Pediatric emergency medicine trisk 2

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 />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
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other things, conditions of use, warnings and side effects, and identify any changes in dosage
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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 do 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