Pediatric EM Morsels

MARCH 17, 2023

Available from: [link] Correa JA, Fallon SC, Cruz AT, et al. Sarkar S, Sinha R, Chaudhury AR, et al. In the US, the venomous snakes include rattlesnakes , copperheads, cottonmouths/water moccasins , and coral snakes [ CDC, 2021 ] Rattlesnakes live all across the United State s Copperheads inhabit the eastern U.S. Snake Toxicity.

Frozen Plasma 130

Frozen Plasma Plasma First Aid OR 130

EMDocs

OCTOBER 21, 2023

All patients who receive thrombolytics for ischemic stroke should be admitted to a neurosurgical, neurologic, or medical ICU for management and monitoring, as this is shown to decrease mortality and length of stay. References: Gaillard F, Glick Y, Tatco V, et al. 61.4.496 Navi BB, Kamel H, Shah MP, et al. Epub 2014 Dec 4.

EMS 97

EMS ALS OR ACS 97

REBEL EM

MARCH 23, 2023

Treatment options for alcohol withdrawal include benzodiazepines such as lorazepam, diazepam, or chlordiazepoxide, gabapentin, and phenobarbital (Buell et al.). Phenobarbital can be used as a monotherapy or in combination with benzodiazepines to treat alcohol withdrawal (Hawa et al.). Paper : Hawa F et al.

ICU 52

ICU Emergency Department ALS OR 52

Emergency Medicine Ireland

OCTOBER 14, 2024

This has been moderately well studied with MIST-2 2011 and the Picollo trial (2014) being commonly quoted trials suggesting benefit. The major barrier to implementation in the ICU setting is the almost complete absence of ICU patients from these trial cohorts. 11, 1419–1425 (2014). – M., Cochrane Database Syst.Rev.

Critical Care 52

Critical Care ICU ALS OR 52

EMDocs

SEPTEMBER 25, 2023

Despite the risk of hypotension and bradycardia, propofol has been shown in the ICU setting to be a safe and effective monotherapy intubation agent for hemodynamically unstable patients (19). References: Heffner AC et al. PMID: 23911630 Kim WY et al. PLoS One 2014; 9(11): e112779. PMID: 25402500 Forsythe SM et al.

ED 92

ED Emergency Department ALS Paramedic 92

Don't Forget the Bubbles

JUNE 30, 2023

They found NO difference in drain failure rates ( 11% pigtail vs 13% chest tube P=0.74), total daily volume drained or length of ICU stay between groups. A recent review was conducted on Trauma Quality Improvement Program data between 2014 and 2016. 2014 Sep;45(9):1287-95. Laan DV, Vu TD, Thiels CA et al. Emerg Med J.

E-9-1-1 139

E-9-1-1 FFP Plasma Emergency Department 139

EMDocs

NOVEMBER 1, 2023

Disposition : Admission to ICU with potential GI, IR, and/or surgical management. McGraw-Hill Education; 2014. In: Tintinalli JE, Ma OJ, Yealy DM, et al., May not be an option. If there will be a delay in definitive management and there is evidence of intra-thoracic gastric contents, consider chest tube placement.

Critical Care 93

Critical Care ED EMS OR 93

Don't Forget the Bubbles

JUNE 17, 2024

The team sits down for a hot debrief once the patient is stabilised and transferred to the ICU. 2014 Jun 26;23(12):653-9. Frich JC, Brewster AL, Cherlin EJ, Bradley EH. While you are leading the resuscitation, one of your senior colleagues belittles a junior staff member for struggling to site an IV line. 2015 May;30:656-74.

E-9-1-1 105

E-9-1-1 Critical Care CPR ICU 105

EMDocs

APRIL 22, 2024

Alerhand et al described ten individual echocardiographic findings of RV strain that suggest PE. 2014 May;145(5):950-957. Marino’s the ICU book, Wolters Kluwer Health, pgs 105-109, 4th ed., VUMC Emergency Medicine, “RV Strain & TAPSE” YouTube Video [link] Farcy et al. 10,11 Vid 1.

ED 98

ED NARCAN ALS OR 98

AAEM RSA

AUGUST 27, 2020

Nielsen N, Wetterslev J, Cronberg T et al. By the time of the study by Nielsen et al. Kirkegaard H, Soreide E, de Haas, I et al. Kirkegaard et al. De Fazio C, Skrifvars MB, Soreide E et al. The trial was conducted in 25 ICUs in France between 2014 and 2018. New Engl J Med. 2013;369(23):2197–2206.

E-9-1-1 52

E-9-1-1 CPR ICU ALS 52

ECG & Echo Learning

OCTOBER 2, 2022

Below follows a drug manual for use in the CCU (coronary care unit), ICU (intensive care unit) or ER (emergency room). References Overgaard, Dzavik et al. Jentzer et al. J Cardiovasc Pharmacol Therap (2014). Müllner M, Urbanek B, Havel C, et al. Lherm T, Troché G, Rossignol M, et al. Circulation 2011.

E-9-1-1 52

E-9-1-1 ALS Coronary Epinephrine 52

REBEL EM

JANUARY 25, 2023

PMID: 23758299 Maung AA et al. Emery Med J 2014; 31(3): 248-9. PMID: 24532357 Oyasiji T et al. 2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5 3.6 – 55.6) (-) LR: 0.13 (0.08 – 0.20) ED US (+) LR: 9.5 (2.1 Louis, Mosby, Inc., 2010, (Ch) 92: p 1216-1227.

ED 52

ED ALS OR ICU 52

Don't Forget the Bubbles

MAY 3, 2023

Forestell B, Battaglia F, Sharif S, et al. Prekker ME, Bjorklund AR, Myers C, et al. O’Connell KJ, Sandler A, Dutta A, et al. O’Connell et al. O’Connell et al. Garabon et al. Which way should we go? Crit Care Explor. 2023;5(2):e0857. Published 2023 Feb 17. doi:10.1097/CCE.0000000000000857

CPR 52

CPR Emergency Department ALS ICU 52

AAEM RSA

APRIL 1, 2021

Holcomb JB, Tilley BC, Baraniuk S, et al. There was no difference in the secondary outcomes of time to hemostasis, ventilator-free days, ICU-free days, disposition at 30 days, incidence of primary surgical procedures, and functional status at hospital discharge (measured as Glasgow Outcome Scale-Extended Score). 2015;313(5):471-82.

E-9-1-1 52

E-9-1-1 Plasma ACS ALS 52

Dr. Smith's ECG Blog

MARCH 6, 2019

If for some reason the angiogram is delayed, they should receive maximal medical therapy in an ICU setting with continuous 12-lead ST segment monitoring under the close attention of a practitioner with advanced ECG interpretation training. Patel et al., Krucoff et al.) Patel et al. Krucoff et al. Schomig et al.

STEMI 52

STEMI ALS ACS ICU 52

EMDocs

FEBRUARY 12, 2024

In this situation, an ABG should be obtained periodically for correlation, though this is more relevant for the intensive care unit (ICU) setting than in routine ED care (5, 9). References/Further Reading (1) Byrne AL, Bennett M, Chatterji R, Symons R, Pace NL, Thomas PS. 2014 Feb;19(2):168-175. Epub 2014 Jan 3.

Emergency Department 98

Emergency Department E-9-1-1 ED ICU 98

EMDocs

DECEMBER 18, 2023

Disposition The SSC guidelines suggest that patients with septic shock or critical illness be moved to the intensive care unit (ICU) within six hours of presentation to the ED. References Evans L, Rhodes A, Alhazzani W, et al. Piccioni A, Saviano A, Cicchinelli S, et al. Fleischmann C, Scherag A, Adhikari NK, et al.

E-9-1-1 91

E-9-1-1 ALS Emergency Department Plasma 91

EMDocs

JANUARY 6, 2024

You review his chart and note that he had a heart transplant in 2014 but has not followed up with a cardiologist for at least 3 years. Cardiogenic shock in the setting of acute rejection would warrant inotropic agents and ICU admission (C) , but these would not be indicated in cases of mild rejection, such as in this patient.

EMS 89

EMS E-9-1-1 ACS Coronary 89

AAEM RSA

SEPTEMBER 17, 2020

Marik P, Khangoora V, Rivera R, et al. All treatments were given for the assigned time frame or until ICU discharge, whichever came first. Keh D, Trips E, Marx G, et al. Questions Does the treatment of sepsis with a combination of vitamin C, thiamine, and hydrocortisone improve outcomes in septic shock? 2017;151(6):1229-38.

ICU 52

ICU E-9-1-1 ALS OR 52

REBEL EM

NOVEMBER 11, 2024

Article: Chanderraj R, Admon AJ, He Y, et al. What They Did: Investigators performed a retrospective cohort study in the Emergency Department at the University of Michigan between July 1, 2014 through December 31, 2018. Imbalances Between Treatment Groups : ICU Admissions : Higher in piperacillin-tazobactam (33% vs. 30%).

E-9-1-1 113

E-9-1-1 ICU ALS Critical Care 113

EMDocs

JUNE 27, 2024

Alkindi S, Al-Busaidi I, Al-Salami B, Raniga S, Pathare A, Ballas SK. Alghamdi FA, Al-Kasim F, Alshhada F, Ghareeb E, Azmet FR, Almudaibigh A, Baitalmal L, Alnawfal B, Alluqmani R. 2014 Feb;69(2):144-51. Roy A, Allareddy V, Lee M, Nalliah R, Rampa S, Allareddy V, Rotta A. 2020 Feb 12;10(1):2470. Annu Rev Pathol.

E-9-1-1 97

E-9-1-1 ICU ACS EMS 97

EMDocs

JUNE 7, 2023

Disposition is often admission to an intensive care unit (ICU) setting. Further management and resuscitation were required, and she had a lengthy ICU stay of 21 days until she was extubated. References: Boostani R, Mellat A, Afshari R, et al: Delayed polyneuropathy in farm sprayers due to chronic low dose pesticide exposure.

E-9-1-1 98

E-9-1-1 ICU Emergency Department ED 98

Don't Forget the Bubbles

JULY 5, 2023

They should be admitted to hospital in case of clinical deterioration to receive ICU treatment. This treatment is usually done in the ICU setting. Blood transfusions are indicated in major surgical procedures, acute priapism > 3 hours not responsive to treatment, severe acute chest syndrome with hypoxia requiring ICU.

E-9-1-1 126

E-9-1-1 ACS OR ICU 126

EMDocs

JANUARY 16, 2025

Carlton EF, Gebremariam A, Maddux AB, et al. Zimmerman JJ, Banks R, Berg RA, et al; Life After Pediatric Sepsis Evaluation (LAPSE) Investigators. Weiss SL, Fitzgerald JC, Maffei FA, et al; SPROUT Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators Network. Zhao C, Xin MY, Li J, et al. Emerg Med J.

ALS 95

ALS ICU Critical Care Emergency Department 95

Dr. Smith's ECG Blog

FEBRUARY 10, 2025

and the patient was given more insulin/dextrose/calcium and admitted to ICU. Lindner et al. Durfey et al. Farkas et al. Rather than the numerical value of serum K+ it is the rate of change in serum K+ levels that is more important as a predisposing factor for hemodynamic deterioration ( Simon et al StatPearls, 2023 ).

ALS 118

ALS ED ICU OR 118

EMDocs

JANUARY 20, 2025

9 In terms of assessing volume status in general, Joseph et al. 11 A study by Stephan et al. Since the 2010s multiple trials have explored the feasibility of fluid restrictive resuscitation both on initial resuscitation in the ED, as well as in the intensive care unit (ICU). Andrews et al. Similar to Andrews et al.,

ED 75

ED ALS Emergency Department Critical Care 75

Don't Forget the Bubbles

JANUARY 4, 2024

In 2014, the Royal College of Radiologists (RCR) Paediatric Trauma Protocols were published, recommending that CT chest imaging be appropriately limited to children in specific high-risk groups. Yam JC, Zhang XJ, Zhang Y, Yip BHK, Tang F, Wong ES, Bui CHT, Kam KW, Ng MPH, Ko ST, Yip WWK, Young AL, Tham CC, Chen LJ, Pang CP. JACEP Open.

ED 129

ED ICU ALS OR 129

Core EM

JANUARY 16, 2025

The nasal alae are perfused by an anastomosis of both the internal and external carotid arteries (Morey 2014), and continue to get good blood flow even in most people in shock who have poorly perfused fingers (Schallom 2018). Figure 17 Observational findings from (Zamora 2014) on how to grip the blade C) Scissor the mouth open.

E-9-1-1 130

E-9-1-1 EMS ALS OR 130

EMDocs

JANUARY 6, 2025

84 All patients with severe malaria need inpatient admission, ideally to the intensive care unit (ICU). 57 Adapted from: Long B, MacDonald A, Liang SY, et al. link] Rother B, Pierre G, Lombardo D, et al. link] Franco JR, Cecchi G, Priotto G, et al. Biggs H, Behravesh CB, Bradley KK et al. 57 Table 2. 2024;77:7-16.

ED 75

ED E-9-1-1 ALS Emergency Department 75