Subject(s)
Emergency Medical Services/legislation & jurisprudence , Emergency Medicine/legislation & jurisprudence , Ethics, Medical , Pediatrics/legislation & jurisprudence , Child , Decision Making , Humans , Infant , Male , Parents , Patient Transfer/legislation & jurisprudence , Refusal to Treat , Respiration, Artificial , Treatment Refusal , United StatesABSTRACT
Injury is the number one cause of death and life-years lost for children. In children, injury mortality is greater than childhood mortality from all other causes combined. Modern injury prevention and control seeks to prevent and limit or control injuries through the 4 Es of injury prevention: engineering, enforcement, education, and economics. Emergency physicians are often placed in a critical role in the lives of individuals, are respected authorities on the health and safety of children and adults, and have daily exposure to high-risk populations. This gives emergency physicians a unique perspective and an opportunity to take an active role in injury control and prevention. Specific methods or strategies for promulgating injury prevention and control in our emergency medicine practices are suggested, ranging from education (for our patients and health professionals); screening and intervention for domestic violence, child maltreatment, drug-alcohol dependency and abuse; data collection; reporting unsafe products; research; legislation; serving in regulatory and governmental agencies; emergency medical services-community involvement; and violence prevention. Emergency physicians can play a significant role in decreasing pediatric injury and its concomitant morbidity and mortality.
Subject(s)
Child Abuse/prevention & control , Domestic Violence/prevention & control , Emergency Medicine/methods , Primary Prevention/methods , Wounds and Injuries/mortality , Wounds and Injuries/prevention & control , Child , Child, Preschool , Emergency Service, Hospital , Female , Humans , Infant , Injury Severity Score , Male , Risk Assessment , Survival Analysis , United States/epidemiology , Wounds and Injuries/therapySubject(s)
Conflict, Psychological , Emergency Medicine/standards , Ethics, Medical , Pediatrics/standards , Child Advocacy , Female , HIV Seropositivity/psychology , Humans , Infant , Morals , Mothers/psychology , Otitis Media/complications , Otitis Media/therapy , Physicians/psychology , Recurrence , United StatesSubject(s)
Apnea/diagnosis , Emergency Service, Hospital , Medical History Taking , Apnea/therapy , Female , Humans , Infant , Male , Medical History Taking/methodsABSTRACT
We determined the prevalence of cocaine and cannabinoid exposure among young children presenting to an urban pediatric emergency department without signs or symptoms suggestive of the exposure. The study included 460 children between 1 and 60 months of age in whom urinalysis was required for investigation of routine pediatric complaints. Anonymously and without informed consent, an aliquot of urine was screened for cocaine metabolite (benzoylecgonine) and 11- or delta-9-tetrahydrocannabinol-9 carboxylic acid with the enzyme multiplied immunoassay technique. Positive specimens were rescreened with a radioimmunoassay and confirmed with gas chromatography/mass spectrometry, if a sufficient quantity of urine was available. Benzoylecgonine was identified in 25 patients (5.4%) by both screening techniques. Enough urine was available for confirmatory testing in eight patients, and all eight urine specimens contained benzoylecgonine. Neither 11- nor delta-9-tetrahydrocannabinol-9 carboxylic acid was detected in any patient. We documented the magnitude of the problem of occult passive cocaine exposure in young children living in an urban environment. Such exposure has serious implications for the assessment of outcomes in postnatal follow-up studies of prenatally exposed children as well as potential risks to children living in household environments where occult cocaine exposure occurs.