Pediatric EM Morsels

APRIL 5, 2024

Globally, ticks are the second most common vector to transmit illnesses after mosquitos (Parola 2018). Time from tick bite to onset of symptoms generally ranges from 1 week to 4 weeks but can start within 2 days (CDC 2022) Tick-Borne Encephalitis can also be transmitted in unpasturized dairy. These resolve within 1 week.

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ALiEM

OCTOBER 30, 2023

It should be no surprise that academic clinical educators are at high risk for burnout, stalled career advancement, and abandonment of academic medicine altogether [1, 2]. PMID 18945997 Elster MJ, O’Sullivan PS, Muller-Juge V, et al. 2022; 11(1):45-52. 2018; 10(2):227-228. 2018 May;19(3):619-629.

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Pediatric EM Morsels

NOVEMBER 17, 2023

Bibl K, Pracher L, Küng E, Wagner M, Roesner I, Berger A, Hermon M, Werther T. 1994 Jul;125(1):57-62. 2018 Mar;28(3):210-217. 2019 Sep;74(9):1186-1190. 2016 Feb;30(1):3-11. Differences in intubation outcomes for pediatric patients between pediatric and general Emergency Departments. Paediatr Anaesth. PMID: 8021785.

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REBEL EM

FEBRUARY 29, 2024

1, 2 Its occurrence often portends worse outcomes in intubated patients, whose projected hospital course was already tenuous. 1, 4, 6 The overall incidence of VAP is somewhere around 5%-40% of all intubated patients, depending on the study and country from which it is reported. 4, 8 Paper: Dahyot-Fizelier, C.,

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Dr. Smith's ECG Blog

DECEMBER 27, 2023

Written by Willy Frick A man in his 50s with a history of hypertension, dyslipidemia, type 2 diabetes mellitus, and prior inferior OMI status post DES to his proximal RCA 3 years prior presented to the emergency department at around 3 AM complaining of chest pain onset around 9 PM the evening prior. ECG 1 What do you think? Grines, C.

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EMDocs

NOVEMBER 13, 2024

Commonly a monomicrobial infection with gram-negative bacteria like E. Paracentesis is a safe procedure with a low complication rate (< 1%). For the remaining fluid inject 1 mL into a purple top EDTA blood tube for cell count; send 2-3 mL for Gram stain in a red-top tube or sterile urine container. coli (50-90% of cases).

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EMS 12-Lead

APRIL 28, 2022

Initial vital signs include: NIBP 99/58 HR 150-160 (trend) RR 10 (spontaneous, but shallow) SpO2 86 (RA) BBS CTA The initial rhythm strip is attached: Figure 1 There is a wide complex tachycardia of varying morphology, amplitude, and R-R cycle length. A prominent vertical scar, however, is noted at the sternum.

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REBEL EM

JANUARY 25, 2024

A 2018 systematic review and meta-analysis of 25 studies focusing on the accuracy of emergency lung ultrasound showed sensitivity of 85-95% and specificity of 75-90% for pneumonia, sensitivity of 78% and specificity of 94% for COPD/asthma, and sensitivity of 75-90% and specificity of 80-90% for acute heart failure [4]. Emerg Med J.

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EMS 12-Lead

AUGUST 22, 2022

Question 1: What is the rhythm? Beat 1 : Sinus, narrow QRS complex. The assumption is that a premature complex discharged prior to Beat 1, which prolonged its respective refractory period in the same manner as Beat 5. We can, therefore, put down the defibrillation pads, set aside the amiodarone, and look further at the ECG.

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Pediatric EM Morsels

AUGUST 18, 2023

Myth #1: Musculoskeletal Adverse Events (MAE) This concern is likely the most common reason fluoroquinolones are rarely used in children. Which is a risk of 1 event for 62.5 Wirth 2018) One study including 4.4 Meesters 2018) Resistance is growing (likely from inappropriate / overuse)! Arthropathy was seen in 13.7%

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Don't Forget the Bubbles

JUNE 30, 2023

E – Temp 37.2 Survival was better, both at 24 hours and six months, in the TXA group, although the primary outcome, a quality of life score at six months, called the Glasgow Outcome Scale Extended (GOS-E), was the same in both groups ( 53.7% Last year, Kornelson et al. A retrospective cohort study in Japan by Maeda et al.

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Don't Forget the Bubbles

JUNE 30, 2023

He has already climbed Ben Nevis in Scotland, visited the Gobi desert (possibly from the comfort of his parents 4 x 4, but who’s judging) and has his bronze D of E nailed. She calls out her findings: A – OK B – 1 puncture mark to the anterior left chest wall, covered with a three-sided dressing. Actively oozing.

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Don't Forget the Bubbles

JULY 22, 2024

The 2018 PREVIEW trial reported a significant reduction in length of stay (LOS) in children given prednisolone in Australia (24-71 months, mean 41 months) compared to placebo. Compare this with the Panickar et al. study from 200 9. Fortunately, Lee et al. Lee B, Turner S, Borland M, Csonka P, Grigg J, Guilbert TW, et al.

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EMDocs

JULY 17, 2023

1 While less common than small bowel obstruction (SBO), obstruction of the large bowel is more likely to be a surgical emergency and is often associated with a serious underlying condition. 1 The most common causes of non-cancer-related LBO are cecal and sigmoid volvulus. Small bowel dilation may also be seen.

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EMDocs

MAY 11, 2024

CT head without contrast 1 is performed and reveals the following: Question: What is the diagnosis? Rosh Review Website Link Further Reading: FOAMed: [link] [link] [link] [link] [link] [link] [link] References : Turi B, Smith D, Kusel K, et al. Updated November 9, 2023. link] Sharma R, Gaillard F, Bell D, et al.

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Don't Forget the Bubbles

JUNE 17, 2024

Here are ten things to think about: 1. Churruca K, Pavithra A, McMullan R, Urwin R, Tippett S, Cunningham N, Loh E, Westbrook J. John Wiley & Sons, 2018 Edward KL, Ousey K, Warelow P, Lui S. John Wiley & Sons, 2018 Edward KL, Ousey K, Warelow P, Lui S. 2014 Jun 26;23(12):653-9. 2020 Jan 1;35(1):70-6.

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Dr. Smith's ECG Blog

JULY 22, 2023

A prior ECG from 1 month ago was available: The presentation ECG was interpreted as STEMI and the patient was transferred emergently to the nearest PCI center. Patients that develop a Type 1 pattern without any precipitating or provoking factors have a risk of SCD of 0.5-0.8% per year incidence of SCD in this cohort [1].

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EMDocs

JUNE 7, 2023

1-5 Farmers also treat sheep for parasites using OPs and may become symptomatic after exposure, an illness called Dipper’s Flu. 8 Intermediate syndrome Occurs 1 to 5 days after acute exposure in up to 40% on individuals. 7, 9 Often have absence of excessive cholinergic stimulation. 7 May lead to respiratory failure.

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EMDocs

JUNE 27, 2024

Abdomen : ND, NT, no guarding or rebound MSK : Tenderness to palpation over L ribs 7-9 Derm : No rashes Imaging: Image 1: Case courtesy of Miriam Leiderer, Radiopaedia.org, rID: 81468 Chest radiograph (CXR) shows new left lower lobe opacity What’s most likely diagnosis? 2022 Jul 5;328(1):57-68. 2018 Aug;46(3):144-151.

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Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

To me, it was clearly atrial flutter with 1:1 conduction. Continue Eliquis 5mg BID, should be continued for 3 months == MY Comment , by K EN G RAUER, MD ( 9/18 /2024 ): == I found the following aspects of today's case of special interest. Why did Dr. Smith immediately say the rhythm was AFlutter with 1:1 AV conduction?

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EMDocs

MARCH 4, 2024

A wide variety of conditions can result in either type of cholestasis (Figure 1). 1 Extrahepatic obstruction is due to mechanical obstruction occurring downstream of the hepatic ducts such as pancreatic disease, gallstone obstruction of the common bile duct, and cancer. 9 How are cholestatic labs defined?

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EMDocs

MARCH 30, 2024

Comprehensive physical exam is unremarkable, but she does have pain at the T-12/L-1 region of her back. Her patellar reflexes are 1+ bilaterally, no ankle clonus is noted, and she denies any saddle anesthesia or bowel/bladder incontinence. CT of lower spine is ordered and shows the following: 1 What is the diagnosis?

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EMDocs

MAY 25, 2024

Massaging the gland causes expression of purulent material. What is the diagnosis?

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This Podcast Will Kill You

DECEMBER 10, 2024

Randal, et al. Girard-Madoux, Mathilde JH, et al. Academic Press, 2018. Nature Reviews Gastroenterology & Hepatology , 20 (9), pp.615-624. 2016): 1-9. Conficconi, E., BioMed research international , 2017 (1), p.9784565. History Biology Ball, Chad G., ” Canadian journal of surgery 55.2

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Don't Forget the Bubbles

MAY 29, 2023

A study of teams over a 1-year period highlights that people witnessing incivility are also affected, which could lead to individuals feeling unsupported in their teams. 2021:36:1–2, NP448–NP473 Available at. Review of Cultivating Communities of Practice: A Guide to Managing Knowledge, by Wenger E, McDermott R, Snyder WM].

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Don't Forget the Bubbles

JULY 5, 2023

Figure 1: Clinical manifestations and long-term consequences of sickle cell disease Training and education on sickle cell disease: Training and education are crucial to improve morbidity and mortality. Investigations : Bloods show Hb of 8 g/L, White cell count 13x 10 9 /L, Platelets 570 x10 9 /L, CRP 35mg/L.

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Don't Forget the Bubbles

AUGUST 28, 2023

The median age at diagnosis was 47 months (range 1-173 months). 2014;9(9):S102-S109. 0000000000000294 Carter BW, Benveniste MF, Madan R, et al. doi:10.1136/archdischild-2018-315269 Hammer MM, Miskin N, Madan R, Hunsaker AR. 2019;43(1):98-103.doi:10.1097/RCT.0000000000000782 2019;19(1):2126.doi:10.1016/j.bjae.2018.10.001

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Don't Forget the Bubbles

MARCH 18, 2024

The Royal Children’s Hospital in Melbourne summarises them in an easy-to-follow flow diagram (figure 1). Typical HUS has a diarrheal prodrome, usually caused by an infection with a Shiga-toxin-producing E. Blood tests Urine Stool Full blood count with blood film Urinalysis Stool MC&S Coagulation Urine MC&S E.

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This Podcast Will Kill You

OCTOBER 1, 2024

Medical journal of Australia , 190 (9). Cabezas-Cruz, Alejandro, et al. Delayed anaphylaxis, angioedema, or urticaria after consumption of red meat in patients with IgE antibodies specific for galactose-α-1, 3-galactose. Cabezas-Cruz, Alejandro, et al. Ronmark, E. Ronmark, E. Cabezas-Cruz, Alejandro, et al.

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EMDocs

NOVEMBER 18, 2023

A point of care ultrasound of the liver reveals the following: Image 1: Ultrasound of the liver showing abnormal hepatic artery flow and resistance index 1 Question: What is the diagnosis? Rosh Review Website Link References 1) Karmazyn B, Sağlam D, Rao GS, Jennings SG, Mangus RS. In: Molmenti E, Santibañes M, Santibañes E.

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EMDocs

JUNE 1, 2023

Source Article: Cooper DJ, Nichol AD, Bailey M, et al. 2018; 320(21):2211-2220. Bradycardia: 18.8% Average ventilator days (8.3 Take Aways: The data do not suggest that targeted hypothermia improves neurological function, reduces death, or reduces hospital length of stay as compared to normothermia. Bradycardia: 18.8%

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Don't Forget the Bubbles

FEBRUARY 26, 2024

In 2015, Silva et al. 2007 Jan 1;25(1):6-9. 2018 Jun;54(6):633-7. Add in PEFR <33% and SpO2 <92% Management of acute asthma* * as per BTS guidelines Acute asthma is managed in a stepwise fashion using the following guidelines. reviewed the two published randomised control trials. Frontiers in Pediatrics.

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Don't Forget the Bubbles

FEBRUARY 5, 2024

The study surveyed 2855 Canadian adolescents in 2018 and found that those who skipped breakfast were 2.55 Paediatric advocacy still has a long road ahead… You will find the list is broken down into four sections: 1.Reviews 2024 Jan 1;43(1):e11-e13. Anagnostou A, et al. Rodgers O, et al. Schoeffl I, et al.

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ECG & Echo Learning

OCTOBER 2, 2022

Most agents exhibit both vasopressor and inotropic effects (Figure 1). μg/kg/min Bolus : 1 mg IV every 3 to 5 min (max 0.2 mg/kg) IM: (1:1000): 0.1 mg (max 1 mg) Safe for peripheral use ++ + N/A Beta-effect more pronounced at low doses. References Overgaard, Dzavik et al. Jentzer et al. Circulation 2011.

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Dr. Smith's ECG Blog

FEBRUARY 28, 2020

4 important features that indicate acute right hear strain: 1. Kosuge et al. In this study, (quote) "negative T waves in leads III and V 1 were observed in only 1% of patients with ACS compared with 88% of patients with APE (p less than 0.001). Witting et al. Finally, Stein et al. Tachycardia (or nearly) 2.

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This Podcast Will Kill You

SEPTEMBER 10, 2024

Perantoni, E., Kaimakamis, E., ” Breath Sounds: From Basic Science to Clinical Practice (2018): 15-31. Longtin, Yves, et al. JMIR Medical Informatics, 9(1), p.e22753. .” The Boston Medical and Surgical Journal 195.5 1926): 208-211. Lung sounds recordings: Rocha, B.M., Vogiatzis, I., Natsiavas, P.,

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This Podcast Will Kill You

NOVEMBER 7, 2023

New England Journal of Medicine, 355(1), pp.51-65. Nature reviews Disease primers, 1(1), pp.1-20. Lee, Carrie, et al. Craythorne, E. and Al-Niami, F., International journal of dermatology, 49(9), pp.978-986. Public Health Research & Practice, 32(1). Schadendorf, D., van Akkooi, A.C.,

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