Working in the environment of the emergency department, we experienced
a plethora of clinical pathology that enhanced and finely tuned our visual
diagnosis skills. Armed with a digital camera and a consent form, we were
able to build a library of educational material in the form of clinical
pictures, radiographic images, and fascinating stories. With these assets we
prepared the first edition of the Atlas of Pediatric Emergency Medicine
and have been humbled and pleased at the enthusiastic response of our
audience. Based upon that response we have prepared this second edition.
The pressures of clinical practice continue to increase
with demands of increasing productivity, decreasing reimbursement, and
increasing numbers of patients, all leading to the potential to spend more
time ordering tests than observing and examining patients. Thus, the art of
visual diagnosis remains an endangered species. Where the bedside experience
was once the highlight of our clinical day, the “art” has been
replaced by mechanics. Our trainees are being schooled in processing flow
and survival mode ideation.
Sir William Osler once
wrote: “Avoid the common and fatal facility of reaching conclusions
from superficial observations and being constantly misled by the ease with
which our minds fall into the ruts of one or two experiences.” The
more patients one sees and examines, the better one becomes at forming a
concise differential diagnosis prior to ordering an expensive,
time-consuming, and often invasive work-up. The student of visual diagnosis
is not only more likely to make the right diagnosis, but is also more likely
to avoid the costly error. We urge our fellow physicians to hold on to this
art. By perfecting the tools we were born with and supplementing them with
those that we developed, we will continue to have pride in what we do, love
our patients, and enjoy our careers.
We have made
an attempt to make this second edition even more user friendly than the
first. The Atlas features a consistent format with concise
text regarding Clinical Summary, Emergency Department Treatment and
Disposition, and Pearls. Side by side with this concise,
easy-to-read text is a wealth of images illustrating what these clinical
problems look like in real life in an emergency setting. By making the text
higher yield, we have been fortunate to be able to double the number
of images in this new edition, greatly enhancing the work. Not only have we
doubled the amount of images, but we have updated the book with the newest
imaging techniques available to all who work in the emergency setting. A new
section on Emergency Ultrasound is also added; however, as the medical and
lay communities have become “radiation conscious and cautious,”
ultrasound and plain radiography still remain the workhorses of pediatric
imaging.
This Atlas is intended to assist
the busy clinician in diagnosis, work-up, and disposition. It is written for
anyone who has the privilege of taking care of acutely ill and injured
children. We hope our experience and images will aid those in practice at
continuing to hone their visual diagnostic and differential diagnosis
skills, and also that it will stimulate clinicians who are starting their
careers to never stop asking questions, always strive to improve the art of
visual diagnosis, work on eliminating any fear of patient contact, and never
stop learning from your patients.
Ars longa
vita brevis (art is long while life is short). With this quote,
Hippocrates reminds us how much there is to learn in a short period and
thereby (hopefully) inspire us to be humble, scholarly, and better doctors.
Binita R. Shah, MD, FAAP
Michael Lucchesi, MD, FACEP
John Amodio, MD
Mark Silverberg, MD, MMB, FACEP