PEMP 0317 Pneumothorax In Pediatric Patients.pdf


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Pneumothorax In Pediatric
Patients: Management
Strategies To Improve Patient
Outcomes
Abstract
The clinical presentation of pneumothorax is highly variable. Spontaneous pneumothoraces may present with subtle symptoms when a
small air leak is present, but can progress to hemodynamic instability
in the setting of tension physiology. The etiologies are broad and the
severity can vary greatly. A trauma patient with a pneumothorax may
also have the added complexity of other potentially life-threatening
injuries. While there is a wealth of evidence-based guidelines for the
management of pneumothoraces in the adult literature, the approach
to pediatric patients is largely extrapolated from that literature without a significant evidence base. In this issue, aspects of the history and
physical examination, the use of various diagnostic imaging modalities, and the range of interventions available to the emergency clinician
are discussed.
Editor-in-Chief

March 2017

Volume 14, Number 3
Authors
Matthew Harris, MD
Fellow in EMS and Disaster Medicine, Newark Beth Israel, Newark,
NJ, RWJ/Barnabas Health; Attending Physician, Division of
Pediatric Emergency Medicine, Cohen Children's Medical Center,
New Hyde Park, NY
Joshua Rocker, MD
Associate Chief, Division of Pediatric Emergency Medicine, Cohen
Children's Medical Center; Assistant Professor of Emergency
Medicine and Pediatrics, Hofstra Northwell School of Medicine,
New Hyde Park, NY
Peer Reviewers
Steven Choi, MD
Assistant Vice President, Montefiore Network Performance
Improvement; Director, Montefiore Institute for Performance
Improvement; Assistant Professor of Pediatrics, Albert Einstein
College of Medicine, Bronx, NY
Michelle K. Hughes, DO, FAAP
Children’s Hospital of the King's Daughters, Pediatric Emergency
Medicine Attending Physician, Associate Medical Director for
Trauma, Chair of Resuscitation Outcomes Committee, Assistant
Professor of Pediatrics, Eastern Virginia Medical School Department
of Pediatrics, Norfolk, VA
Steven Yung, MD
Medical Director of Pediatric Quality and Safety Services, Assistant
Professor, Pediatric Critical Care Medicine, Kravis Children’s
Hospital at Mount Sinai, New York, NY
Prior to beginning this activity, see “Physician CME Information”
on the back page.

Ilene Claudius, MD
Associate Professor, Department
of Emergency Medicine and
Pediatrics, USC Keck School of
Medicine, Los Angeles, CA

Alson S. Inaba, MD, FAAP
Garth Meckler, MD, MSHS
Pediatric Emergency Medicine
Associate Professor of Pediatrics,
Specialist, Kapiolani Medical Center
University of British Columbia;
for Women & Children; Associate
Division Head, Pediatric Emergency
Professor of Pediatrics, University
Medicine, BC Children's Hospital,
of
Hawaii
John
A.
Burns
School
of
Vancouver, BC, Canada
Ari Cohen, MD
Medicine, Honolulu, HI
Chief of Pediatric Emergency Medicine
Joshua Nagler, MD, MHPEd
Services, Massachusetts General
Madeline Matar Joseph, MD, FACEP, Assistant Professor of Pediatrics,
Hospital; Instructor in Pediatrics,
FAAP

Harvard Medical School; Fellowship
Associate Editor-in-Chief
Harvard Medical School, Boston, MA
Professor of Emergency Medicine
Director, Division of Emergency
and Pediatrics, Chief and Medical
Medicine, Boston Children’s
Vincent J. Wang, MD, MHA
Marianne Gausche-Hill, MD, FACEP,
Director,
Pediatric
Emergency
Hospital, Boston, MA
Professor of Pediatrics, Keck
FAAP
Medicine
Division,
University
School of Medicine of the
Medical Director, Los Angeles
James Naprawa, MD
of Florida College of MedicineUniversity of Southern California;
County EMS Agency; Professor of
Attending Physician, Emergency
Jacksonville, Jacksonville, FL
Associate Division Head, Division
Clinical Medicine and Pediatrics,
Department USCF Benioff
of Emergency Medicine, Children's
David Geffen School of Medicine at Stephanie Kennebeck, MD
Children's Hospital, Oakland, CA
Hospital Los Angeles, Los Angeles,
UCLA, Los Angeles, CA
Associate Professor, University of
Joshua Rocker, MD
CA
Cincinnati Department of Pediatrics,
Michael J. Gerardi, MD, FAAP,
Associate Chief, Division of
Cincinnati, OH
FACEP, President
Pediatric Emergency Medicine,
Editorial Board
Associate Professor of Emergency
Anupam Kharbanda, MD, MS
Cohen Children's Medical Center;
Jeffrey R. Avner, MD, FAAP
Medicine, Icahn School of Medicine Chief, Critical Care Services
Assistant Professor of Emergency
Professor of Pediatrics and Chief
at Mount Sinai; Director, Pediatric
Children's Hospitals and Clinics of
Medicine and Pediatrics, Hofstra
of Pediatric Emergency Medicine,
Emergency Medicine, Goryeb
Minnesota, Minneapolis, MN
Northwell School of Medicine, New
Albert Einstein College of Medicine,
Children's Hospital, Morristown
Hyde Park, NY
Tommy Y. Kim, MD, FAAP, FACEP
Children’s Hospital at Montefiore,
Medical Center, Morristown, NJ
Associate Professor of Pediatric
Steven Rogers, MD
Bronx, NY
Sandip Godambe, MD, PhD
Emergency Medicine, University of
Associate Professor, University of
Steven Bin, MD
Vice President, Quality & Patient
California Riverside School of Medicine,
Connecticut School of Medicine,
Associate Clinical Professor
Safety, Professor of Pediatrics and
Riverside Communtiy Hospital,
Attending Emergency Medicine
of Emergency Medicine and
Emergency Medicine, Attending
Department of Emergency Medicine,
Physician, Connecticut Children's
Pediatrics, UCSF School of
Physician, Children's Hospital of the
Riverside, CA
Medical Center, Hartford, CT
Medicine; Medical Director, UCSF
King's Daughters Health System,
Melissa Langhan, MD, MHS
Christopher Strother, MD
Benioff Children's Hospital, San
Norfolk, VA
Associate Professor of Pediatrics and Assistant Professor, Emergency
Francisco, CA
Ran D. Goldman, MD
Emergency Medicine; Fellowship
Medicine, Pediatrics, and Medical
Richard M. Cantor, MD, FAAP,
Professor, Department of Pediatrics,
Director, Director of Education,
Education; Director, Undergraduate
FACEP
University of British Columbia;
Pediatric Emergency Medicine, Yale
and Emergency Department
Professor of Emergency Medicine
Research Director, Pediatric
University School of Medicine, New
Simulation; Icahn School of Medicine
and Pediatrics; Director, Pediatric
Emergency Medicine, BC Children's
Haven, CT
at Mount Sinai, New York, NY
Emergency Department; Medical
Hospital, Vancouver, BC, Canada
Robert Luten, MD
Director, Central New York Poison
Professor, Pediatrics and
Control Center, Golisano Children's
Emergency Medicine, University of
Hospital, Syracuse, NY
Florida, Jacksonville, FL
Adam E. Vella, MD, FAAP
Associate Professor of Emergency
Medicine, Pediatrics, and Medical
Education, Director Of Pediatric
Emergency Medicine, Icahn School
of Medicine at Mount Sinai, New
York, NY

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David M. Walker, MD, FACEP, FAAP
Director, Pediatric Emergency
Medicine; Associate Director,
Department of Emergency Medicine,
New York-Presbyterian/Queens,
Flushing, NY

International Editor
Lara Zibners, MD, FAAP, FACEP
Honorary Consultant, Paediatric
Emergency Medicine, St. Mary's
Hospital Imperial College Trust,
London, UK; Nonclinical Instructor
of Emergency Medicine, Icahn
School of Medicine at Mount Sinai,
New York, NY

Pharmacology Editor
James Damilini, PharmD, MS, BCPS
Clinical Pharmacy Specialist,
Emergency Medicine, St. Joseph's
Hospital and Medical Center,
Phoenix, AZ

Quality Editor
Steven Choi, MD
Assistant Vice President, Montefiore
Network Performance Improvement;
Director, Montefiore Institute for
Performance Improvement; Assistant
Professor of Pediatrics, Albert
Einstein College of Medicine, Bronx,
NY

CME Editor
Deborah R. Liu, MD
Assistant Professor of Pediatrics,
Keck School of Medicine of USC;
Division of Emergency Medicine,
Children's Hospital Los Angeles,
Los Angeles, CA

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