Pediatric emergency medicine trisk 565

Methemoglobinemia
Cortazzo JA, Lichtman AD. Methemoglobinemia: a review and recommendations for
management. J Cardiothorac Vasc Anesth 2014;28:1055–1059.
Wright RO, Lewander WJ, Woolf AD. Methemoglobinemia: etiology, pharmacology,
and clinical management. Ann Emerg Med 1999;34:646–656.
Sickle Cell Disease
Baskin MN, Goh XL, Heeney MM, et al. Bacteremia risk and outpatient management of
febrile patients with sickle cell disease. Pediatrics 2013;131:1035–1041.
Field JJ, DeBaun MR. Asthma and sickle cell disease: two distinct diseases or part of
the same process? Hematology Am Soc Hematol Educ Program 2009:45–53. doi:
10.1182/asheducation-2009.1.45.
Ogunlesi F, Heeney MM, Koumbourlis AC. Systemic corticosteroids in acute chest
syndrome: friend or foe? Paediatr Respir Rev 2014;15:24–27.
Quinn CT. Sickle cell disease in childhood: from newborn screening through transition
to adult medical care. Pediatr Clin North Am 2013;60:1363–1381.
Rees DC, Williams TN, Gladwin MT. Sickle-cell disease. Lancet 2010;376:2018–2031.
Venkataraman A, Adams RJ. Neurologic complications of sickle cell disease. Handb
Clin Neurol 2014;120:1015–1025.
Yee ME, Bakshi N, Graciaa SH, et al. Incidence of invasive Haemophilus influenzae
infections in children with sickle cell disease. Pediatr Blood Cancer 2019;66:e27642.
Neutropenia
Boxer LA, Newburger PE. A molecular classification of congenital neutropenia
syndromes. Pediatr Blood Cancer 2007;49:609–614.
Dokal I, Vulliamy T. Inherited aplastic anaemias/bone marrow failure syndromes. Blood
Rev 2008;22:141–153.
Newburger PE, Dale DC. Evaluation and management of patients with isolated
neutropenia. Semin Hematol 2013;50:198–206.
Immune Thrombocytopenia
Buchanan GR, Adix L. Grading of hemorrhage in children with idiopathic
thrombocytopenic purpura. J Pediatr 2002;141:683–688.
Labarque V, Van Geet C. Clinical practice: immune thrombocytopenia in paediatrics.

Eur J Pediatr 2014;173:163–172.
Neunert CE, Buchanan GR, Imbach P, et al; Intercontinental Childhood ITP Study
Group Registry II Participants. Severe hemorrhage in children with newly diagnosed
immune thrombocytopenic purpura. Blood 2008;112:4003–4008.
Neunert C, Lim W, Crowther M, et al; American Society of Hematology. The American
Society of Hematology 2011 evidence-based practice guideline for immune
thrombocytopenia. Blood 2011;117:4190–4207.


Other Disorders Associated With Thrombocytopenia
Balduini CL, Pecci A, Noris P. Diagnosis and management of inherited
thrombocytopenias. Semin Thromb Hemost 2013;39:161–171.
Bertrand G, Kaplan C. How do we treat fetal and neonatal alloimmune
thrombocytopenia? Transfusion 2014;54:1698–1703.
Warkentin TE, Linkins LA. Non-necrotizing heparin-induced skin lesions and the 4T’s
score. J Thromb Haemost 2010;8:1483–1485.
Thrombocytosis
Bleeker JS, Hogan WJ. Thrombocytosis: diagnostic evaluation, thrombotic risk
stratification, and risk-based management strategies. Thrombosis 2011:1–16.
Fu R, Zhang L, Yang R. Paediatric essential thrombocythaemia: clinical and molecular
features, diagnosis and treatment. Br J Haematol 2013;163:295–302.
Schafer AI. Thrombocytosis and thrombocythemia. Blood Rev 2001;15:159–166.
Teofili L, Larocca LM. Advances in understanding the pathogenesis of familial
thrombocythaemia. Br J Haematol 2011;152:701–712.
Disorders of Hemostasis
Al-Samkari H, Croteau SE. Shifting current clinical coagulation assays. Am J Hematol
2018;93:1082–1090.
Lee LK, Dayan PS, Gerardi MJ, et al; Traumatic Brain Injury Study Group for the
Pediatric Emergency Care Applied Research Network (PECARN). Intracranial
hemorrhage after blunt head trauma in children with bleeding disorders. J Pediatr

2011;158:1003–1008.e1–e2.
Sarnaik A, Kamat D, Kannikeswaran N. Diagnosis and management of bleeding
disorder in a child. Clin Pediatr (Phila) 2010;49:422–431.
Sharma R, Flood VH. Advances in the diagnosis and treatment of von Willebrand
disease. Blood 2017;130(22):2386–2391.
Singleton T, Kruse-Jarres R, Leissinger C. Emergency department care for patients with
hemophilia and von Willebrand disease. J Emerg Med 2010;39:158–165.
Hypercoaguability
Andrew M, Marzinotto V, Massicotte P, et al. Heparin therapy in pediatric patients: a
prospective cohort study. Pediatr Res 1994;35:78–83.
Monagle P, Chan AK, Goldenberg NA, et al; American College of Chest Physicians.
Antithrombotic therapy in neonates and children: Antithrombotic Therapy and
Prevention of Thrombosis, 9th ed: American College of Chest Physicians EvidenceBased Clinical Practice Guidelines. Chest 2012;141:e737S–e801S.
Monagle P, Newall F. Management of thrombosis in children and neonates: practical use
of anticoagulants in children. Hematology Am Soc Hematol Educ Program
2018;2018(1):399–404.


Nowak-Göttl U, van Ommen H, Kenet G. Thrombophilia testing in children: what and
when should be tested? Thromb Res 2018;164:75–78.
Roach ES, Golomb MR, Adams R, et al; American Heart Association Stroke Council;
Council on Cardiovascular Disease in the Young. Management of stroke in infants
and children: a scientific statement from a Special Writing Group of the American
Heart Association Stroke Council and the Council on Cardiovascular Disease in the
Young. Stroke 2008;39:2644–2691.
Young G. How I treat pediatric venous thromboembolism. Blood 2017;130(12):1402–
1408.
Transfusion Reactions
Osterman JL, Arora S. Blood product transfusions and reactions. Emerg Med Clin North
Am 2014;32:727–738.

CHAPTER 94 ■ INFECTIOUS DISEASE EMERGENCIES
ANDREA T. CRUZ

GOALS OF EMERGENCY CARE
Fever is one of the most common presenting complaints for children seen in the emergency department (ED). ED
physicians face the challenge of differentiating potentially life-, limb-, or sensory-threatening causes of infection
from the vast majority of children with febrile illnesses that will spontaneously resolve without intervention. For
infectious disease (ID) emergencies, the clinical evaluation should focus upon prompt recognition of potentially
serious conditions. Evidence-based diagnostic strategies can facilitate care and avoid unnecessary evaluations of
otherwise well-appearing children.
RELATED CHAPTERS
Signs and Symptoms
Diarrhea: Chapter 23
Fever: Chapter 31
Lymphadenopathy: Chapter 47
Neck Mass: Chapter 48
Oral Lesions: Chapter 52
Septic-Appearing Infant: Chapter 73
Sore Throat: Chapter 74
Tachycardia: Chapter 77
Medical, Surgical, and Trauma Emergencies
Cardiac Emergencies: Chapter 86
Gastrointestinal Emergencies: Chapter 91
Gynecology Emergencies: Chapter 92
Oncologic Emergencies: Chapter 98

BACTEREMIA AND SEPSIS
CLINICAL PEARLS AND PITFALLS

It can be difficult to differentiate among children with uncomplicated viral infections and occult
bacteremia.
With reduction in vaccine-preventable diseases, most positive blood cultures are false positive with
contaminants.
Evidence-based guidelines can optimize management in the young febrile child.

Current Evidence
The epidemiology of pediatric bacteremia has changed dramatically over the last three decades due to widespread
use of the 13-valent pneumococcal conjugate and Haemophilus influenzae type B (Hib) vaccines. The most
common isolates now causing bacteremia are listed in Table 94.1 . While rates of pneumococcal bacteremia have
declined in the post-pneumococcal conjugate vaccine era, Streptococcus pneumoniae still comprises most cases of
bacteremia, along with Staphylococcus aureus, Salmonella, group A streptococcus (GAS), and meningococcus;
group B streptococcus (GBS) and gram-negative rods remain the most common causes of bacteremia and sepsis in
neonates and young infants. In some studies, contaminants are up to sevenfold more common than true pathogens.
As a consequence, use of evidence-based algorithms in the approach to the febrile child (Chapter 31 Fever ) can
reduce unnecessary evaluation and optimize treatment of the well-appearing child.