Evidenced-based guidelines for management of infants and children with community-acquired pneumonia (CAP) were prepared by an expert panel comprising clinicians and investigators representing community pediatrics, public health, and the pediatric specialties of critical care, emergency medicine, hospital medicine, infectious diseases, pulmonology, and surgery. These guidelines are intended for use by primary care and subspecialty providers responsible for the management of otherwise healthy infants and children with CAP in both outpatient and inpatient settings. Site-of-care management, diagnosis, antimicrobial and adjunctive surgical therapy, and prevention are discussed. Areas that warrant future investigations are also highlighted.

Evidenced-based guidelines for management of infants and children with community-acquired pneumonia (CAP) were prepared by an expert panel comprising clinicians and investigators representing community pediatrics, public health, and the pediatric specialties of critical care, emergency medicine, hospital medicine, infectious diseases, pulmonology, and surgery. These guidelines are intended for use by primary care and subspecialty providers responsible for the management of otherwise healthy infants and children with CAP in both outpatient and inpatient settings. Site-of-care management, diagnosis, antimicrobial and adjunctive surgical therapy, and prevention are discussed. Areas that warrant future investigations are also highlighted.

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Despite advances in medical care including antibiotics and vaccines, meningitis still has a high morbidity and mortality rate, especially in certain high-risk patients. Early diagnosis with the administration of appropriate antibiotics remains the key element of management. This article highlights methods of diagnosis, differential diagnoses, treatment options, and complications of treating bacterial meningitis.

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discuss management strategies. This article summarizes the recommendations of the consensus panel for physicians. The recommendations for nurses will be published separately. Definition and Scope of the ProblemEarly identification of DVA is the first step in optimizing patient care. The consensus panel described DVA as a clinical condition in which multiple attempts and/or special interventions are anticipated or required to achieve and maintain peripheral venous access. Special interventions are defined as the use of any technique or hospital resource with the potential to improve peripheral IV insertion success rates. These include traditional methods of enhancing the visibility and palpability of peripheral veins (eg, warming the catheter site to induce vasodilation) [10][11][12] ; advanced visualization technologies such as ultrasound, transillumination, and nearinfrared lighting 2,[13][14][15] ; and enlisting designated IV specialists and/or hospital staff with extensive experience in starting pediatric IVs.16 Some children may need more invasive interventions such as intraosseous (IO) infusion, a peripherally inserted central catheter, or a central venous catheter (CVC) to achieve parenteral access.There is a dearth of clinical evidence on the incidence of DVA in pediatric patients. Studies of IV insertion success rates indicate that 5% to 33% of children require more than 2 needle sticks to achieve IV access. [1][2][3][4] Even when interventions such as transillumination and ultrasound are used, up to 15% of children still require more than 2 attempts to establish venous access.2 A recent prospective analysis of 593 insertion attempts in centers with pediatric hospitalist services showed that successful placement E stablishing peripheral intravenous (IV) access in pediatric patients can be challenging. Clinical studies show that only 53% to 76% of children are successfully cannulated on the first attempt.1-4 Multiple failed attempts are painful and upsetting for the child and distressing for family members and caregivers, 5-9 yet there are no guidelines or consensus statements on the recognition and management of this problem.In January 2008, a panel of physicians and nurses specializing in emergency medicine, anesthesia, critical care, and hospital medicine convened to discuss peripheral difficult venous access (DVA) in children. Daniel Rauch, MD, FAAP, and Laura L. Kuensting, MSN(R), RN, CPNP, cochaired the roundtable discussion, which was made possible by a grant from Baxter Healthcare, Inc. The main objectives of the meeting were to estimate the frequency of DVA in pediatric patients; describe its clinical and emotional impact on the patient, the patient's family, and clinicians; develop terminology that accurately describes the condition; review the factors that help identify children with DVA; and

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