Pediatric EM Morsels

OCTOBER 27, 2023

PAWPER [Wells 2013, Silvagni 2022] Takes into account body habitus. Initially tested in Johannesburg, South Africa: 1 month old to 12 years old Broselow predicted within 10% of weight in 63.6% Zhu 2022] In Nepalese children, the Broselow correlated well at lower weights, but accuracy decreased at higher weights >18 kg. [K

E-9-1-1 271

E-9-1-1 Emergency Medical Services Life Support ALS 271

Pediatric EM Morsels

JULY 19, 2024

Since tonsillectomy is one of the most common pediatric surgeries in the US (~500,000 per year) and the rate of post-tonsillectomy hemorrhage is about 1-5% , it is a good idea that we all are familiar with how to manage this issue! 2022 Sep-Oct;43(5):103582. Epub 2022 Aug 6. 2020 Sep;38(9):1943. 2022 Mar 4;14(3):e22857.

E-9-1-1 290

E-9-1-1 Epinephrine Emergency Department OR 290

EMDocs

JANUARY 11, 2025

3, 9, 11, 12 The average age tends to be greater than 60 years old. Up to 1/3 of adults over 60 suffer from chronic constipation. Clinical exam: 2, 3, 9 Abdominal distension and tenderness Nausea and vomiting Stool present in the rectal vault Peritonitis may be accompanied by hemodynamic instability in the case of sepsis.

E-9-1-1 98

E-9-1-1 EMS Emergency Department OR 98

ALiEM

OCTOBER 11, 2023

Most pufferfish contain tetrodotoxin , a dangerous marine toxin up to 1200 times more toxic to humans than cyanide [1]. 4, 9-12] Consider activated charcoal for patients presenting within 60 minutes of ingestion if the patient’s airway is not an imminent threat or has been secured. 2022 Feb 8;14(2):123. 2022;20(1):47.

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E-9-1-1 ALS OR 204

Pediatric EM Morsels

JULY 28, 2023

Rates of type 1 diabetes have increased since the COVID-19 pandemic. Insulin (in Bag #1) is for the Acidosis. 2010 Dec;1(2):103-20. 2001 Jan 25;344(4):264-9. PubMed] [Read by QxMD] [link] Weiss A, Donnachie E, Beyerlein A, Ziegler A, Bonifacio E. Is your patient hyperglycemic, acidotic, with ketonuria?

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E-9-1-1 ALS OR Critical Care 246

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. Updated 2022 Feb 10]. 2011;46(9):1771. McGraw Hill Education; 2019:125-138 Ziu E, Mesfin FB.

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E-9-1-1 Epinephrine ALS EMS 304

Core EM

JANUARY 25, 2024

7 86% of burn injuries are thermal burns (as opposed to chemical or electric), with 43% resulting from a direct exposure to fire, 34% from scalding liquid, and 9% from a hot object. 9 Apply a topical antimicrobial (eg. Updated 2022 May 30]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Tintinalli, et al.

ED 246

ED E-9-1-1 First Aid OR 246

ALiEM

MAY 19, 2023

The SB tube was created in 1950 in order to help tamponade variceal bleeds [1]. Apply traction to the tube by tying a roller bandage to the end of it and then the other end to a 1 L bag of IV fluids. Pearl 1: Check the units of pressure being used. The conversion rate is: 1 cmH2O = 0.74 1950 May;131(5):781-9.

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

Pediatric EM Morsels

AUGUST 9, 2024

Worldwide, congenital syphilis complicates about 1 million pregnancies / year. Early Congenital Syphilis Present before 2 years of age [ Hussain, 2023 ; Foles, 2024; Fang, 2022; Morrisroe, 2021 ] Only ~33% of newborns present with symptoms at birth and can be subtle. gross ) Rash Occurs 1-2 weeks after rhinitis. BMJ Case Rep.

E-9-1-1 154

E-9-1-1 Plasma Emergency Department OR 154

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). Tsou et al.,

E-9-1-1 246

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

EMDocs

OCTOBER 30, 2023

” – Musings of an American ED resident in July 2022 when US healthcare was affected simultaneously by supply chain issues from GE Healthcare (contrast media) and Abbott Laboratories (Similac baby formula). 11 Table 1. 11 Table 1. A baby formula milk shortage for adults.”

E-9-1-1 99

E-9-1-1 Emergency Department ALS CCT 99

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.

E-9-1-1 145

E-9-1-1 Plasma ALS OR 145

Pediatric EM Morsels

NOVEMBER 17, 2023

Bibl K, Pracher L, Küng E, Wagner M, Roesner I, Berger A, Hermon M, Werther T. 2022 May 11;10:864766. 2022 Apr;29(4):406-414. Epub 2022 Jan 12. 1994 Jul;125(1):57-62. 2019 Sep;74(9):1186-1190. 2016 Feb;30(1):3-11. Paediatr Anaesth. 2021 Jun;31(6):713-719. doi: 10.1111/pan.14185. Epub 2021 Apr 11.

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E-9-1-1 Operating Room Emergency Department ALS 187

ALiEM

MAY 13, 2024

Her symptoms started 1 week ago as a scratch which progressively got more red and painful. Pediatric Soft Tissue POCUS Ultrasound Technique Figure 1. Cellulitis with cobblestoning Video 1. Abscess with irregular borders and surrounding cellulitis E. Superficial abscess with well-circumscribed borders Table 1.

E-9-1-1 161

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

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

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.

E-9-1-1 131

E-9-1-1 OR Coronary ACS 131

Dr. Smith's ECG Blog

OCTOBER 3, 2024

I agree, however: 1) I don't think you can get a good enough ech o without bubble contrast. 3) E cho is another step that takes time. I had only 9 false positives but I missed 2 OMI. The rhythm for the ECG in Figure-1 is sinus — with normal intervals and axis ( mean QRS axis about +80 degrees ). Time is myocardium.

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E-9-1-1 Coronary ALS ED 124

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. 2019 Nov 27;4(Suppl 1):S130-S139. 2022; 42(4):291-293. And as study after study tells us, everyone is susceptible to burnout.

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E-9-1-1 ALS OR 161

Dr. Smith's ECG Blog

AUGUST 14, 2024

R waves 6 through 9 have no preceding P waves and are suspiciously regularly spaced. Impulses E, F, G, H, and I were blocked. Progress in Biophysics and Molecular Biology , 120 (1–3), 164–178. Science Translational Medicine , 9 (400). Figure-1: I've labeled the initial ECG in today's case to illustrate my theory.

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E-9-1-1 OR ALS 110

Dr. Smith's ECG Blog

SEPTEMBER 23, 2024

Here is lead I from ECGs 1 and 2 shown side-by-side to highlight the change in axis from borderline right to completely normal. Consider the following: We become attuned to looking for acute coronary occlusion in patients who present with acute symptoms to the ED ( E mergency D epartment ).

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E-9-1-1 Coronary STEMI ALS 128

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.

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E-9-1-1 ALS Defibrillator OR 113

Dr. Smith's ECG Blog

DECEMBER 11, 2023

Moreover , the patient has ongoing symptoms and has an unexplained elevated troponin, so she is having an MI and the only question is whether it is type 1 or type 2 due to hypertension. Case continued She was loaded with aspirin 325 mg, and repeat troponin drawn around the time of EKG 1 resulted at 267 ng/L. Peterson, E.

E-9-1-1 123

E-9-1-1 ACS Coronary STEMI 123

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

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. 2023 Mar 22;27(1):122. Management: 1) Discontinue meds causing hypertriglyceridemia, 2) Gemfibrozil 600 mg BID, 3) Electrolyte repletion, 4) Gentle dextrose/insulin infusion, 5) Nutritional support.

E-9-1-1 98

E-9-1-1 ICU ALS OR 98

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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E-9-1-1 FFP Plasma Emergency Department 139

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].

E-9-1-1 92

E-9-1-1 CAD OR STEMI 92

REBEL EM

MAY 27, 2024

What they did: Prospective randomized controlled trial, unblinded, multicenter study Conducted from January 2017 to December 2022 Patients with confirmed PSVT were randomly assigned to receive MVM, IV Adenosine, or combined therapy. No significant differences in heart rate 1 minute after cardioversion were observed between the three groups.

OR 134

OR E-9-1-1 ED ALS 134

REBEL EM

JANUARY 25, 2024

What They Did: Design: Randomized, controlled, blinded-outcome trial Sites: Three emergency departments in Denmark Duration: October 9, 2019 to May 26, 2021. The first evaluation of the patient was to be done within 1 hour of arrival to ED (Including the first POCUS). to −0.66) and −1.66 (95% CI −2.09

ED 125

ED E-9-1-1 Emergency Department ALS 125

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. 2023 Mar 22;27(1):122. Today we focus on pancreatitis. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. N Engl J Med.

E-9-1-1 92

E-9-1-1 ICU ALS OR 92

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]

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E-9-1-1 Plasma Epinephrine Life Support 111

EMDocs

MAY 25, 2024

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

EMS 98

EMS E-9-1-1 OR ED 98

Broome Docs

OCTOBER 31, 2022

2022 Jan;48(1):78-91. 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. 2022 Sep 18. 2022 Aug;41(4):101096. Epub 2022 Apr 28. 2022 Aug 3;11:100284. Epub 2021 Dec 14.

E-9-1-1 52

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

EMDocs

FEBRUARY 7, 2024

Despite a plateau in overall union membership of around 10% in 2023 1 , major labor actions shook the U.S. there were 31 recorded healthcare strikes in 2021, 39 recorded healthcare strikes in 2022, and 37 healthcare strikes in 2023 as of November 3rd. months since 2022. 2023 October 9. 2012 Feb 1;4(1):127-57.

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E-9-1-1 Ambulance OR 98

This Podcast Will Kill You

JULY 23, 2024

Official journal of the American College of Gastroenterology| ACG , 118 (1), pp.59-76. Annals of internal medicine , 172 (1), pp.ITC1-ITC16. ” BMC medicine 17 (2019): 1-20. . ” BMC medicine 17 (2019): 1-20. Gastroenterology , 160 (1), pp.63-75. ” Internal and emergency medicine 9 (2014): 249-256.

E-9-1-1 98

E-9-1-1 ALS OR 98

EMDocs

JULY 29, 2023

Other bacterial causes include anaerobic oral flora, Strep viridans, E. Other bacterial causes include anaerobic oral flora, Strep viridans, E. Other bacterial causes include anaerobic oral flora, Strep viridans, E. Other bacterial causes include anaerobic oral flora, Strep viridans, E.

E-9-1-1 96

E-9-1-1 EMS Emergency Department OR 96

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. Ann Emerg Med.

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E-9-1-1 ACS ALS OR 103

Don't Forget the Bubbles

SEPTEMBER 13, 2023

An expert committee appraised the evidence behind recommendations to avoid imaging to inform the 2022 NICE guidance. When considering tumours, 37 observation studies involving 2661 children found that 3% (95% CI 1-7%) had tumours. Reaffirmed October 17, 2020 Jaffe M, Bar-Joseph G, Tirosh E. 2021;26(1):50-57 NICE.

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E-9-1-1 Emergency Department ALS OR 131