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