Pediatric emergency medicine trisk 4208 4208

Management As noted above, ED physicians should adhere to their normal clinical decision-making processes when working up a patient’s symptoms Symptoms that could legitimately have an emergent underlying medical etiology should be assessed accordingly Conversely, ED physicians should avoid performing unnecessary tests, especially for nonemergent diagnoses Unnecessary testing rarely reassures families; it overmedicalizes patients, strengthens the reinforcement of the symptoms/impairment, places patients at risk for the sequelae of false-positive or incidental findings, confers iatrogenic risk and discomfort without clear benefit, and distracts attention away from interventions that are more likely to be successful The same concept holds true for prescribing medications or other treatment interventions ( Table 126.29 ) Efforts should focus on relaying the “good news” of the negative findings and the lack of need for further intervention at this time Education about the nature of psychosomatic symptoms should be given in a supportive and nonjudgmental way Treatment recommendations should focus on referrals for psychological support, providing anticipatory guidance and advice to parents around supporting return to function (including the use of physical therapy when indicated) In some circumstances, inpatient medical admission may be necessary, including in cases where video EEG monitoring is indicated or patients are unable to orally hydrate themselves or ambulate It can be helpful at these times for the ED physician to try to “set up” the admission as one that may very well not lead to the identification of an underlying medical illness or alleviate all of the symptoms but rather to facilitate further workup, specialists consultation to put an appropriate aftercare plan into place Psychiatric etiologies should be listed in a nonjudgmental fashion as part of the differential and involvement of the mental health team for diagnostic purposes and support of recovery should be presented, whenever possible, from the start