Pediatric emergency medicine trisk 2794 2794

Clinical Indications for Discharge or Admission Indications for hospitalization will vary according to the acute conditions diagnosed and underlying severity of disease Consultation with a pulmonologist or the patient’s CF team may provide insight into the need for hospitalization Follow-Up Care The majority of CF patients in the United States are followed in CFF approved and supported centers All centers’ contact information is available at the CFF website (http://www.cff.org ) Close contact between emergency physicians and the CF center team caring for this patient population facilitates acute management and continuity of care PULMONARY HEMORRHAGE CLINICAL PEARLS AND PITFALLS Pulmonary hemorrhage may be seen in acute respiratory illnesses or after thoracic trauma, the initial presentation of a chronic vasculitic condition, or during exacerbation of a chronic condition such as CF Pulmonary hemorrhage can present with significant respiratory distress and hemodynamic compromise Management primarily involves assessment and support of oxygenation, ventilation, and hemodynamics, with consideration of diagnostic testing for the underlying condition Bronchoscopy is generally reserved for patients with persistent bleeding or when diagnostically necessary Blood products including packed red blood cells, platelets, coagulation factors, and fresh-frozen plasma should be considered if signs of significant bleeding and/or shock are present Current Evidence Pulmonary hemorrhage, or bleeding into the lung, most commonly manifests clinically with hemoptysis Although relatively uncommon, pulmonary hemorrhage can be dramatic and life threatening Therefore, early evaluation and treatment is paramount The potential causes vary and include acute infection, exacerbation of chronic pulmonary disease, vascular malformations, and thoracic trauma among others The relative frequency of causative etiologies will vary significantly by the