culture of high reliability With this new edition of the Textbook of Pediatric Emergency Medicine, we provide easy web-based access for use in practice, links to clinical pathways based on the latest evidence and expert consensus, and a new, streamlined format that emphasizes the goals of quality care”–Provided by publisher Identifiers: LCCN 2020013643 | eISBN 9781975121532 Subjects: MESH: Emergencies | Child | Critical Care | Emergency Treatment | Infant Classification: LCC RJ370 | NLM WS 205 | DDC 618.92/0025–dc23 LC record available at https://lccn.loc.gov/2020013643 This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied, including any warranties as to accuracy, comprehensiveness, or currency of the content of this work This work is no substitute for individual patient assessment based upon healthcare professionals’ examination of each patient and consideration of, among other things, age, weight, gender, current or prior medical conditions, medication history, laboratory data, and other factors unique to the patient The publisher does not provide medical advice or guidance and this work is merely a reference tool Healthcare professionals, and not the publisher, are solely responsible for the use of this work including all medical judgments and for any resulting diagnosis and treatments Given continuous, rapid advances in medical science and health information, independent professional verification of medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and treatment options should be made and healthcare professionals should consult a variety of sources When prescribing medication, healthcare professionals are advised to consult the product information sheet (the manufacturer’s package insert) accompanying each drug to verify, among other things, conditions of use, warnings and side effects, and identify any changes in dosage schedule or contraindications, particularly if the medication to be administered is new, infrequently used or has a narrow therapeutic range To the maximum extent permitted under applicable law, no responsibility is assumed by the publisher for any injury and/or damage to persons or property, as a matter of products liability, negligence law or otherwise, or from any reference to or use by any person of this work shop.lww.com DEDICATION I would like to dedicate this book to all my colleagues, nationally and internationally, in Emergency Medicine and Pediatrics that care for ill and injured children I hope this new edition will help in our mission to provide high-quality care To the many students, residents, fellows, and junior colleagues whom I have taught and have taught me, thank you for your dedication Finally, and most importantly, my love and gratitude to my family for their support: my husband Ben Green and our children Andrew, Becca, and Eric Kathy N Shaw Upon reflecting on this endeavor, I first need to thank my extraordinary mentor, Gary Fleisher, who bestowed this editorial position on me and provided strong guidance and support over the last 33 years Taking the lead from Steve and Gary on this iconic tool of our specialty is one of the highest honors of my career To Kathy Shaw, you are an inspiring partner and a visionary PEM leader—you have enhanced every aspect of this process and thank you for the opportunity to work with you To Bernadette, Ryan, and Abby, thank you for your love and encouragement As we release this 8th edition, I am extremely hopeful that this textbook continues to be a tremendous resource for all those dedicated to emergency care for children Richard G Bachur I would like to dedicate this work to my brilliant wife, Pamela Berry, my children, Daniel, Michael, Meghan, and Eleanor, and my grandson Arthur You give me the “strength to what needs to be done.” I’d like to thank my colleagues, fellows, and patients, from whom I relearn daily the joys of practicing medicine James M Chamberlain To my Mom and Dad, thanks for inspiring me to follow my passion and for instilling in me a strong work ethic and the importance of contributing to the world in some small way To my incredible family, Drew, Adam, and Jamie, thanks for the adventures Jane Lavelle Thank you to all our wonderful contributors who devoted so much time and effort toward creating this steadfast reference for all of us to share What an amazing opportunity for young faculty to work alongside senior colleagues who helped build pediatric emergency medicine as a subspecialty And of course, a special thanks to my truest heroes, Jan, Maddie, and Jack, for their unfaltering support Joshua Nagler I dedicate this work to my family: Jeff, Nathan, Hannah, Matthew, Kate, and Tommy Starke—you are the lights of my life I also love my work family, the PEM community, with whom I have the pleasure to work every day And finally, I want to recognize the patients and families we serve Thank you Joan E Shook CONTRIBUTING AUTHORS Mary Kate F Abbadessa, MSN, RN, ACCNS-P, RN-BC, CPEN Clinical Nurse Specialist Emergency Medicine Children’s Hospital of Philadelphia/Perelman School of Medicine at the University of Pennsylvania Philadelphia, Pennsylvania Alyssa Abo, MD, FAAP, FACEP, FAIUM Director of Strategic Innovation | Emergency Medicine Chair, Hospital Oversight Committee for Point-of-Care Ultrasound Children’s National Hospital Associate Professor of Pediatrics and Emergency Medicine George Washington University School of Medicine and Health Sciences Washington, DC Dewesh Agrawal, MD Professor of Pediatrics and Emergency Medicine Vice-Chair for Medical Education and Designated Institutional Official Children’s National Hospital/George Washington University School of Medicine and Health Sciences Washington, DC Michael S.D Agus, MD Division Chief/Associate Professor of Pediatrics Division of Medical Critical Care Boston Children’s Hospital/Harvard Medical School Boston, Massachusetts Aletha Y Akers, MD, MPH Associate Professor of Pediatrics Department of Pediatrics ... Strategic Innovation | Emergency Medicine Chair, Hospital Oversight Committee for Point-of-Care Ultrasound Children’s National Hospital Associate Professor of Pediatrics and Emergency Medicine George... Medicine George Washington University School of Medicine and Health Sciences Washington, DC Dewesh Agrawal, MD Professor of Pediatrics and Emergency Medicine Vice-Chair for Medical Education and... Abbadessa, MSN, RN, ACCNS-P, RN-BC, CPEN Clinical Nurse Specialist Emergency Medicine Children’s Hospital of Philadelphia/Perelman School of Medicine at the University of Pennsylvania Philadelphia, Pennsylvania