Pediatric emergency medicine trisk 4208 4208
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Management
As noted above, ED physicians should adhere to their normal clinical
decision-making processes when working up a patient’s symptoms.
Symptoms that could legitimately have an emergent underlying medical
etiology should be assessed accordingly. Conversely, ED physicians should
avoid performing unnecessary tests, especially for nonemergent diagnoses.
Unnecessary testing rarely reassures families; it overmedicalizes patients,
strengthens the reinforcement of the symptoms/impairment, places patients
at risk for the sequelae of false-positive or incidental findings, confers
iatrogenic risk and discomfort without clear benefit, and distracts attention
away from interventions that are more likely to be successful. The same
concept holds true for prescribing medications or other treatment
interventions ( Table 126.29 ).
Efforts should focus on relaying the “good news” of the negative findings
and the lack of need for further intervention at this time. Education about the
nature of psychosomatic symptoms should be given in a supportive and
nonjudgmental way. Treatment recommendations should focus on referrals
for psychological support, providing anticipatory guidance and advice to
parents around supporting return to function (including the use of physical
therapy when indicated).
In some circumstances, inpatient medical admission may be necessary,
including in cases where video EEG monitoring is indicated or patients are
unable to orally hydrate themselves or ambulate. It can be helpful at these
times for the ED physician to try to “set up” the admission as one that may
very well not lead to the identification of an underlying medical illness or
alleviate all of the symptoms but rather to facilitate further workup,
specialists consultation to put an appropriate aftercare plan into place.
Psychiatric etiologies should be listed in a nonjudgmental fashion as part of
the differential and involvement of the mental health team for diagnostic
purposes and support of recovery should be presented, whenever possible,
from the start.
