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A case-based book organized by the top 10 common complaints of patients presenting to emergency departments. This approach allows the reader to learn the pathophysiology of the major diseases, and analyze each case in a way that more closely approximates the clinical practice of medicine; not knowing which organ system is damaged or compromised before examining the patient. The cases are based on real patients and the diseases are either common in emergency practice, or are dangerous diagnoses not to be missed. The case descriptions include questions regarding the patient's presentation and basic information about the disease, illustrating key elements from the history, physical, and when necessary ancillary studies that help lead to a diagnosis. Each chapter ends with a flow diagram showing how diseases of different organ systems can present with similar initial complaints. This book is an ideal resource for medical students, residents and trainees in emergency medicine.
Pain in infants poses a major challenge for health professionals. Although infants are uniquely vulnerable to pain and its consequences, pain is less adequately controlled in this patient population than in any other. Many reasons account for the undertreatment of pain in infants with the most common problem being a paucity of knowledge regarding pain and analgesia for the infant population.
Definition of Pain in Infants
The International Association for the Study of Pain (IASP) has defined pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage” (from reference). It has been suggested that this definition is inappropriate for infants.
The interpretation of pain is subjective and infants lack the ability of self-report in the traditional sense. This inability to verbalize pain contributes to the failure of health-care professionals to recognize and treat pain aggressively in infants.
It has also been hypothesized that pain perception occurs in a less-organized fashion in the infant than the child or adult. Pain is a combination of sensory (discriminative) and emotional (affective) components. The sensory component of pain is defined as nociception. Nociception incorporates the physiologic and behavioral responses of infants to a painful stimulus but not the cognitive responses that are part of pain perception. Consequently, health-care professionals are required to rely on physiologic and behavioral responses when assessing pain in an infant.
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