Age-Related Deficits in Taste and Smell.
Abstract Disturbances in both the ability to smell and to taste are common in older persons. Such disturbances influence nutrition, safety, quality of life, and psychological and physical health. The anatomic and physiologic causes of age-related disturbances are multiple and interacting, and depend on genetic and environmental factors. Frank losses of function, distortions, and hallucinations are common. Most distortions resolve over time, although this can take months or even years. Olfactory dysfunction occurs during the earliest stages of several neurologic disorders, most notably Alzheimer's disease and Parki...
Source: The Medical Clinics of North America - July 14, 2018 Category: General Medicine Authors: Doty RL Tags: Otolaryngol Clin North Am Source Type: research

Addressing Unhealthy Substance Use in Primary Care.
Abstract Unhealthy substance use is common in primary care populations and is a major contributor to morbidity and mortality. Two key strategies to address unhealthy substance use in primary care are the process of screening, brief intervention, and referral to treatment (SBIRT), and integration of treatment for substance use disorders into primary care. Implementation of SBIRT requires buy-in from practice leaders, careful planning, and staff and primary care provider training. Primary care-based treatment of opioid and alcohol use disorders can be effective; more data are needed to better understand the benefits...
Source: The Medical Clinics of North America - June 26, 2018 Category: General Medicine Authors: Pace CA, Uebelacker LA Tags: Med Clin North Am Source Type: research

Inpatient Addiction Consult Service: Expertise for Hospitalized Patients with Complex Addiction Problems.
Abstract Substance use disorders are highly prevalent and are a large driver of costly inpatient medical care; however, historically the substance use disorder has gone unaddressed during an inpatient stay. Inpatient addiction consult services are an important intervention to use the reachable moment of hospitalization to engage patients and initiate addiction treatment. Addiction consultation involves taking an addiction-specific history, motivational interviewing, withdrawal symptom management, and initiation of long-term pharmacotherapy. Addiction consult services have the potential to decrease readmissions and...
Source: The Medical Clinics of North America - June 26, 2018 Category: General Medicine Authors: Weinstein ZM, Wakeman SE, Nolan S Tags: Med Clin North Am Source Type: research

Addressing Adolescents' and Young Adults' Substance Use Disorders.
Abstract Adolescents and young adults (AYAs) have unique needs and important biopsychosocial differences when compared with older adults who use substances. As their brains continue to develop, youth are especially susceptible to the reinforcing effects of substances in the context of a still-developing capacity for executive control and decision making. In this article, the authors highlight key differences in the neurobiologic, epidemiologic, and relational aspects of substance use found in AYA. They also discuss how best to engage with youth who use substances and how prevention and intervention can be adapted ...
Source: The Medical Clinics of North America - June 26, 2018 Category: General Medicine Authors: Chadi N, Bagley SM, Hadland SE Tags: Med Clin North Am Source Type: research

Preventing Opioid Overdose in the Clinic and Hospital: Analgesia and Opioid Antagonists.
Abstract Drawing from existing opioid prescribing guidelines, this article describes how medical providers can reduce the risk of overdose. Through primary prevention, providers can prevent initial exposure and associated risks by educating patients, using risk stratification, minimizing opioid dose and duration, and avoiding coprescribing with sedatives. Secondary prevention efforts include monitoring patients with urine toxicology and prescription monitoring programs, and screening for opioid use disorders. Tertiary prevention includes treating opioid use disorders and providing naloxone to prevent overdose deat...
Source: The Medical Clinics of North America - June 26, 2018 Category: General Medicine Authors: Peglow SL, Binswanger IA Tags: Med Clin North Am Source Type: research

Office-Based Addiction Treatment in Primary Care: Approaches That Work.
Abstract Primary care is an important setting for delivering evidence-based treatment to address substance use disorders. To date, effective approaches to treat, care largely incorporate pharmacotherapy with counseling-based interventions and rely on multidisciplinary teams. There is strong support for primary care-based approaches to address alcohol and opioid use disorder with growing data focused on people living with human immunodeficiency virus and those experiencing incarceration. Future work should focus on the implementation of these effective approaches to decrease health disparities among people with sub...
Source: The Medical Clinics of North America - June 26, 2018 Category: General Medicine Authors: Edelman EJ, Oldfield BJ, Tetrault JM Tags: Med Clin North Am Source Type: research

Pharmacotherapy for Alcohol Use Disorder.
Abstract Alcohol use disorder is a common, destructive, and undertreated disease. As understanding of alcohol use disorder has evolved, so has our ability to manage patients with pharmacotherapeutic agents in addition to nondrug therapy, including various counseling strategies. Providers now have a myriad of medications, both approved and not approved by the US Food and Drug Administration, to choose from and can personalize care based on treatment goals, comorbidities, drug interactions, and drug availability. This review explores these treatment options and offers the prescriber practical advice regarding when e...
Source: The Medical Clinics of North America - June 26, 2018 Category: General Medicine Authors: Holt SR, Tobin DG Tags: Med Clin North Am Source Type: research

When and How to Treat Possible Cannabis Use Disorder.
This article reviews the current state of knowledge regarding effective treatments for cannabis use disorder. PMID: 29933822 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - June 26, 2018 Category: General Medicine Authors: Lévesque A, Le Foll B Tags: Med Clin North Am Source Type: research

Nontraditional Alcohol and Opioid Agonist Treatment Interventions.
This article reviews the available evidence of these treatment modalities. PMID: 29933823 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - June 26, 2018 Category: General Medicine Authors: Fairgrieve C, Fairbairn N, Samet JH, Nolan S Tags: Med Clin North Am Source Type: research

New and Emerging Illicit Psychoactive Substances.
Abstract Several novel psychoactive substances have emerged in recent years. Users are typically young men who use other substances. In the category of stimulants, cathinones ("bath salts") have predominated and can lead to agitation, psychosis, hyperthermia, and death. Synthetic cannabinoids ("spice") are more potent than marijuana and can lead to agitation, psychosis, seizures, and death. There are no rapid tests to identify these substances and general treatment includes benzodiazepines for agitation and supportive therapy. Many Synthetic opioids are potent analogues of fentanyl and carry a ...
Source: The Medical Clinics of North America - June 26, 2018 Category: General Medicine Authors: Graddy R, Buresh ME, Rastegar DA Tags: Med Clin North Am Source Type: research

The Role of Technology-Based Interventions for Substance Use Disorders in Primary Care: A Review of the Literature.
This article provides an overview of technology-based interventions (eg, computer-based and Web-based interventions, text messaging, interactive voice recognition, smartphone apps, and emerging technologies) that are extending the reach of effective addiction treatments both in substance use treatment and primary care settings. It discusses the efficacy of existing technology-based interventions for SUDs, prospects for emerging technologies, and special considerations when integrating technologies in primary care (eg, privacy and regulatory protocols) to enhance the management of SUDs. PMID: 29933825 [PubMed - in proc...
Source: The Medical Clinics of North America - June 26, 2018 Category: General Medicine Authors: Tofighi B, Abrantes A, Stein MD Tags: Med Clin North Am Source Type: research

Sleep Management Among Patients with Substance Use Disorders.
Abstract Sleep and substance use disorders commonly co-occur. Insomnia is commonly associated with use and withdrawal from substances. Circadian rhythm abnormalities are being increasingly linked with psychoactive substance use. Other sleep disorders, such as sleep-related breathing disorder, should be considered in the differential diagnosis of insomnia, especially in those with opioid use or alcohol use disorder. Insomnia that is brief or occurs in the context of active substance use is best treated by promoting abstinence. A referral to a sleep medicine clinic should be considered for those with chronic insomni...
Source: The Medical Clinics of North America - June 26, 2018 Category: General Medicine Authors: Chakravorty S, Vandrey RG, He S, Stein MD Tags: Med Clin North Am Source Type: research

Pain and Addiction: An Integrative Therapeutic Approach.
Abstract The current opioid crisis highlights an urgent need for better paradigms for prevention and treatment of chronic pain and addiction. Although many approach this complex clinical condition with the question, "Is this pain or is this addiction?," it is more than the sum of its parts. Chronic pain among those with dependence and addiction often evolves into a complex disabling condition with pain at multiple sites, psychosocial dysfunctions, medical and psychiatric disorders, polypharmacy, and polysubstance use, all interacting with each other in complex ways (multimorbidity). The authors offer an ...
Source: The Medical Clinics of North America - June 26, 2018 Category: General Medicine Authors: Manhapra A, Becker WC Tags: Med Clin North Am Source Type: research

Weighing the Risks and Benefits of Electronic Cigarette Use in High-Risk Populations.
This article reviews the current evidence on electronic cigarette (e-cigarette) safety and efficacy for smoking cessation, with a focus on smokers with cardiovascular disease, pulmonary disease, or serious mental illness. In the United States, adult smokers use e-cigarettes primarily to quit or reduce cigarette smoking. An understanding of the potential risks and benefits of e-cigarette use may help clinicians counsel smokers about the potential impact of e-cigarettes on health. PMID: 29933828 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - June 26, 2018 Category: General Medicine Authors: Camenga DR, Tindle HA Tags: Med Clin North Am Source Type: research

Smoking Cessation for Those Pursuing Recovery from Substance Use Disorders.
This article summarizes the literature regarding the similar biopsychosocial mechanisms of tobacco use and alcohol and substance use disorders, and the evidence for and against the provision of tobacco cessation for those in treatment for alcohol and substance use disorders. The practicality of treatment, focusing on methods, timing, and breadth of intervention strategies, are also presented. Common methodologies that may be used across tobacco use and alcohol and substance use disorder to prevent lapse and relapse are discussed. Physicians can and should adhere to the policy that tobacco use is a common and dangerous como...
Source: The Medical Clinics of North America - June 26, 2018 Category: General Medicine Authors: Derefinko KJ, Salgado García FI, Sumrok DD Tags: Med Clin North Am Source Type: research

More than "Just Say No".
More than "Just Say No". Med Clin North Am. 2018 Jul;102(4):xv-xvi Authors: Ashar BH PMID: 29933830 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - June 26, 2018 Category: General Medicine Authors: Ashar BH Tags: Med Clin North Am Source Type: research

The Internist's Challenge: Addressing Our Patients' Unhealthy Substance Use.
PMID: 29933831 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - June 26, 2018 Category: General Medicine Authors: Samet JH, O'Connor PG, Stein MD Tags: Med Clin North Am Source Type: research

Nuclear Medicine Imaging in the Dentomaxillofacial Region.
Abstract Nuclear medicine studies evaluate physiology on a molecular level providing earlier detection of lesions before morphologic change is evident. 99mTc-MDP and 18F-fluoride bone scans detect osteomyelitis earlier than radiographs and computed tomography (CT); aid in diagnosis of temporomandibular joint disorder; and evaluate activity of condylar hyperplasia, extent of Paget disease, and viability of bone grafts. 18F-FDG PET/CT distinguish between soft tissue and bone infections and diagnose osteomyelitis complicated by fracture or surgery. FDG PET is more accurate than CT alone and has a major role in stagin...
Source: The Medical Clinics of North America - June 17, 2018 Category: General Medicine Authors: Wassef HR, Colletti PM Tags: Dent Clin North Am Source Type: research

Pulmonary Embolism in Children.
Abstract Pulmonary embolism (PE) in children is a rare condition with potential for high mortality. PE incidence is increasing owing to increased survival of children with predisposing conditions, increased use of central venous catheters, and improved awareness and recognition. Although pediatric PE is distinct from adult PE, management guidelines in children are extrapolated from the adult data. Treatment includes thrombolysis or thrombectomy, and pharmacologic anticoagulation. Ongoing clinical trials are evaluating the use of direct oral anticoagulants in children. Further research is required to develop pediat...
Source: The Medical Clinics of North America - June 1, 2018 Category: General Medicine Authors: Ramiz S, Rajpurkar M Tags: Pediatr Clin North Am Source Type: research

Acquired Aplastic Anemia: What Have We Learned and What Is in the Horizon?
Abstract Acquired aplastic anemia (aAA) characterized by peripheral pancytopenia and bone marrow aplasia is a rare and serious disorder. Differential diagnosis includes constitutional bone marrow failure syndromes and myelodysplastic disorders. Autoimmune reaction to altered hematopoietic stem cells highlights the underlying mechanism. Matched related donor allogeneic hematopoietic stem cell transplantation is the ideal pediatric treatment; alternative approaches include immunosuppressive therapy and use of eltrombopag. Progression to clonal disorders can occur. Recently, alternative donor hematopoietic stem cell ...
Source: The Medical Clinics of North America - June 1, 2018 Category: General Medicine Authors: Savaşan S Tags: Pediatr Clin North Am Source Type: research

Benign Hematology.
PMID: 29803288 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - June 1, 2018 Category: General Medicine Authors: Callaghan MU Tags: Pediatr Clin North Am Source Type: research

Adrenal Surgery for Cushing's Syndrome: An Update.
Abstract Recent advances in the molecular pathogenesis and the natural history of Cushing's syndrome have improved the understanding of the management of this disease. The long-term efficacy of several cortisol-lowering medical treatments is currently under evaluation. However, adrenalectomy is a safe option for the treatment of patients affected by Cushing's syndrome. Unilateral adrenalectomy is the gold standard for treatment of adrenocortical adenomas associated with hypercortisolism. Bilateral adrenalectomy has been widely used in the past as definitive treatment of bilateral macronodular hyperplasia and persi...
Source: The Medical Clinics of North America - May 15, 2018 Category: General Medicine Authors: Di Dalmazi G, Reincke M Tags: Endocrinol Metab Clin North Am Source Type: research

Maternal Genetic Disorders in Pregnancy.
Abstract The life expectancy and quality of life of women with genetic disorders continues to improve, resulting in more women reaching reproductive age and desiring fertility. It is becoming increasingly important that obstetricians become familiar with common genetic disorders and their associated risks in pregnancy. The authors review pregnancy in women with various genetic disorders, including review of pregnancy outcomes, management recommendations, and genetic risk assessment. Most data on pregnancies in women with genetic conditions are based on case reports and literature reviews. Additional studies, inclu...
Source: The Medical Clinics of North America - May 13, 2018 Category: General Medicine Authors: Harris S, Vora NL Tags: Obstet Gynecol Clin North Am Source Type: research

The Enduring Value of the Physical Examination.
This article focuses exclusively on physical examination (PE) in the context of clinical medicine, that is, the interaction between a health care provider and patient. In essence, there is not only benefit (value) to PE but also that it will last (endure) for some time. Both "enduring" and "value" are explored in more depth with respect to the future integration of PE into the clinical assessment of a patient and how its value extends well beyond current diagnostic/cost-based metrics. PMID: 29650063 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - April 16, 2018 Category: General Medicine Authors: Zaman JAB Tags: Med Clin North Am Source Type: research

The Physical Examination as Ritual: Social Sciences and Embodiment in the Context of  the Physical Examination.
The Physical Examination as Ritual: Social Sciences and Embodiment in the Context of the Physical Examination. Med Clin North Am. 2018 May;102(3):425-431 Authors: Costanzo C, Verghese A Abstract The privilege of examining a patient is a skill of value beyond its diagnostic utility. A thorough physical examination is an important ritual that benefits patients and physicians. The concept of embodiment helps one understand how illness and pain further define and shape the lived experiences of individuals in the context of their race, gender, sexuality, and socioeconomic status. Understanding ritual ...
Source: The Medical Clinics of North America - April 16, 2018 Category: General Medicine Authors: Costanzo C, Verghese A Tags: Med Clin North Am Source Type: research

The Hypothesis-Driven Physical Examination.
Abstract The physical examination remains a vital part of the clinical encounter. However, physical examination skills have declined in recent years, in part because of decreased time at the bedside. Many clinicians question the relevance of physical examinations in the age of technology. A hypothesis-driven approach to teaching and practicing the physical examination emphasizes the performance of maneuvers that can alter the likelihood of disease. Likelihood ratios are diagnostic weights that allow clinicians to estimate the post-probability of disease. This hypothesis-driven approach to the physical examination ...
Source: The Medical Clinics of North America - April 16, 2018 Category: General Medicine Authors: Garibaldi BT, Olson APJ Tags: Med Clin North Am Source Type: research

The Role of Technology in the Bedside Encounter.
Abstract Technology has the potential to both distract and reconnect providers with their patients. The widespread adoption of electronic medical records in recent years pulls physicians away from time at the bedside. However, when used in conjunction with patients, technology has the potential to bring patients and physicians together. The increasing use of point-of-care ultrasound by physicians is changing the bedside encounter by allowing for real-time diagnosis with the treating physician. It is a powerful example of the way technology can be a force for refocusing on the bedside encounter. PMID: 29650066...
Source: The Medical Clinics of North America - April 16, 2018 Category: General Medicine Authors: Kumar A, Liu G, Chi J, Kugler J Tags: Med Clin North Am Source Type: research

Diagnostic Errors and the Bedside Clinical Examination.
Abstract Diagnostic errors are common in clinical practice and lead to adverse patient outcomes. Systematic reviews have shown that inadequate history taking and physical examination lead to a plurality, if not a majority, of diagnostic errors. Recent advances in cognitive science have also shown that unconscious biases likely contribute to many diagnostic errors. Research into diagnostic error has been hampered by methodologic inconsistency and a paucity of studies in real-world clinical settings. The best evidence indicates that educational interventions to reduce diagnostic error should give physicians feedback...
Source: The Medical Clinics of North America - April 16, 2018 Category: General Medicine Authors: Clark BW, Derakhshan A, Desai SV Tags: Med Clin North Am Source Type: research

The Outpatient Physical Examination.
Abstract The physical examination in the outpatient setting is a valuable tool. Even in settings where there is lack of evidence, such as the annual physical examination of an asymptomatic adult, the physical examination is beneficial for the physician-patient relationship. When a patient has specific symptoms, the physical examination-in addition to a thorough history-can help narrow down, or in many cases establish, a diagnosis. In a time where imaging and laboratory tests are easily available, but are expensive and can be invasive, a skilled physical examination remains an important component of patient evaluat...
Source: The Medical Clinics of North America - April 16, 2018 Category: General Medicine Authors: Artandi MK, Stewart RW Tags: Med Clin North Am Source Type: research

The Electronic Health Record and the Clinical Examination.
Abstract This review examines how the adoption of the electronic health record (EHR) has changed the most fundamental unit of medicine: the clinical examination. The impact of the EHR on the clinical history, physical examination, documentation, and the doctor-patient relationship is described. The EHR now has a dominant role in clinical care and will be a central factor in clinical work of the future. Conversation needs to be shifted toward defining best practices with current EHRs inside and outside of the examination room. PMID: 29650069 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - April 16, 2018 Category: General Medicine Authors: Hedian HF, Greene JA, Niessen TM Tags: Med Clin North Am Source Type: research

Communication and Ethics in the Clinical Examination.
Abstract At the heart of every effective patient-physician interaction is a relationship that is built on trust. Cultivating sound communication skills coupled with the awareness and application of ethical principles is integral to this process. One of the foremost challenges in competent practice is negotiating situations that arise at the bedside when such issues as patient autonomy, differing world views, honesty, and cost stewardship come into conflict. It is essential for health care providers to consider how to detect and prioritize these issues as they advocate for high-quality and patient-centered care. ...
Source: The Medical Clinics of North America - April 16, 2018 Category: General Medicine Authors: Onguti S, Mathew S, Todd C Tags: Med Clin North Am Source Type: research

Improving Observational Skills to Enhance the Clinical Examination.
Abstract For much of the 20th century, educators lacked evidence that teaching observational skills could benefit modern medicine. But in 2001, a statistical model emerged that supported the effectiveness of teaching observational skills to medical students using a museum-based curriculum. The story that led to that ground-breaking study, and the consequences that sprung from it, is retold here, traveling from the darkened caves in the foothills of France to the brightly lit galleries of the Yale center for British art. It never would have happened without the indelible mark made by one curious man's journey. ...
Source: The Medical Clinics of North America - April 16, 2018 Category: General Medicine Authors: Russell SW Tags: Med Clin North Am Source Type: research

Patient-Centered Bedside Rounds and the Clinical Examination.
Abstract Bedside hospital rounds promote patient-centered care in teaching and nonteaching settings. Patients and families prefer bedside rounds and provider acceptance is increasing. Efficient bedside rounds with an interprofessional team or with learners requires preparation of the patient and the rounding team. Bedside "choreography" provides structure and sets expectations for time spent in the room. By using relationship-centered communication, rounds can be both patient proximate and patient centered. The clinical examination can be integrated into the flow of the presentation and case discussion. ...
Source: The Medical Clinics of North America - April 16, 2018 Category: General Medicine Authors: Lichstein PR, Atkinson HH Tags: Med Clin North Am Source Type: research

The Clinical Examination and Socially At-Risk Populations: The Examination Matters for Health Disparities.
We describe strategies for relationship-centered care within routine encounters. Our goal is to train clinicians to mitigate differences and reduce disparities in health care delivery. PMID: 29650073 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - April 16, 2018 Category: General Medicine Authors: Murphy KA, Ellison-Barnes A, Johnson EN, Cooper LA Tags: Med Clin North Am Source Type: research

Clinical Examination Component of Telemedicine, Telehealth, mHealth, and Connected Health Medical Practices.
Abstract Telemedicine and telehealth are the practices of medicine at a distance. Performing the equivalent of a complete clinical examination by telemedicine would be unusual. However, components of a more traditional clinical examination are part of the telemedicine workup for specific conditions. Telemedicine clinical examinations are facilitated, and enhanced, through the integration of a class of medical devices referred to as telemedicine peripherals (eg, electronic stethoscopes, tele-ophthalmoscopes, video-otoscopes, and so forth). Direct-to-consumer telehealth is a rapidly expanding segment of the health c...
Source: The Medical Clinics of North America - April 16, 2018 Category: General Medicine Authors: Weinstein RS, Krupinski EA, Doarn CR Tags: Med Clin North Am Source Type: research

Clinical Skills Assessment in the Twenty-First Century.
This article summarizes contemporary approaches to clinical skills assessment that, if more widely adopted, could support the maintenance and reinvigoration of bedside clinical skills. PMID: 29650075 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - April 16, 2018 Category: General Medicine Authors: Elder A Tags: Med Clin North Am Source Type: research

Digital Tools to Enhance Clinical Reasoning.
This article highlights digital resources that increase the number of cases a clinician experiences and learns from. PMID: 29650076 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - April 16, 2018 Category: General Medicine Authors: Manesh R, Dhaliwal G Tags: Med Clin North Am Source Type: research

Recapturing the Lost Art.
PMID: 29650077 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - April 16, 2018 Category: General Medicine Authors: Ashar BH Tags: Med Clin North Am Source Type: research

The Clinical Examination in Twenty-First Century Medicine.
PMID: 29650078 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - April 16, 2018 Category: General Medicine Authors: Garibaldi BT Tags: Med Clin North Am Source Type: research

Cross-Sectional Imaging Techniques and Normal Anatomy of the Salivary Glands.
Abstract The salivary glands play an important role in digestion and oral hygiene, and give rise to a variety of benign and malignant pathologies. In suspected pathology, the goal of imaging is to confirm a lesion as being of salivary gland origin, narrow the list of differential considerations, define the extent of disease, and guide further management decisions. This review outlines the function, embryologic development, anatomy, and normal imaging features of the major salivary glands. The article also discusses imaging indications, the general approach to imaging the salivary glands, and the commonly used cros...
Source: The Medical Clinics of North America - April 7, 2018 Category: General Medicine Authors: Atkinson C, Fuller J, Huang B Tags: Neuroimaging Clin N Am Source Type: research

Evaluation and Management of Dehydration in Children.
Abstract The article discusses the evaluation of dehydration in children and reviews the literature on physical findings of dehydration. Pediatric dehydration is a common problem in emergency departments and wide practice variation in treatment exists. Dehydration can be treated with oral, nasogastric, subcutaneous, or intravenous fluids. Although oral rehydration is underutilized in the United States, most children with dehydration can be successfully rehydrated via the oral route. Selection of oral rehydration solution and techniques for successful oral rehydration are presented. Appropriate selection and rate o...
Source: The Medical Clinics of North America - April 7, 2018 Category: General Medicine Authors: Santillanes G, Rose E Tags: Emerg Med Clin North Am Source Type: research

Bronchiolitis: From Practice Guideline to Clinical Practice.
Abstract The American Academy of Pediatrics' clinical practice guideline in bronchiolitis was last updated in 2014 with recommendations to improve care for pediatric patients with bronchiolitis. As most treatments of bronchiolitis are supportive, the guideline minimizes the breadth of treatments previously used and cautions the use of tests and therapies that have a limited evidence base. Emergency physicians must be familiar with the guidelines in order to apply best practices appropriately. PMID: 29622322 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - April 7, 2018 Category: General Medicine Authors: Kou M, Hwang V, Ramkellawan N Tags: Emerg Med Clin North Am Source Type: research

Pediatric Minor Head Injury 2.0: Moving from Injury Exclusion to Risk Stratification.
Abstract Visits for pediatric minor blunt head trauma continue to increase. Variability exists in clinician evaluation and management of this generally low-risk population. Clinical decision rules identify very low-risk children who can forgo neuroimaging. Observation before imaging decreases neuroimaging rates. Outcome data can be used to risk stratify children into more discrete categories. Decision aids improves knowledge and accuracy of risk perception and facilitates identification of caregiver preferences, allowing for shared decision making. For children in whom imaging is performed and is normal or shows i...
Source: The Medical Clinics of North America - April 7, 2018 Category: General Medicine Authors: Homme JJL Tags: Emerg Med Clin North Am Source Type: research

Pediatric Syncope: High-Risk Conditions and Reasonable Approach.
This article reviews some of the most dangerous causes of syncope in the pediatric patient. PMID: 29622324 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - April 7, 2018 Category: General Medicine Authors: Schunk PC, Ruttan T Tags: Emerg Med Clin North Am Source Type: research

Pediatric Pain Management.
Abstract Nearly 20 years ago, standards were established for hospitals to assess and treat pain in all patients. Research continues to demonstrate evolving trends in the measurement and effective treatment of pain in children. Behavioral research demonstrating long-lasting effects of inadequate pain control during childhood supports the concepts of early and adequate pain control for children suffering from painful conditions in the acute care setting. The authors discuss pain concepts, highlighting factors specific to the emergency department, and include a review of evidence for pharmacologic and nonpharmac...
Source: The Medical Clinics of North America - April 7, 2018 Category: General Medicine Authors: Gaglani A, Gross T Tags: Emerg Med Clin North Am Source Type: research

What to Do when Babies Turn Blue: Beyond the Basic Brief Resolved Unexplained Event.
Abstract The term "brief resolved unexplained event" was created to replace "apparent life-threatening event," narrowing the definition and providing evidence-based guidelines for management. The emphasis is placed on using clinical clues to classify patients as low risk or exclude them from the categorization altogether. Infants who meet low-risk classification can be briefly observed in the emergency department and be discharged home. Infants who demonstrate elements suggestive of a specific etiology should be evaluated and treated accordingly. Patients who demonstrate no specific findings ye...
Source: The Medical Clinics of North America - April 7, 2018 Category: General Medicine Authors: McFarlin A Tags: Emerg Med Clin North Am Source Type: research

Imaging Gently.
This article reviews the evidence supporting the risk of ionizing radiation from medical imaging as well as discusses clinical scenarios in which clinicians play an important role in supporting the judicious use of imaging studies. PMID: 29622327 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - April 7, 2018 Category: General Medicine Authors: Puchalski AL, Magill C Tags: Emerg Med Clin North Am Source Type: research

Inborn Errors of Metabolism in the Emergency Department (Undiagnosed and Management of the Known).
This article reviews the approach to the patient with unknown metabolic diagnosis and up-to-date management pearls for children with known disorders. PMID: 29622328 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - April 7, 2018 Category: General Medicine Authors: MacNeill EC, Walker CP Tags: Emerg Med Clin North Am Source Type: research

Pediatric Emergency Noninvasive Ventilation.
Abstract Noninvasive ventilation (NIV) has emerged as a powerful tool for the pediatric emergency management of acute respiratory failure (ARF). This therapy is safe and well tolerated and seems to frequently prevent both the need for invasive mechanical ventilation and the associated risks/complications. Although NIV can be the primary treatment of ARF resulting from multiple respiratory disease states, it must be meticulously monitored and, when unsuccessful, may aid in preoxygenation for prompt endotracheal intubation and invasive mechanical ventilation. The following article reviews the physiologic effects of ...
Source: The Medical Clinics of North America - April 7, 2018 Category: General Medicine Authors: Viscusi CD, Pacheco GS Tags: Emerg Med Clin North Am Source Type: research

Pediatric Ventilator Management in the Emergency Department.
This article uses cases to provide a framework to initiate and troubleshoot mechanical ventilation of pediatric patients in the emergency department. PMID: 29622330 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - April 7, 2018 Category: General Medicine Authors: Pacheco GS, Mendelson J, Gaspers M Tags: Emerg Med Clin North Am Source Type: research