Pediatric EM Morsels

JULY 28, 2023

Rates of type 1 diabetes have increased since the COVID-19 pandemic. Kendra Jackson and Rebecca Raffler While we’ve gotten to snack on a Morsel on this subject before , new guidelines and research surrounding DKA and cerebral edema have come to light since the first go ‘round! Neuroimaging is NOT required. GCS score is not sensitive enough.

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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.

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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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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.

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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!

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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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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.

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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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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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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.,

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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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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.

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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.

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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). 2023 Sep 1:113720. 2023 Sep 1:113717. 2023 Sep 1:e2023062521.

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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. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. N Engl J Med. Systematic review and meta-analysis.

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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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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. Asthma is the most common trigger in kids.

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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). What alternative testing can be done in these circumstances?

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Dr. Smith's ECG Blog

OCTOBER 15, 2022

Here are many examples which we have already posted: 5 of LVH mimicking Precordial Swirl 1 case (Case 6) of LVH mimicking precordial swirl, but it is actually LVH + posterior OMI 14 Cases (Cases 7-20) of OMI with Precordial Swirl First, 5 mimics: Case 1. The voltage is high but not huge. Read the case. Chest Pain and RBBB.

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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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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.

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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. What are the treatment options for a benzonatate overdose?

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

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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.

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

EMDocs

SEPTEMBER 7, 2023

1 Clinical Questions: When should a clinician suspect diethylene glycol (DEG) toxicity? Toxicity typically evolves through three phases: 2,3,7,8,9 Phase 1: Gastrointestinal symptoms (e.g., Upon review of the history, several of the patients had been exposed to a liquid acetaminophen-based teething medication.

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

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

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. Craythorne, E. International journal of dermatology, 49(9), pp.978-986. Non-melanoma skin cancer. The lancet, 375(9715), pp.673-685. Schadendorf, D.,

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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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EMDocs

MAY 11, 2024

CT head without contrast 1 is performed and reveals the following: Question: What is the diagnosis? On exam, the patient opens eyes to voice, has extraocular movements intact, is unable to speak, and has 0/5 strength in all extremities. The patient was intubated for acute hypercapnic and hypoxic respiratory failure and airway protection.

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EMDocs

MAY 28, 2024

Each episode of ACS has a 9% mortality rate. ACS accounts for 25% of deaths in SCD patients. Diagnosis of acute chest syndrome requires: New segmental radiodensity on chest imaging Plus one of the following: Fever > 38.5C. A vaso-occlusive pain crisis is the most common trigger in adults. Asthma is the most common trigger in kids.

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ACS E-9-1-1 ALS OR 75

Broome Docs

JANUARY 30, 2023

2022 Nov 6. 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. 2022 Sep 1;5(9):e2235575. 2022 Nov 29. 2022 Jul;57:76-80.

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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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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.

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Don't Forget the Bubbles

JANUARY 17, 2024

Around 80% of those reported pass spontaneously, with another 10-20% requiring endoscopic removal and only 1% requiring surgical intervention. BMC Pediatrics , 21 (1), Jackson, J., Journal of The Korean Society of Emergency Medicine , 33 (1), pp.134-138. Roy was less than impressed when young Kendall tried to eat his Orbeez.

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