Pediatric EM Morsels

JULY 19, 2024

2022 Sep-Oct;43(5):103582. Epub 2022 Aug 6. 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. Get a hold of ENT early as OR management and/or admission are common. Set up suction x2 in the room! Headlamps can also be helpful!

E-9-1-1 286

E-9-1-1 Epinephrine Emergency Department OR 286

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. This absence of detail leaves the study open to bias.

OR 137

OR E-9-1-1 ED ALS 137

ALiEM

NOVEMBER 17, 2023

Accessed January 5, 2022. Accessed January 5, 2022. The grandmother first noted blood in the patient’s underwear the previous morning when she was helping the patient wipe and she noticed it again prior to arrival, this time saturating the patient’s underwear. The patient in this case was treated with a 4-week estrogen cream taper.

Emergency Department 250

Emergency Department OR 250

Core EM

JANUARY 25, 2024

source: “Thrombotic Thrombocytopenic Purpura (TTP)”, 2022 , National Heart, Lung, and Blood Institute. An example of petechiae and purpura frequently seen with thrombocytopenic disorders. link] ) Laboratory Evaluation: Clinical presentation and laboratory findings can help suggest TTP in the emergency department.

Plasma 246

Plasma Frozen Plasma Emergency Department FFP 246

Dr. Smith's ECG Blog

DECEMBER 27, 2023

Smith's ECG Blog — with detailed description of this entity in the May 23, 2022 post by Dr. McLaren ( Please check out My Comment and illustrative Figure at the bottom of the page of this post ). mV in 2 or more contiguous leads (excluding V1-V3) The QRS duration should be < 120 ms This definition is not perfect. link] Lupu, L.,

E-9-1-1 117

E-9-1-1 OR Coronary ACS 117

Pediatric EM Morsels

OCTOBER 27, 2023

PAWPER [Wells 2013, Silvagni 2022] Takes into account body habitus. Zhu 2022] In Nepalese children, the Broselow correlated well at lower weights, but accuracy decreased at higher weights >18 kg. [K Reduces dosing errors during resus, up to 33.88%. Recommended by ATLS and PALS. Krug 2007] What If the Child is Obese or Emaciated?

E-9-1-1 269

E-9-1-1 Emergency Medical Services Life Support ALS 269

Pediatric EM Morsels

JULY 21, 2023

Jain 2022] Now used for critically ill trauma and medical patients in >75 countries. Jain 2022] Now used for critically ill trauma and medical patients in >75 countries. Jain 2022] Glasgow Coma Scale in Children – How do you perform it correctly? When is it useful and what does it tell us?

Critical Care 246

Critical Care ALS Life Support OR 246

ALiEM

FEBRUARY 5, 2024

These posts have been flagged by and agreed upon by AIR Board members as worthwhile, accurate, unbiased, and appropriately referenced despite an average score. Take the AIR Toxicology Module at ALiEMU Interested in taking the AIR quiz for fun or asynchronous (Individualized Interactive Instruction) credit? Please go to the above link.

Overdose 215

Overdose Critical Care EMS Emergency Department 215

ALiEM

FEBRUARY 28, 2024

July 27, 2022. Clinical photograph for: Ludwig Angina. CorePendium. For Media Without an Associated Publication: This type of citation may be helpful if the image is used in multiple places within a publication, or if it is not tied to a particular publication. In the example below, there is no specified date of publication for the image.

OR 130

OR ED 130

Core EM

JANUARY 25, 2024

Calculate the maximum safe local anesthetic dosage for the patient. Published February 4, 2022. Accessed September 29, 2022, [link] [6] Pepe J, Ausman C, Madhani NB. 2022, Accessed September 29, 2022, [link] [8] Luftig J, Dreyfuss A, Mantuani D, Howell K, White A, Nagdev A. In: StatPearls. Am J Emerg Med.

Epinephrine 246

Epinephrine ED Emergency Department OR 246

The Skeptics' Guide to EM

SEPTEMBER 9, 2023

In 2022 Mobasseri et al published a review of 9 such diagnostic studies and concluded that from an orthopedic perspective that the accuracy was not acceptable, the lack of a randomized controlled trial meant that there was not enough data to support the use of ultrasound over X-ray as an initial diagnostic test [7]. Reference: Snelling et al.

Critical Care 304

Critical Care ALS ED Emergency Department 304

Pediatric EM Morsels

SEPTEMBER 22, 2023

Updated 2022 Feb 10]. Updated 2022 Mar 3]. Spinal shock is a phenomenon of transient, physiologic (rather than anatomic) complete loss of spinal cord function inferior to an injury. Refers to the Spinal Cord Function and Reflexes, not specifically hemodynamic issues. Thought to be a “stunning” of the spinal cord. 5 th Edition.

E-9-1-1 300

E-9-1-1 Epinephrine ALS EMS 300

Pediatric EM Morsels

MARCH 29, 2024

Pediatr Rev (2022) 43 (7): 371–383. To keep things simple, IEM is characterized by the inability to break down macromolecules (fatty acids, carbohydrates, and proteins) or store energy (glycogen). Timing of Presentation / Diagnosis: For severe forms of IEM will present in the first few days of life —before the newborn screen is back!

ED 294

ED Plasma OR EMS 294

ALiEM

JULY 20, 2023

Highlighted Quality Posts: Infectious Disease Site Article Author Date Label SGEM Lumbar punctures in febrile infants with positive urinalysis – it’s just overkill Dennis Ren, MD December 31, 2022 AIR EMDocs Bacterial Meningitis Mounir Contreras Cejin, MD January 28, 2023 HM ALiEM The Febrile Infant Corey Ziemba, MD, Justin Hacnik, MD and J.D.

Emergency Department 188

Emergency Department EMS OR 188

The Skeptics' Guide to EM

DECEMBER 21, 2024

The inspiration for the SGEM Xtra episode is the BMJ 2022 holiday article called "The 12 Days of Christmas, the Statistician Gave to Me,". Its fun to mix it up and not do a structured critical appraisal of a recent publication and have a more philosophical chat. And remember, CIs dont mean certainty!

OR 239

OR 239

Dr. Smith's ECG Blog

OCTOBER 15, 2024

It should be treated as such unless there is more information such as old or serial EKGs that can confirm a benign diagnosis, as BTWI patterns can mimic the South Africa Flag Sign (Compare this EKG to case 4 here: [link] com/2022/05/quiz-post-which- of-these-if-any-are-omi.html ). Still, such dramatic changes cannot be overlooked.

OR 106

OR STEMI Coronary ED 106

FOAMfrat

SEPTEMBER 24, 2024

It’s probably safe to assume that your patient has a traumatic brain injury, so at what point in your treatment pathway do you reach for an antiepileptic drug (AED)? Are you carrying antiepileptics on your truck or aircraft? To give an AED or not to give an AED, that is the question. (Bet Bet you thought you left Shakespeare in high school).

OR 106

OR ALS 106

ALiEM

OCTOBER 11, 2023

2022 Feb 8;14(2):123. Treasure Island (FL): StatPearls Publishing; August 8, 2022. 2022 Feb;60(2):262-266. 2022 Nov 8;19(22):146-8. [4, 5] Onset: Most cases will present within 5-30 minutes of ingestion; however, onset of symptoms as late as 20 hours after ingestion is reported. Toxins (Basel). Channels (Austin).

E-9-1-1 204

E-9-1-1 ALS OR 204

Pediatric EM Morsels

MARCH 1, 2024

Wojsyk-Banaszak, 2018 ) Mainstay of initial therapeutic management is: ( Wojsyk-Banaszak, 2018 ; Fernando, 2022 ) Prolonged course of IV antibiotics Chest physiotherapy Patients managed with medical strategies (compared to surgical) had lower complication rates and shorter hospitalizations. 2022 Jul;92(7-8):1850-1855. Epub 2022 Jun 9.

EMS 169

EMS Critical Care OR 169

Pediatric EM Morsels

AUGUST 23, 2024

Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport-Amsterdam, October 2022. It does NOT have structural brain damage visible on standard neuroimaging. In the research setting, abnormalities can be found via functional, blood flow, or metabolic imaging. Br J Sports Med. 2023 Jun;57(11):695-711.

Emergency Department 278

Emergency Department OR ED EMS 278

Core EM

JANUARY 25, 2024

Written By: Kaitlynn Tracy, MD Edited By: Sean Schnarr, MD and Gregg Chesney, MD Definition/Background: Burns are classified as being major, moderate, or minor in severity. 4 Survival rate for all burn injuries is around 97%, which is a notable increase from 75% in the 1960’s.

ED 246

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

Pediatric EM Morsels

JUNE 30, 2023

PMID: 28050458 Salerno M, Sessa F, Cocimano G, Roccuzzo S, Esposito M, Pomara C. Congenital Cystic Adenomatoid Malformation (CCAM) Type II: A Rare Case of Sudden Infant Death. Dec: 9 (12): 1830. link] PMID: 36553274 The post Congenital Pulmonary Airway Malformation (CPAM) appeared first on Pediatric EM Morsels.

E-9-1-1 281

E-9-1-1 ED EMS OR 281

ALiEM

OCTOBER 14, 2023

These posts have been flagged by and agreed upon by AIR Board members as worthwhile, accurate, unbiased, and appropriately referenced despite an average score. Take the AIR Respiratory Module at ALiEMU Interested in taking the AIR quiz for fun or asynchronous (Individualized Interactive Instruction) credit? Please go to the above link.

Critical Care 169

Critical Care EMS Emergency Department ALS 169

ALiEM

OCTOBER 4, 2023

Epub 2022 Dec 30. May 24, 2022. This kit has historically been issued to US service members for treating nerve agent toxicity from agents such as soman, sarin, tabun, and VX, all of which are organophosphates and cause a cholinergic toxidrome. What are nerve agents? [1-3] They have been used in Europe recently for assassinations [4].

Plasma 195

Plasma OR ED 195

Core EM

JANUARY 25, 2024

Data was collected from August 1, 2021 – February 20, 2022. Population This study occurred in an urban academic hospital with over 90,000 annual visits. Of this group, 78 patients were placed in the SQuID protocol (subcutaneous insulin in DKA), and 99 were in the traditional cohort.

EMS 246

EMS ICU ED OR 246

EMS 12-Lead

MARCH 30, 2024

The University of Maryland found that capture occurred in only 42-78% of patients, dependent on pad positioning (Moayedi et al, 2022). The patient did have massive pulmonary emboli, but he also had profound intraventricular and subarachnoid hemorrhages. The patient was ultimately discharged with a poor neurologic outcome.

CPR 312

CPR Paramedic Ambulance Defibrillator 312

Pediatric EM Morsels

JUNE 2, 2023

Allergy Asthma Clin Immunol 18, 54 (2022). Rare diseases are not confined to the pages of a textbook or computer screen. Our patients have varied past medical histories that require us to be well-versed in even the most uncommon disorders (or know where to look things up in a pinch)!

Emergency Department 189

Emergency Department ALS EMS OR 189

Pediatric EM Morsels

JULY 28, 2023

Glucose > 200 mg/dL Moderate or Large Ketonuria The severity of DKA is categorized by the degree of acidosis Mild : venous pH < 7.3 or serum bicarbonate between 11-17 mmol/L Moderate : venous pH < 7.2 or serum bicarbonate between 5-10 mmol/ L Severe : venous pH < 7.1 Neuroimaging is NOT required. GCS score is not sensitive enough.

E-9-1-1 246

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

Pediatric EM Morsels

AUGUST 2, 2024

Balanitis and Balanoposthitis – Basics Terminology [Assim 2022, Dynamedex 2024, Perkins 2024] Balanitis – Inflammation of the glans penis Posthitis – Inflammation of the foreskin (prepuce) Balanoposthitis – Inflammation of both (ouch!) It’s even more distressing when the skin problem affects the penis.

Allergic Reaction 152

Allergic Reaction OR EMS 152

Pediatric EM Morsels

JULY 26, 2024

2022 Jul 6;9(5):e200013. While it is important for us to maintain a safe work environment for our patients and our team, managing the agitated patient requires more of us than administering Droperidol or Ketamine. Make sure to consult your friendly neighborhood pediatric neurologist and/or rheumatologist! The prevalence ranges from 12.5%-61%

Plasma 269

Plasma OR ED Critical Care 269

Core EM

JANUARY 25, 2024

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

ICU 246

ICU Emergency Department Critical Care ALS 246

ALiEM

NOVEMBER 3, 2023

These posts have been flagged by and agreed upon by AIR Board members as worthwhile, accurate, unbiased, and appropriately referenced despite an average score. Take the AIR Trauma Module at ALiEMU Interested in taking the AIR quiz for fun or asynchronous (Individualized Interactive Instruction) credit? Please go to the above link.

Critical Care 211

Critical Care EMS Emergency Department ALS 211

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

ALiEM

MARCH 11, 2024

In July 2022, a 32-year-old male with a past medical history of HIV (on antiretroviral therapy, CD4 390, viral load undetectable) presented to the emergency department with constitutional symptoms and a rash for 4-5 days. Epub 2022 Jul 27. The 2022 outbreak and the pathobiology of the monkeypox virus. 2022 Jul;131:102855.

Emergency Department 141

Emergency Department ALS OR 141

The Skeptics' Guide to EM

JANUARY 6, 2024

Background: Back in August of 2022, we announced the start of #SGEMPeds for SGEM Season 11. As a seasoned clinician, she wants your opinion and asks you, “How prepared do you think we are in handling sick children?” and “Do you have any thoughts about how we can improve?” July 2023 * Population: ED leadership across the United States.

Emergency Department 257

Emergency Department Emergency Medical Services ALS ED 257

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

Review of the 2 ECGs in today's case is insightful ( Figure-1 ): The initial ECG shows sinus rhythm, LAHB and meets Peguero Criteria for LVH ( See My Comment in the August 15, 2022 post of Dr. Smith's ECG Blog for more on LVH criteria ). Thus, the lumen observed may actually still be the same size as the original, normal lumen.

Coronary 116

Coronary ACS OR EMR 116

Pediatric EM Morsels

AUGUST 9, 2024

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. Neonates presenting to the Emergency Department often cause a lot of uncertainty. Is this scalp swelling normal? Is this bloody stool concerning?

E-9-1-1 152

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