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  • The clinician must have a reasonable knowledge of the developmental stages so that one can identify abnormal or delayed development.
  • Simply observing the child play or watch TV can tell the physician many things. Often, the best examination occurs while the parent is holding the child in her lap or arms.
  • Good history taking can minimize the need for blood work as the child's age, immunization status, and past medical history all impact the need for them.
  • The “as low as reasonably achievable” (ALARA) radiation concept is ever-important in pediatrics.

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The game plan for approaching children in the emergency department (ED) is completely different than for the adult. The physician gets one attempt to engage the patient, greet the parent, perform the examination, and formulate a treatment plan.

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Children present to the ED for a variety of reasons (Table 1–1).1 This chapter focuses on deconstructing the visit and empowering the emergency physician to be comfortable with and competently treat the child.

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Table 1-1. Most Common Diagnoses for Children Presenting to Emergency Department
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Tables 1–2, 1–3, 1–4, and 1–525 provide quick reference for normal pediatric respiratory rate, heart rate, blood pressure, and weight. Figure 1–16 references the Pediatric Assessment Triangle (PAT), which was popularized in Advanced Pediatric Life Support (APLS) by Ronald Dieckmann, MD. The PAT can help the provider establish a quick initial assessment of the patient. The components of the PAT are appearance, effort of breathing, and circulation to skin.

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Table 1-2. Normal Respiratory Rates for Children
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Table 1-3. Normal Heart Rates for Children

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