Pediatric emergency medicine trisk 2798 2798

difficult Occasionally, for brisk bleeding in a patient with a known or likely source, such as in bronchiectasis from CF or a known vascular malformation, embolization of vessels may be employed to rapidly stop the hemorrhage Additional treatment is tailored to the underlying etiology of disease In allergic, vasculitic, and idiopathic hemorrhage, the administration of methylprednisolone (2 mg/kg/day IV divided in three to four divided doses) is indicated When hemorrhage is caused by infection, especially tuberculosis, antimicrobial therapy should be instituted and steroids avoided Clinical Indications for Discharge or Admission Most patients with pulmonary hemorrhage will require hospitalization for supportive care, until the cause of the bleeding has been determined and the hemorrhage has been controlled PULMONARY EMBOLISM CLINICAL PEARLS AND PITFALLS Most pediatric patients with PE have underlying conditions that predispose them to thrombotic events; central venous catheter (CVC) is the greatest risk factor, while oral contraceptive (OCP) use may also predispose to clotting Wells score, PERC, and other adult PE rule-out scoring systems should be used with caution in pediatric populations The decision to image with CTA must weigh the risk of radiation exposure against the pretest probability of this relatively rare condition Management of PE involves supportive care and prevention of progression of thrombus Current Evidence PE is the partial or complete obstruction of the pulmonary artery or its branches due to a thrombus, detached from its origination within the systemic venous system The degree of anatomic obstruction of the arterial vessel will dictate the degree of hemodynamic compromise Pulmonary arterial occlusion will lead to increases in right-sided afterload with cardiovascular pulmonary hypertension as well as concomitant reductions in left-sided preload which can result in cardiovascular collapse Beyond direct vascular obstruction, release of vasoactive and bronchoconstrictive cytokines may also lead to further V/Q mismatching and