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. Refers to the Spinal Cord Function and Reflexes, not specifically hemodynamic issues. Basics are the Best!

E-9-1-1 300

E-9-1-1 Epinephrine ALS EMS 300

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

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. Can identify T.

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E-9-1-1 Plasma Emergency Department OR 152

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 137

OR E-9-1-1 ED ALS 137

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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E-9-1-1 OR Coronary ACS 117

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).

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

Pediatric EM Morsels

APRIL 5, 2024

CDC 2022) Testing for many of these illnessess can take time during the acute phase as many are ELISA or PCR tests. CDC 2022) Divided into Soft tick relapsing fever and Hard tick relapsing fever , depending on what type of ticks carry the Borrelia sp (CDC 2022) There is also a louse which carries a Borrelia sp.

E-9-1-1 161

E-9-1-1 ALS OR EMS 161

Pediatric EM Morsels

FEBRUARY 2, 2024

In one ED study, ALL cases of missed travel-related illness did not have a documented travel history in their ED note , whereas 90% of the identified travel-related illnesses had a provider documented travel history (Greenky 2022) Those who are visiting friends and relatives (VFR) are typically at highest risk.

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E-9-1-1 ED OR Emergency Department 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. Pre-warmed ultrasound gel is helpful when available.

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

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

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

REBEL EM

NOVEMBER 6, 2024

Elbow Dislocation Definition: Disarticulation of the proximal radius & ulna bones from the humerus Epidemiology: Incidence Second most common joint dislocation (after shoulder) in adults Most commonly dislocated joint in children Accounts for 10-25% of all injuries to the elbow ( Cohen 1998 ) Posterolateral is the most common type of dislocation (..)

E-9-1-1 118

E-9-1-1 ACS OR Emergency Department 118

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. In a systematic review of 10 RCTs comparing cuffed vs. uncuffed ETTs. 1.70) and 0.78 (0.46–1.35),

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E-9-1-1 Operating Room Emergency Department ALS 183

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]. After spending her first year acclimating to the new department and achieving board certification, Dr. Garcia finds herself at a bit of a crossroad. In short, no.

E-9-1-1 161

E-9-1-1 ALS OR 161

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 74

E-9-1-1 Emergency Department ALS ED 74

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% Pupils are equal and reactive. This is not good. This is not good. This is not good.

E-9-1-1 145

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

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. Patients : Compared standard of care to serial US plus stand care in patients with dyspnea. to −0.66) and −1.66 (95% CI −2.09 to −0.78) and -1.97 (95% CI −2.70

ED 129

ED E-9-1-1 Emergency Department ALS 129

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. This was sent to me from Sam Ghali ( @EM_Resus ) with no other information. I assumed it was a patient with acute chest pain. Real or just fake?"

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E-9-1-1 Coronary ALS ED 111

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. At midnight. At midnight.

E-9-1-1 123

E-9-1-1 Coronary ACS STEMI 123

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. RR 25-30. Actively oozing.

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

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

EMDocs

DECEMBER 1, 2024

Answer : Murine Typhus Epidemiology: Murine typhus is endemic in several parts of the U.S.:

EMS 83

EMS E-9-1-1 OR ED 83

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. The parents of 18-month-old Susie brought her to the Emergency Department after she had a seizure at home.

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

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.

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E-9-1-1 ICU ALS OR 84

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).

E-9-1-1 80

E-9-1-1 ALS OR ED 80

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 ). Answer : Bedside ultrasound!

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E-9-1-1 Coronary STEMI ALS 115

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). Janssen, P. & Fedorov, V. link] Li, N., Hansen, B. Ignozzi, A. Zakharkin, S.

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E-9-1-1 OR ALS 93

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. Burki, Talha Khan. 2019): 100. Rubin, J.E. and Crowe, S.E.,

E-9-1-1 98

E-9-1-1 ALS OR 98

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 Fluoroquinolone Use in Children: A Bad Rep? Hersh 2014) Another study looked at all MAEs in juvenile beagles given either low dose or high dose fluoroquinolone.

E-9-1-1 130

E-9-1-1 ACS OR ALS 130

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

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. A 12 Lead ECG was recorded secondary to bizarre telemetry findings at bedside. Said differently, it’s a mess.

E-9-1-1 130

E-9-1-1 Coronary ALS ICU 130

Broome Docs

MARCH 28, 2024

2022 Feb;52:85-91. 2022 Feb;52:85-91. PMID: 34890894 Myth 1: Kayexalate is safe and useful. 2024 Jan 2;53(1):afad255. Yerke JR, Mireles-Cabodevila E, Chen AY, Bass SN, Reddy AJ, Bauer SR, Kokoczka L, Dugar S, Moghekar A. Casey wrote a protocol for peripheral noradrenaline 9 years ago… in 2015!

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E-9-1-1 ICU Emergency Department ALS 107

Don't Forget the Bubbles

JULY 17, 2023

You will find the list is broken down into four sections: 1.Reviews 2023 Jun 1. 2023 Jun 20:archdischild-2022-324884. 2023 Jun 5:archdischild-2022-325148. Reviews and opinion articles Point-of-care ultrasound in pediatric nephrology. Sethi SK, et al. Pediatr Nephrol. 2023 Jun;38(6):1733-1751. Rivacoba MC, et al.

E-9-1-1 98

E-9-1-1 ALS Emergency Department Emergency Medical Services 98

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 94

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? Other lung fields unremarkable. C or 100.4 mg/kg, max 0.4

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E-9-1-1 ICU ACS EMS 76

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. months since 2022. months since 2022.

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E-9-1-1 Ambulance OR 78