What is pediatric emergency medicine?
Physicians who specialize in pediatric emergency medicine have been trained to diagnose and treat patients in order to prevent death or any further disability for children in health crises. They are also skilled at health promotion and injury prevention efforts. For some young patients, emergency departments are increasingly the only source of routine medical care. Pediatric emergency physicians represent the front line of medicine.
Emergency medicine emphasizes the anticipation and recognition of a life-threatening process, rather than seeking a definitive diagnosis. The emergencies that these physicians treat are often the type parents hope never to see. The perceptions and complaints of the patients or the people who bring them to the emergency department or pediatric trauma center define the emergencies themselves. Most children treated in an emergency department will be seen in a general hospital whose staff is unlikely to include pediatric specialists. Each year, about one-third of the children who visit the emergency department are there because of an injury. Two-thirds of the visits are the result of illnesses such as debilitating asthma or life-threatening meningitis. Services are available twenty-four hours a day, seven days a week, 365 days a year in the hospital and in the field. They are provided by a network of health specialists, nurses, paramedics, emergency medical technicians, police officers, firefighters, and others dedicated to offering emergency medical services to children and adults.
Pediatric emergency specialists are needed because children are not little adults. The differences between children and adults are so great that they exist in virtually every organ system, body part, physiological process, and disease syndrome. For example, children’s lungs are smaller and more fragile than those of adults, so that they require gentler thrusts during cardiopulmonary resuscitation (CPR). Children have faster heart and respiration rates than do adults, so that what may look like normal adult rates may be a sign of serious trouble in a child. Children require different and special equipment, different-sized instruments, different doses of different medicines, and different approaches to the psychological support and remedial care given to the ill or injured patient.
Physicians and other health care providers who lack pediatric emergency medical training and experience may find it difficult to recognize children who are critically ill and require the most urgent care. For example, infants may not develop a fever to signal infection. In children, respiratory arrest or shock signals the risk of cardiopulmonary arrest, rather than the arrhythmias that typically precede cardiac arrest in adults.
A good medical outcome depends on the prompt identification and treatment of serious illness or injury in children. Emergency services personnel use a system called triage to decide whether patients are at risk for severe illness or imminent death, whether they have less urgent but still serious medical problems, or whether they have routine problems. Health care professionals use a system called the abc ’s. Children who are choking (a for airway obstruction), in respiratory distress (b for breathing), or in shock (c for circulatory collapse) are treated immediately. The sickest patients always come first.
Doctors often make the most important decisions about a patient within the first five to fifteen minutes of care. The physician first determines whether the patient is in need of treatment and confirms or rules out the presence of catastrophic disease as quickly as possible. The doctor then stabilizes the patient’s vital signs to reduce the risk of worsening symptoms or death. Next, the physician acts to relieve the most acute symptoms. The patient may then be hospitalized or discharged with directions about what to do next.
Physicians have been treating pediatric emergencies for centuries. Only recently, however, has there been much recognition among the medical community or the public that pediatric emergency care requires unique training, equipment, and procedures.
Emergency medicine as a discipline in the United States dates to 1968, when the American College of Emergency Physicians was formed. During the 1970s, pediatricians and pediatric surgeons recognized that children’s emergency care needs were not receiving adequate attention. The American Medical Association (AMA) and the American Board of Medical Specialties recognized emergency medicine as the twenty-third medical specialty in 1979. In the early 1980s, growing numbers of pediatric specialists and professional societies began to participate in the development of emergency medical systems. In 1993, a committee of the Institute of Medicine published a major study on the state of emergency care for children. The committee focused on standardizing the emergency care system so that the quality of emergency care would be consistent from state to state and community to community. It encouraged the creation of a nationwide 911 emergency response system and the establishment of minimum standards of care.
The tools, technologies, treatments, and problem-solving methods used by pediatric emergency physicians have been advancing rapidly. These specialists have gotten better at coping with the gamut of children’s emergencies, including the medical and behavioral crises of newborns, infants, toddlers, young children, and adolescents. Emergency physicians have been and continue to be responsible for the development of new treatment techniques and the widespread availability of specialized pediatric equipment.
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