Pediatric EM Morsels

SEPTEMBER 22, 2023

Pathophysiology Primary injury happens at the time of the traumatic event or shortly after in the high cervical to mid-thoracic spine. Tenenbein M, Macias CG, Sharieff GQ, et al, eds. Tenenbein M, Macias CG, Sharieff GQ, et al, eds. Refers to the Spinal Cord Function and Reflexes, not specifically hemodynamic issues.

E-9-1-1 300

E-9-1-1 Epinephrine ALS EMS 300

The Skeptics' Guide to EM

JULY 2, 2022

Date: June 30th, 2022 Reference: McGinnis et al. Major adverse cardiac event rates in moderate-risk patients: Does prior coronary disease matter? Date: June 30th, 2022 Reference: McGinnis et al. Major adverse cardiac event rates in moderate-risk patients: Does prior coronary disease matter? Reference: McGinnis et al.

Coronary 100

Coronary Heart Attack ACS CAD 100

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. Musculoskeletal Adverse Events include: Articular cartilage damage causing arthralgias or arthritis , Tendonitis , and Tendon rupture. Which is a risk of 1 event for 62.5

E-9-1-1 130

E-9-1-1 OR ACS ALS 130

Core EM

JULY 23, 2024

Because most radiation injuries are not immediately life-threatening, patients with isolated radiation injuries will not require immediate attention in mass casualty events. Radioactive sources include medical isotopes, fuel rods, generators, and other industrial sources. Sources of Radiation Cosmic: Radiation generated by the sun and stars.

ALS 130

ALS OR Emergency Department ED 130

REBEL EM

MAY 29, 2024

EMRAP HD: Epistaxis Posterior Pack References Cassisi NJ et al. PMID: 5569677 Zeyyan E et al. Take Home Points: Posterior epistaxis is a rare, life-threatning presentation. The key is in identifying and rapidly gaining control with a posterior pack or foley catheter. Laryngoscope 1971; 81(8): 1261-6.

ICU 104

ICU ALS ACS EMS 104

EMDocs

FEBRUARY 7, 2024

GLP-1 agonists are also associated with improved ejection fraction, coronary blood flow, and cardiac output while reducing the risk of cardiovascular events, infarction size, and all-cause mortality. Adverse events are common in those using GLP-1 agonists, but the vast majority of these are minor. Take for example semaglutide.

Allergic Reaction 75

Allergic Reaction ALS CAD OR 75

The Skeptics' Guide to EM

JULY 22, 2023

Date: July 21, 2023 Reference: Prekker et al. Date: July 21, 2023 Reference: Prekker et al. Intubation FPS is associated with fewer adverse events, most importantly hypoxia, hypotension, and cardiac arrest. Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults.

Emergency Medical Services 181

Emergency Medical Services Defibrillator CPR EMS 181

The Skeptics' Guide to EM

OCTOBER 3, 2020

Reference: Claiborne Johnston S et al. Reference: Claiborne Johnston S et al. Aspirin has been used to prevent a subsequent stroke in patients who suffered an acute ischemic stroke (AIS) or transient ischemic attack (TIA), which occur in approximately 5-10% of patients in the first few months after their primary event.

Emergency Department 100

Emergency Department ALS OR 100

NAEMSP

JUNE 18, 2024

Article Summary by Sarah Fabiano, MD, FACEP, FAAEM Sobieraj DM, Martinez BK, Miao B, et al. There is insufficient evidence for the adverse events. Opioids may cause more adverse events—dizziness, but not enough strength regarding hypotension or respiratory depression. Opioids may cause more adverse events and drowsiness.

ALS 52

ALS OR 52

The Skeptics' Guide to EM

NOVEMBER 1, 2022

Date: October 27th, 2022 Reference: Hayashi et al. Date: October 27th, 2022 Reference: Hayashi et al. Although minor adverse events, such as brief apnea or hypoxia, are common, significant adverse events are very rare, and the benefits are clear (Bellolio 2016).

ALS 152

ALS Emergency Department OR ED 152

NAEMSP

FEBRUARY 1, 2023

1] Hypoglycemia events may occur in patients on medications, including insulin and oral medications, to manage diabetes. Article Summary by James Li, MD Sinclair, Julie E., “Characteristics, prehospital management, and outcomes in patients assessed for hypoglycemia: repeat access to prehospital or emergency care.” 2019): 364-376.

OR 52

OR Emergency Department Emergency Medical Services Paramedic 52

ACEP Now

JANUARY 14, 2024

Three Groups of Patients at High Risk for Drug Interactions Older patients are especially sensitive to medications with a narrow therapeutic range such as diabetes medications (insulin, sulfonylureas), anticoagulants, sedatives, immunosuppressants, and anticonvulsants. 22,23 Macrolides are another group of antibiotics to be careful prescribing.

E-9-1-1 52

E-9-1-1 ALS Emergency Department ED 52

Don't Forget the Bubbles

AUGUST 23, 2023

This simple intervention aims to acknowledge the tragic and unexpected event humanely and respectfully. The Pause creates an opportunity for loved ones and healthcare workers to respectfully honour the patient and the significant event they have been involved in before moving on to the next task ahead. Kapoor et al. 23 (2), pp.

Emergency Department 98

Emergency Department ICU ALS Critical Care 98

The Skeptics' Guide to EM

APRIL 2, 2022

Date: March 31st, 2022 Reference: Butt et al. Date: March 31st, 2022 Reference: Butt et al. Children represent one group of patients that are less likely to receive adequate analgesia ( Brown et al , Selbst and Clark ). Reference: Butt et al.

Emergency Department 130

Emergency Department ALS ED OR 130

Don't Forget the Bubbles

NOVEMBER 22, 2023

A systematic review examined 69 articles (mostly cohort studies and clinical trials) looking at the common adverse events (not just PRIS) following the use of propofol in children and neonates. Mortality associated with PRIS has been estimated to be around 33% and becomes even higher if the diagnosis is delayed. References Bray RJ.

E-9-1-1 126

E-9-1-1 Critical Care Operating Room ALS 126

Don't Forget the Bubbles

OCTOBER 4, 2023

Formentin C, et al. Jørgensen RM, et al. Harris J, et al. Bhatia S, et al. Vivarelli M, et al. Morello W, et al. McGowan EC, et al. Hirata K, et al. Shaikh N, et al. Wald ER, et al. could be responsible for the fractures. As always, more research seems needed. Pediatr Nephrol.

E-9-1-1 111

E-9-1-1 ALS Emergency Department OR 111

The Skeptics' Guide to EM

JUNE 12, 2022

Date: June 12th, 2022 Reference: Finfer et al. Date: June 12th, 2022 Reference: Finfer et al. Two large, cluster-randomized trials ( SMART and SALT-ED ) showed a small benefit to the use of balanced crystalloids in preventing a composite outcome of Major Adverse Kidney Events within 30 days (aka MAKE-30).

ICU 132

ICU Plasma Critical Care ALS 132

Core EM

MARCH 12, 2024

Because most radiation injuries are not immediately life-threatening, patients with isolated radiation injuries will not require immediate attention in mass casualty events. Radioactive sources include medical isotopes, fuel rods, generators, and other industrial sources. Sources of Radiation Cosmic: Radiation generated by the sun and stars.

ALS 130

ALS OR Emergency Department ED 130

REBEL EM

MARCH 6, 2024

Melatonin Farahmand S, et al. Morgenthaler TI et al; Standards of Practice Committee of the American Academy of Sleep Medicine. Driving Sleepy Barger LK, Cade BE, Ayas NT, et al. Green W, Gao X, Li K, et al. The Association of Sleep Hygiene and Drowsiness with Adverse Driving Events in Emergency Medicine Residents.

ALS 104

ALS OR EMS 104

EMDocs

JUNE 22, 2024

A) Amniotic fluid embolism B) Eclampsia C) Placental abruption D) Pulmonary embolism Answer: A Amniotic fluid embolism (AFE) is a rare but potentially fatal complication of pregnancy. AFE should be considered in a patient who experiences cardiorespiratory collapse during labor or shortly thereafter.

EMS 96

EMS Ambulance FFP ICU 96

The Skeptics' Guide to EM

OCTOBER 10, 2020

Reference: Friedman et al. Reference: Friedman et al. million visits each year in the USA ( Friedman et al Spine 2010 ). However, their use is associated with increased adverse events. These include: acetaminophen ( Williams et al Lancet 2014), muscle relaxants ( Friedman et al JAMA 2015), NSAIDs ( Machado et al

Emergency Department 130

Emergency Department ALS ED OR 130

Don't Forget the Bubbles

SEPTEMBER 2, 2024

Neonatal Bubble Wrap from Brian Dunn Seidler AL, Aberoumand M, Hunter KE, Barba A, Libesman S, Williams JG, Shrestha N, Aagerup J, Sotiropoulos JX, Montgomery AA, Gyte GM. Effect of early vs late inguinal hernia repair on serious adverse event rates in preterm infants: a randomized clinical trial. 2024 Mar 26;331(12):1035-44.

ALS 105

ALS EMS OR 105

EMDocs

NOVEMBER 7, 2023

The DIABLO trial: Daniels L, Ünlü Ç, de Korte N, et al; Dutch Diverticular Disease (3D) Collaborative Study Group. Randomized vs. 12%), adverse events (48.5 van Dijk ST, Daniels L, Ünlü Ç, et al; Dutch Diverticular Disease (3D) Collaborative Study Group. The STAND trial: Jaung R, Nisbet S, Gosselink MP, et al. Antibiotics

ACPE 88

ACPE ALS OR ED 88

Don't Forget the Bubbles

MAY 6, 2024

Article 1: Positive urine cultures without pyuria Wang ME, Jones VG, Kane M, et al. Article 1: Positive urine cultures without pyuria Wang ME, Jones VG, Kane M, et al. Reviewed by: Sarah Gentle and Owen Hibberd Article 2: Second attempt success in neonatal intubation Johnson MD, Tingay DG, Perkins EJ et al. Acad Pediatr.

E-9-1-1 75

E-9-1-1 Emergency Department OR ALS 75

Dr. Smith's ECG Blog

APRIL 17, 2023

CASE #2: I am more disturbed by learning of the events associated with the ECG in Case #2. NOTE: For illustrative purposes — I’ve adapted Figure-1 from the original manuscript by deWinter et al, published in this 2008 NEJM citation. de Winter et al in N Engl J Med 359:2071-2073, 2008. QOH: "Not OMI, High confidence."

OR 52

OR STEMI ACS Emergency Department 52

REBEL EM

OCTOBER 30, 2023

Paper: Davenport R et al. Fibrinogen products may also be needed to stabilize clots and stem bleeding. The optimal approach to fibrinogen administration in massive hemorrhage protocols is unknown. Early and Empirical High-Dose Cryoprecipitate for Hemorrhage After Traumatic Injury: The CRYOSTAT-2 Randomized Clinical Trial. to 1.23; p = 0.74

FFP 127

FFP ALS OR EMS 127

The Skeptics' Guide to EM

MAY 19, 2018

[display_podcast] Date: May 16, 2018 Reference: Freund et al. Effect of the Pulmonary Embolism Rule-Out Criteria on Subsequent Thromboembolic Events
 Among Low-Risk Emergency Department Patients: The PROPER Randomized Clinical Trial. display_podcast] Date: May 16, 2018 Reference: Freund et al. Reference: Freund et al.

Emergency Department 130

Emergency Department ALS Coronary OR 130

ACEP Now

JULY 7, 2024

Should emergency physicians rely on standard textbooks for diagnostic and treatment regimens? Or should recent literature guide diagnosis and management? Status epilepticus has previously been defined as seizure(s) greater than or equal to 30 minutes in which the patient does not regain normal mental status between seizures.

Emergency Department 52

Emergency Department Critical Care ALS ED 52

Don't Forget the Bubbles

MAY 8, 2024

Dell KM, et al. Eisen S et al. Fielder AR, et al. Bm MV, et al. Toepfner N, et al. Toniutti M, et al. Meoli M, et al. Ashton JJ, et al. Ding G et al. Tanti DC, et al. Ahlqvist VH, et al. Chiang HL, et al. Wong J, et al. Fuller S et al. Pediatr Nephrol.

E-9-1-1 69

E-9-1-1 ALS Emergency Department Epinephrine 69

The Skeptics' Guide to EM

OCTOBER 31, 2018

[display_podcast] Date: October 30th , 2018 Reference: Raskob GE et al. display_podcast] Date: October 30th , 2018 Reference: Raskob GE et al. In non-cancer patients, new oral anticoagulants (NOACs) like rivaroxaban have been shown to be effective in treatment without increasing bleeding events. Reference: Raskob GE et al.

ALS 130

ALS EMS OR 130

EMDocs

MAY 11, 2024

Some refer to an ischemic event in this territory with clinical findings as posterior inferior cerebellar artery syndrome. Central causes of vertigo include ischemic stroke, demyelinating conditions, cerebellar hemorrhage, vertebrobasilar insufficiency, vertebral artery dissection, multiple sclerosis, malignancy, and vestibular migraine.

EMS 89

EMS E-9-1-1 ALS OR 89

EMDocs

OCTOBER 9, 2023

12 Weight gain (up to 70%), development of cataracts (up to 15%), fractures (up to 12%), and neuropsychiatric events (up to 10%) are the most common adverse events. 12 Weight gain (up to 70%), development of cataracts (up to 15%), fractures (up to 12%), and neuropsychiatric events (up to 10%) are the most common adverse events.

ED 82

ED Life Support Advanced Life Support CPR 82

ALiEM

AUGUST 16, 2023

PMID 7073040 Moore TJ, Walsh CS, Cohen MR. Reported adverse event cases of methemoglobinemia associated with benzocaine products. Nelson, et al., Nelson, et al., Background Methemoglobinemia is a disorder of hemoglobin in which the iron atom has been oxidized from the normal Fe 2+ to Fe 3+. Methemoglobinemia. Ann Emerg Med.

E-9-1-1 130

E-9-1-1 ALS OR 130

The Skeptics' Guide to EM

OCTOBER 14, 2019

Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial. Zehtabchi et al published a SRMA of TXA for traumatic brain injuries (TBI). Date: October 14th, 2019 Reference: CRASH-3 Trial Collaborators.

Emergency Department 130

Emergency Department EMS ALS OR 130

The Skeptics' Guide to EM

NOVEMBER 24, 2018

This turned out to be a very meta event. This turned out to be a very meta event. The highest prevalence of burnout (70%) was reported by emergency physicians (Shanafelt et al 2015). One of the most common reasons cited for burnout is the electronic medical record (EMR) (Shanafelt et al 2016). got seriously ill.

EMR 130

EMR ALS Emergency Department OR 130

ACEP Now

MARCH 6, 2024

Empiric PCC infusion was associated only with increased pro-thrombotic events without corresponding witnessed benefits. 4 Repeated trials have not shown alteplase to have any signal of better outcomes, nor tenecteplase to have an association with increased adverse events. 2 The brief answer from the “PROAG” trial in France is “no.”

ALS 52

ALS Critical Care Emergency Department OR 52

Dr. Smith's ECG Blog

SEPTEMBER 5, 2024

A Short Comment on PIRP and T Waves: Oliva et al found a strong association of myocardial rupture with postinfarction regional pericarditis. It has been estimated that in the aggregate, they occur at a rate of about 3 per 1000 patients with acute MI, and most of these events occur in patients with STEMI.

STEMI 106

STEMI Coronary OR ALS 106