Palliative care-

• Who- patients w/ end stage diseases, AIDs, malignancy, multi-organ failure, devastating injuries.
• Benefits to patients- improves quality of life, avoids undesired interventions.
• Benefits to providers- aids with burnout and staying focused on what patient would want.
• Symptom management- pain, dyspnea (opioids are first line, delirium, constipation.

DNR/DNI-

• Advanced directive indicating what patient would want from a care perspective.
• Otherwise consider POAs and next of kin.

Special Populations in the ED-

• Patient’s with intellectual disability: Consider barriers to health including physical, communicational, attitudinal, transportation, financial.
• Patient’s whose primary language is another language.
• Patient’s involved human trafficking.  Always be mindful of red flag signs.
• Elderly patient’s or those affected by dementia/cognitive decline.
• Patient’s affected by housing insecurity.

Systemic infections in children-

• Measles (Rubeola): symptom 10-14 days after exposure with cough, coryza, conuctivitis, Koplik spots.  Rash starts on face, spreading down, including palms and soles. First vaccine at 12 mo. Treatment = supportive.
• German measles (Rubella): symptoms include low grade fever, headache, sore throat and lymphadenopathy (post auricular). First vaccine 12 mo.  Treatment = supportive.
• Varicella: symptoms include fever, cough, rash with vesicular lesions at different stages of healing.  First vaccine at 12 mo. Treatment = supportive.
• Erythema infectiosum: nonspecific viral prodrome with slapped cheek rash caused by parvo. Treatment = supportive.  Most dangerous for sickle cell patients and pregnant patients.
• Roseola: characteristic pattern of high fever followed by rash, starting on trunk and spreading outward, caused by HHV6.  Treatment = supportive.
• Hand- foot- mouth disease: non specific viral symptoms with rash, caused by cocksackie.  Treatment = supportive.
• Papular acrodermatitis: immunologic response resulting in pruritic, popular rash in acral distribution often caused by EBV or hep B. Treatment = supportive.
• Scarlet Fever: sandpaper rash which is blanching and popular in the setting of Group A strep. Treatment = amoxicillin x 10 days.
• SSSS/TSS: peeling beefy red skin around moth, armpits, groin.
• Pediatic sepsis: consider the incredible ability to compensate in children.  Be wary of tachycardia not improved by bolus (up to 60 ml/kg of isotonic crystalloid).

Operations updates-

• East wing annex transitions to come May/June.
• Obs unit within the next year.
• 85% on sepsis compliance.