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. 2011;46(9):1771. 5 th Edition. J Pediatr Surg.

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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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Broome Docs

MAY 31, 2024

Do we need to intubate French drunkards in ED? 2023 Dec 19;330(23):2267-2274. 2023 Mar;64(3):400-404. 2013 Sep;24(9):1848-53. 2023 Nov 28;27(1):465. 2024 Apr 1:e240167. 2023 Sep 8;9(1):73. doi: 10.1001/jama.2023.24391. 2023.24391. Marking the midline… is it a thing? J Emerg Med.

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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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ACEP Now

AUGUST 29, 2023

9—Kickoff Party with a speakeasy theme at the Old Reading Terminal Oct. Check Out This New Opioids Education Series from E-QUAL ACEP’s Emergency Quality Network (E-QUAL) is serving up some fresh educational content as part of its Opioid Initiative. The post September 2023 News from the College appeared first on ACEP Now.

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EMDocs

FEBRUARY 26, 2024

1 While PJP gained significant recognition among HIV-positive adults during the early AIDS epidemic, the growing utilization of immunosuppressants has resulted in an increased incidence of the disease in individuals who are HIV-negative. 9 The signs and symptoms of PJP infection are non-specific. for detecting pulmonary opacities.

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EMDocs

FEBRUARY 15, 2024

1 These plants contain tropane alkaloids such as atropine (mixture of d-hyoscyamine and l-hyoscyamine) and scopolamine which are muscarinic receptor antagonists. 2 Jimson weed ( Datura stramonium, Figure 1) is one of several anticholinergic plants that if ingested can cause anticholinergic toxicity. 3 Figure 1. 3 Figure 1.

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Dr. Smith's ECG Blog

DECEMBER 19, 2023

link] A 62 year old man with a history of hypertension, type 2 diabetes mellitus, and carotid artery stenosis called 911 at 9:30 in the morning with complaint of chest pain. Challenge QUESTION: The relative change in T-QRS-D is not the only thing that changes during period of time that passed between recording of the 2 ECGs shown in Figure-1.

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ACEP Now

FEBRUARY 13, 2024

A 77-year-old man presented to the emergency department (ED) with hip pain following a fall. On ED presentation, he was experiencing 10 out of 10 pain level. A radiograph is shown (see figure 1). LEARN MORE The most common nerve blocks in this study are shown in Table 1. 2023 Sep 2;15(9):e44583. Pain Pract.

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Dr. Smith's ECG Blog

DECEMBER 11, 2023

The neighbor recorded a systolic blood pressure again above 200 mm Hg and advised her to come to the ED to address her symptoms. 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. At midnight.

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Don't Forget the Bubbles

JULY 17, 2023

’, ‘ Does the language of the patient influence A&E triage? ’, ‘ What is the association between breastfeeding duration and educational achievement? ’, and ‘ What are the findings of the SCOUT trial? ’. You will find the list is broken down into four sections: 1.Reviews 2023 Jun;38(6):1733-1751. 2023 May 16;28(3):172-183.

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Broome Docs

MARCH 28, 2024

doi: 10.1136/emermed-2023-213285. 2023 Sep 21:ciad571. 2023 Sep 19:S0196-0644(23)00671-6. PMID: 34890894 Myth 1: Kayexalate is safe and useful. 2024 Jan 2;53(1):afad255. 2023 Dec;193:109991. Yerke JR, Mireles-Cabodevila E, Chen AY, Bass SN, Reddy AJ, Bauer SR, Kokoczka L, Dugar S, Moghekar A.

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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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Broome Docs

JANUARY 30, 2023

PMID: 33933300 Khan A, Saleem MS, Willner KD, Sullivan L, Yu E, Mahmoud O, Alsaid A, Matsumura ME. 2022 Sep 1;5(9):e2235575. doi: 10.1007/s00381-022-05455-1. Association of Chest Pain Protocol-Discordant Discharge With Outcomes Among Emergency Department Patients With Modest Elevations of High-Sensitivity Troponin. 2022.26809.

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EMDocs

NOVEMBER 13, 2024

Commonly a monomicrobial infection with gram-negative bacteria like E. Major takeaway: Consider SBP in any patient who comes into the ED with ascites. Paracentesis is a safe procedure with a low complication rate (< 1%). g/kg of 20% albumin IV at the time of diagnosis and 1 g/kg IV 48 hours later. Dosing is 1.5

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EMDocs

MARCH 2, 2024

A 58-year-old female with a history of diabetes, hypertension, and chronic back pain presents to the ED with severe headache and nausea. Answer : Pneumocephalus 1-21 Background: Pneumocephalus is defined by the presence of air within the cranial cavity.  2017 Jan-Mar;7(1):58-64.  An Pediatr (Engl Ed). 2019

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EMDocs

OCTOBER 19, 2024

to 1 case per 100,000 children. 2][3][9] Hypoxia, respiratory muscle retractions, fatigue, altered mental status, and decreased breath sounds are signs indicative of impending airway failure. [2] 2][3][9] Glucocorticoid were not shown to alter clinical course or patient outcomes. [2][3] Published 2023. Published 2020.

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REBEL EM

MAY 27, 2024

Clinical Question: Does simultaneously performing the modified valsalva maneuver and administering intravenous adenosine, compared to either treatment alone, have greater success in achieving normal sinus rhythm in patients presenting to the ED with PSVT? Duration of Antiarrhythmic Effect: MVM group: 35.44 seconds (range: 22.5,

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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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Don't Forget the Bubbles

SEPTEMBER 16, 2023

You will find the list is broken down into four sections: 1.Reviews 2023 Aug 23:e2023062806. 2023 Aug 23. 2023 Aug 16. 2023 Aug 2. 2023 Aug 10:e2023062307 Rosacea in children: a review. 2023 Aug 10:e2023062307 Rosacea in children: a review. 2023 Aug 9. 2023 Aug 2. 2023 Aug 21.

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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.

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EMDocs

JUNE 27, 2024

An 8-year old male with a history of sickle cell anemia presents to the ED for evaluation of fever for 2 days and “feeling like I can’t get a full breath”. 2 mcg/kg, max 100 mcg) while obtaining IV access 20 IV/IM ketorolac (1 mg/kg, max 15 mg) Morphine (05-0.1 2022 Jul 5;328(1):57-68. C or 100.4 mg/kg, max 0.4 C or 100.4

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EMDocs

MAY 11, 2024

A 74-year-old female with a past medical history of hypertension, diabetes, recent basilar artery stent placement with a 20 pack-year smoking history presents to the ED via EMS for altered mental status and episodes of apnea. CT head without contrast 1 is performed and reveals the following: Question: What is the diagnosis?

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Don't Forget the Bubbles

JULY 22, 2024

Pre-school wheezers remain a poorly understood cohort of children despite seeing them every day in paediatric EDs. However, there was no difference in LOS (83 minutes for placebo vs 79 minutes for prednisolone) in participants who were discharged straight from the ED ( 32% ). study from 200 9. What does it mean to our patients?

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EMDocs

APRIL 13, 2024

A 24-year-old male presents to the ED from a mixed marital arts competition after being struck on the side of the right head by a fist earlier today. 1] In a survey of college wrestlers, the incidence of auricular hematoma was found to be 52% for those who do not wear headgear versus 26% who wore ear protection.[2]

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ACEP Now

OCTOBER 11, 2024

Introduction Pediatric intubations in the emergency department (ED) occur at only a tenth the frequency of adult intubations. 1 Pediatric rapid sequence intubation (RSI) in the ED is associated with a higher frequency of failed first attempts and adverse effects than in adult patients. Her breathing is irregular. 3 mg/kg IV.

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This Podcast Will Kill You

NOVEMBER 12, 2024

1996 Jul;10(9):1002-13. Dermato-endocrinology , 1 (3), pp.162-169. International journal of women’s dermatology , 8 (1), p.e003. Aesthetic Surgery Journal , 30 (1), pp.74-77. The Journal of clinical and aesthetic dermatology , 14 (9), p.33. John Wiley & Sons, Inc, 2022. Kligman, Albert M., 1981): 278-285.

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Dr. Smith's ECG Blog

JUNE 17, 2024

Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage. C Examination notable for diaphoresis, 1+ bilateral lower extremity edema, regular heart rate and rhythm, and no signs of respiratory distress with normal breath sounds. What do you think? In fact, Kosuge et al. Stein et al.

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REBEL EM

JANUARY 23, 2023

Patients were randomized in a 1:1 ratio. Key Secondary Endpoints: 5 (3.9%) patients in the IV cetirizine group returned to any ED or clinic within 24 hours compared to 15 (11.1%) in the IV diphenhydramine group; P=0.04 Risk of first-generation H(1)-antihistamines: a GA(2)LEN position paper. 2005 Sep;116(3):643-9.

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EMDocs

SEPTEMBER 7, 2024

A 70-year-old female with a past medical history of hypertension, coronary artery disease s/p 2x drug eluting stent placement one month ago, atrial fibrillation on apixaban presents to the ED with weakness and lightheadedness. 1 Risk Factors: 1-4 Spontaneous Anticoagulants (Apixaban, Rivaroxaban, etc.)

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ACEP Now

JANUARY 9, 2024

A 3-year-old male was brought to the emergency department (ED) by his mother, who reported the sudden onset of a rash (hives) covering his entire body, with no rash on his palms and soles. FIGURE 1: Abdominal X-ray showing particulate radiopaque foreign bodies involving the stool. 1 Children are particularly vulnerable.

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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). 3 A study of CT use trends in the ED has shown increasing use of CTs by almost 60% from 2005 to 2013.

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This Podcast Will Kill You

NOVEMBER 5, 2024

1996 Jul;10(9):1002-13. Dermato-endocrinology , 1 (3), pp.162-169. International journal of women’s dermatology , 8 (1), p.e003. Aesthetic Surgery Journal , 30 (1), pp.74-77. The Journal of clinical and aesthetic dermatology , 14 (9), p.33. John Wiley & Sons, Inc, 2022. Kligman, Albert M., 1981): 278-285.

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Dr. Smith's ECG Blog

NOVEMBER 14, 2023

Here is the first ED ECG recorded, now pain free after sublingual Nitro: There is what appears to be a reperfusion T-wave in I and aVL. Learning Point: 1. 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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Don't Forget the Bubbles

MAY 8, 2024

You will find the list is broken down into four sections: 1.Reviews Arch Dis Child Fetal Neonatal Ed. 2024 Apr 9. 2024 Apr 25:archdischild-2023-326533. Arch Dis Child Fetal Neonatal Ed. 2024 Apr 18:fetalneonatal-2023-326679. 2024 Apr 16:archdischild-2023-326247. 2024 Apr 16:archdischild-2023-326331.

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Don't Forget the Bubbles

JUNE 17, 2024

The Importance of Civility in Critical Care Resuscitation A 3-year-old patient with diabetic ketoacidosis arrives at your ED. Here are ten things to think about: 1. Churruca K, Pavithra A, McMullan R, Urwin R, Tippett S, Cunningham N, Loh E, Westbrook J. 2014 Jun 26;23(12):653-9. 2020 Jan 1;35(1):70-6. 2020 Aug 20.

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EMDocs

MAY 25, 2024

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

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