Pediatric EM Morsels

SEPTEMBER 22, 2023

Negative E-FAST and no signs of long bone injuries should raise concern for neurogenic shock in the hypotensive trauma patient with suspected spinal injury. Alpha 1 agonists are necessary to maintain appropriate blood pressure. Tenenbein M, Macias CG, Sharieff GQ, et al, eds. Updated 2022 Feb 10]. 2011;46(9):1771.

E-9-1-1 300

E-9-1-1 Epinephrine ALS EMS 300

Broome Docs

OCTOBER 31, 2022

2022 Jan;48(1):78-91. The PEACH trial: No body had a fit, so… we have no clue Peter-Derex L, Philippeau F, Garnier P, et al. 2022 Sep;21(9):781-791. PMID: 30206143 Less is more when it comes to intravenous fluids de-Madaria E, Buxbaum JL, Maisonneuve P, et al. 2022 Sep 15;387(11):989-1000.

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E-9-1-1 Defibrillator ICU Critical Care 52

Don't Forget the Bubbles

OCTOBER 4, 2023

The NEJM published the PREDICT trial, concluding that prophylaxis is ‘statistically’ effective in preventing the first UTI in neonates (albeit a small effect, and it comes at the cost of an increased occurrence of non– E coli organisms and antibiotic resistance). Formentin C, et al. Jørgensen RM, et al. Harris J, et al.

E-9-1-1 111

E-9-1-1 ALS Emergency Department OR 111

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.,

E-9-1-1 246

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

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. PMID 29686766 Jordan J, Coates WC, Clarke S, et al.

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E-9-1-1 ALS OR 161

EMDocs

FEBRUARY 20, 2024

Fluids in Pancreatitis #1 : de-Madaria E, Buxbaum JL, Maisonneuve P, et al; ERICA Consortium. 2022 Sep 15;387(11):989-1000. 2: Li XW, Wang CH, Dai JW, et al. 2023 Mar 22;27(1):122. These videos will cover post summaries, take homes on clinical condition, and EBM/guideline literature updates. N Engl J Med.

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E-9-1-1 ICU ALS OR 83

This Podcast Will Kill You

NOVEMBER 27, 2023

” Cambridge: Cambridge University Press 197 (1993): 9-23. Parasites & Vectors , 15 (1), pp.1-9. World Health Organization, 2022. Brown, Amanda MV, et al. The Lancet Global Health , 8 (9), pp.e1186-e1194. Ferri, Emanuele, et al. Gerth, Michael, et al. Kaur, Rupinder, et al. Addiss, D.

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E-9-1-1 ALS ED 52

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. 2020 Feb 12;10(1):2470.

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E-9-1-1 ICU ACS EMS 75

EMDocs

NOVEMBER 29, 2023

EBM Update: Fluids in Pancreatitis, Hypertriglyceridemic Pancreatitis #1: de-Madaria E, Buxbaum JL, Maisonneuve P, et al; ERICA Consortium. 2022 Sep 15;387(11):989-1000. 2: Li XW, Wang CH, Dai JW, et al. 2023 Mar 22;27(1):122. Today we focus on pancreatitis. N Engl J Med. to 9.8L) Moderate: 5.5L (Range 4.0

E-9-1-1 66

E-9-1-1 ICU ALS OR 66

EMDocs

MAY 15, 2024

Today on the emDOCs cast with Brit Long, MD ( @long_brit) , we cover acute chest syndrome part 1. Episode 100: Acute Chest Syndrome Part 1 Background SCD is an autosomal recessive condition that results in the formation of hemoglobin S (HbS). Each episode of ACS has a 9% mortality rate. 2022 Aug;58:235-244. Br J Haematol.

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E-9-1-1 ACS ALS OR 78

This Podcast Will Kill You

SEPTEMBER 10, 2024

Perantoni, E., Kaimakamis, E., Longtin, Yves, et al. JMIR Medical Informatics, 9(1), p.e22753. 2022): 168-173. . “Laennec, the Man—1781–1826.” ” The Boston Medical and Surgical Journal 195.5 1926): 208-211. Lung sounds recordings: Rocha, B.M., Vogiatzis, I., Natsiavas, P., Oliveira, A.,

E-9-1-1 52

E-9-1-1 ALS 52

Don't Forget the Bubbles

JANUARY 17, 2024

After Meshram et al, 2020 When Orbeez are exposed to water, the water molecules diffuse into the polymer network through osmosis. Image adapted from Mullens et al., After Darracq et al., A recent literature review by Caré et al. Zamora et al., From Mullens et al., His abdominal X-ray looked a lot like this.

E-9-1-1 111

E-9-1-1 ALS Emergency Department OR 111

EMDocs

SEPTEMBER 7, 2023

1 Clinical Questions: When should a clinician suspect diethylene glycol (DEG) toxicity? Metabolism of DEG adapted from Bessenhofer, et al. Toxicity typically evolves through three phases: 2,3,7,8,9 Phase 1: Gastrointestinal symptoms (e.g., References: Abubukar et al. Nelson, et al. Schier, Capt.

E-9-1-1 66

E-9-1-1 ALS Emergency Department Plasma 66

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.

EMS 89

EMS E-9-1-1 ALS OR 89

This Podcast Will Kill You

NOVEMBER 7, 2023

2022): 666-670. Taylor & Francis, 2022. 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. Non-melanoma skin cancer.

E-9-1-1 52

E-9-1-1 ALS ED OR 52

EMDocs

APRIL 10, 2024

1-5] Since then, many more medications have been developed and deployed. 1-5] This post focuses on the identification and management of Local Anesthetic Systemic Toxicity (LAST). 3-5,7] Symptom onset is usually within 1 minute of intravascular injection but can be delayed if multiple injections or continuous infusion. [5]

E-9-1-1 93

E-9-1-1 Plasma Epinephrine EMS 93

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.

E-9-1-1 145

E-9-1-1 OR ALS Critical Care 145

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.

E-9-1-1 130

E-9-1-1 Coronary ALS ICU 130

Broome Docs

JANUARY 30, 2023

2022 Nov 6. Vedantham S, Goldhaber SZ, Julian JA, et al; ATTRACT Trial Investigators. 2022 Nov;61:87-89. Epub 2022 Aug 28. 2022 Nov;29(11):1403-1404. Epub 2022 Aug 17. PMID: 33933300 Khan A, Saleem MS, Willner KD, Sullivan L, Yu E, Mahmoud O, Alsaid A, Matsumura ME. 2022 Aug 1;5(8):e2226809.

E-9-1-1 52

E-9-1-1 Emergency Department Defibrillator ALS 52

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.

Emergency Department 94

Emergency Department E-9-1-1 ED ICU 94

EMDocs

JANUARY 17, 2024

1) There are a limited number of antitussives on the US market which include benzonatate, codeine, dextromethorphan, diphenhydramine, and hydrocodone. 9) The safety announcement highlighted the mortality risk of exploratory ingestions in children under 10 years. 2021;30(1):45-52. 2022;18(4):344-9. 11) A bolus dose at 1.5

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E-9-1-1 Overdose Emergency Medical Services Life Support 67

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?

EMS 90

EMS E-9-1-1 Emergency Department Ambulance 90

ALiEM

FEBRUARY 9, 2024

The 2022 American College of Cardiology (ACC) pathway provides timely guidance [1]. Applying the 2022 ACC guideline Before delving into the specifics of the hs-cTn pathways, start with the ECG. The ACC 2022 pathway has a section dedicated to ECGs in ischemia [1], and FOAMcast has a great visual summary.

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E-9-1-1 ED Coronary ALS 276

EMDocs

MAY 28, 2024

Each episode of ACS has a 9% mortality rate. 2022 Aug;58:235-244. Epub 2022 Jun 11. Vichinsky EP, Neumayr LD, Earles AN, et al. Howard J, Hart N, Roberts-Harewood M, et al. PMID: 25824256 Chou ST, Alsawas M, Fasano RM, et al. PMID:31985807 Alkindi S, Al-Busaidi I, Al-Salami B, Raniga S, Pathare A, Ballas SK.

ACS 75

ACS E-9-1-1 ALS OR 75

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 Morley 2022) This myth is: BUSTED. PMID: 27940800 Hersch AL, Gerber JS, Hicks LA, Pavia AT. Fluoroquinolone Use in Children: A Bad Rep? Pediatrics.

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E-9-1-1 OR ACS ALS 130

EMDocs

MAY 25, 2024

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

EMS 80

EMS E-9-1-1 OR ED 80

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.

ED 85

ED E-9-1-1 ALS OR 85

Dr. Smith's ECG Blog

JULY 14, 2023

Two recent interventions have proven in randomized trials to improve neurologic survival in cardiac arrest: 1) the combination of the ResQPod and the ResQPump (suction device for compression-decompression CPR -- Lancet 2011 ) and 2) Dual Sequential defibrillation. Figure-1: The initial ECG in today's case — obtained after ROSC.

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E-9-1-1 Defibrillator CPR STEMI 88

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?

Emergency Department 87

Emergency Department E-9-1-1 ALS OR 87

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

Post cath ECG: Now there are hyperacute T-waves again, and recurrent ST depression in V2 This ECG would normally diagnostic of OMI until proven otherwise No further troponins were measured, but it looks like there is recurrent OMI Next day: A CT Coronary Angiogram was done (CTCA) CARDIAC MORPHOLOGY AND FUNCTION: 1. IMPRESSION: 1.

Coronary 104

Coronary E-9-1-1 STEMI ACS 104

EMDocs

AUGUST 22, 2024

1 However, we recognize that many patients prefer to speak a language other than English regardless of their English proficiency, and this does not indicate a deficiency. 9 Less likely to be satisfied with their care and have a lower understanding of their discharge instructions. Lion KC, et al. Regenstein M, et al.

Emergency Department 82

Emergency Department ALS E-9-1-1 ED 82

ACEP Now

OCTOBER 9, 2023

3 A new 2022 proposed change to Section 1557 hopes to expand its scope to other HHS activities (including Medicare Part B) and telehealth services, require staff training on availability of services, and further define the roles of qualified versus nonqualified interpreters. Centers for Medicare and Medicaid Services, et al.

Emergency Department 64

Emergency Department E-9-1-1 ALS OR 64

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.

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E-9-1-1 Emergency Department ALS ED 177

Don't Forget the Bubbles

OCTOBER 19, 2023

Over 1,500 children in EDs, aged 1 to 4 with acute hypoxemic respiratory failure needing hospital admission, across 14 emergency departments in Australia and New Zealand were randomly allocated 1:1 to high-flow oxygen therapy OR standard oxygen therapy (approximately 750 children in each group). days compared to 1.50

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E-9-1-1 OR ED Emergency Department 81

REBEL EM

MAY 25, 2023

mental status, urine output, capillary refill) is more important than an actual goal PERMISSIVE HYPOTENSTION IN PTS WITH TBI Brotfain E et al. mental status, urine output, capillary refill) is more important than an actual goal PERMISSIVE HYPOTENSTION IN PTS WITH TBI Brotfain E et al. Richards JE et al.

E-9-1-1 145

E-9-1-1 Plasma ALS OR 145

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

ECG #1 Interpretation: ECG #1 shows sinus rhythm at a heart rate of 77 bpm. Following more detailed questioning — it turned out the patient had started taking 9 different herbal remedies to ease lethargy and unspecific neurological symptoms. For clarity in Figure-1 — I've reproduced the initial ECG in today's case.

E-9-1-1 107

E-9-1-1 ALS Defibrillator OR 107

Don't Forget the Bubbles

SEPTEMBER 18, 2023

2022 Dec;41(12):947–52. Davidson L, Foley DA, Clifford P, Blyth CC, Bowen AC, Hazelton B, et al. 2022 Jun;58(6):1007–12. Frost HM, Bizune D, Gerber JS, Hersh AL, Hicks LA, Tsay SV. 2022 Dec;251:98-104.e5. NICE; [cited 2022 Dec 28]. 2017 Sep 7 [cited 2022 Dec 28];2022(8). Pediatr Infect Dis J.

Emergency Department 142

Emergency Department E-9-1-1 ALS OR 142