MD
Assistant Professor of Pediatrics and Emergency Medicine,
University of Connecticut School of Medicine,
Farmington; Attending Physician, Division of
Emergency Medicine, Connecticut Children’s Medical
Center, Hartford, Connecticut
Abdominal Hernias; Metabolic Acidosis; Metabolic Alkalosis
Daniel F. Brennan, MD
Clinical Associate Professor, Department of Emergency
Medicine, University of Florida College of Medicine,
Gainesville; Clinical Associate Professor, Department of
Clinical Sciences, Florida State University College of
Medicine, Orlando Campus, Tallahassee; Attending
Physician, Department of Emergency Medicine,
Emergency Medicine Residency Program, Orlando
Regional Medical Center, Orlando, Florida
Ectopic Pregnancy
John A. Brennan, MD, FACEP, FAAP
Executive Director, Newark Beth Israel Medical Center and
the Children’s Hospital of New Jersey, Newark, New
Jersey; Senior Vice President for Clinical and Emergency
Services, and Director, Pediatric Emergency Medicine,
Saint Barnabas Health Care System, West Orange, New
Jersey
The Sick or Injured Child in a Community Hospital
Emergency Department; Patient Safety, Medical Errors,
and Quality of Care; Hernia Reduction
Allison V. Brewer, MD
Attending Physician, Mercy Hospital, Portland, Maine
Musculoskeletal Disorders in Systemic Disease
Kenneth B. Briskin, MD, FACS
Associate Clinical Professor, Temple University,
Philadelphia; Assistant Clinical Professor, University
of Pennsylvania, Philadelphia, Pennsylvania; Chief,
Division of Otolaryngology, Crozer-Chester Medical
Center, Upland, Pennsylvania
Epistaxis; Epistaxis Control
Kathleen Brown, MD
Assistant Professor of Pediatrics and Emergency Medicine,
George Washington University School of Medicine;
Medical Unit Director, Pediatric Emergency Medicine,
Children’s National Medical Center, Washington, DC
Lumbar Puncture
Lance Brown, MD, MPH, FACEP, FAAP
Chief, Division of Pediatric Emergency Medicine, and
Associate Professor of Emergency Medicine and
Pediatrics, Loma Linda University Medical Center and
Children’s Hospital, Loma Linda, California
Approach to Multisystem Trauma; Excessive Crying

Linda L. Brown, MD, MSCE
Assistant Professor of Pediatrics, Yale University School of
Medicine; Attending, Pediatric Emergency Medicine,
Yale-New Haven Children’s Hospital, New Haven,
Connecticut
Dental Disorders
Michael D. Burg, MD, FACEP
Assistant Clinical Professor of Emergency Medicine,
Department of Emergency Medicine, University of
California, San Francisco-Fresno, University Medical
Center, Fresno, California
Upper Extremity Trauma
Sean P. Bush, MD, FACEP
Professor of Emergency Medicine, Department of
Emergency Medicine, Loma Linda University School of
Medicine; Director, Fellowship of Envenomation
Medicine, Department of Emergency Medicine, Loma
Linda University Medical Center, Loma Linda,
California
Snake and Spider Envenomations
James M. Callahan, MD
Associate Professor of Clinical Pediatrics, Department of
Pediatrics, Division of Emergency Medicine, University
of Pennsylvania School of Medicine; Director, Medical
Education, Emergency Department, The Children’s
Hospital of Philadelphia, Philadelphia, Pennsylvania
Wound Management
Richard M. Cantor, MD
Associate Professor of Emergency Medicine and Pediatrics,
Upstate Medical University; Director, Pediatric
Emergency Services, University Hospital, Syracuse, New
York
Neonatal Resuscitation; Common Pediatric Overdoses
Nicole P. Carbonell, MD
Resident, School of Medicine, University of Alabama at
Birmingham; Resident, Department of Emergency
Medicine, University Hospital, University of Alabama at
Birmingham, Birmingham, Alabama
Thoracostomy
Eric T. Carter, MD
Assistant Medical Director, Emergency Department, South
Lake Hospital, Clermont, Florida
Hypokalemia; Hyperkalemia; Hypocalcemia
David D. Cassidy, MD
Clinical Assistant Professor, Department of Emergency
Medicine, University of Florida College of Medicine,
Gainesville; Clinical Assistant Professor, Department of
Clinical Sciences, Florida State University College of
Medicine, Tallahassee; Assistant Director, Department
of Emergency Medicine, and Attending and Ultrasound
Director, Emergency Medicine Residency Program,
Orlando Regional Medical Center, Orlando, Florida
Pyloric Stenosis; Constipation
Contributors ix
Marina Catallozzi, MD
Assistant Professor of Clinical Pediatrics and Population
and Family Health, Columbia University—College of
Physicians and Surgeons, Mailman School of Public
Health, New York, New York
Human Immunodeficiency Virus Infection and Other
Immunosuppressive Conditions
Esther H. Chen, MD
Assistant Professor, University of Pennsylvania; Attending
Physician, Hospital of the University of Pennsylvania,
Philadelphia, Pennsylvania
Postexposure Prophylaxis
Richard E. Chinnock, MD
Professor and Chair of Pediatrics, Loma Linda University
School of Medicine; Physician-in-Chief, and Director,
Pediatric Heart Transplant Program, Loma Linda
University Children’s Hospital, Loma Linda, California
Postsurgical Cardiac Conditions and Transplantation
Christine S. Cho, MD, MPH
Assistant Clinical Professor, Department of Pediatrics,
University of California San Francisco, San Francisco;
Attending Physician, Children’s Hospital and Research
Center, Oakland, California
Circulatory Emergencies: Shock
Thomas H. Chun, MD
Assistant Professor, Departments of Emergency Medicine
and Pediatrics, Brown University; Attending Physician,
Emergency Department, Hasbro Children’s Hospital,
Providence, Rhode Island
Psychobehavioral Disorders
Mark C. Clark, MD, FACEP, FAAP
Clinical Associate Professor, Department of Emergency
Medicine, University of Florida College of Medicine,
Gainesville; Medical Director, Department of
Emergency Medicine, Arnold Palmer Hospital for
Children, Orlando; Clinical Associate Professor,
Department of Clinical Sciences, Florida State University
College of Medicine, Tallahassee, Florida
Hernia Reduction
Robert L. Cloutier, MD
Assistant Professor, Department of Emergency Medicine &
Pediatrics, Oregon Health & Science University,
Portland, Oregon
Ovarian Disorders; Vaginal and Urethral Disorders
Teresa J. Coco, MD
Assistant Professor of Pediatric Emergency Medicine,
University of Alabama at Birmingham School of
Medicine; Administrator, After Hours Clinic Children’s
South, Children’s Hospital of Alabama, Birmingham,
Alabama
General Approach to Poisoning
Arthur Cooper, MD, MS
Professor of Surgery, Columbia University College of
Physicians & Surgeons; Director of Trauma & Pediatric
Surgical Services, Harlem Hospital Center, New York,
New York
Thoracic Trauma; Abdominal Trauma
x Contributors
James D’Agostino, MD
Assistant Professor of Emergency Medicine and Pediatrics,
Department of Emergency Medicine, Upstate Medical
University, Syracuse, New York
Malrotation and Midgut Volvulus
Elizabeth M. Datner, MD
Associate Professor, University of Pennsylvania School of
Medicine; Medical Director, Department of Emergency
Medicine, Hospital of the University of Pennsylvania,
Philadelphia, Pennsylvania
Pregnancy-Related Complications
Sergio V. Delgado, MD
Associate Professor, Child and Adolescent Psychiatry,
Department of Psychiatry, University of Cincinnati
School of Medicine; Medical Director, Outpatient
Services, Department of Psychiatry, Cincinnati
Children’s Hospital Medical Center, Cincinnati, Ohio
Major Depression and Suicidality
T. Kent Denmark, MD
Associate Professor of Emergency Medicine and Pediatrics,
and Medical Director, Medical Simulation Center, Loma
Linda University School of Medicine; Program Director,
Pediatric Emergency Medicine, Attending Physician,
Pediatric Emergency Department, Loma Linda
University Medical Center and Children’s Hospital,
Loma Linda, California
Inborn Errors of Metabolism; Near Drowning and
Submersion Injuries
Andrew DePiero, MD
Assistant Professor of Pediatrics, Jefferson Medical College,
Philadelphia, Pennsylvania; Attending Physician,
Division of Emergency Medicine, A.I. duPont Hospital
for Children, Wilmington, Delaware
Apparent Life-Threatening Events
Stephanie J. Doniger, MD, FAAP
Pediatric Emergency Medicine Fellow, Children’s Hospital
and Health Center/University of California, San Diego,
San Diego, California
Dysrhythmias
Aaron J. Donoghue, MD, MSCE
Assistant Professor of Pediatrics and Anesthesia, University
of Pennsylvania School of Medicine; Attending
Physician, Division of Emergency Medicine and Critical
Care Medicine, The Children’s Hospital of Philadelphia,
Philadelphia, Pennsylvania
Intubation, Rescue Devices, and Airway Adjuncts
Gregory M. Enns, MB, ChB
Associate Professor of Pediatrics, and Director, Biomedical
Genetics Program, Division of Medical Genetics,
Stanford University, Stanford, California
Hypoglycemia
Mirna M. Farah, MD
Assistant Professor, Division of Emergency Medicine,
Department of Pediatrics, University of Pennsylvania
School of Medicine; Attending Physician, The Children’s
Hospital of Philadelphia, Philadelphia, Pennsylvania
Family Presence
Joel A. Fein, MD, MPH
Associate Professor of Pediatrics and Emergency Medicine,
University of Pennsylvania School of Medicine;
Attending Physician, Emergency Department, The
Children’s Hospital of Philadelphia, Philadelphia,
Pennsylvania
Interpersonal and Intimate Partner Violence
George L. Foltin, MD
Associate Professor of Pediatrics and Emergency Medicine,
New York University School of Medicine; Director,
Center for Pediatric Emergency Medicine, Bellevue
Hospital Center, New York, New York
Thoracic Trauma; Abdominal Trauma; Emergency Medical
Services and Transport
Eron Y. Friedlaender, MD, MPH
Assistant Professor of Clinical Pediatrics, University of
Pennsylvania School of Medicine; Attending Physician,
Division of Emergency Medicine, Department of
Pediatrics, The Children’s Hospital of Philadelphia,
Philadelphia, Pennsylvania
Cystic Fibrosis
Susan Fuchs, MD
Professor of Pediatrics, Feinberg School of Medicine,
Northwestern University; Associate Director, Division of
Pediatric Emergency Medicine, Children’s Memorial
Hospital, Chicago, Illinois
The Child-Friendly Emergency Department: Practices,
Policies, and Procedures
Gregory Garra, DO
Assistant Clinical Professor of Emergency Medicine, Stony
Brook University School of Medicine; Emergency
Medicine Residency Program Director, Stony Brook
University Hospital, Stony Brook, New York
Removal of Ocular Foreign Bodies; Fracture Reduction and
Splinting Techniques
Marianne Gausche-Hill, MD
Professor of Clinical Medicine, David Geffen School of
Medicine at UCLA, Los Angeles; Director, EMS and
Pediatric Emergency Medicine Fellowships, Harbor-
UCLA Medical Center, Torrance, California
Respiratory Distress and Respiratory Failure
Barry G. Gilmore, MD, MSW
Associate Professor of Pediatrics, Department of Pediatrics,
University of Tennessee Health Sciences Center College
of Medicine; Attending Physician, and Director of
Emergency Services, Division of Emergency Services,
LeBonheur Children’s Medical Center, Memphis,
Tennessee
Disorders of Movement; Ultrasonography
Timothy G. Givens, MD
Associate Professor, Emergency Medicine and Pediatrics,
Vanderbilt University Medical Center; Associate Medical
Director, and Fellowship Director, Pediatric Emergency
Medicine, Monroe Carell Jr. Children’s Hospital at
Vanderbilt, Nashville, Tennessee
Sickle Cell Disease

Nicole Glaser, MD
Associate Professor of Pediatrics, University of California,
Davis, School of Medicine; Department of Pediatrics,
University of California, Davis, Medical Center,
Sacramento, California
Diabetic Ketoacidosis; Hypoglycemia
Theodore E. Glynn, MD
Department of Emergency Medicine, Ingham Regional
Medical Center, Lansing; Assistant Clinical Professor,
Michigan State University, East Lansing, Michigan
Syncope
Ran D. Goldman, MD
Division Head and Medical Director, Division of Pediatric
Emergency Medicine, BC Children’s Hospital; Associate
Professor, Department of Pediatrics, University of
British Columbia; Senior Associate Clinician Scientist,
Child & Family Research Institute (CFRI), Vancouver,
British Columbia, Canada
Oral, Ocular, and Maxillofacial Trauma
Marc H. Gorelick, MD, MSCE
Professor of Pediatrics and Population Health, Medical
College of Wisconsin; Jon E. Vice Chair in Emergency
Medicine, Children’s Hospital of Wisconsin, Milwaukee,
Wisconsin
Urinary Tract Infection in Infants
Vincent J. Grant, MD, FRCP(C), FAAP
Assistant Professor, Division of Pediatric Emergency
Medicine, Department of Pediatrics, University of
Ottawa; Medical Director, Trauma Program, Children’s
Hospital of Eastern Ontario, Ottawa, Ontario, Canada
Head Trauma
Steven M. Green, MD
Professor of Emergency Medicine and Pediatrics, Loma
Linda University, Loma Linda, California
Procedural Sedation and Analgesia
Victoria S. Gregg, MD
Assistant Professor of Pediatrics, Baylor College of
Medicine; Attending Physician, Emergency Department,
Texas Children’s Hospital, Houston, Texas
Overuse Syndromes and Inflammatory Conditions
Jacqueline Grupp-Phelan, MD, MPH
Associate Professor of Clinical Pediatrics, University of
Cincinnati College of Medicine; Assistant Professor of
Clinical Pediatrics, Division of Emergency Medicine,
Cincinnati Children’s Hospital Medical Center,
Cincinnati, Ohio
Major Depression and Suicidality
Martin I. Herman, MD
Professor of Pediatrics, University of Tennessee Health
Sciences Center College of Medicine; Attending
Physician, Director of Urgent Care Services, and
Assistant Director, Emergency Services, LeBonheur
Children’s Medical Center, Memphis, Tennessee
Disorders of Movement; Testicular Torsion
Contributors xi
Marilyn P. Hicks, MD*
Director of Pediatric Emergency Medicine Education,
Department of Emergency Medicine, WakeMed Health
Systems, Raleigh; Adjunct Assistant Professor of
Emergency Medicine, University of North Carolina at
Chapel Hill, Chapel Hill, North Carolina
Excessive Crying
Nancy E. Holecek, RN
Senior Vice President for Patient Care Services, Saint
Barnabas Health Care System, West Orange New Jersey
Patient Safety, Medical Errors, and Quality of Care
Mark A. Hostetler, MD, MPH, FACEP, FAAP
Associate Professor, Department of Pediatrics, and Chief,
Section of Pediatric Emergency Medicine, The
University of Chicago, Pritzker School of Medicine;
Medical Director, Pediatric Emergency Department, The
University of Chicago Comer Children’s Hospital,
Chicago, Illinois
Inhalation Exposures
Vivian Hwang, MD
Assistant Clinical Professor of Emergency Medicine, The
George Washington University School of Medicine and
Health Sciences, Washington, DC; Attending Physician,
Inova Fairfax Hospital, Falls Church, Virginia
Muscle and Connective Tissue Disorders
Alson S. Inaba, MD, PALS-NF
Associate Professor of Pediatrics, University of Hawaii John
A. Burns School of Medicine; Pediatric Emergency
Medicine Attending Physician and Course Director,
Kapiolani Medical Center for Women and Children;
Course Director, Pediatric Advanced Life Support, The
Queen’s Medical Center; Pediatric Advanced Life
Support National Faculty and PROAD Subcommittee,
American Heart Association National ECC Committee,
Honolulu, Hawaii
Congenital Heart Disease
Sean F. Isaak, MD
Clinical Assistant Professor, Department of Clinical
Sciences, Florida State University College of Medicine,
Tallahassee; Attending Emergency Medicine,
Department of Emergency Medicine, Orlando Regional
Healthcare, Orlando, Florida
Incision and Drainage
Paul Ishimine, MD
Assistant Clinical Professor, Departments of Medicine and
Pediatrics, University of California, San Diego, School of
Medicine; Director, Pediatric Emergency Medicine,
Department of Emergency Medicine, University of
California, San Diego, Medical Center; Associate
Fellowship Director, Division of Pediatric Emergency
Medicine, Rady Children’s Hospital—San Diego, San
Diego, California
Hyperthermia; Hypothermia
*Deceased
xii Contributors
Cynthia R. Jacobstein, MD, MSCE
Clinical Assistant Professor of Pediatrics, University of
Pennsylvania School of Medicine; Attending Physician,
Emergency Department, The Children’s Hospital of
Philadelphia, Philadelphia, Pennsylvania
Issues of Consent, Confidentiality and Minor Status
Gloria Cecelia C. Jacome, MD
Emergency Medical Associates, Long Branch, New Jersey
Digital Injuries and Infections
David M. Jaffe, MD
Dana Brown Professor of Pediatrics, and Director, Division
of Emergency Medicine, Washington University, and St.
Louis Children’s Hospital, St. Louis, Missouri
Fever in the Well-Appearing Young Infant
David P. John, MD
Director of Quality and Risk Management, Department of
Emergency Medicine, Middlesex Healthcare System,
Middletown, Connecticut
Patient Safety, Medical Errors, and Quality of Care
Madeline Matar Joseph, MD
Associate Professor of Emergency Medicine and Pediatrics,
Chief, Pediatric Emergency Medicine Department, and
Medical Director, Pediatric Emergency Department,
University of Florida Health Science Center, Jacksonville,
Florida
Gastrointestinal Foreign Bodies; Hepatitis; Pancreatitis
Kelly A. Keogh, MD
Assistant Professor of Paediatrics, University of Toronto;
Division of Pediatric Emergency Medicine, Hospital for
Sick Children Toronto, Ontario, Canada
Enterostomy Tubes
Nazeema Khan, MD
Pediatric Emergency Medicine Attending, Joe DiMaggio
Children’s Hospital, Hollywood, Florida
Hypertensive Emergencies; Valvular Heart Disease
Grace J. Kim, MD
Assistant Professor of Emergency Medicine, Loma Linda
University School of Medicine; Assistant Program
Director, Pediatric Emergency Medicine Fellowship, Loma
Linda University Medical Center, Loma Linda, California
Postsurgical Cardiac Conditions and Transplantation
Tommy Y. Kim, MD
Assistant Professor, Department of Pediatric Emergency
Medicine, Loma Linda University Medical Center, Loma
Linda, California
Headaches; Conditions Causing Increased Intracranial
Pressure
Brent R. King, MD
Professor of Emergency Medicine and Pediatrics, and
Chairman, Department of Emergency Medicine, The
University of Texas Medical School at Houston; Chief of
Emergency Services, Memorial Hermann Hospital;
Attending Physician, Department of Emergency
Medicine, Lyndon B. Johnson General Hospital,
Houston, Texas
Sepsis
Christopher R. King, MD, FACEP
Associate Professor of Emergency Medicine and Pediatrics,
University of Pittsburgh School of Medicine, UPMC
Presbyterian Hospital, Children’s Hospital of Pittsburgh,
Pittsburgh, Pennsylvania
Local and Regional Anesthesia
Niranjan Kissoon, MD, FRCP(C), FAAP, FCCM, FACPE
Professor and Associate Head, Department of Pediatrics,
Faculty of Medicine, University of British Columbia;
Senior Medical Director, Acute and Critical Care
Program, BC Children’s Hospital, Vancouver, British
Columbia, Canada
Jaundice
Craig A. Kizewic, DO
Pediatric Emergency Medicine Fellow, Department of
Emergency Medicine, University of Florida Health
Science Center—Shands Jacksonville, Jacksonville, Florida
Gastrointestinal Foreign Bodies
Ann Klasner, MD, MPH
Associate Professor of Pediatrics, University of Alabama at
Birmingham; Co-Director, Pediatric Emergency
Fellowship Program, and Attending Physician,
Emergency Department, The Children’s Hospital of
Alabama, Birmingham, Alabama
Brain Tumor
Terry P. Klassen, MD, MSc, FRCPC
Professor and Chair, Department of Pediatrics, University
of Alberta; Regional Program Clinical Director,
Department of Child Health, Stollery Children’s
Hospital, Capital Health, Edmonton, Alberta, Canada
Upper Airway Disorders
Stephen R. Knazik, DO, MBA
Clinical Associate Professor of Pediatrics and Emergency
Medicine, Wayne State University School of Medicine;
E.D. Medical Director and Chief of Pediatric Emergency
Medicine, Children’s Hospital of Michigan, Detroit,
Michigan
Chest Pain
Paul Kolecki, MD, FACEP
Associate Professor, Department of Emergency Medicine,
Thomas Jefferson University; Consultant, Philadelphia
Poison Control Center, Philadelphia, Pennsylvania
Adverse Effects of Anticonvulsants and Psychotropic Agents
Baruch Krauss, MD, EdM
Assistant Professor of Pediatrics, Harvard Medical School
and Children’s Hospital, Boston, Massachusetts
Procedural Sedation and Analgesia
Kelly L. Kriwanek, MD
Attending Physician, Children’s Hospital Central
California, Madera, California
Peripheral Neuromuscular Disorders
Nathan Kuppermann, MD, MPH
Professor of Emergency Medicine and Pediatrics, University
of California, Davis, School of Medicine, Sacramento,
California
Diabetic Ketoacidosis

Kenneth T. Kwon, MD, FACEP, FAAP
Associate Clinical Professor, Department of Emergency
Medicine, University of California, Irvine, School of
Medicine, Irvine; Director of Pediatric Emergency
Medicine, Department of Emergency Medicine,
University of California, Irvine, Medical Center, Orange,
California
Electrical Injury
Steve Levi, MD
Assistant Clinical Professor of Medicine, Robert Wood
Johnson School of Medicine; Chief, Electrophysiology,
Our Lady of Lourdes Medical Center, Camden, New
Jersey
Pacemakers and Internal Defibrillators
Deborah A. Levine, MD
Clinical Assistant Professor of Pediatrics and Emergency
Medicine, New York University School of Medicine;
Attending Physician, Bellevue Hospital Center, New
York, New York
Bronchiolitis
Stuart Lewena, MBBS, BMedSci, FRACP
Honorary Fellow, Department of Pediatrics, Melbourne
University, Melbourne; Pediatric Emergency Physician,
Royal Children’s Hospital, Victoria, Australia
Central Nervous System Vascular Disorders; Vaccination-
Related Complaints and Side Effects
Erica L. Liebelt, MD
Associate Professor of Pediatrics and Emergency Medicine,
University of Alabama at Birmingham School of
Medicine; Director, Medical Toxicology Services,
Children’s Hospital and University of Alabama at
Birmingham Hospital, Birmingham, Alabama
General Approach to Poisoning
Marc Y. R. Linares, MD
Director, Pediatric Emergency Fellowship Program, and
Attending Physician, Emergency Department, Miami
Children’s Hospital, Miami, Florida
Gallbladder Disorders
Robert Luten, MD
Professor of Pediatrics and Emergency Medicine,
Department of Emergency Medicine, University of
Florida School of Medicine, Shands Hospital,
Jacksonville, Florida
Approach to Resuscitation and Advanced Life Support for
Infants and Children
Sharon E. Mace, MD
Associate Professor, Department of Emergency Medicine,
The Ohio State University School of Medicine,
Columbus; Faculty, and Emergency Medicine Residency,
MetroHealth Medical Center, Cleveland; Director,
Pediatric Education/Quality Improvement, and Director,
Observation Unit, Cleveland Clinic, Cleveland, Ohio
Triage
Contributors xiii
Charles G. Macias, MD, MPH
Associate Professor of Pediatrics, Baylor College of
Medicine; Attending Physician, Emergency Department,
Texas Children’s Hospital, Houston, Texas
Bone, Joint, and Spine Infections; Overuse Syndromes and
Inflammatory Conditions
Ian Maconochie, MBBS, FRCPCH, FCEM
Honorary Senior Lecturer, Imperial College; Lead
Clinician, Paediatric Emergency Department, St. Mary’s
Hospital, St. Mary’s Trust, London, United Kingdom
Dehydration and Disorders of Sodium Balance
William K. Mallon, MD, FACEP, FAASM
Associate Professor of Clinical Emergency Medicine, Keck
School of Medicine of University of Southern California;
Director, Division of International Emergency Medicine,
Department of Emergency Medicine, Los Angeles
County + University of Southern California Medical
Center, Los Angeles, California
Neck Trauma
Courtney H. Mann, MD
Adjunct Instructor, University of North Carolina at Chapel
Hill, Chapel Hill; Medical Director, Pediatric Emergency
Department, WakeMed Health and Hospitals, Raleigh,
North Carolina
Vomiting and Diarrhea
Deborah J. Mann, MD
Assistant Professor, Emergency Medicine, State University
of New York Upstate Medical University, Syracuse,
New York
Common Pediatric Overdoses
Jonathan Marr, MD
Pediatric Emergency Medicine Fellow, University of Texas
Southwestern Medical School, and Children’s Medical
Center Dallas, Dallas, Texas
Monitoring in Critically Ill Children; Seizures
Nestor Martinez, MD
Fellow, Pediatric Emergency Medicine, Miami Children’s
Hospital, Miami, Florida
Gallbladder Disorders
Andrew D. Mason, MD
Division of Pediatric Emergency Medicine, Hospital for
Sick Children, Toronto, Ontario, Canada
Enterostomy Tubes
Todd A. Mastrovitch, MD
Instructor of Emergency Medicine in Clinical Pediatrics,
Weill Medical College of Cornell University, New York;
Academic Pediatric Emergency Medicine Attending, and
Director, Pediatric Education, Department of Emergency
Medicine, New York Hospital Queens, Flushing, New
York
Failure to Thrive
Thom A. Mayer, MD
Chairman of Emergency Medicine, Fairfax Medical Center,
Fairfax, Virginia
Triage
xiv Contributors
James J. McCarthy, MD, FACEP
Assistant Professor, Department of Emergency Medicine,
University of Texas at Houston Medical School; Medical
Director, Emergency Center, Memorial Hermann
Hospital, Houston, Texas
Sepsis
Maureen McCollough, MD, FACEP
Associate Professor of Emergency Medicine and Pediatrics,
Keck School of Medicine of University of Southern
California; Medical Director, Department of Emergency
Medicine, and Director, Pediatric Emergency
Department, Los Angeles County + University of
Southern California Medical Center, Los Angeles,
California
The Critically Ill Neonate
Ryan S. McCormick, BS, EMT-P
Director, Office of Emergency Management, and Director,
Center for Healthcare Preparedness, Saint Barnabas
Health Care System, West Orange, New Jersey
Disaster Preparedness for Children
Barbara E. McDevitt, MD
Director of Pediatric Emergency Services, Saint Barnabas
Medical Center, Livingston, New Jersey
Thoracic Trauma; Vomiting, Spitting Up, and Feeding
Disorders
William M. McDonnell, MD, JD
Assistant Professor of Pediatrics, Division of Pediatric
Emergency Medicine, University of Utah School of
Medicine; Primary Children’s Medical Center, Salt Lake
City, Utah
High Altitude–Associated Illnesses
Mark S. McIntosh, MD, MPH, FAAP, FACEP
Clinical Assistant Professor, Department of Emergency
Medicine, University of Florida, Jacksonville, Florida
Valvular Heart Disease
Francis Mencl, MD, MS, FACEP
Associate Professor of Emergency Medicine, Northeastern
Ohio Universities College of Medicine, Rootstown;
Director of EMS, and Attending Emergency Department
Staff, Summa Health Systems, Akron, Ohio
Urinary Tract Infections in Children and Adolescents
Russell Migita, MD
Clinical Assistant Professor, Division of Emergency
Medicine, Department of Pediatrics, University of
Washington School of Medicine; Clinical Director,
Emergency Services, Children’s Hospital and Regional
Medical Center, Seattle, Washington
Ventriculoperitoneal and Other Intracranial Shunts
Angela M. Mills, MD, FACEP
Assistant Professor, University of Pennsylvania School of
Medicine; Attending Physician, Department of
Emergency Medicine, Hospital of the University of
Pennsylvania, Philadelphia, Pennsylvania
Pregnancy-Related Complications
Lilit Minasyan, MD
Fellow, Pediatric Emergency Medicine, Loma Linda
University Children’s Hospital and Medical Center,
Loma Linda, California
Lower Extremity Trauma
Rakesh D. Mistry, MD, MS
Assistant Professor of Pediatrics, University of Pennsylvania
School of Medicine; Attending Physician, Division of
Emergency Medicine, The Children’s Hospital of
Philadelphia, Philadelphia, Pennsylvania
Urinary Tract Infection in Infants
Ameer P. Mody, MD, MPH
Assistant Professor of Emergency Medicine and Pediatrics,
Loma Linda University School of Medicine, Loma Linda;
Clinical Director, Pediatric Emergency Medicine,
Emergency Medicine Specialists of Orange County,
Children’s Hospital of Orange County, Orange,
California
Trauma in Infants; The Steroid-Dependent Child; Addisonian
Crisis; Thyrotoxicosis
Cynthia J. Mollen, MD, MSCE
Assistant Professor, Pediatrics, University of Pennsylvania;
Attending Physician, Emergency Medicine, The
Children’s Hospital of Philadelphia, Philadelphia,
Pennsylvania
Sexually Transmitted Infections
James A. Moynihan, MS, DO, FAAP
Assistant Residency Director for Pediatric Emergency
Medicine Fellowship, and Assistant Professor of
Emergency Medicine, Division of Pediatric Emergency
Medicine, Department of Emergency Medicine, Loma
Linda University School of Medicine; Assistant Medical
Director, Department of Emergency Medicine, Loma
Linda University Medical Center and Children’s
Hospital, Loma Linda, California
Snake and Spider Envenomations
Antonio E. Muñiz, MD, FACEP, FAAP, FAAEM
Associate Professor of Emergency Medicine and Pediatrics,
The University of Texas Medical School at Houston;
Medical Director of Pediatric Emergency Medicine,
Children’s Memorial Hermann Hospital, Houston, Texas
Stridor in Infancy; Neonatal Skin Disorders; Erythema
Multiforme Major and Minor; Henoch-Schönlein Purpura;
Classic Viral Exanthems; Dermatitis; Infestations; Other
Important Rashes
Stacey Murray-Taylor, MD
Associate Director, Adult Emergency Department, Newark
Beth Israel Medical Center, Newark, New Jersey
Access of Ports and Catheters and Management of
Obstruction
Michael J. Muszynski, MD
Professor of Clinical Sciences, and Orlando Regional
Campus Dean, Florida State University College of
Medicine, Tallahassee, Florida
Skin and Soft Tissue Infections

Frances M. Nadel, MD, MSCE
Assistant Professor of Clinical Pediatrics, University of
Pennsylvania School of Medicine; Attending Physician,
Division of Emergency Medicine, The Children’s
Hospital of Philadelphia, Philadelphia, Pennsylvania
Vascular Access
Alan L. Nager, MD
Assistant Professor of Pediatrics, Department of Pediatrics,
Keck School of Medicine of University of Southern
California; Director, Department of Emergency and
Transport Medicine, Children’s Hospital Los Angeles,
Los Angeles, California
Dehydration and Disorders of Sodium Balance
John F. O’Brien, MD, FACEP
Associate Clinical Professor, Department of Emergency
Medicine, University of Florida Gainesville, Gainesville;
Orlando Regional Medical Center, Associate Residency
Director, Department of Emergency Medicine, Orlando
Regional Medical Center, Orlando, Florida
Incision and Drainage
Pamela J. Okada, MD
Associate Professor of Pediatrics, University of Texas
Southwestern Medical Center at Dallas; Attending
Physician, Emergency Department, Children’s Medical
Center Dallas, Dallas, Texas
Seizures
Robert P. Olympia, MD
Assistant Professor of Emergency Medicine and Pediatrics,
Penn State College of Medicine; Attending Physician,
Department of Emergency Medicine, Penn State Milton
S. Hershey Medical Center, Hershey, Pennsylvania
Selected Infectious Diseases
Kevin C. Osterhoudt, MD, MSCE
Associate Professor of Pediatrics, University of
Pennsylvania School of Medicine; Medical Director, The
Poison Control Center, The Children’s Hospital of
Philadelphia, Philadelphia, Pennsylvania
Toxic Alcohols
Patricia S. Padlipsky, MD
Fellow in Pediatric Emergency Medicine, Harbor-UCLA
Medical Center, Torrance, California
Respiratory Distress and Respiratory Failure
Joe Pagane, MD
Department of Emergency Medicine, Orlando Regional
Medical Center, Orlando, Florida
Foreign Body Removal
Ruth Ann Pannell, MD
Resident, Emergency Medicine, Orlando Regional Medical
Center, Orlando, Florida
Foreign Body Removal
Norman A. Paradis, MD
Senior Medical Director, Emergency Medicine, and
Professor of Surgery and Medicine, University of
Colorado Health Sciences Center, Denver, Colorado
Cerebral Resuscitation
Contributors xv
Ronald I. Paul, MD
Professor of Pediatrics, and Chief, Division of Pediatric
Emergency Medicine, University of Louisville; Chief,
Pediatric Emergency Medicine, Kosair Children’s
Hospital, Louisville, Kentucky
Diseases of the Hip
Barbara M. Garcia Peña, MD, MPH
Research Director, Assistant Fellowship Director,
Emergency Department, Miami Children’s Hospital,
Miami, Florida
Inflammatory Bowel Disease
Jay Pershad, MD, FAAP
Associate Professor of Pediatrics, and Co-Director,
Pediatric Emergency Fellowship Program, University of
Tennessee Health Sciences Center; Attending Physician,
Emergency Department, and Associate Medical Director,
EMSC Education, and Sedationist, Radiology
Department, LeBonheur Children’s Medical Center,
Memphis, Tennessee
Peripheral Neuromuscular Disorders; Ultrasonography
Shari L. Platt, MD, FAAP
Associate Professor of Clinical Pediatrics, Weill Cornell
College of Medicine; Director, Pediatric Emergency
Service, New York Presbyterian Hospital, New York,
New York
Pneumonia
Jill C. Posner, MD, MSCE
Assistant Professor of Pediatrics, University of Pennsylvania
School of Medicine, University of Pennsylvania;
Attending Physician, Pediatric Emergency Medicine, The
Children’s Hospital of Philadelphia, Philadelphia,
Pennsylvania
Menstrual Disorders; Replacing a Tracheostomy Tube
Amy L. Puchalski, MD
Assistant Professor of Pediatrics and Emergency Medicine,
Medical College of Georgia; Attending Physician,
Children’s Medical Center, Augusta, Georgia
Neck Infections; Neck Masses
Earl J. Reisdorff, MD
Director of Medical Education, Department of Emergency
Medicine, Ingham Regional Medical Center, Lansing;
Associate Professor, Michigan State University, East
Lansing, Michigan
Syncope; Chest Pain
Mark G. Roback, MD
Professor of Pediatrics, and Associate Director, Division of
Emergency Medicine, University of Minnesota Medical
School, Minneapolis, Minnesota
High Altitude–Associated Illnesses
Steven C. Rogers, MD
Fellow, Pediatric Emergency Medicine, University of Utah
Health Sciences Center, Salt Lake City, Utah
Near Drowning and Submersion Injuries
xvi Contributors
Genie E. Roosevelt, MD, MPH
Assistant Professor, Section of Emergency Medicine,
Department of Pediatrics, University of Colorado at
Denver and Health Sciences Center; Attending
Physician, Emergency Department, The Children’s
Hospital, Denver, Colorado
Cerebral Resuscitation
Lazaro G. Rosales, MD
Department of Pathology, State University of New York
Upstate Medical University, Syracuse, New York
Utilizing Blood Bank Resources/Transfusion Reactions and
Complications
Kimberly R. Roth, MD
Assistant Professor, Division of Pediatric Emergency
Medicine, University of Pittsburgh School of Medicine,
Children’s Hospital of Pittsburgh, Pittsburgh,
Pennsylvania
Local and Regional Anesthesia
Steven G. Rothrock, MD, FACEP, FAAP
Professor of Emergency Medicine, University of Florida;
Associate Professor of Clinical Sciences, Florida State
University, Orlando Regional Healthcare System,
Orlando, Florida
Approach to Resuscitation and Advanced Life Support for
Infants and Children; Rapid Sequence Intubation;
Neonatal Resuscitation; The Critically Ill Neonate;
Circulatory Emergencies: Shock; Oral, Ocular, and
Maxillofacial Trauma; Appendicitis
Alfred Sacchetti, MD
Assistant Clinical Professor, Emergency Medicine, Thomas
Jefferson University, Philadelphia, Pennsylvania; Chief,
Emergency Services, Our Lady of Lourdes Medical
Center, Camden, New Jersey
The Sick or Injured Child in a Community Hospital
Emergency Department; Pacemakers and Internal
Defibrillators
Peter D. Sadowitz, MD
Associate Professor of Pediatric Emergency Medicine and
Associate Professor of Medicine, State University of New
York, Syracuse, New York
Cancer and Cancer-Related Complications in Children; Acute
Childhood Immune Thrombocytopenic Purpura and
Related Platelet Disorders
Esther Maria Sampayo, MD
Assistant Professor of Pediatrics and Pediatric Emergency
Medicine, University of Pennsylvania; Children’s
Hospital of Philadelphia, Philadelphia, Pennsylvania
Oral Lesions
John P. Santamaria, MD
Affi liate Professor, Department of Pediatrics, University of
South Florida School of Medicine, Tampa, Florida
Dysbarism
Neil Schamban, MD
Associate Clinical Professor, Emergency Medicine, Mount
Sinai School of Medicine, New York, New York; Vice
Chairman, Department of Emergency Medicine, Newark
Beth Israel Medical Center, Newark, New Jersey
Eye Disorders; The Sick or Injured Child in a Community
Hospital Emergency Department; Access of Ports and
Catheters and Management of Obstruction
Carl H. Schultz, MD, FACEP
Professor of Clinical Emergency Medicine, and Co-
Director, EMS and Disaster Medical Sciences Fellowship,
Department of Emergency Medicine, University of
California, Irvine, School of Medicine, Irvine; Director,
Disaster Medical Services, Department of Emergency
Medicine, University of California, Irvine, Medical
Center, Orange, California
Electrical Injury
Sandra H. Schwab, MD
Assistant Professor, Department of General Pediatrics,
University of Pennsylvania; Attending Physician,
Department of General Pediatrics, Division of
Emergency Medicine, The Childrens Hospital of
Philadelphia, Philadelphia, Pennsylvania
Menstrual Disorders
Fred Schwartz, MD
Attending Physician, Pediatric Emergency Medicine, Saint
Barnabas Medical Center, Livingston, New Jersey
Paraphimosis Reduction
Deborah Scott, RN, ARNP
Nurse Examiner, Arnold Palmer Hospital Child Advocacy
Center, Orlando, Florida
Sexual Abuse
Matthew A. Seibel, MD
Clinical Professor, Florida State University; Pediatric
Hospitalist, Arnold Palmer Hospital for Children,
Orlando, Florida
Sexual Abuse
Samir S. Shah, MD
Assistant Professor of Pediatrics and Epidemiology,
University of Pennsylvania School of Medicine;
Attending Physician, Divisions of Infectious Diseases
and General Pediatrics, The Children’s Hospital of
Philadelphia, Philadelphia, Pennsylvania
Post-Liver Transplantation Complications
Ghazala Q. Sharieff, MD, FACEP, FAAEM, FAAP
Associate Clinical Professor, Children’s Hospital and
Health Center, University of California, San Diego;
Director of Pediatric Emergency Medicine, Palomar-
Pomerado Hospitals, California Emergency Physicians,
San Diego, California
Dysrhythmias; Pericarditis, Myocarditis, and Endocarditis
Richard D. Shih, MD, FAAEM, FACEP
Associate Professor of Surgery, New Jersey Medical School,
UMDNJ, Newark; Residency Director, Emergency
Medicine, Morristown Memorial Hospital, Morristown,
New Jersey
Adverse Effects of Anticonvulsants and Psychotropic Agents

Jan M. Shoenberger, MD, FACEP, FAAEM
Assistant Professor of Clinical Emergency Medicine, Keck
School of Medicine of University of Southern California;
Associate Residency Director, Department of Emergency
Medicine, Los Angeles County + University of Southern
California Medical Center, Los Angeles, California
Neck Trauma
Ian Shrier, MD, PhD, Dip Sport Med (FACSM)
Associate Professor, Department of Family Medicine,
SMBD-Jewish General Hospital, McGill University;
Investigator, Centre for Clinical Epidemiology and
Community Studies, Montréal, Québec, Canada
Compartment Syndrome
Jonathan I. Singer, MD, FAAP, FACEP
Professor of Emergency Medicine and Pediatrics, Vice
Chair, and Associate Program Director, Department of
Emergency Medicine, Boonshoft School of Medicine,
Wright State University; Staff Physician, Children’s
Medical Center, Dayton, Ohio
Intussusception
Sharon R. Smith, MD
Associate Professor of Pediatrics, Department of Pediatrics,
University of Connecticut Health Center, Farmington;
Associate Professor of Pediatrics, Department of
Emergency Medicine, Connecticut Children’s Medical
Center, Hartford, Connecticut
Management of Acute Asthma
Abdul-Kader Souid, MD, PhD
Professor of Pediatrics and Biochemistry, State University
of New York Upstate Medical University, Syracuse, New
York
Cancer and Cancer-Related Complications in Children; Acute
Childhood Immune Thrombocytopenic Purpura and
Related Platelet Disorders; Disorders of Coagulation;
Hemolytic-Uremic Syndrome; Utilizing Blood Bank
Resources/Transfusion Reactions and Complications
Blake Spirko, MD, FACEP, FAAP
Pediatric Emergency Medicine Fellowship Director, and
Assistant Professor, Department of Emergency Medicine,
Tufts University School of Medicine, Boston; Pediatric
Emergency Medicine Fellowship Director, and Assistant
Professor, Department of Emergency Medicine, Baystate
Medical Center, Springfield, Massachusetts
Musculoskeletal Disorders in Systemic Disease
Nicole S. Sroufe, MD, MPH
Pediatric Emergency Medicine Fellow, Department of
Emergency Medicine, University of Michigan, Ann
Arbor, Michigan
Rhabdomyolysis
Rachel M. Stanley, MD, MHSA
Assistant Professor, University of Michigan; Department of
Emergency Medicine, University of Michigan Health
Center, Ann Arbor, Michigan
Rhabdomyolysis
Contributors xvii
Robert Steele, MD, FACEP
Associate Professor, Loma Linda University Medical
School; Interim Medical Director, Department of
Emergency Medicine, Loma Linda University Medical
Center, Loma Linda, California
Pericardiocentesis
Mardi Steere, MBBS, FAAP
Staff Specialist, Pediatric Emergency, Women’s and
Children’s Hospital, North Adelaide, South Australia,
Australia
Pancreatitis
Gail M. Stewart, DO, FAAP
Associate Professor of Emergency Medicine and Pediatrics,
Loma Linda University School of Medicine; Attending
Physician, Pediatric Emergency Department, Loma
Linda University Medical Center and Children’s
Hospital, Loma Linda, California
Trauma in Infants; Conditions Causing Increased Intracranial
Pressure
Patricia Sweeney-McMahon, RN, MS
Assistant Vice President, Clinical and Emergency Services,
Saint Barnabas Health Care System, West Orange, New
Jersey
Patient Safety, Medical Errors, and Quality of Care; Digital
Injuries and Infections
David A. Talan, MD, FACEP, FIDSA
Professor of Medicine, UCLA School of Medicine, Los
Angeles; Chairman, Department of Emergency
Medicine, and Faculty, Division of Infectious Diseases,
Olive View-UCLA Medical Center, Sylmar, California
Tetanus Prophylaxis; Rabies Postexposure Prophylaxis
Todd B. Taylor, MD
Adjunct Associate Professor, Department of Emergency
Medicine, Vanderbilt University School of Medicine,
Vanderbilt University, Nashville, Tennessee
Emergency Medical Treatment and Labor Act (EMTALA)
Stephen J. Teach, MD, MPH
Professor of Pediatrics and Emergency Medicine,
Department of Pediatrics, George Washington
University School of Medicine and Health Sciences;
Associate Chief, Division of Emergency Medicine,
Children’s National Medical Center; Associate Director,
Center for Clinical and Community Research, Children’s
National Medical Center, Washington, DC
Gastrointestinal Bleeding
Sieuwert-Jan C. ten Napel, MD
Resident, Emergency Medicine, Emergency Department,
Onze lieve Vrouwe Gasthuis-Hospital, Amsterdam, The
Netherlands
Upper Extremity Trauma
Thomas E. Terndrup, MD, FACEP, FAAEM
Professor and Chair, Emergency Medicine, and Associate
Dean for Clinical Research, Penn State Milton S.
Hershey Medical Center, Penn State College of Medicine,
Hershey, Pennsylvania
Thoracostomy
xviii Contributors
Tonya M. Thompson, MD, MA
Assistant Professor, Departments of Pediatrics and
Emergency Medicine, University of Arkansas for
Medical Sciences; Associate Pediatric Emergency
Medicine Fellowship Director, Department of Pediatrics,
Arkansas Children’s Hospital, Little Rock, Arkansas
Headaches
Andrea Thorp, MD
Fellow in Pediatric Emergency Medicine, Loma Linda
University Medical Center and Children’s Hospital,
Loma Linda, California
Pericardiocentesis
Irene Tien, MD, MSc
Assistant Professor, Boston University School of Medicine,
Boston; Staff Physician, Newton-Wellesley Hospital,
Newton, Massachusetts
Ear Diseases; Physical Abuse and Child Neglect
John A. Tilelli, MD
Clinical Assistant Professor, Florida State University,
Tallahassee; Intensivist, Division of Pediatric Critical
Care Medicine, Arnold Palmer Children’s Hospital,
Orlando Regional Healthcare System, Orlando, Florida
Drugs of Abuse; Cardiovascular Agents; Ventilator
Considerations
Nicholas Tsarouhas, MD
Associate Professor of Clinical Pediatrics, Department of
Pediatrics, University of Pennsylvania School of
Medicine; Medical Director, Emergency Transport
Services, and Attending Physician, Emergency
Department, The Children’s Hospital of Philadelphia,
Philadelphia, Pennsylvania
Burns
Michael G. Tunik, MD
Associate Professor of Pediatrics and Emergency Medicine,
New York University School of Medicine; Research
Director, and Associate Director, Pediatric Emergency
Medicine, Bellevue Hospital Center, New York, New York
Emergency Medical Services and Transport
Christian Vaillancourt, MD, MSc, FRCPC
Assistant Professor, Department of Emergency Medicine,
The Ottawa Hospital, University of Ottawa; Associate
Scientist, Ottawa Health Research Institute, Ottawa,
Ontario, Canada
Compartment Syndrome
Jonathan H. Valente, MD, FACEP
Assistant Professor, Departments of Emergency Medicine
and Pediatrics, Brown Medical School, Brown
University; Attending Physician, Rhode Island Hospital
and Hasbro Children’s Hospital, Providence, Rhode
Island
Minor Infant Problems
Peter Viccellio, MD
Clinical Professor of Emergency Medicine, Stony Brook
University Medical Center, Stony Brook, New York
Spinal Trauma
Andrew Wackett, MD
Assistant Clinical Professor of Emergency Medicine, Stony
Brook University Medical Center, Stony Brook, New
York
Spinal Trauma
Ron M. Walls, MD
Professor of Medicine, Department of Emergency
Medicine, Harvard Medical School; Chairman,
Department of Emergency Medicine, Brigham and
Women’s Hospital, Boston, Massachusetts
Intubation, Rescue Devices, and Airway Adjuncts
Jennifer L. Waxler, DO
Emergency Medical Associates, Long Branch, New Jersey
Digital Injuries and Infections
Evan J. Weiner, MD, FAAP
Fellow, Pediatric Emergency Medicine, University of
Florida Health Science Center; Physician, Pediatric
Emergency Medicine, Wolfson Children’s Hospital,
Jacksonville, Florida
Hepatitis
Stuart B. Weiss, MD
Partner, MedPrep Consulting Group, LLC, New York, New
York
Disaster Preparedness for Children
James A. Wilde, MD, FAAP
Associate Professor of Emergency Medicine and Pediatrics,
and Director, Pediatric Emergency Medicine, Medical
College of Georgia, Augusta, Georgia
Central Nervous System Infections
Kristine G. Williams, MD, MPH
Instructor, Pediatrics, Washington University School of
Medicine; Instructor, Pediatrics, Division of Emergency
Medicine, St. Louis Children’s Hospital, St. Louis,
Missouri
Fever in the Well-Appearing Young Infant
Michael Witt, MD, MPH
Instructor in Pediatrics, Harvard Medical School;
Attending Physician, Children’s Hospital, Boston,
Massachusetts
Abdominal Hernias
Aaron Wohl, MD
Clinical Assistant Professor, Department of Emergency
Medicine, University of Florida College of Medicine,
Gainesville; Attending Physician, Department of
Emergency Medicine, Lee Memorial Hospital, Fort
Myers, Florida
Constipation

Tony Woodward, MD, MBA
Professor, Division of Emergency Medicine, Department of
Pediatrics, University of Washington School of
Medicine; Director, Emergency Services, Children’s
Hospital and Regional Medical Center, Seattle,
Washington
Ventriculoperitoneal and Other Intracranial Shunts
Robert Bruce Wright, MD, FAAP, FRCPC
Assistant Professor, Division of Pediatric Emergency
Medicine, Department of Pediatrics, University of
Alberta; Assistant Director, Division of Pediatric
Emergency Medicine, Stollery Children’s Hospital,
Edmonton, Alberta, Canada
Upper Airway Disorders
Todd Wylie, MD, MPH
Assistant Professor, Program Director Pediatric Emergency
Medicine Fellowship, Department of Emergency
Medicine, University of Florida, Jacksonville, Florida
Pericarditis, Myocarditis, and Endocarditis; Hypertensive
Emergencies
Contributors xix
Kelly D. Young, MD, MS
Associate Clinical Professor of Pediatrics, David Geffen
School of Medicine at UCLA, Los Angeles; Director,
Pediatric Emergency and Pain Management Education,
Department of Emergency Medicine, Harbor-UCLA
Medical Center, Torrance, California
Approach to Pain Management
Joseph J. Zorc, MD
Associate Professor of Pediatrics and Emergency Medicine,
University of Pennsylvania School of Medicine;
Attending Physician, The Children’s Hospital of
Philadelphia, Philadelphia, Pennsylvania
Altered Mental Status/Coma
Alexander Zouros, MD, FRCS(C)
Assistant Professor, Department of Neurosurgery, Loma
Linda University Medical Center, Loma Linda,
California
Conditions Causing Increased Intracranial Pressure
 Preface
Societies are often judged by the care they provide for the
young and the weak. The quality of care for injured and ill
children has grown tremendously since the formation and
growth of pediatric emergency medicine as a subspecialty
within the pediatric and emergency medicine communities.
The body of knowledge that defines pediatric emergency
medicine is deep in breadth and wide in scope. Those who
practice it are energetic, intelligent, and caring. They come
from diverse backgrounds and share the common goal of
providing safe, comprehensive, high quality, cost-effective
care. Because children are treated in many venues ranging
from the prehospital setting, to urgent care clinics, com-
munity hospital emergency departments, academic medical
centers and pediatric specialty care hospitals, the provision
of excellent pediatric emergency care is of great interest to
many.
This text is designed to meet the needs of anyone who cares
for childhood emergencies. It is a highly practical and clini-
cally useful reference organized in a logical fashion – accord-
ing to the way one would think and problem solve when
confronted with any emergency in a child. The emphasis is
on information that has an impact in real-time care at the
bedside and therefore helps the emergency practitioner at the
moment help is most required. The book includes 200 chap-
ters replete with clinical algorithms, tables, photos, figures,
and expert commentary. The information is presented in
a format which highlights key points, important clinical
features, potential pitfalls, and delineates the diagnostic
approach and specific management for a myriad of pediatric
emergency problems.
The sections of the book are divided according to the
typical way that one experiences patients in an emergency
department – by level of acuity, type of disease, and patient
characteristics. Section I: Immediate Approach to the Critical
Patient addresses life-threatening presentations of medical
and surgical disease and contains crucial information on
providing immediate and life-saving therapies. Section II:
Approach to the Trauma Patient, provides similar information
when dealing with acute injury as well as definitive manage-
ment recommendations for a wide range of traumatic con-
ditions. Section III: Approach to Unique Problems of Infancy
highlights important clinical features and critical manage-
ment information for conditions which specifically affect this
high-risk population of emergency patients. Sections IV and
V: Approach to the Acutely Ill Patient and Approach to Envi-
ronmental Illness and Injury cover the wide spectrum of con-
ditions encountered on a regular basis in the emergency care
of children. Section VII: Procedures, Sedation, Pain Manage-
ment and Devices, provides step by step techniques, im-
portant clinical considerations, and helpful illustrations for
performing procedures and managing devices in children in
the emergency department.
Several unique features of this text will prove invaluable
to busy clinicians. Section VI: The Practice Environment,
explicitly discusses difficult issues such as triage, the care of
minors, end of life care, and family presence during resusci-
tation and offers practical and workable solutions. Section
VIII: Quick Looks, offers an immediate differential diagnosis
to common pediatric emergency department symptom-
oriented complaints ranging from abdominal pain and cya-
nosis to jaundice and lymphadenopathy. The text is extensively
cross referenced to provide the most rapid and useful assis-
tance to the reader.
The creation of the first edition of Pediatric Emergency
Medicine was borne out of the desire to synthesize and dis-
seminate the evidence based practice of emergency care for
children, where such evidence exists. There has been an
explosive amount of research in the last several years on
many aspects of pediatric emergency medicine, with findings
that challenge current practices on a regular basis. Much is
still to be learned, however, each year therapies based on
anecdotal evidence or opinion are replaced with evidence
based guidelines and validated decision rules. When evidence
to support a particular diagnostic strategy or treatment could
not be found, this text makes the best possible recommen-
dation based on current literature and expert opinion or
consensus, referencing statements in text for our readers’
convenience. It also highlights controversies, cutting edge
developments and areas that are in need of further study.
Our goal is to assure that a scientifically sound rationale
is used as the basis for the management of ill and injured
children. We hope to further such care on a regular basis
in emergency departments everywhere to individuals of all
backgrounds who provide pediatric emergency care. It is our
intention that this first edition of Pediatric Emergency Medi-
cine will become an invaluable resource in this capacity. With
the knowledge and insight gained from the experts who have
written on these pages, we sincerely hope that this text will
promote and advance excellent emergency care to the young
and vulnerable.
xxi
We gratefully acknowledge the work of Joanie Milnes, our developmental editor. Joanie was
the ultimate professional, gently guiding us through every stage of publication. She was tough
and persistent when we needed her to be but always kind, and remarkably hard working. We
also appreciate the guidance and assistance of other Elsevier staff, particularly Todd Hummel
who gave us a great start, and Maria Lorusso who gave us a great fi nish.

Ran D. Goldman, our pharmacology editor, did us a tremendous service and we are indebted
to him for providing an efficient and thorough review of our chapters and for checking every
medication dose and reference contained within. Ran, we thank you for that extra reassur-
ance and for your tremendous hard work.

We pay tribute to all our contributors who authored chapters and put up with many requests
and deadlines. Their level of excitement about the project as well as their knowledge and
commitment to creating a high quality, thoroughly referenced work was unsurpassed. Several
colleagues volunteered above and beyond the call of duty to author multiple chapters and we
are indebted to them for the volume of work they embraced in a short period of time.

We especially thank our colleagues at The Children’s Hospital of Philadelphia, the Hospital
of the University of Pennsylvania, Saint Barnabas Health Care System, Loma Linda Univer-
sity Medical Center and Children’s Hospital, and Orlando Regional Healthcare for their
willingness to become authors and for the daily privilege of working with them in our respec-
tive emergency departments.

And finally, the motivation to create this book comes in large part, from our patients. They
are a constant source of learning and inspiration and we thank them for the opportunity to
care for them. It is our intention and hope that this text will improve the health and well
being of those we are privileged to serve.

Jill M. Baren, MD, MBE, FACEP, FAAP

Steven G. Rothrock, MD, FACEP, FAAP
John A. Brennan, MD, FACEP, FAAP
Lance Brown, MD, MPH, FACEP, FAAP

xxiii

SECTION I
Immediate Approach to the Critical Patient
Chapter 1 Approach to Resuscitation and
Advanced Life Support for Infants and
Children 3
Robert Luten, MD and Steven G. Rothrock, MD
Chapter 2 Respiratory Distress and Respiratory
Failure 13
Patricia S. Padlipsky, MD and
Marianne Gausche-Hill, MD
Chapter 3 Rapid Sequence Intubation
Steven G. Rothrock, MD
Chapter 4 Intubation, Rescue Devices, and
Airway Adjuncts 37
Aaron J. Donoghue, MD, MSCE and
Ron M. Walls, MD
Chapter 5 Monitoring in Critically Ill
Children 50
Jonathan Marr, MD and Thomas J. Abramo, MD
Chapter 6 Neonatal Resuscitation 58
Richard M. Cantor, MD and
Steven G. Rothrock, MD
Chapter 7 The Critically Ill Neonate
Maureen McCollough, MD and
Steven G. Rothrock, MD
Chapter 8 Circulatory Emergencies: Shock
Christine S. Cho, MD, MPH and
Steven G. Rothrock, MD
Chapter 9 Cerebral Resuscitation 94
Genie E. Roosevelt, MD, MPH and
Norman A. Paradis, MD
Chapter 10 General Approach to Poisoning
Teresa J. Coco, MD and Erica L. Liebelt, MD
Chapter 11 Altered Mental Status/Coma
Joseph J. Zorc, MD
Contents
Chapter 12 Approach to Multisystem
Trauma 123
Lance Brown, MD, MPH
Chapter 13 Sepsis 132
Jesus M. Arroyo, MD, James J. McCarthy, MD, and
Brent R. King, MD
Chapter 14 Anaphylaxis 141
Suzanne M. Beno, MD
SECTION II
28 Approach to the Trauma Patient
Chapter 15 Trauma in Infants 149
Gail M. Stewart, DO and
Ameer P. Mody, MD, MPH
Chapter 16 Oral, Ocular, and Maxillofacial
Trauma 154
Ran D. Goldman, MD and Steven G. Rothrock, MD
Chapter 17 Head Trauma 164
Vincent J. Grant, MD
Chapter 18 Neck Trauma 169
Jan M. Shoenberger, MD and
William K. Mallon, MD
66
Chapter 19 Upper Extremity Trauma 172
Michael D. Burg, MD and
Sieuwert-Jan C. ten Napel, MD
78
Chapter 20 Lower Extremity Trauma 182
Besh Barcega, MD, MBA and Lilit Minasyan, MD
Chapter 21 Pelvic and Genitourinary Trauma 188
Peter S. Auerbach, MD
Chapter 22 Compartment Syndrome 194
106 Christian Vaillancourt, MD, MSc and
Ian Shrier, MD, PhD
115 Chapter 23 Spinal Trauma 199
Andrew Wackett, MD and Peter Viccellio, MD
xxv
xxvi Contents
Chapter 24 Thoracic Trauma 210
Barbara E. McDevitt, MD, George L. Foltin, MD, and
Arthur Cooper, MD, MS
Chapter 25 Abdominal Trauma 225
Frederick C. Blum, MD, George L. Foltin, MD, and
Arthur Cooper, MD, MS
Chapter 26 Burns 246
Nicholas Tsarouhas, MD and
Paula Agosto, RN, MHA
Chapter 27 Neurovascular Injuries
Isabel Barata, MD
SECTION III
Approach to Unique Problems of Infancy
Chapter 28 Apparent Life-Threatening Events
Andrew DePiero, MD
Chapter 29 Inborn Errors of Metabolism
T. Kent Denmark, MD
Chapter 30 Congenital Heart Disease
Alson S. Inaba, MD
Chapter 31 Excessive Crying 288
Marilyn P. Hicks, MD and Lance Brown, MD, MPH
Chapter 32 Fever in the Well-Appearing Young
Infant 291
Kristine G. Williams, MD, MPH and David M. Jaffe, MD
Chapter 33 Urinary Tract Infection in Infants
Rakesh D. Mistry, MD, MS and
Marc H. Gorelick, MD, MSCE
Chapter 34 Stridor in Infancy 306
Antonio E. Muñiz, MD
Chapter 35 Vomiting, Spitting Up, and Feeding
Disorders 319
Barbara E. McDevitt, MD
Chapter 36 Failure to Thrive 328
Todd A. Mastrovitch, MD
Chapter 37 Minor Infant Problems
Jonathan H. Valente, MD
Chapter 38 Jaundice 340
Niranjan Kissoon, MD
Chapter 39 Neonatal Skin Disorders
Antonio E. Muñiz, MD
SECTION IV
Approach to the Acutely Ill Patient
Central Nervous System
Chapter 40 Seizures 353
Jonathan Marr, MD and Pamela J. Okada, MD
Chapter 41 Headaches 360
Tommy Y. Kim, MD and Tonya M. Thompson, MD
258 Chapter 42 Conditions Causing Increased
Intracranial Pressure 367
Gail M. Stewart, DO, Tommy Y. Kim, MD, and
Alexander Zouros, MD
Chapter 43 Central Nervous System
Infections 372
269 James A. Wilde, MD
Chapter 44 Central Nervous System Vascular
273 Disorders 381
Stuart Lewena, MBBS and Franz E. Babl, MD, MPH
277 Chapter 45 Brain Tumor 385
Ann Klasner, MD, MPH
Chapter 46 Disorders of Movement 388
Martin I. Herman, MD and
Barry G. Gilmore, MD
Chapter 47 Peripheral Neuromuscular
Disorders 391
Jay Pershad, MD and Kelly L. Kriwanek, MD
299
HEENT/Neck
Chapter 48 Eye Disorders 397
Michael C. Bachman, MD, MBA and
Neil Schamban, MD
Chapter 49 Epistaxis 402
Kenneth B. Briskin, MD
Chapter 50 Rhinosinusitis 405
Robert Acosta, MD
Chapter 51 Ear Diseases 409
335 Irene Tien, MD, MSc and
Miriam Aschkenasy, MD, MPH
Chapter 52 Oral Lesions 416
Esther Maria Sampayo, MD
345 Chapter 53 Dental Disorders 422
Linda L. Brown, MD, MSCE

Chapter 54 Neck Infections 427
Amy L. Puchalski, MD
Chapter 55 Neck Masses 435
Amy L. Puchalski, MD
Respiratory
Chapter 56 Management of Acute Asthma
Sharon R. Smith, MD
Chapter 57 Bronchiolitis 450
Deborah A. Levine, MD
Chapter 58 Pneumonia 456
Shari L. Platt, MD
Chapter 59 Cystic Fibrosis 462
Eron Y. Friedlaender, MD, MPH
Chapter 60 Upper Airway Disorders
Robert Bruce Wright, MD and
Terry P. Klassen, MD
Cardiovascular
Chapter 61 Syncope 473
Theodore E. Glynn, MD and Earl J. Reisdorff, MD
Chapter 62 Chest Pain 481
Stephen R. Knazik, DO, MBA and
Earl J. Reisdorff, MD
Chapter 63 Dysrhythmias 487
Stephanie J. Doniger, MD and
Ghazala Q. Sharieff, MD
Chapter 64 Pericarditis, Myocarditis, and
Endocarditis 500
Ghazala Q. Sharieff, MD and Todd Wylie, MD
Chapter 65 Hypertensive Emergencies
Todd Wylie, MD, MPH and Nazeema Khan, MD
Chapter 66 Postsurgical Cardiac Conditions and
Transplantation 514
Grace J. Kim, MD and Richard E. Chinnock, MD
Chapter 67 Valvular Heart Disease
Mark S. McIntosh, MD, MPH and
Nazeema Khan, MD
Infectious Disease
Chapter 68 Bacteremia 530
Elizabeth R. Alpern, MD, MSCE
Contents xxvii
Chapter 69 Human Immunodeficiency Virus
Infection and Other
Immunosuppressive Conditions 535
Marina Catallozzi, MD
Chapter 70 Sexually Transmitted Infections 543
Cynthia J. Mollen, MD, MSCE
440 Chapter 71 Selected Infectious Diseases 560
Robert P. Olympia, MD
Gastrointestinal
Chapter 72 Vomiting and Diarrhea 567
Courtney H. Mann, MD
Chapter 73 Appendicitis 576
Steven G. Rothrock, MD
467 Chapter 74 Intussusception 582
Jonathan I. Singer, MD
Chapter 75 Gastrointestinal Bleeding 587
Jeffrey S. Blake, MD and
Stephen J. Teach, MD, MPH
Chapter 76 Pyloric Stenosis 593
David D. Cassidy, MD
Chapter 77 Constipation 598
David D. Cassidy, MD and Aaron Wohl, MD
Chapter 78 Gastrointestinal Foreign Bodies 603
Craig Kizewic, DO and
Madeline Matar Joseph, MD
Chapter 79 Hepatitis 609
Evan J. Weiner, MD and Madeline Matar Joseph, MD
Chapter 80 Pancreatitis 613
Mardi Steere, MBBS and
506 Madeline Matar Joseph, MD
Chapter 81 Post–Liver Transplantation
Complications 619
Samir S. Shah, MD
Chapter 82 Inflammatory Bowel Disease 625
522 Barbara M. Garcia Peña, MD, MPH
Chapter 83 Malrotation and Midgut Volvulus 630
James D’Agostino, MD
Chapter 84 Abdominal Hernias 634
Michael Witt, MD, MPH and
John C. Brancato, MD
xxviii Contents

Chapter 85 Gallbladder Disorders 639 Chapter 99 Rhabdomyolysis 730

Marc Y. R. Linares, MD and Nestor Martinez, MD Nicole S. Sroufe, MD, MPH and
Rachel M. Stanley, MD, MHSA

Genitourinary/Renal Chapter 100 Diseases of the Hip 735

Ronald I. Paul, MD
Chapter 86 Urinary Tract Infections in Children
and Adolescents 643
Francis Mencl, MD and Daan Biesbroeck, MD
Immunologic/Allergic

Chapter 87 Testicular Torsion 648 Chapter 101 Serum Sickness 741

Lee S. Benjamin, MD
Martin I. Herman, MD

Chapter 88 Renal Disorders 651 Chapter 102 Vaccination-Related Complaints and

Suzanne M. Beno, MD Side Effects 744
Franz E. Babl, MD, MPH and Stuart Lewena, MBBS

Chapter 89 Penile and Testicular Disorders 658

Roger A. Band, MD
Chapter 103 Tetanus Prophylaxis 749
Fredrick M. Abrahamian, DO and
David A. Talan, MD
Obstetrics/Gynecology
Chapter 104 Rabies Postexposure Prophylaxis 754
Chapter 90 Ectopic Pregnancy 662 Fredrick M. Abrahamian, DO and
Daniel F. Brennan, MD David A. Talan, MD

Chapter 91 Pregnancy-Related Endocrine

Complications 676
Angela M. Mills, MD and Elizabeth M. Datner, MD Chapter 105 Diabetic Ketoacidosis 759
Nicole Glaser, MD and
Chapter 92 Menstrual Disorders 683 Nathan Kuppermann, MD, MPH
Sandra H. Schwab, MD and
Jill C. Posner, MD, MSCE Chapter 106 Hypoglycemia 765
Nicole Glaser, MD and Gregory M. Enns, MB, ChB
Chapter 93 Ovarian Disorders 689
Beverly H. Bauman, MD and Robert L. Cloutier, MD Chapter 107 The Steroid-Dependent Child 771
Ameer P. Mody, MD, MPH
Chapter 94 Vaginal and Urethral Disorders 692
Beverly H. Bauman, MD and Robert L. Cloutier, MD Chapter 108 Addisonian Crisis 775
Ameer P. Mody, MD, MPH

Musculoskeletal/Rheumatologic
Chapter 109 Thyrotoxicosis 779
Ameer P. Mody, MD, MPH
Chapter 95 Musculoskeletal Disorders in Systemic
Disease 696
Blake Spirko, MD and Allison V. Brewer, MD Metabolic

Chapter 96 Bone, Joint, and Spine Infections 705 Chapter 110 Dehydration and Disorders of Sodium
Charles G. Macias, MD, MPH and Balance 782
Coburn Allen, MD Alan L. Nager, MD and Ian K. Maconochie, MBBS

Chapter 97 Muscle and Connective Tissue Chapter 111 Metabolic Acidosis 787
Disorders 716 John C. Brancato, MD
Vivian Hwang, MD
Chapter 112 Metabolic Alkalosis 790
Chapter 98 Overuse Syndromes and Inflammatory John C. Brancato, MD
Conditions 724
Charles G. Macias, MD, MPH and Chapter 113 Hypokalemia 793
Victoria S. Gregg, MD Eric T. Carter, MD

Chapter 114 Hyperkalemia 796
Eric T. Carter, MD
Chapter 115 Hypocalcemia 799
Eric T. Carter, MD
Psychiatric/Behavioral
Chapter 116 Psychobehavioral Disorders
Thomas H. Chun, MD
Chapter 117 Major Depression and
Suicidality 806
Jacqueline Grupp-Phelan, MD, MPH and
Sergio V. Delgado, MD
Chapter 118 Sexual Abuse 810
Matthew A. Seibel, MD and Deborah Scott, RN, ARNP
Chapter 119 Physical Abuse and Child
Neglect 816
Irene Tien, MD, MSc
Dermatologic
Chapter 120 Skin and Soft Tissue Infections
Michael J. Muszynski, MD
Chapter 121 Erythema Multiforme Major and
Minor 836
Antonio E. Muñiz, MD
Chapter 122 Henoch-Schönlein Purpura
Antonio E. Muñiz, MD
Chapter 123 Classic Viral Exanthems
Antonio E. Muñiz, MD
Chapter 124 Dermatitis 859
Antonio E. Muñiz, MD
Chapter 125 Infestations 871
Antonio E. Muñiz, MD
Chapter 126 Other Important Rashes
Antonio E. Muñiz, MD
Hematologic/Oncologic
Chapter 127 Sickle Cell Disease 898
Timothy G. Givens, MD
Chapter 128 Cancer and Cancer-Related
Complications in Children 905
Peter D. Sadowitz, MD and
Abdul-Kader Souid, MD, PhD
Contents xxix
Chapter 129 Acute Childhood Immune
Thrombocytopenic Purpura and
Related Platelet Disorders 912
Peter D. Sadowitz, MD and
Abdul-Kader Souid, MD, PhD
Chapter 130 Disorders of Coagulation 917
Abdul-Kader Souid, MD, PhD
801
Chapter 131 Hemolytic-Uremic Syndrome 927
Boura’a Bou Aram, MD and
Abdul-Kader Souid, MD, PhD
Chapter 132 Utilizing Blood Bank Resources/
Transfusion Reactions and
Complications 931
Abdul-Kader Souid, MD, PhD, Lazaro G. Rosales, MD,
and Boura’a Bou Aram, MD
Toxicologic
Chapter 133 Common Pediatric Overdoses 936
Deborah J. Mann, MD and Richard M. Cantor, MD
Chapter 134 Toxic Alcohols 947
Kevin C. Osterhoudt, MD, MSCE
825
Chapter 135 Drugs of Abuse 950
John A. Tilelli, MD
Chapter 136 Adverse Effects of Anticonvulsants and
Psychotropic Agents 970
Paul Kolecki, MD and Richard D. Shih, MD
841
Chapter 137 Cardiovascular Agents 975
John A. Tilelli, MD
846
SECTION V
Approach to Environmental Illness and Injury
Chapter 138 Near Drowning and Submersion
Injuries 987
T. Kent Denmark, MD and Steven C. Rogers, MD
880 Chapter 139 Hyperthermia 992
Paul Ishimine, MD
Chapter 140 Hypothermia 997
Paul Ishimine, MD
Chapter 141 Snake and Spider
Envenomations 1002
Sean P. Bush, MD and James A. Moynihan, MS, DO
Chapter 142 Electrical Injury 1011
Kenneth T. Kwon, MD and Carl H. Schultz, MD
xxx Contents

Chapter 143 Inhalation Exposures 1016 Chapter 156 Postexposure Prophylaxis 1097
Mark A. Hostetler, MD, MPH Esther H. Chen, MD

Chapter 144 Dysbarism 1021 Chapter 157 Interpersonal and Intimate Partner
John P. Santamaria, MD Violence 1103
Joel A. Fein, MD, MPH and
Chapter 145 High Altitude–Associated Megan H. Bair-Merritt, MD, MSCE
Illnesses 1025
William M. McDonnell, MD, JD and Chapter 158 Approach to Pain Management 1108
Mark G. Roback, MD Kelly D. Young, MD, MS

SECTION VI SECTION VII

The Practice Environment
Chapter 146 The Sick or Injured Child in a
Community Hospital Emergency
Department 1031
Alfred Sacchetti, MD, John A. Brennan, MD, and
Neil Schamban, MD
Chapter 147 Emergency Medical Services and
Transport 1035
Michael G. Tunik, MD and George L. Foltin, MD
Chapter 148 End-of-Life Issues 1043
Jill M. Baren, MD, MBE
Chapter 149 Patient Safety, Medical Errors, and
Quality of Care 1048
David P. John, MD, John A. Brennan, MD,
Nancy E. Holecek, RN, and
Patricia Sweeney-McMahon, RN, MS
Chapter 150 Emergency Medical Treatment and
Labor Act (EMTALA) 1053
Todd B. Taylor, MD
Procedures, Sedation, Pain Management and
Devices
Chapter 159 Procedural Sedation and
Analgesia 1119
PART 1 䊏 PRINCIPLES AND
PRACTICE 1119
Steven M. Green, MD and Baruch Krauss, MD, EdM
PART 2 䊏 DRUG SELECTION 1125
Steven M. Green, MD and Baruch Krauss, MD, EdM
Chapter 160 Wound Management 1138
Jason E. Bernad, MD and James M. Callahan, MD
Chapter 161 Vascular Access 1147
Frances M. Nadel, MD, MSCE
Chapter 162 Foreign Body Removal 1157
Ruth Ann Pannell, MD and Joe Pagane, MD
Chapter 163 Enterostomy Tubes 1168
Andrew D. Mason, MD and Kelly A. Keogh, MD

Chapter 151 Issues of Consent, Confidentiality and Chapter 164 Replacing a Tracheostomy Tube 1173
Minor Status 1062 Jill C. Posner, MD, MSCE
Cynthia R. Jacobstein, MD, MSCE
Chapter 165 Ventilator Considerations 1177
Chapter 152 Disaster Preparedness for John A. Tilelli, MD
Children 1065
Stuart B. Weiss, MD and Chapter 166 Incision and Drainage 1184
Ryan S. McCormick, BS, EMT-P Sean F. Isaak, MD and John F. O’Brien, MD

Chapter 153 Family Presence 1076 Chapter 167 Ventriculoperitoneal and Other
Mirna M. Farah, MD Intracranial Shunts 1189
Russell Migita, MD and Tony Woodward, MD, MBA
Chapter 154 The Child-Friendly Emergency
Department: Practices, Policies, and Chapter 168 Thoracostomy 1194
Procedures 1080 Nicole P. Carbonell, MD and
Susan Fuchs, MD Thomas E. Terndrup, MD

Chapter 155 Triage 1087 Chapter 169 Hernia Reduction 1201

Sharon E. Mace, MD and Thom A. Mayer, MD Mark C. Clark, MD and John A. Brennan, MD
 Contents xxxi

Chapter 170 Access of Ports and Catheters and SECTION VIII

Management of Obstruction 1205 Quick Looks
Stacey Murray-Taylor, MD and Neil Schamban, MD

Chapter 181 Headaches 1265

Chapter 171 Lumbar Puncture 1208
Kathleen Brown, MD and
Chapter 182 Abdominal Pain 1266
Deena Berkowitz, MD, MPH

Chapter 172 Local and Regional Anesthesia 1212 Chapter 183 Cyanosis 1267
Kimberly R. Roth, MD and Christopher King, MD
Chapter 184 Vomiting 1268
Chapter 173 Digital Injuries and Infections 1220
Chapter 185 Chest Pain 1269
PART 1 䊏 INJURIES 1220
Gloria Cecelia C. Jacome, MD, Chapter 186 Near Syncope/Syncope 1270
Jennifer L. Waxler, DO, and
Patricia Sweeney-McMahon, RN, MS Chapter 187 Muscular Weakness/Paralysis 1271

PART 2 䊏 INFECTIONS 1224 Chapter 188 Limp 1272

Gloria Cecelia C. Jacome, MD,
Jennifer L. Waxler, DO, and Chapter 189 Lymphadenopathy 1273
Patricia Sweeney-McMahon, RN, MS
Chapter 190 Wheezing 1274
Chapter 174 Epistaxis Control 1230
Kenneth B. Briskin, MD Chapter 191 Hematuria 1275
Chapter 175 Removal of Ocular Foreign Chapter 192 Hypertension 1276
Bodies 1234
Gregory Garra, DO
Chapter 193 Jaundice 1277
Chapter 176 Pacemakers and Internal
Chapter 194 Pallor 1278
Defibrillators 1238
Alfred Sacchetti, MD and Steve Levi, MD
Chapter 195 Arthralgias/Arthritis 1279
Chapter 177 Paraphimosis Reduction 1243
Fred Schwartz, MD
Chapter 196 Stridor 1280

Chapter 178 Fracture Reduction and Splinting Chapter 197 Vaginal Bleeding 1281
Techniques 1246
Gregory Garra, DO Chapter 198 Weakness 1282

Chapter 179 Ultrasonography 1253 Chapter 199 Weight Loss 1283

Barry G. Gilmore, MD and Jay Pershad, MD
Chapter 200 The Septic-Appearing Child 1284
Chapter 180 Pericardiocentesis 1259
Robert Steele, MD and Andrea Thorp, MD Index 1285