Update in Pediatric Emergency Medicine: Pediatric Resuscitation, Pediatric Sepsis, Interfacility Transport of the Pediatric Patient, Pain and sedation in the Emergency Department, Pediatric Trauma

  • Tania Principi
  • Deborah Schonfeld
  • Laura Weingarten
  • Suzan Schneeweiss
  • Daniel Rosenfield
  • Genevieve Ernst
  • Suzanne Schuh
  • Dennis Scolnik
Chapter

Abstract

This chapter summarizes the state-of-the-art approach to several critical aspects of pediatric emergency care. While the field of pediatric emergency medicine is much broader, we have chosen some key topics which are essential for every physician providing care to children. The resuscitation section highlights the challenges and the particularities of pediatric airway management as well as the correct technique for effective cardiopulmonary resuscitation, defibrillation and vascular access. The sepsis section stresses that the key to a successful outcome is early recognition; it outlines the clinical spectrum of sepsis, the systemic inflammatory response and the pathophysiology of septic shock, with emphasis on early clinical signs, airway management, volume resuscitation, vasoactive support and antibiotic therapy. In the last decade, attention to pediatric pain management has resulted in increasing awareness of assessment tools and pharmacologic as well as non-pharmacologic strategies for pain control and anxiolysis. The pain section updates these important aspects of pediatric care and includes management of procedural sedation. Although the general principles of trauma care in children are similar to those of adults, the trauma section highlights the key differences, with respect to anatomy and physiology, and how these impact on early recognition of hemorrhagic shock, susceptibility to specific injuries, indications for imaging (no pan-CTs!) and the more prevalent non-surgical management. Healthcare providers must also know how to safely transport a child who requires additional resources or an escalation in level of care. The regionalization of pediatric intensive care units and trauma services has made it imperative for pediatricians to understand the general principles of transport medicine outlined in this chapter. The overview of pediatric inter-facility transport discusses choice of transport team and modality, emphasizes patient stabilization prior to transport and outlines required medications and supplies.

References

  1. Alexandre J, Manno M. Under use of analgesia in very young pediatric patients with isolated painful injuries. Annu Emerg Med. 2003;41(5):617–22.Google Scholar
  2. Ali S, McGrath T, Drendel AL. An evidence-based approach to minimizing acute procedural pain in the emergency department. Pediatr Emerg Care. 2016;32(1):36–42.PubMedGoogle Scholar
  3. American College of Emergency Physicians. Clinical policy: procedural sedation and analgesia in the emergency department. Ann Emerg Med. 2014;63(2):247–57.Google Scholar
  4. Atkins DL, et al. Part 11: Pediatric basic life support and cardiopulmonary resuscitation quality: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132(18 Suppl 2):S519–25.PubMedGoogle Scholar
  5. Atkinson SJ, Cvijanovich NZ, Thomas NJ, et al. Corticosteroids and pediatric septic shock outcomes: a risk stratified analysis. PLoS One. 2014;9(11):e112702.PubMedPubMedCentralGoogle Scholar
  6. Balamuth F, Weiss SL, Neuman MI, et al. Pediatric severe sepsis in U.S. children's hospitals. Pediatr Crit Care Med. 2014;15:798.PubMedPubMedCentralGoogle Scholar
  7. Bar-Joseph G, Guilburd Y, Tamir A, Guilburd JN. Effectiveness of ketamine in decreasing intracranial pressure in children with intracranial hypertension. J Neurosurg Pediatr. 2009;4(1):40–6.PubMedGoogle Scholar
  8. Barry P, Leslie A. Paediatric and neonatal critical care transport. London: BMJ Publishing Group; 2003.Google Scholar
  9. Batton DG, Barrington KJ, Wallman C, American Academy of Pediatrics, Committee on Fetus and Newborn, Section of Anesthesiology and Pain Medicine; Canadian Paediatric Society Fetus and Newborn Committee. Prevention and management of pain the neonate: an update. Pediatrics. 2006;118(5):2231–41.PubMedGoogle Scholar
  10. Beno S, Ackery AD, Callum J, Rizoli S. Tranexamic acid in pediatric trauma: why not? Crit Care. 2014;18(4):313.PubMedPubMedCentralGoogle Scholar
  11. Berona K, Kang T, Rose E. Pelvic free fluid in asymptomatic pediatric blunt abdominal trauma patients: a case series and review of the literature. J Emerg Med. 2016;50(5):753–8.PubMedGoogle Scholar
  12. Bistritz JF, Horton LM, Smaldone A. Therapeutic hypothermia in children after cardiac arrest: a systematic review and meta-analysis. Pediatr Emerg Care. 2015;31(4):296–303.PubMedGoogle Scholar
  13. Bonadio WA. Safe and effective method for application of tetracaine, adrenaline and cocaine to oral lacerations. Ann Emerg Med. 1996;28(4):396–8.PubMedGoogle Scholar
  14. Borland M, Jacobs I, King B, et al. A randomized controlled trial comparing intranasal fentanyl to intravenous morphine for managing acute pain in children in the emergency department. Ann Emerg Med. 2007;49(3):335–40.PubMedGoogle Scholar
  15. Boyd JR, Stuart P. The efficacy of structured assessment and analgesia provision in the paediatric emergency department. Emerg Med J. 2005;22:30–2.PubMedPubMedCentralGoogle Scholar
  16. Brierley J, Carcillo JA, Choong K, et al. Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine. Crit Care Med. 2009;37:666.PubMedPubMedCentralGoogle Scholar
  17. Bruder EA, et al. Single induction dose of etomidate versus other induction agents for endotracheal intubation in critically ill patients. Cochrane Database Syst Rev. 2015;1:CD010225.PubMedGoogle Scholar
  18. Carcillo JA, Kuch BA, Han YY, et al. Mortality and functional morbidity after use of PALS/APLS by community physicians. Pediatrics. 2009;124(2):500.PubMedGoogle Scholar
  19. Chan CM, Mitchell AL, Shorr AF. Etomidate is associated with mortality and adrenal insufficiency in sepsis: a meta-analysis. Crit Care Med. 2012;40(11):2945–53.PubMedGoogle Scholar
  20. Chang A, Berry A, Jones LJ, Sivasangari S. Specialist teams for neonatal transport to neonatal intensive care units for prevention of morbidity and mortality. Cochrane Database Syst Rev. 2008;4:CD007485.Google Scholar
  21. Chang LC, Raty SR, Ortiz J, Bailard NS, Mathew SJ. The emerging use of ketamine for anesthesia and sedation in traumatic brain injuries. CNS Neurosci Ther. 2013;19(6):390–5.PubMedPubMedCentralGoogle Scholar
  22. Chidester SJ, Williams N, Wang W, Groner JI. A pediatric massive transfusion protocol. J Trauma Acute Care Surg. 2012;73(5):1273–7.PubMedGoogle Scholar
  23. Chou EH, et al. Ultrasonography for confirmation of endotracheal tube placement: a systematic review and meta-analysis. Resuscitation. 2015;90:97–103.PubMedGoogle Scholar
  24. Connelly CR, Yonge JD, Eastes LE, Bilyeu PE, Kemp Bohan PM, Schreiber MA, et al. Performance improvement and patient safety program (PIPS) guided quality improvement initiatives can significantly reduce CT imaging in pediatric trauma patients. J Trauma Acute Care Surg. 2016;81(2):278–84.PubMedGoogle Scholar
  25. Cooper A, Barlow B, DiScala C, String D. Mortality and truncal injury: the pediatric perspective. J Pediatr Surg. 1994;29(1):33–8.PubMedGoogle Scholar
  26. Cruz AT, Perry AM, Williams EA, et al. Implementation of goal-directed therapy for children with suspected sepsis in the emergency department. Pediatrics. 2011;127:e758.PubMedGoogle Scholar
  27. Davis AL, Wales PW, Malik T, Stephens D, Razik F, Schuh S. The BIG score and prediction of mortality in pediatric blunt trauma. Crit Care Med. 2017;45:1061–93.PubMedGoogle Scholar
  28. de Caen AR, et al. Part 12: Pediatric advanced life support: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Pediatrics. 2015a;136(Suppl 2):S176–95.PubMedGoogle Scholar
  29. de Caen AR, Berg MD, Chameides L, et al. Part 12: pediatric advanced life support 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015b;132(Suppl 2):S526–42.PubMedPubMedCentralGoogle Scholar
  30. de Caen AR, Maconochie IK, Aickin R, et al. Part 6: Pediatric basic life support and pediatric advanced life support 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2015c;132(suppl 1):S177–203.PubMedGoogle Scholar
  31. den Brinker M, et al. One single dose of etomidate negatively influences adrenocortical performance for at least 24 h in children with meningococcal sepsis. Intensive Care Med. 2008;34(1):163–8.Google Scholar
  32. Dodgion CM, Gosain A, Rogers A, St Peter SD, Nichol PF, Ostlie DJ. National trends in pediatric blunt spleen and liver injury management and potential benefits of an abbreviated bed rest protocol. J Pediatr Surg. 2014;49(6):1004–8. discussion 1008PubMedGoogle Scholar
  33. Dong L, Donaldson A, Metzger R, Keenan H. Analgesic administration in the emergency department for children requiring hospitalization for long bone fractures. Pediatr Emerg Care. 2012;28:109–14.PubMedGoogle Scholar
  34. Drendel AL, Kelly BT, Ali S. Pain assessment for children: overcoming challenges and optimizing care. Pediatr Emerg Care. 2011;27(8):773–80.PubMedGoogle Scholar
  35. Dzik WH, Blajchman MA, Fergusson D, Hameed M, Henry B, Kirkpatrick AW, et al. Clinical review: Canadian National Advisory Committee on Blood and Blood Products – massive transfusion consensus conference 2011: report of the panel. Crit Care. 2011;15(6):242.PubMedPubMedCentralGoogle Scholar
  36. Eckert MJ, Wertin TM, Tyner SD, Nelson DW, Izenberg S, Martin MJ. Tranexamic acid administration to pediatric trauma patients in a combat setting: the pediatric trauma and tranexamic acid study (PED-TRAX). J Trauma Acute Care Surg. 2014;77(6):852–8. discussion 858PubMedGoogle Scholar
  37. Eidelman A, Weiss JM, Baldwin CL, et al. Topical anaesthetics for repair of dermal laceration. Cochrane Database Syst Rev. 2011;6:CD005364.Google Scholar
  38. Ellis DY, Harris T, Zideman D. Cricoid pressure in emergency department rapid sequence tracheal intubations: a risk-benefit analysis. Ann Emerg Med. 2007;50(6):653–65.PubMedGoogle Scholar
  39. Fahy AS, Antiel RM, Polites SF, Ishitani MB, Moir CR, Zielinski MD. Pretransfer computed tomography delays arrival to definitive care without affecting pediatric trauma outcomes. J Pediatr Surg. 2016;51(2):323–5.PubMedGoogle Scholar
  40. Farion KJ, Splinter KL, Newhook K, et al. The effect of vapocoolant spray on pain due to intravenous cannulation in children: a randomized controlled trial. CMAJ. 2008;179(1):31–6.PubMedPubMedCentralGoogle Scholar
  41. Fein JA, Zempsky WT, Cravero JP, The Committee on Pediatric Emergency Medicine and Section on Anesthesiology and Pain Medicine. Relief of pain and anxiety in pediatric patients in emergency medical systems. Pediatrics. 2012;130(5):e1391–405.PubMedGoogle Scholar
  42. Filanovsky Y, Miller P, Kao J. Myth: ketamine should not be used as an induction agent for intubation in patients with head injury. CJEM. 2010;12(02):154–7.PubMedGoogle Scholar
  43. Gaines NN, Patel B, Williams EA, Cruz AT. Etiologies of septic shock in a pediatric emergency department population. Pediatr Infect Dis J. 2012;31:1203.PubMedGoogle Scholar
  44. Girotra S, et al. Survival trends in pediatric in-hospital cardiac arrests: an analysis from get with the guidelines-resuscitation. Circulation. 2013;6(1):42–9.PubMedGoogle Scholar
  45. Goldstein B, Giroir B, Randolph A. International consensus conference on pediatric sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005;6:2.PubMedGoogle Scholar
  46. Grant PS. Analgesia delivery in the emergency department. Am J Emerg Med. 2006;24:806–9.PubMedGoogle Scholar
  47. Haasz M, Simone LA, Wales PW, Stimec J, Stephens D, Beno S, et al. Which pediatric blunt trauma patients do not require pelvic imaging? J Trauma Acute Care Surg. 2015;79(5):828–32.PubMedGoogle Scholar
  48. Han YY, Carcillo JA, Dragotta MA, et al. Early reversal of pediatric-neonatal septic shock by community physicians is associated with improved outcome. Pediatrics. 2003;112:793.PubMedGoogle Scholar
  49. Hartman ME, Linde-Zwirble WT, Angus DC, Watson RS. Trends in the epidemiology of pediatric severe sepsis. Pediatr Crit Care Med. 2013;14:686.PubMedGoogle Scholar
  50. Harty E, Bellis F. CHALICE head injury rule: an implementation study. Emerg Med J. 2010;27(10):750–2.PubMedGoogle Scholar
  51. Hasegawa T, Oshima Y, Maruo A, Matsuhisa H, Tanaka A, Noda R, et al. Intraoperative tranexamic acid in pediatric bloodless cardiac surgery. Asian Cardiovasc Thorac Ann. 2014;22(9):1039–45.PubMedGoogle Scholar
  52. Hendrickson JE, Shaz BH, Pereira G, Parker PM, Jessup P, Atwell F, et al. Implementation of a pediatric trauma massive transfusion protocol: one institution's experience. Transfusion. 2011;52(6):1228–36.PubMedGoogle Scholar
  53. Horst J, Leonard JC, Vogel A, Jacobs R, Spinella PC. A survey of US and Canadian hospitals' paediatric massive transfusion protocol policies. Transfus Med. 2016;26(1):49–56.PubMedGoogle Scholar
  54. Hotchkiss RS, Karl IE. The pathophysiology and treatment of sepsis. N Engl J Med. 2003;348:138.PubMedGoogle Scholar
  55. Hughes S. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 3: is ketamine a viable induction agent for the trauma patient with potential brain injury. Emerg Med J. 2011;28(12):1076–7.PubMedGoogle Scholar
  56. Hutchison JS, Ward RE, Lacroix J, Hébert PC, Barnes MA, Bohn DJ, et al. Hypothermia therapy after traumatic brain injury in children. N Engl J Med. 2008;358(23):2447–56.PubMedGoogle Scholar
  57. Hutchison JS, Frndova H, Lo T-YM, Guerguerian A-M. Hypothermia Pediatric Head Injury Trial Investigators, Canadian Critical Care Trials Group. Impact of hypotension and low cerebral perfusion pressure on outcomes in children treated with hypothermia therapy following severe traumatic brain injury: a post hoc analysis of the Hypothermia Pediatric Head Injury Trial. Dev Neurosci. 2010;32(5–6):406–12.PubMedGoogle Scholar
  58. Kelly LE, Rieder M, van den Anker J, et al. More codeine fatalities after tonsillectomy in North American Children. Pediatrics. 2012;129:e1324–7.Google Scholar
  59. Kennedy RM. Sedation in the emergency department: a complex and multifactorial challenge. In: Mason KP, editor. Pediatric sedation outside of the operating room. New York, NY: Springer; 2015. p. 367–422.Google Scholar
  60. Kennedy RM, Luhmann J, Zempsky WT. Clinical implications of unmanaged needle-insertion pain and distress in children. Pediatrics. 2008;122:S130–3.PubMedGoogle Scholar
  61. Kleinman ME, et al. Part 14: pediatric advanced life support: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2010a;122(18 Suppl 3):S876–908.PubMedGoogle Scholar
  62. Kleinman ME, de Caen AR, Chameides L, et al. Pediatric basic and advanced life support: 2010 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Pediatrics. 2010b;126:e1261.PubMedPubMedCentralGoogle Scholar
  63. Krauss BS, Calligari L, Green SM, Barbi E. Current concepts in management of pain in children in the emergency department. Lancet. 2016;387:83–92.PubMedGoogle Scholar
  64. Kuppermann N, Holmes J, Dayan P, Hoyle J, Atabaki S, Dean J, et al. Blunt head trauma in the pediatric emergency care applied research network (PECARN). Acad Emerg Med. 2007;14(5 Suppl 1):S94–5.Google Scholar
  65. Kutko MC, Calarco MP, Flaherty MB, et al. Mortality rates in pediatric septic shock with and without multiple organ system failure. Pediatr Crit Care Med. 2003;4:333.PubMedGoogle Scholar
  66. Langevin M. Ditch the spine board – emergency physicians monthly. Bel Air, MD: Emergency Physicians Monthly; 2016. p. 1–6.Google Scholar
  67. Larsen GY, Mecham N, Greenberg R. An emergency department septic shock protocol and care guideline for children initiated at triage. Pediatrics. 2011;127:e1585–92.PubMedGoogle Scholar
  68. Le May S, Gouin S, Fortin C, et al. Efficacy of an ibuprofen/codeine combination for pain management in children presenting to the emergency department with a limb injury: a pilot study. J Emerg Med. 2013;33(2):536–41.Google Scholar
  69. Leonard JC, Kuppermann N, Olsen C, Babcock-Cimpello L, Brown K, Mahajan P, et al. Factors associated with cervical spine injury in children after blunt trauma. Ann Emerg Med. 2011;58(2):145–55.PubMedGoogle Scholar
  70. Lorch S, Myers S, Carr B. The regionalization of pediatric health care. Pediatrics. 2010;126(6):1182–90.PubMedPubMedCentralGoogle Scholar
  71. Maitland K, Kiguli S, Opoka RO, et al. Mortality after fluid bolus in African children with severe infection. N Engl J Med. 2011;364:2483.PubMedPubMedCentralGoogle Scholar
  72. Marin JR, Lewiss RE, American Academy of Pediatrics, Committee on Pediatric Emergency Medicine, Society for Academic Emergency Medicine, Academy of Emergency Ultrasound, American College of Emergency Physicians, Pediatric Emergency Medicine Committee, World Interactive Network Focused on Critical Ultrasound. Point-of-care ultrasonography by pediatric emergency medicine physicians. Pediatrics. 2015;135(4):e1113–22.PubMedGoogle Scholar
  73. McPherson ML, Jefferson LS, Graf JM. A validated pediatric transport survey: how is your team performing? Air Med J. 2008;27(1):40–5.PubMedGoogle Scholar
  74. Menaker J, Blumberg S, Wisner DH, Dayan PS, Tunik M, Garcia M, et al. Use of the focused assessment with sonography for trauma (FAST) examination and its impact on abdominal computed tomography use in hemodynamically stable children with blunt torso trauma. J Trauma Acute Care Surg. 2014;77(3):427–32.PubMedGoogle Scholar
  75. Menon K, McNally D, Choong K, Sampson M. A systematic review and meta-analysis on the effect of steroids in pediatric shock. Pediatr Crit Care Med. 2013;14(5):474.PubMedGoogle Scholar
  76. Meyer MT, Gourlay DM, Weitze KC, Ship MD, Drayna PC, Wener C, Lerner EB. Helicopter interfacility transport of pediatric trauma patients: are we overusing a costly resource? J Trauma Acute Care Surg. 2016;80(2):313–7.PubMedGoogle Scholar
  77. Michailidou M, Goldstein SD, Salazar J, Aboagye J, Steward D, Efron D, Abdullah F, Haut ER. Helicopter overtriage in pediatric trauma. J Pediatr Surg. 2014;49(110):1673–7.PubMedGoogle Scholar
  78. Michaleff ZA, Maher CG, Verhagen AP, Rebbeck T, Lin C-WC. Accuracy of the Canadian C-spine rule and NEXUS to screen for clinically important cervical spine injury in patients following blunt trauma: a systematic review. CMAJ Can Med Assoc. 2012;184(16):E867–76.Google Scholar
  79. Mikhail J. The trauma triad of death: hypothermia, acidosis, and coagulopathy. AACN Clin Issues. 1999;10(1):85–94.PubMedGoogle Scholar
  80. Mittiga MR, Rinderknecht AS, Kerrey BT. A modern and practical review of rapid-sequence intubation in pediatric emergencies. Clin Pediatr Emerg Med. 2015;16(3):172–85.Google Scholar
  81. Moler FW, et al. Therapeutic hypothermia after out-of-hospital cardiac arrest in children. N Engl J Med. 2015;372(20):1898–908.PubMedPubMedCentralGoogle Scholar
  82. Nellensteijn DR, Greuter MJ, Moumni El M, Hulscher JB. The use of CT scan in hemodynamically stable children with blunt abdominal trauma: look before you leap. Eur J Pediatr Surg. 2016;26(4):332–5.PubMedGoogle Scholar
  83. Nelson BP, Cohen D, Lander O, et al. Mandated pain scores improves frequency of ED analgesic administration. Am J Emerg Med. 2004;22(7):582–5.PubMedGoogle Scholar
  84. Nigrovic LE, Rogers AJ, Adelgais KM, Olsen CS, Leonard JR, Jaffe DM, et al. Utility of plain radiographs in detecting traumatic injuries of the cervical spine in children. Pediatr Emerg Care. 2012;28(5):426–32.PubMedGoogle Scholar
  85. Oliveira CF, Nogueira de Sá FR, Oliveira DS, et al. Time- and fluid-sensitive resuscitation for hemodynamic support of children in septic shock: barriers to the implementation of the American College of Critical Care Medicine/pediatric advanced life support guidelines in a pediatric intensive care unit in a developing world. Pediatr Emerg Care. 2008;24(12):810.PubMedGoogle Scholar
  86. Ong CK, Seymour RA, Lirk P, Merry AF. Combining paracetamol (acetaminophen) with nonsteroidal anti-inflammatory drugs: a qualitative systematic review of analgesic efficacy for acute postoperative pain. Anesth Analg. 2010;110(4):1170–9.PubMedGoogle Scholar
  87. Orr RA, Felmet KA, Han Y, McCloskey KA, Dragotta MA, Bills DM, Kuch BA, Watson RS. Pediatric specialized transport teams are associated with improved outcomes. Pediatrics. 2009;124(1):40–8.PubMedGoogle Scholar
  88. Osmond MH, Klassen TP, Wells GA, Correll R, Jarvis A, Joubert G, et al. CATCH: a clinical decision rule for the use of computed tomography in children with minor head injury. Can Med Assoc J. 2010;182(4):341–8.Google Scholar
  89. Pandit V, Michailidou M, Rhee P, Zangbar B, Kulvatunyou N, Khalil M, et al. The use of whole body computed tomography scans in pediatric trauma patients: Are there differences among adults and pediatric centers? J Pediatr Surg. 2016;51(4):649–53.PubMedGoogle Scholar
  90. Paul R, Neuman MI, Monuteaux MC, Melendez E. Adherence to PALS sepsis guides decreases hospital length of stay. Pediatrics. 2012;130:e273–80.PubMedGoogle Scholar
  91. Paul R, Melendez E, Stack A, et al. Improving adherence to PALS septic shock guidelines. Pediatrics. 2014;133(5):e1358–66.PubMedGoogle Scholar
  92. Perez-Brayfield MR, Gatti JM, Smith EA, Broecker B, Massad D, Scherz H, et al. Blunt traumatic hematuria in children. is a simplified algorithm justified? J Urol. 2002;167:2543–7.PubMedGoogle Scholar
  93. Perrott DA, Piira T, Goodenough B, Champion GD. Efficacy and safety of acetaminophen vs. ibuprofen for treating children’s pain and fever. JAMA Pediatr. 2004;15(6):521–6.Google Scholar
  94. Pizarro CF, Troster EJ, Damiani D, Carcillo JA. Absolute and relative adrenal insufficiency in children with septic shock. Crit Care Med. 2005;33(4):855.PubMedGoogle Scholar
  95. Poonai N, Bhullar G, Kangrui L, et al. Oral administration of morphine versus ibuprophen to manage postfracture pain in children: a randomized trial. CMAJ. 2014;186(18):1358–63.PubMedPubMedCentralGoogle Scholar
  96. Public Health Agency of Canada. The cost of injury in Canada. Ottawa, ON: Public Health Agency of Canada; 2015. p. 1–177.Google Scholar
  97. Ramnarayan P, Thiru K, Parslow RC, Harrison DA, Draper ES, Rowan KM. Effect of specialist retrieval teams on outcomes in children admitted to paediatric intensive care units in England and Wales: a retrospective cohort study. Lancet. 2010;376:698–704.PubMedGoogle Scholar
  98. Ruth A, McCracken CE, Fortenberry JD, et al. Pediatric severe sepsis: current trends and outcomes from the pediatric health information systems database. Pediatr Crit Care Med. 2014;15:828.PubMedGoogle Scholar
  99. Sahyoun C, Krauss B. Clinical implications of pharmacokinetics and pharmacodynamics of procedural sedation agents in children. Curr Opin Pediatr. 2012;24:225–32.PubMedGoogle Scholar
  100. Santucci RA, Langenburg SE, Zachareas MJ. Traumatic hematuria in children can be evaluated as in adults. J Urol. 2004;171(2 Pt 1):822–5.PubMedGoogle Scholar
  101. Scaife ER, Rollins MD, Barnhart DC, Downey EC, Black RE, Meyers RL, et al. The role of focused abdominal sonography for trauma (FAST) in pediatric trauma evaluation. J Pediatr Surg. 2013;48(6):1377–83.PubMedGoogle Scholar
  102. Scott HF, Donoghue AJ, Gaieski DF, et al. The utility of early lactate testing in undifferentiated pediatric systemic inflammatory response syndrome. Acad Emerg Med. 2012;19:1276.PubMedGoogle Scholar
  103. Scott HF, Brou L, Deakyne SJ, et al. Lactate clearance and normalization and prolonged organ dysfunction in pediatric sepsis. J Pediatr. 2016;170:149–55.e1–4.  https://doi.org/10.1016/j.jpeds.2015.11.071.CrossRefPubMedGoogle Scholar
  104. Shaw KN, Bachur RG, editors. Fleisher and Ludwig’s textbook of pediatric emergency medicine. 17th ed. Philidelphia, PA: Wolters Kluwer; 2016.Google Scholar
  105. Shi F, et al. Cuffed versus uncuffed endotracheal tubes in children: a meta-analysis. J Anesth. 2016;30:3–11.PubMedGoogle Scholar
  106. Shlamovitz GZ, Mower WR, Bergman J, Crisp J, DeVore HK, Hardy D, et al. Lack of evidence to support routine digital rectal examination in pediatric trauma patients. Pediatr Emerg Care. 2007;23(8):537–43.PubMedGoogle Scholar
  107. Singh A, Frenkel O. Evidence-based emergency management of the pediatric airway. Pediatr Emerg Med Pract. 2013;10(1):1–25.PubMedGoogle Scholar
  108. Skippen P, Seear M, Poskitt K, Kestle J, Cochrane D, Annich G, et al. Effect of hyperventilation on regional cerebral blood flow in head-injured children. Crit Care Med. 1997;25(8):1402–9.PubMedGoogle Scholar
  109. Srouji R, Ratnapalan S, Schneeweiss S. Pain in children: assessment and non-pharmacologic management. Int J Pediatr. 2010;2010:Article ID: 474838.Google Scholar
  110. Steiner, J. The use of apneic oxygenation during prolonged intubation in pediatric patients: a randomized clinical trial. 2016.; https://clinicaltrials.gov/ct2/show/NCT01886807?term=apneic+oxygenation&rank=3. Accessed 24 Mar 2016.
  111. Stevens B, Yamada J, Lee GY, et al. Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev. 2013;1:CD001069.Google Scholar
  112. Stollings JL, et al. Rapid-sequence intubation a review of the process and considerations when choosing medications. Ann Pharmacother. 2014;48(1):62–76.PubMedGoogle Scholar
  113. Taddio A, Ohlsson A, Einarson TR, Stevens B, Koren G. A systematic review of lidocaine-prilocaine cream (EMLA) in the treatment of acute pain in neonates. Pediatrics. 1998;101(2):E1.PubMedGoogle Scholar
  114. Taddio A, Kaur Soin H, Schuh S, et al. Liposomal lidocaine to improve procedural success rates and reduce procedural pain among children: a randomized controlled trial. CMAJ. 2005;172(13):1691–5.PubMedPubMedCentralGoogle Scholar
  115. Tepas JJ III, Mollitt DL, Talbert JL, Bryant M. The pediatric trauma score as a predictor of injury severity in the injured child. J Pediatr Surg. 1987;22(1):14–8.PubMedGoogle Scholar
  116. Totten VY, Sugarman DB. Respiratory effects of spinal immobillzatlon. Prehosp Emerg Care. 2009;3(4):347–52.Google Scholar
  117. Tuuri RE, Gehrig MG, Busch CE, et al. "Beat the shock clock": an interprofessional team improves pediatric septic shock care. Clin Pediatr (Phila). 2016;55(7):626–38.Google Scholar
  118. Ventura AM, Shieh HH, Bousso A, et al. Double-blind prospective randomized controlled trial of dopamine versus epinephrine as first-line vasoactive drugs in pediatric septic shock. Crit Care Med. 2015;43:2292.PubMedGoogle Scholar
  119. Vinson DR. NEXUS cervical spine criteria. Ann Emerg Med. 2001;37(2):237–8.PubMedGoogle Scholar
  120. Wang X, Ding X, Tong Y, Zong J, Zhao X, Ren H, et al. Ketamine does not increase intracranial pressure compared with opioids: meta-analysis of randomized controlled trials. J Anesth. 2014;28(6):821–7.PubMedGoogle Scholar
  121. Watson RS, Carcillo JA, Linde-Zwirble WT, et al. The epidemiology of severe sepsis in children in the United States. Am J Respir Crit Care Med. 2003;167:695.PubMedGoogle Scholar
  122. Weingart SD, Levitan RM. Preoxygenation and prevention of desaturation during emergency airway management. Ann Emerg Med. 2012;59(3):165–75. e1PubMedGoogle Scholar
  123. Weiss M, et al. Prospective randomized controlled multi-centre trial of cuffed or uncuffed endotracheal tubes in small children. Br J Anaesth. 2009;103(6):867–73.PubMedGoogle Scholar
  124. Weiss SL, Parker B, Bullock ME, et al. Defining pediatric sepsis by different criteria: discrepancies in populations and implications for clinical practice. Pediatr Crit Care Med. 2012;13:e219.PubMedGoogle Scholar
  125. Weiss SL, Fitzgerald JC, Pappachan J, et al. Global epidemiology of pediatric severe sepsis: the sepsis prevalence, outcomes, and therapies study. Am J Respir Crit Care Med. 2015a;191:1147.PubMedPubMedCentralGoogle Scholar
  126. Weiss SL, Fitzgerald JC, Maffei FA, et al. SPROUT Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators Network. Discordant identification of pediatric severe sepsis by research and clinical definitions in the SPROUT international point prevalence study. Crit Care. 2015b;19:325.PubMedPubMedCentralGoogle Scholar
  127. White NJ. Kim Mk, Brousseau DC et al. The anesthetic effectiveness of lidocaine-adrenaline-tetracaine gel on finger lacerations. Pediatr Emerg Care. 2004;20(12):812–5.PubMedGoogle Scholar
  128. Whyte HE, Jefferies AL. The interfacility transport of critically ill newborns. Paediatr Child Health. 2015;20(5):265–75.PubMedPubMedCentralGoogle Scholar
  129. Wisner DH, Kuppermann N, Cooper A, Menaker J, Ehrlich P, Kooistra J, et al. Management of children with solid organ injuries after blunt torso trauma. J Trauma Acute Care Surg. 2015;79(2):206–14.PubMedGoogle Scholar
  130. Yanchar NL, Warda LJ, Fuselli P. Child and youth injury prevention: a public health approach. Paediatr Child Health. 2012;17(9):511–2.PubMedPubMedCentralGoogle Scholar
  131. Zimmerman JJ, Williams MD. Adjunctive corticosteroid therapy in pediatric severe sepsis: observations from the RESOLVE study. Pediatr Crit Care Med. 2011;12(1):2.PubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Tania Principi
    • 1
  • Deborah Schonfeld
    • 1
  • Laura Weingarten
    • 2
  • Suzan Schneeweiss
    • 1
  • Daniel Rosenfield
    • 1
  • Genevieve Ernst
    • 1
  • Suzanne Schuh
    • 3
  • Dennis Scolnik
    • 4
    • 5
  1. 1.Department of Pediatrics, Division of Pediatric Emergency MedicineUniversity of TorontoTorontoCanada
  2. 2.Pediatric Emergency Physician and Assistant Clinical ProfessorDepartment of Pediatrics at McMaster UniversityHamiltonCanada
  3. 3.Division of Paediatric Emergency MedicineResearch Institute, Hospital for Sick Children, University of TorontoTorontoCanada
  4. 4.Department of Paediatrics, Faculty of MedicineUniversity of TorontoTorontoCanada
  5. 5.Divisions of Paediatric Emergency Medicine and Clinical Pharmacology and ToxicologyThe Hospital for Sick ChildrenTorontoCanada

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