Measles investigation: a moving target.

Measles is a highly contagious respiratory infection with significant transmission risk once thought to be on the verge of elimination. Outbreaks in Europe have resulted in resurgence; however, experience with measles is limited in the United States. We describe the impact of 2 measles cases presenting to our emergency department in May 2011. Exposure criteria were defined and revised. Guidance documents were developed and distributed. Suspect cases were masked and escorted to negative pressure. Lack of prompt IgM and polymerase chain reaction testing resulted in delayed disease confirmation. Computerized flagging systems were established. Exposed individuals were screened to determine the need for prophylaxis. Investigation costs were calculated. A total of 171 patients and visitors and 94 employees met exposure criteria. Employees had proof of immunity to measles. Of these, 43 patients and visitors returned for prophylaxis. No subsequent transmission occurred. The conservative cost for these investigations was $63,176.39. Multiple challenges were identified. Inexperience with measles can result in significant outbreaks. Although transmission did occur at another facility, it was prevented at our facility because of rapid case recognition, isolation, health care worker immunity, and multidisciplinary response. Discordance between the Healthcare Infection Control Practices Advisory Committee and public health guidelines for measles control created unnecessary challenges.

Emergency management of blunt chest trauma in children: an evidence-based approach.

Pediatric trauma is commonly encountered in the emergency department, and trauma to the head, chest, and abdomen may be a source of significant morbidity and mortality. As children have unique thoracic anatomical and physiological properties, they may present with diagnostic challenges that the emergency clinician must be aware of. This review examines the effects of blunt trauma to the pediatric chest, as well as its relevant etiologies and associated mortality. Diagnostic and treatment options for commonly encountered injuries such as pulmonary contusions, rib fractures, and pneumothoraces are examined. Additionally, this review discusses rarely encountered--yet highly lethal--chest wall injuries such as blunt cardiac injuries, commotio cordis, nonaccidental trauma, and aortic injuries.