Pediatric EM Morsels

APRIL 5, 2024

CDC 2024) Generally, most ticks require >24 hours of attachment for there to be a risk of transfer of the infectious agent. Other Rickettsial Disease of concern from non-tick vectors (CDC Yellow Book 2024) Murine Typhus Causative Agent: Rickettsia typhi and the principal vector is the Asiatic rat flea. These resolve within 1 week.

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Don't Forget the Bubbles

FEBRUARY 5, 2024

Paediatric advocacy still has a long road ahead… You will find the list is broken down into four sections: 1.Reviews 2024 Jan 8. 2024 Jan 1;43(1):e11-e13. 2024 Jan 12:archdischild-2023-326225. 2024 Jan 23:archdischild-2023-325984. 2024 Jan 9. 2024 Jan 8:e2023063654. 2024 Jan 6.

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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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Pediatric EM Morsels

MAY 10, 2024

Chest Pain in Children: Hysteria vs Vigilance Diverse pathology can present as chest pain in children Cardiac 1-9% GI 2-10% Musculoskeletal – 2-20% No Identifiable cause – 21-45% of the time! Pediatr Rev September 2020; 41 (9): 469–480. 2021;13(1):2. Pediatrics. 2013 Oct;132(4):e1010-7. 2011;140(4):859-866.

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REBEL EM

NOVEMBER 6, 2024

Treasure Island (FL): StatPearls Publishing; 2024 Jan–. 1998 Jan-Feb;6(1):15-23. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 32644703 Robinson PM, Griffiths E, Watts AC. 2017 Jul;9(3):195-204. 1999 Jan;13(1):58-9.

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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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REBEL EM

FEBRUARY 29, 2024

1, 2 Its occurrence often portends worse outcomes in intubated patients, whose projected hospital course was already tenuous. 1, 4, 6 The overall incidence of VAP is somewhere around 5%-40% of all intubated patients, depending on the study and country from which it is reported. Mimoz (2024). 4, 8 Paper: Dahyot-Fizelier, C.,

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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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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] Accessed August 11, 2024.

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Dr. Smith's ECG Blog

OCTOBER 1, 2024

== MY Comment , by K EN G RAUER, MD ( 8/30 /2024 ): == I was sent the ECG shown in Figure-1 — knowing only that the patient was being seen in the ED ( E mergency D epartment ). Figure-1: The initial ECG in today's case. After seeing ECG #2 — Can you explain: i ) Why no negative P wave was seen in lead V1 of ECG #1? —

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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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EMDocs

SEPTEMBER 7, 2024

1 Risk Factors: 1-4 Spontaneous Anticoagulants (Apixaban, Rivaroxaban, etc.) Older Age (median age of 70 years) 1 Abnormal vasculature/neoplasm of the kidney (e.g., 5 Clinical Presentation: 1-3 Variable presentation but may present with dropping hemoglobin/hematocrit without other findings in spontaneous cases.

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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? 2022 Jul 5;328(1):57-68. 2020 Feb 12;10(1):2470.

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Pediatric EM Morsels

FEBRUARY 2, 2024

2021 May; 8:1-16. While there is no “right” work up for these patients, hopefully this morsel will help illuminate your evaluation of Travel-Related Illness in Children: Travel-related Illness: Basics International travel has been significantly increasing since commercial airlines made travel much easier. References Abdel-Haq N, Asmar BI.

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ACEP Now

OCTOBER 11, 2024

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. Paralytic agents include rocuronium at 1 mg/kg IV and succinylcholine at 1-2 mg/kg IV. References Long E, Sabato S, Babl FE. mg/kg IV, ketamine at 1.5–2

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ACEP Now

FEBRUARY 13, 2024

A radiograph is shown (see figure 1). LEARN MORE The most common nerve blocks in this study are shown in Table 1. 1–4 Emergency physicians commonly prescribe opioid pain medications, and there is significant variability among prescribing patterns. 2023 Sep 2;15(9):e44583. 2024 Jan;83(1):14-21. N Engl J Med.

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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. Accessed May 28, 2024. What do you think? Stein et al.

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Don't Forget the Bubbles

JULY 22, 2024

study from 200 9. 2024 Mar 22 [cited 2024 Mar 25];0(0) Methods – What is an IPD meta-analysis? A large proportion of the trials come from Finland (3) and The UK (2) and also from Australia (1) and the US (1), but only a small number took place in the ED. Castro-Rodriguez JA, Beckhaus AA, Forno E.

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This Podcast Will Kill You

OCTOBER 1, 2024

Medical journal of Australia , 190 (9). Delayed anaphylaxis, angioedema, or urticaria after consumption of red meat in patients with IgE antibodies specific for galactose-α-1, 3-galactose. Ronmark, E. The relevance of tick bites to the production of IgE antibodies to the mammalian oligosaccharide galactose-α-1, 3-galactose.

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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

NOVEMBER 11, 2024

The ECG shows sinus rhythm with a rate of about 78 and 2:1 AV conduction along with right bundle branch block and left anterior fascicular block. 2:1 block is a special case, because the tracing lacks successive PR intervals. I have labeled the P waves below for ease of reference: P waves 8 and 9 both conduct to the ventricles.

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REBEL EM

MAY 27, 2024

No significant differences in heart rate 1 minute after cardioversion were observed between the three groups. 2010;17(1):44-49. Qiu, S., & Zhang, Q. Combined modified Valsalva maneuver with adenosine supraventricular tachycardia: A comparative study. The American Journal of Emergency Medicine, 78, 157–162. seconds (range: 22.5,

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EMDocs

JULY 13, 2024

1997 Mar;11(1):203-22. 2024, [link] Accessed 7 February 2024. 1985 Dec 1;153(7):737-9. Kankuri E, Kurki T, Carlson P, Hiilesmaa V. 2024, [link] Mackeen AD, Packard RE, Ota E, Speer L. Infect Dis Obstet Gynecol. 2000;8(2):77-82. doi: 10.1002/(SICI)1098-0997(2000)8:2<77::AID-IDOG3>3.0.CO;2-6.

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ACEP Now

SEPTEMBER 3, 2024

1 Immediately after the purchase, the real estate holdings of the hospitals were spun off into a separate company owned by Paladin and other PE investors. 7-9 The PE model then aims to sell acquired businesses for a profit within three to six years. Accessed August 25, 2024. Appelbaum E, Batt R. Accessed August, 2024.

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Don't Forget the Bubbles

JUNE 17, 2024

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. InHealthcare 2024 Jan 22 (Vol. 2023 Oct 31;21(1):403. cognitive rehearsal techniques ). Organizational dynamics. 2020 Aug 20.

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Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

To me, it was clearly atrial flutter with 1:1 conduction. Continue Eliquis 5mg BID, should be continued for 3 months == MY Comment , by K EN G RAUER, MD ( 9/18 /2024 ): == I found the following aspects of today's case of special interest. Why did Dr. Smith immediately say the rhythm was AFlutter with 1:1 AV conduction?

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ACEP Now

OCTOBER 9, 2024

1 The diminished left ventricular function in HOCM is often associated with the thickening of the interventricular septum, which is also associated with increased left ventricular wall thickness equal to 15 mm or more. Furthermore, this genetic cardiac disease is autosomal dominant, presenting 1 in 500 in our general population.

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Don't Forget the Bubbles

MARCH 18, 2024

The Royal Children’s Hospital in Melbourne summarises them in an easy-to-follow flow diagram (figure 1). Typical HUS has a diarrheal prodrome, usually caused by an infection with a Shiga-toxin-producing E. Blood tests Urine Stool Full blood count with blood film Urinalysis Stool MC&S Coagulation Urine MC&S E.

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Dr. Smith's ECG Blog

JULY 24, 2024

Easy LINK — [link] — My New E CG P odcasts ( 5/28/2024 ): These podcasts are part of the Mayo Clinic Cardiovascular CME Podcasts Series ( "Making Waves" ) — hosted by Dr. Anthony Kashou. 2:25 — Dr. Grauer: The 1st Error : Too many clinicians in 2024 are still stuck in the outdated millimeter-based STEMI Paradigm”.

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Don't Forget the Bubbles

MAY 6, 2024

Article 1: Positive urine cultures without pyuria Wang ME, Jones VG, Kane M, et al. Clinical Course of Children 1 to 24 Months Old With Positive Urine Cultures Without Pyuria. 2024;24(1):111-118. 2024 Feb 28:fetalneonatal-2023-326501. Giannoni, E., 2024 Jan 27;403(10424):355-64. Acad Pediatr. PMID: 38418208.

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Dr. Smith's ECG Blog

NOVEMBER 14, 2023

Learning Point: 1. The Queen of Hearts AI app will hopefully be FDA approved in Q1 of 2024. 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 ). Figure-1: Comparison between the first 3 ECGs in today's case.

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FOAMfrat

APRIL 22, 2024

This kid had sticks go through his cheek from running with a lollipop, hit by a car, almost kidnapped, attacked by a dog, and almost burnt his house down by throwing a 9-volt battery in the trash. 2024 Mar 15:1-9. Robichaud L, Ross D, Proulx MH, Légaré S, Vacon C, Xue X, Segal E. 2016;20(1):76-81.

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First Responders Childrens' Foundation

DECEMBER 8, 2023

Each VIP experience is available for bidding online at charitystars.com/umg through January 12, 2024. Select packages also benefit the Country Music Hall of Fame, The Store, and C.A.T.S. Foundation.

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ACEP Now

JULY 7, 2024

9 By speaking out, I hope to once again find my calling in medicine. Accessed May 19, 2024. Accessed May 19, 2024. 2024;15(1):3-16. Muir-Cochrane E, Oster C. 2020;55(3 Suppl 1):7-16. 2024;46(1):1,21. The “hidden curriculum” of our training teaches us not to challenge the hierarchy. Use of restraints.

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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. 2012 Jan;3(1):6. 2012;47(9):E19-E22. Metro, D.C., Alharbi, N.

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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. January 23, 2024. 2023 October 9. 2012 Feb 1;4(1):127-57. Essex R, Weldon SM, Thompson T, Kalocsányiová E, McCrone P, Deb S. 2013 Dec;14:1-0. 2022 Nov 9. October 16, 2023. Retrieved from: [link].

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FOAMfrat

MAY 19, 2024

While transporting to the emergency department, the patient’s mother informed me that PDCD affects less than 1 in 50,000 individuals and is more common in males than females. The patient will thank you for it; we are only human. References 1. Ostergaard E, Moller LB, Kalkanoglu-Sivri HS, et al. 2002 Oct 9.

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