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

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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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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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. How would you interpret this tracing? ANSWERS: Common things are common.

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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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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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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

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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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. N Engl J Med.

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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. References Long E, Sabato S, Babl FE.

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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

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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REBEL EM

MAY 27, 2024

PMID: 38281376. 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? Qiu, S., & Zhang, Q. seconds (SD = 7.73) Adenosine group: 24.24

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ACEP Now

OCTOBER 9, 2024

In the emergency department (ED), physicians face the challenge of making rapid decisions that can significantly impact patient outcomes. The patient, a 25-year-old male of color, arrived at the ED with persistent tachycardia, his heart rate consistently in the 120s. HOCM in the ED HOCM is not an everyday diagnosis in the ER.

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EMDocs

JULY 13, 2024

A 37-year-old G2P2 female with no other past medical history presents to the ED with a 2-day history of intermittent fever and foul-smelling vaginal discharge. 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. 2000;8(2):77-82.

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

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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

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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Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

He was brought to the ED. 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. They did not feel they had time to sedate.

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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. Arch Dis Child Fetal Neonatal Ed. 2024 Feb 28:fetalneonatal-2023-326501. Giannoni, E., Acad Pediatr. Stocker, M.,

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ACEP Now

JULY 7, 2024

One night I found myself on the other side of the stretcher, as a patient waiting for a psychiatric assessment in an emergency department (ED). 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.

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Don't Forget the Bubbles

JANUARY 17, 2024

” ( Ed. 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.

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Don't Forget the Bubbles

MARCH 11, 2024

A 4-month-old boy presents to the paediatric ED. New York, USA: The International Society for Pediatric Neurosurgery, 2024 (Accessed January 9, 2024). link] Mitchell, E. Pediatric Annals, 52(1), e10–e17. His parents are concerned about the appearance and shape of his head. They ask how this can be fixed.

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ACEP Now

NOVEMBER 8, 2024

1 Prehospital endotracheal intubation and EGAs are typically placed without paralytics and are reserved for unconscious, apneic, and out-of-hospital cardiac arrest patients. 9 LMAs use an inflatable mask expanded using a similar technique to the endotracheal tube cuff. Accessed October 17, 2024. 2014;4(1):77-87.

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ALiEM

OCTOBER 30, 2024

Due in large part to the proliferation of anonymous chemical factories able to produce industrial volumes of inexpensive synthetic opioids without opium or other controlled precursors, fentanyl spilled into the United States, Canada, and Europe, heroin soon fell to market forces [1, 2]. Some patients require re-dosing in the ED.

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EMDocs

OCTOBER 5, 2024

Answer : ESBL-producing organisms Background 1-3 Extended spectrum beta-lactamases (ESBL) are enzymes produced by certain bacteria that can break down a broad range of beta-lactam antibiotics. 3 Epidemiology 4-8 ESBL-producing Enterobacteriaceae (ESBL-E) have been reported worldwide. ceftriaxone, cefepime).

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EMDocs

NOVEMBER 16, 2024

1-3 Despite its commonality it retains a relatively high rate of complications overall and patients frequently present to the ED for evaluation. 10% of patient’s have an ED visit within 30 or 90 days following THA. 9=11 70% monomicrobial, 25% poly-microbial, 5% culture-negative. 2020 Sep 30;5(9):558-567.

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EMDocs

NOVEMBER 2, 2024

A 51-year-old male with a history of AIDS presents to the ED accompanied by his partner with complaints of cognitive decline and confusion over one month. ED Evaluation Neurosyphilis is known as a “great imitator” due to the extensive variability of nonspecific symptoms [11]. Treasure Island (FL): StatPearls Publishing; April 21, 2024.

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EMDocs

NOVEMBER 4, 2024

Jafar Mahmood, MD (Pain Medicine Attending, Paincare Medical Practice) // Reviewed by: Jessica Pelletier, DO, MHPE (EM Attending, APD, University of Missouri-Columbia), Marina Boushra, MD (EM-CCM Attending, Cleveland Clinic); Brit Long, MD (@long_brit) Introduction: Pain management in the ED can be a unique challenge.

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REBEL EM

NOVEMBER 11, 2024

What They Did: Investigators performed a retrospective cohort study in the Emergency Department at the University of Michigan between July 1, 2014 through December 31, 2018. Comorbidity Index : Higher in the cefepime group (median 2 vs. 1). 9 Instrumental Variable Analysis? Sex : More males in piperacillin-tazobactam (57.1%

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EMDocs

MARCH 14, 2024

1 Medicaid expansion seeks to increase insurance coverage by closing the ‘coverage gap’ for individuals who are unable to afford health insurance but are otherwise ineligible to qualify for traditional Medicaid. Published February 29, 2024. Accessed March 5, 2024. link] Williams E, Rudowitz R, Burns A. Mississippi Today.

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