Pediatric emergency medicine trisk 2799 2799

intrapulmonary shunting, which may contribute to the hypoxemia seen in greater than 80% of cases Pleuritic chest pain and hemoptysis are often due to pulmonary infarction related to the embolus Although a number of diagnostic modalities exist, the most common in pediatrics is CT angiography Validated clinical decision rules exist for use in adult populations (e.g., Wells Criteria, Geneva Score, and Pulmonary Embolism Rule-out Criteria [PERC]) although these scoring systems should be used with caution in pediatric patient populations Therefore, the challenge lies in appropriately identifying those children who require further evaluation with CT, with its increased risk from ionizing radiation exposure weighted against the risk of missing this potentially serious diagnosis Goals of Treatment PE is a rare, but potentially life-threatening condition in pediatrics which often presents with nonspecific signs and symptoms It can often be clinically challenging to determine a patient’s risk of PE and need for advanced workup Once PE is diagnosed, the treatment goals are to correct hemodynamic or respiratory abnormalities and to prevent progression of disease and recurrence Clinical Considerations Clinical Recognition Children with PE commonly have underlying medical conditions which predispose them to thromboembolic events CVCs have been identified as the most common, while others include active malignancy, inherited thrombophilia, nephrotic syndrome, inflammatory bowel disease, congenital heart disease, collagen vascular diseases including systemic lupus erythematosus (SLE), significant trauma/surgery, and severe infection/sepsis Traditional “adult” risk factors including oral contraceptives, elective abortion, prolonged immobilization, IV drug use, rheumatic heart disease, smoking, and obesity may also play a role in some older pediatric patients Triage PE should be considered in the differential diagnosis for children with acute onset pleuritic chest pain, particularly those with known risk factors for thrombosis Children presenting with significant respiratory distress require prompt evaluation Acute circulatory collapse from massive PE is rare in children, though when present, it requires immediate resuscitative interventions Initial Assessment/H&P