Pediatric EM Morsels

AUGUST 4, 2023

Reece, 2016) There is multiple cases of sudden death from undiagnosed SMA syndrome in the literature attributed to a variety of causes at autopsy. 2016: 7809281. (England, 2021) In SMA syndrome the angle is decreased to < 22 o and the normal distance <8 mm. Oka, 2023) Female to male predominance with a ratio of 3:2.

E-9-1-1 246

E-9-1-1 ED OR EMS 246

The Skeptics' Guide to EM

OCTOBER 21, 2023

Population: Adults attending at continuously-staffed EDs in a health network covering 15 states, 2016-19. Implementation of a Clinical Management Tool for Spinal Epidural Abscess Early Diagnosis. AEM October 2023.

Emergency Department 259

Emergency Department ALS ED OR 259

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

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

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

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

The Skeptics' Guide to EM

JUNE 11, 2017

Lancet 2016. Lancet 2016. Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomised, open-label, phase 3 trial. first appeared on The Skeptics Guide to Emergency Medicine. You wonder if they would benefit from a platelet transfusion.

ALS 130

ALS OR EMS 130

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-9-1-1 118

E-9-1-1 ACS OR Emergency Department 118

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

ALiEM

MAY 13, 2024

Scan the entirety of the affected area in 2 planes. Be aware of the patient’s comfort throughout the examination. A water bath may be helpful to visualize lesions in extremities such as the hands or feet. The probe sits just below the water’s surface and does not need to contact the skin. It may also aid in identifying nearby vasculature.

E-9-1-1 161

E-9-1-1 ALS Emergency Department OR 161

The Skeptics' Guide to EM

NOVEMBER 11, 2017

Ann Emerg Med 2016 Guest Skeptic: Dr. Michael Falk is a Pediatric Emergency Medicine provider who works at Harlem Hospital Center in New York and Children’s […] The post SGEM#194: Highway to the Dexamethasone – For Pediatric Asthma Exacerbations first appeared on The Skeptics Guide to Emergency Medicine. Intervention Dexamethasone (DEX) 0.3

Emergency Department 130

Emergency Department ALS OR 130

The Skeptics' Guide to EM

SEPTEMBER 2, 2023

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]. They reported that the type of intravenous fluids (0.45% NaCl or 0.9%

ICU 196

ICU ED Critical Care ALS 196

The Skeptics' Guide to EM

DECEMBER 7, 2019

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. It is a diagnosis of exclusion that applies to infants under the age of 12 months. . * The name was not reassuring and the definition was vague.

CPR 130

CPR ALS OR 130

ALiEM

MAY 19, 2023

Published May 4, 2016. Another minor difference is that the gastric balloon in the Minnesota tube holds 450-500 ccs of air, while the SB gastric balloon holds 250 ccs of air [2]. If bleeding persists, you can go to a maximum of 45 mmHg. What is this “manometer” typically used for the esophageal balloon? EM:RAP HD Videos. EMCrit Project.

E-9-1-1 245

E-9-1-1 Emergency Department ICU OR 245

Pediatric EM Morsels

JULY 5, 2024

It seems like just yesterday ( or maybe ~ a month ago ) when we served up a tasty morsel on the PECARN decision rule for intra-abdominal traumatic injuries in children. Our friends at the PECARN injury group have remained busy this spring with generating more externally validated clinical decision rules. High Risk (12.8% High Risk (12.8%

ALS 161

ALS OR ED Emergency Department 161

ALiEM

SEPTEMBER 9, 2024

2016 Dec 28;7(Suppl 44):S1150-S1153. No peritoneal signs. Neuro : Awake, alert and oriented x3, no focal neurologic deficits. Rectum : Narrow lumen tube-like structure protruding from anus. Soft stool present at anus with no blood or melena. Non-tender rectal exam. Bales J, Morton RP, Airhart N, Flum D, Avellino AM. Surg Neurol Int.

Emergency Department 152

Emergency Department ED OR 152

Pediatric EM Morsels

APRIL 7, 2023

Epub 2016 Oct 17. 2016 Dec 2;2016(1):625-631. Observation, interaction with patient, as well as parent information is key to bring the whole picture together! J Stroke Cerebrovasc Dis. 2017 Jan;26(1):108-115. doi: 10.1016/j.jstrokecerebrovasdis.2016.08.038. 2016.08.038. PMID: 27765556. J Chronic Dis. 1985;38(6):495-505. PMID: 4008590.

ALS 130

ALS OR EMS Critical Care 130

The Skeptics' Guide to EM

SEPTEMBER 30, 2017

In 2016, the American Academy of Pediatrics (AAP) reaffirmed their clinical practice guidelines for the diagnosis and management of UTIs. This two-step process can decrease the rate of catheterization by over 30% without missing UTIs or increasing length of stay in the pediatric emergency department (Lavelle et al Pediatrics 2016 ).

Emergency Department 130

Emergency Department ALS OR 130

The Skeptics' Guide to EM

DECEMBER 16, 2017

NEJM Dec 2016 Guest Skeptic: Dr. Neal Little is an Emergency Physician who works at Chelsea Hospital in Chelsea, Michigan. 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.

ALS 100

ALS ICU Emergency Department Paramedic 100

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

Pediatric EM Morsels

MAY 12, 2023

However clinical judgement was more specific in this same group (54% vs 92%) [ Atabaki, 2016 ]. 2016 May;23(5):566-75. Epub 2016 Apr 20. PECARN is highly sensitive for identifying those with clinically important TBI. Acad Emerg Med. doi: 10.1111/acem.12923. PMID: 26825755.

OR 130

OR EMS 130

The Skeptics' Guide to EM

NOVEMBER 24, 2018

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. The word burnout was coined by Burnout was a term coined by Herbert Freudenberger in 1974.

EMR 130

EMR ALS Emergency Department OR 130

Core EM

OCTOBER 16, 2024

Author: Natalie Bertrand, MD Editor: Naillid Felipe, MD Background: Definition: adverse reaction to blood product administration Incidence: more common in children than adults, except for delayed hemolytic transfusion reactions Allergic (non-anaphylaxis) – Platelets 1-3%; RBCs 0.1-0.3% mg IF requiring IM Epi >3x, switch to IV Epi, 0.05-0.1

Allergic Reaction 188

Allergic Reaction Plasma ED Epinephrine 188

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

OCTOBER 7, 2017

BMJ Nov 2016. BMJ Nov 2016. BMJ Nov 2016. [display_podcast] Date: October 5th, 2017 Reference: Brison et al. Effect of early supervised physiotherapy on recovery from acute ankle sprain: randomised controlled trial. Guest Skeptic: Dr. Steve Joseph. display_podcast] Date: October 5th, 2017 Reference: Brison et al.

Emergency Department 100

Emergency Department ALS OR 100

The Skeptics' Guide to EM

AUGUST 14, 2021

This was the ALPS randomized control trial published in NEJM 2016. Date: August 12th, 2021 Reference: Daya et al. Survival After Intravenous Versus Intraosseous Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Shock-Refractory Cardiac Arrest. first appeared on The Skeptics Guide to Emergency Medicine. Reference: Daya et al.

CPR 130

CPR BLS ALS Paramedic 130

The Skeptics' Guide to EM

OCTOBER 28, 2017

Stevens and colleagues updated their review in 2016 and concluded “sucrose is effective for reducing procedural pain” and “no serious side effects or harms have been documented with this intervention”. That rant relied upon a Cochrane SRMA by Stevens B et al 2013 and a randomized clinical trail published in Pediatrics by Gray L et al 2015.

ALS 130

ALS Emergency Department OR ED 130

ALiEM

JANUARY 8, 2024

2016 May;68(5):689-94. References Huang K, Levy RD, Avina-Zubieta JA. Anti-Melanoma Differentiation-Associated Gene 5 Is Associated With Rapidly Progressive Lung Disease and Poor Survival in US Patients With Amyopathic and Myopathic Dermatomyositis. Arthritis Care Res (Hoboken). doi: 10.1002/acr.22728. PMID: 26414240; PMCID: PMC4864500.

ED 152

ED OR 152

The Skeptics' Guide to EM

MAY 14, 2022

They include: CBT and mindfulness ( Cherkin et al JAMA 2016), chiropractic ( Paige et al JAMA 2017), physical therapy ( Paolucci et al J Pain Research 2018) and acupuncture (Colquhoun and Novella Anesthesia and Analgesia 2013 ). The pain is 10/10 in intensity, gets worse with bending, turning, and prolonged walking.

ALS 130

ALS Emergency Department ED OR 130

The Skeptics' Guide to EM

OCTOBER 22, 2017

A 2016 Cochrane review by Cabello et al found five RCTs in patients with suspected or confirmed acute myocardial infarction. A second smaller study of 50 patients did not look at mortality but showed less ventricular tachycardia (VT) with supplemental oxygen (23% vs. 25%). What would you rather have, more death or less VT?

Emergency Medical Services 130

Emergency Medical Services Coronary ALS STEMI 130

Pediatric EM Morsels

OCTOBER 6, 2023

Mogsale 2016, Shah 2021)Stool cultures are only positive in 30% of cases if collected in 2 nd -3 rd week of illness which makes them a poor choice for definitive diagnosis. 2016; 15: 32. This inspired me to write a series of morsels related to concerning presentations in patients who have recently travelled.

OR 161

OR EMS ED 161

ALiEM

AUGUST 18, 2023

2016 May-Aug;9(2):80-6. The presentation of complete isolated CN III palsy generally involves ipsilateral ptosis (due to levator palpebrae paralysis) and “down and out” ocular deviation (due to preservation of superior oblique and lateral rectus function). Case Question: What are the most common etiologies of the diagnosis?

Emergency Department 130

Emergency Department OR 130

The Skeptics' Guide to EM

FEBRUARY 23, 2019

The Surviving Sepsis Campaign makes a number of recommendations in their 2016 guideline. Recently we covered a paper looking at whether or not pre-hospital antibiotics could provide a benefit to patients with varying degrees of sepsis ( SGEM #207 ). This is a strong recommendation from SSC based on low quality evidence.

Paramedic 130

Paramedic ALS Ambulance EMS 130

The Skeptics' Guide to EM

MAY 1, 2021

Emerg Med Australas 2016. Review article: Why is there still a debate regarding the safety and efficacy of intravenous thrombolysis in the management of presumed acute ischaemic stroke? A systematic review and meta-analysis. This SGEM Xtra is based on the new recommendation on TheNNT website for tPA in acute ischemic stroke.

ALS 130

ALS OR 130

Pediatric EM Morsels

NOVEMBER 17, 2023

2016 Feb;30(1):3-11. On this 10 year anniversary, we chose to throw this one back in the oven to include some even more delicious data on cuffed endotracheal tube (ETT) use. Cuffed Endotracheal Tubes: Evolution of Thought and Technology Why did we historically use uncuffed endotracheal tubes in kids younger than 8? 1.70) and 0.78 (0.46–1.35),

E-9-1-1 183

E-9-1-1 Operating Room Emergency Department ALS 183

The Skeptics' Guide to EM

MAY 2, 2020

July 2019 * Population: All dispatches of a transport-capable ground EMS vehicle to a 911 emergency scene from the 2016 National EMS Information System, both the response to the scene and the transport from the scene. Yes Results: The 2016 NEMSIS database contained 20.4 This is Bob’s eleventh visit to the SGEM.

ED 100

ED Ambulance Medical Transportation EMS 100

The Skeptics' Guide to EM

NOVEMBER 1, 2022

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). Date: October 27th, 2022 Reference: Hayashi et al. Date: October 27th, 2022 Reference: Hayashi et al.

ALS 118

ALS Emergency Department OR ED 118