ALiEM

AUGUST 9, 2023

Technique Positioning and Probe Figure 1: Younger children can sit in their parent’s lap and give a hug for lateral and posterior lung scanning. The patient should be in a position of comfort: supine, sitting, or in parent’s lap (Figure 1). Identify anatomical landmarks on ultrasound (Figure 3, Video 1). Balk et al.,

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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]. 2022; 11(1):45-52. 2018; 10(2):227-228. 2018 May;19(3):619-629. 2019 Nov 27;4(Suppl 1):S130-S139. But what can Dr. Garcia – or you – do?

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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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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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EMDocs

FEBRUARY 12, 2024

Introduction Arterial blood gas (ABG) or venous blood gas (VBG) testing is used to assess the pH and systemic carbon dioxide tension in patients, and, therefore, provide a more complete picture of their acid-base status than an isolated basic metabolic panel (BMP) (1). However, ABGs have many drawbacks compared to VBGs.

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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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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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Pediatric EM Morsels

MAY 5, 2023

2018 Dec 20;11(1):5. Hovinen T, Korkalo L, Freese R, Skaffari E, Isohanni P, Niemi M, Nevalainen J, Gylling H, Zamboni N, Erkkola M, Suomalainen A. Lemale J, Mas E, Jung C, Bellaiche M, Tounian P; French-speaking Pediatric Hepatology, Gastroenterology and Nutrition Group (GFHGNP). J Am Diet Assoc 2001;101:661–9.

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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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Dr. Smith's ECG Blog

NOVEMBER 14, 2023

Learning Point: 1. For examples of this phenomenon — See My Comment in the February 14, 2018 — July 21, 2020 — and December 22, 2022 posts in Dr. Smith's ECG Blog ). For examples of such exceptions — See My Comment in the January 9, 2019 — August 22, 2020 — and June 30, 2023 posts in Dr. Smith's ECG Blog ).

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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. Craythorne, E. International journal of dermatology, 49(9), pp.978-986. Public Health Research & Practice, 32(1). British Journal of Dermatology, 178(1), pp.140-147. Schadendorf, D., van Akkooi, A.C.,

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EMDocs

MAY 25, 2024

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

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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 11, 2024

CT head without contrast 1 is performed and reveals the following: Question: What is the diagnosis? Updated November 9, 2023. Epub 2019 Dec 9. On exam, the patient opens eyes to voice, has extraocular movements intact, is unable to speak, and has 0/5 strength in all extremities. Available from: [link] Guy-Evans, Olivia.

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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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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% Kornelsen E, Kuppermann N, Nishijima DK, Ren LY, Rumantir M, Gill PJ, Finkelstein Y.

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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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Don't Forget the Bubbles

FEBRUARY 26, 2024

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. Start low and increase for the comfort/tolerance of the patient and talk to the patient throughout the process.

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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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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. 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 2022;10(11):1-4. J Thorac Oncol.

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Dr. Smith's ECG Blog

MAY 30, 2023

We recorded an ECG in which V1-V3 were put in the position of V4R-V6R, and V4-6 were placed in V7-9 to (academically) confirm posterior OMI. 1 mg of Atropine was given and the heart rate increased transiently to 60. Atropine usually works in junctional rhythm with a narrow complex 9. What to do? RVMI explains part of the shock.

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EMDocs

JULY 3, 2023

9 Delayed NCHCT is less sensitive due to decreased visibility of blood collection secondary to red blood cell (RBC) degradation. 12 A few studies have shown that phenytoin with a loading dose of 1 g decreases seizure incidence in spontaneous SAH. 2022 Jan;39(1-2):35-48. Avest E, Taylor S, Wilson M, et al. J Neurotrauma.

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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. 2024 Jan 9. 2024 Jan 1;153(1):e2022060119. 2024 Jan 1;178(1):81-84.

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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. De Backer D, Creteur J, Silva E, Vincent JL. Kill C, Wranze E, Wulf H.

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EMDocs

JUNE 25, 2024

Estimate TBSA: may use Lund-Browder chart (most accurate assessment in children and adults), Rule of Nines, or palm method (measure the burn by using patient’s entire palmar surface and fingers as 1% TBSA). National Burn Repository 2019 Update, Report of data from 2009–2018. 2002 Nov;28(7):665-9. link] (2019). J Burn Care Res.

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ALiEM

MARCH 7, 2024

Ultrasound probes from left to right: linear (nenoates), phased array (infants/younger children), and curvilinear (older children/adolescents) Pro tips for performing renal/bladder POCUS on a child [1] Addressing potential anxiety leads to a more efficient and comfortable examination. Estimated volume = 39.2

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Broome Docs

OCTOBER 31, 2022

2022 Jan;48(1):78-91. 2022 Sep;21(9):781-791. 2018 Sep 11;362:k3843. PMID: 30206143 Less is more when it comes to intravenous fluids de-Madaria E, Buxbaum JL, Maisonneuve P, et al. Etomidate versus ketamine for emergency endotracheal intubation: a randomized clinical trial. Intensive Care Med. Epub 2021 Dec 14.

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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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Dr. Smith's ECG Blog

SEPTEMBER 11, 2018

many readers of this blog). -- Comment by K EN G RAUER, MD ( 9/11/2018 ): -- The lesson in this case relates to the recognition of subtle abnormalities that typically go undetected by the computerized interpretation — and which also may be overlooked by clinicians in the setting of a busy ED.

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ACEP Now

OCTOBER 9, 2023

9 Being bilingual is often not enough to be a medical interpreter, which requires precision, experience, and knowledge of medical jargon, as well as culturally specific idioms and phrases. Published Feb 8, 2018. 2022;105(1):62-73. Regenstein M, Anders E, Wynia MK. Int J Qual Health Care. 2007;19(2):60-7. Surinder S.

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Dr. Smith's ECG Blog

OCTOBER 24, 2018

A 40-something male presented with dyspnea and left arm numbness, and perhaps some chest tightness, for 1 1/2 hours. My Comment , by K EN G RAUER, MD ( 10/24/2018 ): = Important teaching points are made in this post by Dr. JACC 2016;67:1531. Here is his triage ECG: There is massive STE in V3-V6, and also STE in II, III, aVF.

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AAEM RSA

AUGUST 27, 2020

1 The primary goal of cardiopulmonary resuscitation (CPR) is to optimize coronary perfusion pressure and maintain systemic perfusion in order to prevent neurologic and other end-organ damage while working to achieve ROSC. Kirkegaard H, Soreide E, de Haas, I et al. De Fazio C, Skrifvars MB, Soreide E et al. 2019;23(1):1–9.

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Dr. Smith's ECG Blog

SEPTEMBER 7, 2020

The Differential Diagnosis is: SVT with aberrancy(#) [AVNRT vs. WPW (also called AVRT*)] Atrial flutter with 1:1 conduction, with aberrancy VT coming from the anterior fascicle ( fascicular VT )@ *AVRT = AV Reciprocating Tachycardia (Tachycardic loop that uses both the AV node and an accessory pathway. See Learning point 1 below.

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Dr. Smith's ECG Blog

AUGUST 9, 2018

It's important and useful to note that 1) Over 90% of healthy young men have up to 3mm ST elevation in one or more precordial leads normally (Atlas of Electrocardiography by K. My Comment , by K EN G RAUER, MD ( 8/9/2018 ): == Our thanks to Lou B for this insightful case. But there is clear ST elevation in lead aVL in Figure-1.

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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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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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Dr. Smith's ECG Blog

DECEMBER 27, 2018

S-wave is in V2 = 17 mm S-wave V4 = 9 mm Total = 26 (not greater than 28), so not LVH by the new rule! For clarity — I’ve reproduced this ECG, to which I’ve made a few additions ( Figure-1 ). If the total is greater than 2.3 mV (23 mm) in women and greater than 2.8 mV (28 mm) in men then left ventricular hypertrophy is diagnosed.

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