Pediatric Emergency Playbook

It's a busy shift.  Today no one seems to have a chief complaint. Someone sends a troponin on a child.  Good, bad, or ugly, how are you going to interpret the result? And while we’re at it – what labs do I need to be careful with in children – sometimes the normal ranges of common labs can have our heads spinning! Read on to go from bread-and-butter pediatric blood work to answer the question – what’s up with troponin, lactate, d-dimer, and BNP in kids?   A fundamental tenet of emergency medicine:     We balance our obligation to detect a dangerous condition with our suspicion of the disease in given patient. Someone with a cough and fever may simply have a viral illness, or he may have pneumonia.  Our obligation is to evaluate for the pneumonia.  It’s ok if we “miss” the diagnosis of a cold. It could be bad if we don’t recognize the pneumonia.   How do we decide?  Another fundamental concept:     The threshold. Depending on the disease and the particular patient, we have a threshold for testing, and the th