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High sensitivity cardiac troponins for ED chest pain evaluation (2022 ACC pathway)

ALiEM

Intermediate-risk patients may be further stratified based on recent stress testing or coronary angiogram findings plus a modified HEART or Emergency Department Assessment of Chest Pain (EDACS) score. You (or someone in your department) needs to know which assay your ED has, and use the appropriate values for that assay.

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SAEM Clinical Images Series: Pediatric Genitourinary Bleeding

ALiEM

A 4-year-old female with no significant past medical history is brought to the Emergency Department by her grandmother for concern for two days of progressive vaginal bleeding. It often presents to the emergency department with complaints of vaginal bleeding, difficulty urinating, or dysuria.

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Post-Tonsillectomy Hemorrhage: ReBaked Morsel

Pediatric EM Morsels

If bleeding, the only lab that is needed in the Emergency Department is a type and cross. 2021 Aug;147:110807. Epub 2021 Jun 24. Your support staff…depending on the amount of bleeding, you are about to have your hands full and may need IV access, medications, airway management, etc. Set up suction x2 in the room!

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Post-Intubation Sedation and Analgesia

Core EM

Lipophilic with adipose deposition, withdrawal symptoms after prolonged infusion Hydromorphone 5 – 15 min 2 – 3 hr 0.5 – 3 mg/hr No active metabolites however parent drug can accumulate in renal failure Morphine 5 – 10 min 3 – 4 hr 2 – 30 mg/hr Active metabolites can accumulate in renal failure Remifentanil 1 – 3 min 3 – 10 min Loading dose: 1.5

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SAEM Clinical Images Series: Back Yard Football Injury

ALiEM

A 10-year-old male with no past medical history presents to the Emergency Department (ED) by EMS for evaluation of an injury sustained while playing tackle football. The patient was forcibly hit by another child against a tree. The patient is reluctant to abduct the right arm secondary to pain.

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SGEM#437: Don’t Be Fooled by the Meds I Got, I Still Need an ESP Block – For My Rib Fractures

The Skeptics' Guide to EM

Efficacy and safety of ultrasound-guided erector spinae plane block compared to sham procedure in adult patients with rib fractures presenting to the emergency department: A randomized controlled trial. Background: We have covered rib fractures once before on the Skeptics’ Guide to Emergency Medicine.

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SGEM#319: Is it Aseptic Meningitis or More Than This?

The Skeptics' Guide to EM

Date: February 12th, 2021 Guest Skeptic: Dr. Dennis Ren is a paediatric emergency medicine fellow at Children’s National Hospital in Washington, DC. first appeared on The Skeptics Guide to Emergency Medicine. Reference: Mintegi S et al. Clinical Prediction Rule for Distinguishing Bacterial from Aseptic Meningitis.

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