Pediatric EM Morsels

NOVEMBER 3, 2023

Worldwide, children <5 years old account for 76% of deaths related to malaria, but these are predominantly in Sub-Saharan Africa (WHO 2022) P. falciparum accounts for >70% of cases of imported malaria , primarily seen in those returning from travel in Sub-Saharan Africa (Mischlinger 2020) Other species include P. vivax , P. knowlesi and P.

ALS 278

ALS Critical Care EMS OR 278

Pediatric EM Morsels

APRIL 5, 2024

Climate change and changes in land usage have contributed to an expanded range of ticks (Beard 2016). Traveling Ticks are more than just ticking off a checklist before you get ready to travel! There are species of ticks found on every continent and carrying a variety of vectors capable of infecting humans.

E-9-1-1 161

E-9-1-1 ALS OR EMS 161

Pediatric EM Morsels

AUGUST 18, 2023

Jackson 2016) Ciprofloxacin was the first fluoroquinolone approved by the FDA in the 1980’s as a broad-spectrum antibiotic. Jackson 2016) It can also be used in UTIs , but is typically reserved for special cases where the infectious bacteria is found to be multidrug resistant or in complicated UTIs. Arthropathy was seen in 13.7%

E-9-1-1 130

E-9-1-1 ACS OR ALS 130

Pediatric EM Morsels

APRIL 7, 2023

References: Al Kasab S, Lynn MJ, Turan TN, Derdeyn CP, Fiorella D, Lane BF, Janis LS, Chimowitz MI; SAMMPRIS Investigators. Epub 2016 Oct 17. Observation, interaction with patient, as well as parent information is key to bring the whole picture together! Increase the Adult Percent! J Stroke Cerebrovasc Dis. 2017 Jan;26(1):108-115.

ALS 130

ALS OR Critical Care EMS 130

Pediatric EM Morsels

OCTOBER 27, 2023

Bowen 2016] Moral of the Morsel: Weight Matters! Reduces dosing errors during resus, up to 33.88%. Recommended by ATLS and PALS. Broselow-Luten System: Supportive Data Physician estimates of weight can underdose children by 49% or overdose by up to 116%. Krug 2007] What If the Child is Obese or Emaciated? Validation study done in Italy.

E-9-1-1 269

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

The Skeptics' Guide to EM

SEPTEMBER 2, 2023

Date: August 30, 2023 Reference: Griffey et al. Date: August 30, 2023 Reference: Griffey et al. However, over the past 20 years, there is burgeoning evidence that fast-acting subcutaneous insulin analogs could be a potential treatment option for mild to moderate severity DKA including a 2016 Cochrane SRMA [4].

ICU 201

ICU ED Critical Care ALS 201

Pediatric EM Morsels

JULY 21, 2023

We use the GCS score in both trauma and medical patients, but where did this score come from? When is it useful and what does it tell us? Is it actually validated in children, like the Ottawa Ankle Rules or are we using a tool for something other than that for which it was designed and validated, like using Kocher criteria for knee and ankle joints?

Critical Care 246

Critical Care ALS OR Life Support 246

Core EM

JANUARY 25, 2024

Renal injury: isolated proteinuria or hematuria, moderate acute kidney injury with serum creatinine levels <2 mg/dL Skin: petechiae and purpura Despite severe thrombocytopenia, clinically significant bleeding is rare Figure 1.

Plasma 246

Plasma Frozen Plasma Emergency Department FFP 246

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

This Podcast Will Kill You

SEPTEMBER 3, 2024

2016): 421-433. Dolin, Raphael, et al. Al-Hello, H., Dolin, Raphael, et al. “Is it gonna be poop or is it gonna be barf?” It’s the question we all fear during a bout of food poisoning when time is of the essence and a decision has to be made before it’s made for us. ” Nature Reviews Microbiology 14.7 De Graaf, M.,

ALS 52

ALS OR 52

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

Don't Forget the Bubbles

JULY 22, 2024

Compare this with the Panickar et al. The most recent meta-analysis , published in 2016 (comparing eleven studies from 1986 to 2009), struggled to reach a consensus because the trials were too heterogeneous to make robust conclusions. Fortunately, Lee et al. Lee B, Turner S, Borland M, Csonka P, Grigg J, Guilbert TW, et al.

E-9-1-1 105

E-9-1-1 ALS ACS ED 105

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

The Skeptics' Guide to EM

AUGUST 14, 2021

Date: August 12th, 2021 Reference: Daya et al. Date: August 12th, 2021 Reference: Daya et al. This was the ALPS randomized control trial published in NEJM 2016. This was a critical appraisal of an observational study published in Annals of EM ( Kawano et al 2018 ). Reference: Daya et al.

CPR 130

CPR BLS ALS Paramedic 130

REBEL EM

APRIL 29, 2024

A study by Lee et al ( 7) compared femoral CVC placement to IO and demonstrated a first-pass success pass rate with IO of 90.3% Over the years emergency and critical care physicians have tried many ways to establish IV access in emergencies including the “crash” or “dirty” central line. compared to only 37.5% in the CVC group.

ALS 105

ALS Epinephrine Critical Care Emergency Department 105

The Skeptics' Guide to EM

OCTOBER 1, 2022

Date: September 28th, 2022 Reference: Hartford et al. Date: September 28th, 2022 Reference: Hartford et al. Brown et al , Selbst and Clark ). Reference: Hartford et al. Disparities in the emergency department management of pediatric migraine by race, ethnicity, and language preference. AEM September 2022.

Emergency Department 130

Emergency Department ALS ED OR 130

The Skeptics' Guide to EM

JUNE 11, 2017

[display_podcast] Date: June 5th, 2017 Reference: Baharoglu et al. Lancet 2016. display_podcast] Date: June 5th, 2017 Reference: Baharoglu et al. Lancet 2016. Background: In the US, daily or every other day aspirin use has been reported to be as high as 61% in adults aged 65 or older ( Ajani et al Am J Prev Med 2006 ).

ALS 130

ALS OR EMS 130

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

ALiEM

AUGUST 9, 2023

Ultrasound Technique Background The lungs were traditionally considered poorly accessible to ultrasound, as ultrasound waves cannot penetrate air-filled structures; however, lung POCUS relies on the interpretation of patterns of artifacts to evaluate the normal, air-filled lungs. Warm gel helps with the child’s comfort.

E-9-1-1 246

E-9-1-1 Emergency Department ALS OR 246

The Skeptics' Guide to EM

MAY 29, 2021

Date: May 20th, 2021 Guest Skeptic: Dr. Robert Edmonds is an emergency medicine physician in the Air Force in Dayton, Ohio, and a University of Missouri-Kansas City residency alumni from 2016. Reference: Jhunjhunwala et al. Reference: Jhunjhunwala et al. Journal of Trauma and Acute Care Surgery.

Emergency Medical Services 130

Emergency Medical Services ACS ALS Emergency Department 130

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

REBEL EM

NOVEMBER 30, 2023

Studies without IRB approval Studies older than 2016 Intervention: Administration of <30 mL/kg IV crystalloid fluids within three hours of sepsis identification. Limitations: The investigators excluded studies published before 2016, non-English studies, and non-published studies, potentially missing valuable data. 2.89, p = 0.01.

E-9-1-1 122

E-9-1-1 ALS ACS ICU 122

The Skeptics' Guide to EM

DECEMBER 7, 2019

Date: October 2nd, 2019 Reference: Ramgopal et al. Date: October 2nd, 2019 Reference: Ramgopal et al. The change in name took place in 2016. The subcommittee on ALTEs in the AAP published a practice guideline renaming ALTEs to brief resolved unexplained events ( BRUEs ) in 2016.

CPR 130

CPR ALS OR 130

Pediatric EM Morsels

JUNE 21, 2024

Available from: [link] Liu H, Li D, Yuan H, et al. The management of pediatric thermal burns always seems to be a hot topic , whether we are caring for a little future chef who splashed a scalding microwaved noodle cup on himself, or a toddling youngster who pulled a pot of boiling water on herself. Updated 2023 May 29]. doi: 10.1097/PEC.0000000000003098.

ALS 169

ALS OR EMS 169

The Skeptics' Guide to EM

NOVEMBER 1, 2022

Date: October 27th, 2022 Reference: Hayashi et al. Date: October 27th, 2022 Reference: Hayashi et al. Although minor adverse events, such as brief apnea or hypoxia, are common, significant adverse events are very rare, and the benefits are clear (Bellolio 2016).

ALS 154

ALS Emergency Department OR ED 154

REBEL EM

NOVEMBER 6, 2024

Elbow Dislocation Definition: Disarticulation of the proximal radius & ulna bones from the humerus Epidemiology: Incidence Second most common joint dislocation (after shoulder) in adults Most commonly dislocated joint in children Accounts for 10-25% of all injuries to the elbow ( Cohen 1998 ) Posterolateral is the most common type of dislocation (..)

E-9-1-1 59

E-9-1-1 ACS OR Emergency Department 59

The Skeptics' Guide to EM

DECEMBER 16, 2017

[display_podcast] Date: November 27th, 2017 Reference: Legriel et al. NEJM Dec 2016 Guest Skeptic: Dr. Neal Little is an Emergency Physician who works at Chelsea Hospital in Chelsea, Michigan. display_podcast] Date: November 27th, 2017 Reference: Legriel et al. Reference: Legriel et al.

ALS 100

ALS ICU Emergency Department Paramedic 100

The Skeptics' Guide to EM

MAY 1, 2021

Reference: Donaldson et al. Reference: Donaldson et al. Emerg Med Australas 2016. The Donaldson et al SRMA included 10,431 patients in 26 randomized trials comparing intravenous thrombolysis with placebo or standard care in acute ischemic stroke [1]. He is also one of the SGEM Hot Off the Press Faculty.

ALS 130

ALS OR 130

NAEMSP

OCTOBER 9, 2024

Steroids such as methylprednisolone (Solu-Medrol) and dexamethasone (Decadron) are commonly available in ALS ambulances and are appropriate for preventing or treating adrenal crisis. The downstream effect is an inability to respond to stress, which can lead to shock, often resistant to fluids and vasopressors.

EMS 122

EMS Crisis Prevention Emergency Department BLS 122

This Podcast Will Kill You

JANUARY 2, 2024

2016): 62-76. Devogelaer, Jean-Pierre, et al. ” Orthopedic research and reviews (2016): 41-55. . ” Orthopedic research and reviews (2016): 41-55. Tsimicalis, Argerie, et al. ” Quality of Life Research 25 (2016): 1877-1896. Radiology 1943 40:2, 145-154 Forlino, A. and Marini, J.C.,

E-9-1-1 52

E-9-1-1 ALS OR 52

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

NOVEMBER 24, 2018

The highest prevalence of burnout (70%) was reported by emergency physicians (Shanafelt et al 2015). One of the most common reasons cited for burnout is the electronic medical record (EMR) (Shanafelt et al 2016). West et al 2016 published a SRMA in the Lancet on interventions to prevent and reduce physician burnout.

EMR 130

EMR ALS Emergency Department OR 130

The Skeptics' Guide to EM

NOVEMBER 11, 2017

[display_podcast] Date: November 9th, 2017 Reference: Cronin JJ et al. display_podcast] Date: November 9th, 2017 Reference: Cronin JJ et al. Reference: Cronin JJ et al. There have been a number of recent studies that have compared prednisolone to dexamethasone for outpatient treatment of asthma. mg/kg (max. mg/kg (max.

Emergency Department 130

Emergency Department ALS OR 130

ACEP Now

OCTOBER 11, 2024

One question that is commonly raised is whether these patients should be trauma activations. One study demonstrated that the minority of the cases reviewed required surgical intervention or had identifiable traumatic injuries, making standard involvement of the trauma team unnecessary. 4 Another study cited only 2.3

ALS 52

ALS Emergency Department Emergency Medical Services ED 52

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

Don't Forget the Bubbles

JANUARY 24, 2024

Going beyond the algorithm, what can we do when a child is still fitting despite appropriate treatment? Four-year-old Fern is a previously healthy girl who presents with a febrile illness and seizures. Whilst in PICU, amplitude-integrated EEG monitoring is commenced and reveals ongoing seizure activity. What is the problem with SRSE?

Critical Care 111

Critical Care ALS OR 111

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