Pediatric EM Morsels

APRIL 7, 2023

Observation, interaction with patient, as well as parent information is key to bring the whole picture together!

ALS 130

ALS OR EMS Critical Care 130

Core EM

JANUARY 25, 2024

Perdue &al. Caterino &al. Sterling &al. Liu &al. Gill &al. Demetriades D &al. Goode &al. Hasegawa &al. Int J Emerg Med 2013; 6:12. Heffernan &al. Li &al. Konda &al. 6 Assessment and Initial Evaluation: What’s different?

ALS 246

ALS ED ICU OR 246

The Skeptics' Guide to EM

JANUARY 6, 2024

Reference: Remick KE, et al. Reference: Remick KE, et al. Two previous studies conducted assessing the state of nationwide pediatric readiness were conducted in 2003 and 2013. Reference: Remick KE, et al. National Assessment of Pediatric Readiness of US Emergency Departments during the Covid-19 Pandemic. JAMA Netw Open.

Emergency Department 261

Emergency Department Emergency Medical Services ALS ED 261

The Skeptics' Guide to EM

DECEMBER 15, 2018

Date: December 13th , 2018 Reference: Murata et al. Date: December 13th , 2018 Reference: Murata et al. They published an epic paper to determine the transit time of a Lego head ( Tagg et al ). Eur J Paediatr Neurol 2013) that concluded antipyretics were ineffective in reducing the recurrence of febrile seizures in children.

OR 130

OR Emergency Department ALS 130

EMDocs

NOVEMBER 13, 2024

Literature concerning risk with PPIs is controversial. Presentation: Classic presentation is abdominal pain or tenderness, fever, and altered mental status. Literature suggests 10-33% of patients are asymptomatic or only have mild symptoms. Clinician sensitivity for SBP based on bedside assessment is between 40-75%. increase in mortality.

E-9-1-1 71

E-9-1-1 ALS OR ED 71

Pediatric EM Morsels

JULY 28, 2023

Glucose > 200 mg/dL Moderate or Large Ketonuria The severity of DKA is categorized by the degree of acidosis Mild : venous pH < 7.3 or serum bicarbonate between 11-17 mmol/L Moderate : venous pH < 7.2 or serum bicarbonate between 5-10 mmol/ L Severe : venous pH < 7.1 Neuroimaging is NOT required. GCS score is not sensitive enough.

E-9-1-1 246

E-9-1-1 ALS OR Critical Care 246

REBEL EM

SEPTEMBER 13, 2023

of people who take NSAIDs ( Nzeako 2010 ). patients that take ACE inhibitors (but 20-30% of all angioedema presentations to the Emergency Department) 3 times more common in Black Americans ( Kostis 2005 ) 0.01 of people who take NSAIDs ( Nzeako 2010 ). Typically involves the mouth, larynx, pharynx, and subglottic tissue ( Kostis 2005 ).

Frozen Plasma 105

Frozen Plasma Allergic Reaction FFP Plasma 105

The Skeptics' Guide to EM

MAY 14, 2022

Date: May 13th, 2022 Reference: Abril et al. Date: May 13th, 2022 Reference: Abril et al. These include: acetaminophen ( Williams et al Lancet 2014), steroids ( Balakrishnamoorthy et al Emerg Med J 2014) and benzodiazepines ( Friedman et al Ann Emerg Med 2017). An Analysis of Data From Randomized Studies.

ALS 130

ALS Emergency Department ED OR 130

REBEL EM

MAY 29, 2024

EMRAP HD: Epistaxis Posterior Pack References Cassisi NJ et al. PMID: 5569677 Zeyyan E et al. PMID: 20938948 Loftus BC et al. PMID: 8170679 Viducich RA et al. Take Home Points: Posterior epistaxis is a rare, life-threatning presentation. Literature doesn’t defend this approach but, the lit is pretty sparse.

ICU 105

ICU ALS ACS EMS 105

The Skeptics' Guide to EM

AUGUST 5, 2023

Reference: Easter JS et al. Reference: Easter JS et al. Reference: Easter JS et al. Population: Children less than 18 years of age presenting with head injury to a level 2 pediatric trauma center in the United States between 2012-2013. Annals of Emergency Medicine 2014. Annals of Emergency Medicine 2014.

ALS 100

ALS Emergency Department OR 100

This Podcast Will Kill You

JULY 23, 2024

Caio, Giacomo, et al. Cenit, María Carmen, et al. Al-Dulaimi, D., Gasbarrini, Giovanni, et al. Gasbarrini, Giovanni Battista, et al. Kerner, Gaspard, et al. Newberry, Carolyn, et al. Suddenly, grocery stores were filled with gluten-free crackers, cookies, buns, you name it. 2019): 100. Rubin, J.E.

E-9-1-1 98

E-9-1-1 ALS OR 98

Don't Forget the Bubbles

OCTOBER 25, 2023

Image adapted by Holland JA et al. Image adapted by Holland JA et al. Strabismus alone is a rare sign of a brain tumour in this age group; however, the associated papilloedema is concerning. The fact that fundoscopy has been carried out on this child is a feat. It is often difficult to do this in an ED setting. How is IIH diagnosed?

ALS 124

ALS OR ED 124

ALiEM

MARCH 7, 2024

Transvere ultrasound views of the bladder: Left – Uterus identified posteriorly in girl; Right – Prostate identified posteriorly in boy (Images courtesy of Dinh et al.) The pain is intermittent, sharp, severe, and associated with 2 episodes of nonbloody, nonbilious emesis. Lay the patient supine when possible.

E-9-1-1 177

E-9-1-1 Emergency Department ALS ED 177

EMDocs

AUGUST 22, 2024

You may be more familiar with the term “limited English proficiency” (LEP), defined as: someone who does not speak English as their primary language and has a limited ability to read, speak, write, or understand English. For instance, displaying posters in multiple languages that explain the language services patients are entitled to.

Emergency Department 81

Emergency Department ALS E-9-1-1 ED 81

The Skeptics' Guide to EM

AUGUST 28, 2021

Date: August 27th, 2021 Reference: Gagnon et al. Date: August 27th, 2021 Reference: Gagnon et al. Direct-access physiotherapy to help manage patients with musculoskeletal disorders in an emergency department: Results of a randomized controlled trial. first appeared on The Skeptics Guide to Emergency Medicine.

ED 130

ED Emergency Department ALS OR 130

Don't Forget the Bubbles

OCTOBER 21, 2024

Available at: The DSM‐5: Classification and criteria changes – Regier – 2013 – World Psychiatry – Wiley Online Library Szejko N, Robinson S, Hartmann A, Ganos C, Debes NM, Skov L et al. Tics are the most common type of paediatric movement disorder. The first three always start before 18 years of age.

ALS 59

ALS Emergency Department OR 59

Pediatric EM Morsels

OCTOBER 27, 2023

PAWPER [Wells 2013, Silvagni 2022] Takes into account body habitus. link] Lubitz DS, Seidel JS, Chameides L, Luten RC, Zaritsky AL, Campbell FW. Reduces dosing errors during resus, up to 33.88%. Recommended by ATLS and PALS. Krug 2007] What If the Child is Obese or Emaciated? There are other systems that account for body habitus.

E-9-1-1 269

E-9-1-1 Emergency Medical Services Life Support ALS 269

Pediatric EM Morsels

APRIL 5, 2024

Treatment : Supportive care Omsk hemorrhagic fever/Kyasanur Forest disease (CDC 2013) Causative Agent: Flavivirus Incubation period : 3-8 days Symptoms start with chills, fevers, headache and GI symptoms followed by symptoms of bleeding 3-4 days later including petechial rash, low hemoglobin and low WBC. John H, Jian J, RIchards AL.

E-9-1-1 161

E-9-1-1 ALS OR EMS 161

The Skeptics' Guide to EM

APRIL 24, 2021

Reference: Martel et al. Way back in 2013 we looked at haloperidol for agitation due to psychosis ( SGEM#45 ) and concluded that it was an effective treatment but had common side effects. Reference: Martel et al. Kirsty is also the creator of the wonderful infographics called #PaperinaPic.

Emergency Department 100

Emergency Department ALS Ambulance ED 100

Pediatric EM Morsels

NOVEMBER 3, 2023

2013 Sep 4; 89(3): 527–530. PMID: 34748988 Conroy AL, Hawkes M, Elphinstone RE, Morgan C, Hermann L, Barker KR, Namasopo S, Opoka RO, John CC, Liles WC, Kain KC. PMID: 27186577 Conroy AL, Opoka RO, Bangirana P, Idro R, Ssenkusu JM, Datta D, Hodges JS, Morgan C, John CC. It appears after an asymptomatic period. vivax or P.

ALS 278

ALS Critical Care EMS OR 278

Dr. Smith's ECG Blog

DECEMBER 12, 2022

This " imbalance of precordial T waves" is not seen very often — and in the “right” clinical setting, has been associated with recent OMI from a LCx culprit artery ( See Manno et al: JACC 1:1213, 1983 — and the July 17, 2013 post by Salim Rezaie in ALiEM ). This is termed " pseudo-normalization."

OR 52

OR ACS STEMI Coronary 52

The Skeptics' Guide to EM

OCTOBER 20, 2018

[display_podcast] Date: October 17th , 2018 Reference #1: Aycock, Westafer et al. Ann Emerg Med 2018 (CRD42017056195) Reference #2: Weisbord SD, Gallagher M, Jneid H, et al; PRESERVE Trial Group. display_podcast] Date: October 17th , 2018 Reference #1: Aycock, Westafer et al. Reference: Aycock, Westafer et al.

Coronary 174

Coronary Emergency Department ALS OR 174

This Podcast Will Kill You

OCTOBER 1, 2024

Cabezas-Cruz, Alejandro, et al. Cabezas-Cruz, Alejandro, et al. Cabezas-Cruz, Alejandro, et al. de la Fuente, José, et al. “Anti‐G al: an abundant human natural antibody of multiple pathogeneses and clinical benefits.” 2013): 1-11. ” Experimental & molecular medicine 49.3 Commins, S.P.,

E-9-1-1 52

E-9-1-1 ALS OR 52

Don't Forget the Bubbles

SEPTEMBER 30, 2024

Simpson et al. A 2011-2012 Australian study by Blake et al. There was a disproportionate number of DNWs on Sundays, and if they presented between 4 pm and midnight, A 2002 Canadian study by Goldman et al., Gaucher et al. Gaucher et al. Similarly, a study by Suastegui et al., What is happening locally?

Emergency Department 89

Emergency Department ALS ED OR 89

FOAMfrat

NOVEMBER 21, 2024

Acidosis Existing literature demonstrates mortality rates up to three times higher in trauma patients presenting with extreme acidosis (pH <7.0) compared to patients with mild acidosis or normal pH. Acidosis can worsen coagulopathy and hypothermia, and vice versa. In trauma patients, acidosis (pH < 7.35) is usually caused by lactic acid.

ICU 111

ICU Emergency Department OR Ambulance 111

The Skeptics' Guide to EM

AUGUST 19, 2023

I responded by posting the 2013 SGEM episode on INTERACT-2 ( SGEM#73 ) which showed no statistical difference between intensive (<140 mmHg) and guideline directed (<180 mmHg). Date: August 14, 2023 Reference: Ma et. Date: August 14, 2023 Reference: Ma et. Most EM physicians shared the frustration and made positive comments.

EMS 126

EMS ALS Emergency Department OR 126

EMDocs

NOVEMBER 21, 2023

Denied weakness of his upper extremities, paresthesias, vision changes, trouble swallowing or speaking, and drug or alcohol use. Exam: 2/5 strength when attempting to flex his bilateral thighs. Could not ambulate. Otherwise normal CN’s, sensation, upper extremity motor exam. HypoPP only impacts skeletal muscles, NOT smooth or cardiac muscle.

E-9-1-1 68

E-9-1-1 ALS ED OR 68

Don't Forget the Bubbles

JUNE 14, 2023

Lava SAG, et al. Hsiao W, et al. Mullaly R, et al. Puoti MG, et al. Stenson EK, et al. Bruinsma RA, et al. Rivetti G, et al. van Gameren-Oosterom HBM, et al. Lester TR, et al. Mansell H, et al. Fernandes AER, et al. Wolstencroft J, et al. Roodbol J, et al.

ALS 119

ALS ACS ED OR 119

EMDocs

SEPTEMBER 23, 2023

On arrival, vital signs are stable with a HR of 71, BP of 121/71 mmHg, RR of 17 bpm, and SpO2 of 97% on room air. Physical exam reveals a well-appearing female in no acute distress. Cardiac exam is unremarkable with normal S1/S2 without rubs, gallops or murmurs. Neurological exam is also unremarkable. Her presenting EKG is shown below.

E-9-1-1 83

E-9-1-1 EMS ALS Defibrillator 83

The Skeptics' Guide to EM

OCTOBER 3, 2020

Reference: Claiborne Johnston S et al. Reference: Claiborne Johnston S et al. SGEM#24 reviewed a randomized controlled trial (RCT) of aspirin vs. aspirin + clopidogrel in patients with recent symptomatic lacunar infarcts identified by MRI ( Benavente et al NEJM 2012 ).

Emergency Department 100

Emergency Department ALS OR 100

REBEL EM

JANUARY 29, 2024

Click here for Direct Download of the Podcast Paper: Aykan AC et al. Because the lungs receive 100% of cardiac output, it has been hypothesized that a lower dose of thrombolytic therapy may still be effective with a better safety profile [3][4]. REBEL Cast Ep123: Reduced-Dose Systemic Peripheral Alteplase in Massive PE?

ALS 137

ALS ACS OR CPR 137

The Skeptics' Guide to EM

JULY 3, 2021

Reference: Dankiewicz et al: TTM2 Trial Investigators. Reference: Dankiewicz et al: TTM2 Trial Investigators. This is the original Target Temperature Management (TTM) trial by Nielson et al NEJM 2013. Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest. This gives a NNT of 4.

Paramedic 130

Paramedic Defibrillator ALS OR 130

EMDocs

JANUARY 29, 2024

The American Heart Association/American Stroke Association (AHA/ASA) recommends maintaining BP below 185/110 mmHg in eligible patients undergoing thrombolytic therapy or endovascular intervention [1]. Following thrombolysis or endovascular therapy, the recommended blood pressure goal is below 180/105 mmHg to prevent hemorrhagic complications [1].

ALS 72

ALS Critical Care OR EMS 72

FOAMfrat

JULY 3, 2024

If they are not already there, get ALS-level care to the patient as soon as possible. I personally know of 2 ALS providers who were exposed to chlorine gas in a pool incident on the job and both ended up retiring from their service and still have lifelong breathing problems as a result. Be prepared to take an advanced airway early.

Life Support 106

Life Support ALS Emergency Response OR 106

Don't Forget the Bubbles

JULY 22, 2024

Compare this with the Panickar et al. Fortunately, Lee et al. Lee B, Turner S, Borland M, Csonka P, Grigg J, Guilbert TW, et al. However, there was no difference in LOS (83 minutes for placebo vs 79 minutes for prednisolone) in participants who were discharged straight from the ED ( 32% ). study from 200 9.

E-9-1-1 105

E-9-1-1 ALS ACS ED 105

EMDocs

SEPTEMBER 8, 2024

Paper: Brown CS, Oliveira J E Silva L, Mattson AE, et al. Anderson CS, Heeley E, Huang Y, et al; INTERACT2 Investigators. 2013 Jun 20;368(25):2355-65. Qureshi AI, Palesch YY, Barsan WG, et al; ATACH-2 Trial Investigators and the Neurological Emergency Treatment Trials Network. Neurocrit Care. 2022;37(2):435-446.

ALS 80

ALS OR 80

Don't Forget the Bubbles

AUGUST 4, 2024

Brewster RCL, et al. Strunk T, et al. Pinon A, et al. Vassilopoulou E, et al. Calvert A, et al. Roumeliotis N, et al. Gallo Ruelas M, et al. This comprehensive list is developed from 34 journals, including major and subspecialty paediatric journals. More studies on this topic will surely follow.

E-9-1-1 52

E-9-1-1 ALS Emergency Department OR 52