Pediatric EM Morsels

AUGUST 23, 2024

Concussions are commonly encountered in the Emergency Department. Concussion – Presentation [ Silverberg, 2023 ] There is no definitive test to diagnose concussion in the ED. We have previously discussed an approach to the question of when a patient “ can return to sport.”

Emergency Department 243

Emergency Department OR ED EMS 243

EMDocs

JULY 3, 2023

Louis); Alex Koyfman, MD (@EMHighAK); Marina Boushra, MD (EM-CCM Attending, Cleveland Clinic Foundation) Case A 62-year-old male with past medical history of hypertension (HTN), hyperlipidemia (HLD), and prior cerebrovascular accident (CVA) presents to the emergency department (ED) via ambulance. Glasgow coma scale (GCS) is 12.

ED 85

ED E-9-1-1 ALS OR 85

EMDocs

JULY 17, 2023

Signs and symptoms of peritonitis, hypotension, tachycardia out of proportion to pain, or fever should raise suspicion for perforation, which is a surgical emergency. Evaluation Imaging A definitive diagnosis of LBO requires imaging, most often a computed tomography (CT) scan with intravenous (IV) contrast. Am J Emerg Med.

E-9-1-1 77

E-9-1-1 ED ALS Operating Room 77

Don't Forget the Bubbles

MAY 31, 2023

Children presenting with diabetes and diabetic ketoacidosis to Emergency Departments during the COVID-19 pandemic in the UK and Ireland: an international retrospective observational study. During the COVID-19 pandemic , we noticed a change in the type of patients presenting to the Emergency Department. Arch Dis Child.

Emergency Department 135

Emergency Department ED OR ALS 135

Dr. Smith's ECG Blog

JANUARY 27, 2024

, tells us that we physicians do not need to even look at this ECG until the patient is placed in a room because the computer says it is normal: Validity of Computer-interpreted “Normal” and “Otherwise Normal” ECG in Emergency Department Triage Patients I reviewed this article for a different journal and recommended rejection and it was rejected.

STEMI 105

STEMI Coronary ACS ED 105

Broome Docs

FEBRUARY 22, 2024

PMID: 36946338 Bottom line: This is a well done RCT that demonstrates pretty convincingly that you should not bother trying to but fingernails back on after nail bed repair (and my guess is you definitely shouldn’t be removing them either). Carson JL, Brooks MM, Hébert PC, et al; MINT Investigators. JAMA Psychiatry. 2023 Sep 27:e233582.

Emergency Department 103

Emergency Department ALS OR ED 103

Don't Forget the Bubbles

AUGUST 23, 2023

In most Emergency Departments, staff are allotted little of that scarce resource, time, to begin processing what has just occurred. Definitive emotional support is critical to our emotional and psychological well-being. The Pause Jonathon Bartels worked as an Emergency Nurse in America in 2009. Psychological harm occurs.

Emergency Department 98

Emergency Department ICU ALS Critical Care 98

ACEP Now

MAY 9, 2024

It has been well over a year since the controversial publication of the Agency for Healthcare Research and Quality (AHRQ) report on diagnostic errors in the emergency department (ED). percent of ED visits resulted in preventable death as result of diagnostic error. Ann Emerg Med. 6 Three cases, Hall v.

Emergency Department 52

Emergency Department ICU ALS ACS 52

REBEL EM

MARCH 8, 2023

REBEL Core Cast 97.0 – Acute Vision Loss II Click here for Direct Download of the Podcast Definition: Decrease of visual acuity due to a non-traumatic cause. Emergency Department Management: Emergency ophthalmology consultation. Transient vision loss defined as vision loss <24 hours. Bagheri 2015 ).

Emergency Department 52

Emergency Department ALS ED OR 52

The Skeptics' Guide to EM

NOVEMBER 1, 2022

AEM October 2022 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the #FOAMed project called First10EM.com Case: A 19-year-old man presents to the emergency department (ED) with his first time anterior should dislocation after trying to recreate one of his favourite scenes in the movie Lethal Weapon.

ALS 152

ALS Emergency Department OR ED 152

EMDocs

SEPTEMBER 16, 2024

Author: Joshua Lowe, MD (EM Attending Physician, San Antonio, TX) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Manpreet Singh, MD (@MPrizzleER); Brit Long, MD (@long_brit) The fluorescent lights above cast a clinical pallor over the bustling ED. The symphony of sounds in the Emergency Department can be overwhelming.

Heart Attack 68

Heart Attack ED OR Emergency Department 68

REBEL EM

DECEMBER 5, 2023

The risk of a biphasic reaction is what keeps patients in the ED while being observed for a set period of time. This varied incidence can be due to inconsistent definitions or inclusion of mild reactions. Incidence of clinically important biphasic reactions in emergency department patients with allergic reactions or anaphylaxis.

Epinephrine 80

Epinephrine Allergic Reaction Emergency Department Emergency Manager 80

Handtevy

SEPTEMBER 20, 2022

Case Report: The study discusses the case of a 17-year-old female who arrived at a community emergency department (ED) following a motor vehicle collision. Initially refusing emergency medical services, she was brought to the ED via a private vehicle. Her condition rapidly deteriorated, requiring intubation.

Operating Room 52

Operating Room Emergency Medical Services ED Emergency Department 52

ACEP Now

AUGUST 1, 2023

Fundamentally, I believe every patient coming to an emergency department is best served by care delivered by board certified emergency physicians. So, to that end, I don’t believe there is a “balance” when it comes to board certified emergency physician anything and scope of practice for non-physicians anything.

Emergency Department 98

Emergency Department EMS ED OR 98

REBEL EM

FEBRUARY 22, 2023

Open angle Closed angle Definitions Increased resistance to aqueous outflow through the trabecular meshwork. et al, Emergency Medicine Clinical Essentials ed 2. Ophthalmology, in Marx J et al (eds): Rosens Emergency Medicine: Concepts and Practice, ed 9. Bagheri 2015 ). Cup to disc ratio >0.6

Emergency Department 52

Emergency Department ALS ED Coronary 52

Handtevy

OCTOBER 20, 2022

Discussion: Quick thinking ED physician Marc Grossman, MD decided to decompress and drain the epidural hematoma with an EZ-IO® drill and 25 mm intraosseous needle under virtual guidance of a pediatric neurosurgeon until definitive care could be obtained. The patients were treated between March 10-17, 2022. Key Findings?

Emergency Medical Services 52

Emergency Medical Services ED EMS Emergency Department 52

REBEL EM

AUGUST 30, 2023

REBEL Core Cast 107.0 – Vertebral Osteomyelitis Click here for Direct Download of the Podcast Definition Inflammation of the vertebrae due to a pyogenic, fungal or mycobacterial organism. Evaluation and Treatment of Acute Back Pain in the Emergency Department. Orthopedic Emergencies 2015 May; 33(2) 311-26.

E-9-1-1 103

E-9-1-1 ALS ED OR 103

Dr. Smith's ECG Blog

JUNE 27, 2024

By Sofiya Diurba MD, reviewed by Meyers, Grauer A woman in her 50s with PMH known RBBB and prior syncopal events presents to the ED for five syncopal events over the last 24 hours. This is her first ECG in the ED: What do you see? Each event is associated with a prodrome of mild substernal CP, SOB, and “brain fog.”

ED 122

ED OR Emergency Department Emergency Manager 122

EMDocs

AUGUST 12, 2023

He presented to the emergency department because he is having numbness distal to the site of injury, as well as constant bleeding and some difficulty with flexing his finger. The Atlas of Emergency Medicine, 5e. Ann Emerg Med. Emergency Medicine Residents’ Association; 2022:10-11. Tendon Lacerations. Open Fracture.

EMS 69

EMS ALS Emergency Department OR 69

The Skeptics' Guide to EM

FEBRUARY 2, 2018

In her spare time, Melissa also enjoys being the fellowship director to an amazing group of PEM trainees. Case: Brian is a 14-year-old male who presents to the emergency department (ED) complaining of acute onset testicular pain. He has vomited twice, but there is no history of any fever or trauma. AEM Dec 2017.

Operating Room 100

Operating Room Emergency Department ALS ED 100

Dr. Smith's ECG Blog

AUGUST 10, 2023

Case submitted and written by Dr. Mazen El-Baba and Dr. Emily Austin, with edits from Jesse McLaren A 50 year-old patient presented to the Emergency Department with sudden onset chest pain that began 14-hours ago. The pain improved (6/10) but is persisting, which prompted him to visit the Emergency Department.

STEMI 90

STEMI ACS Emergency Department ED 90

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. The next day, the patient’s mother was called to come to the emergency department with the patient due to abnormal labs.

E-9-1-1 52

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

Don't Forget the Bubbles

MAY 24, 2023

A 5-year-old boy with a past medical history of Crouzon syndrome presents in the Pediatric ED. Airway complications are also more likely to occur in the emergency department (ED) than in the operating theatre. Intubation of the Critically Unwell Child in the Emergency Department. Anaesthesia. 14123 Currie V.

Emergency Department 98

Emergency Department ED ALS OR 98

Dr. Smith's ECG Blog

SEPTEMBER 8, 2023

A 50 year old presented to the emergency department of a remote rural community (where the nearest cath lab is a plane ride away) with one hour of mild chest pain radiating to the back and jaw, and an ECG labeled ‘normal’ by the computer interpretation. Figure-1: The first 2 tracings in today's case.

OR 131

OR STEMI Coronary Emergency Department 131

REBEL EM

JULY 3, 2023

Background: Atrial fibrillation and atrial flutter with rapid ventricular rate (AF/AFL with RVR) are the most common subtypes of SVT, comprising a large number of ED visits in aging populations. Impact of intravenous calcium with diltiazem for atrial fibrillation/flutter in the emergency department. Am J Emerg Med.

E-9-1-1 98

E-9-1-1 EMR Emergency Department ED 98

ACEP Now

JULY 6, 2023

Emergency physicians have earned the right to “re-brand” ourselves as indispensable, money-saving change agents in the health care enterprise. Of course, the bill for any episode of emergency department (ED) care can be substantial, exceeding the billed charges for equivalent care provided in some primary care offices.

ALS 52

ALS Emergency Department STEMI ED 52

Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

This was sent by anonymous The patient is a 55-year-old male who presented to the emergency department after approximately 3 to 4 days of intermittent central boring chest pain initially responsive to nitroglycerin, but is now more constant and not responsive to nitroglycerin. It is unknown when this pain recurred and became constant.

Defibrillator 134

Defibrillator Coronary STEMI CPR 134

EMDocs

JULY 30, 2024

On arrival to the ED, the patient was agitated, disoriented, tachycardic, and his blood glucose was > 600 mg/dL. As no definitive testing could be performed on the material ingested, it could not be confirmed whether the patient’s symptoms were related to a PNU exposure or new onset diabetes, however, PNU exposure was highly suspected.

Overdose 56

Overdose ED Emergency Department OR 56

EMDocs

DECEMBER 4, 2023

Johnson, MD ( Community EM, Salina Regional Health Center) // Reviewed by: Joshua Lowe, MD (EM Attending Physician, USAF); Marina Boushra, MD (Cleveland Clinic Foundation, EM-CCM); Brit Long, MD (@long_brit) Case A 40-year-old woman presents to a rural emergency department (ED) with left leg pain and swelling for the past 5 days.

ALS 71

ALS Emergency Department ED OR 71

EMDocs

NOVEMBER 18, 2023

A 32-year-old female with a history of hypertension and autoimmune hepatitis status post liver transplant 6 weeks prior on tacrolimus and mycophenolate presents to the ED with abdominal discomfort. What are the complications of liver transplant that we see in the ED? In: Post T, ed. Answer : Hepatic artery thrombosis.

EMS 69

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

Don't Forget the Bubbles

AUGUST 28, 2023

A biopsy is often ultimately required for a definitive diagnosis. Five-year-old Ginny presents to the Emergency Department with a syncopal episode. Arch Dis Child Educ Pract Ed. Some basic knowledge of the structures within each compartment can be helpful when considering differentials. Why do we worry about the airway?

Emergency Management 96

Emergency Management Emergency Manager E-9-1-1 Critical Care 96

Don't Forget the Bubbles

OCTOBER 4, 2023

Arch Dis Child Fetal Neonatal Ed. Determining the Best Definition for a Positive Urine Culture in Young Children. Staphylococcus aureus Bacteremia in the Pediatric Emergency Department and Predictors of Poor Outcome. Hirata K, et al. 2023 Sep 14:fetalneonatal-2023-325600. Shaikh N, et al. Pediatrics. Wald ER, et al.

E-9-1-1 111

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

ACEP Now

MAY 10, 2024

A 59-year-old man presents to your community emergency department (ED) with chest pain that is radiating to his back. However, the diagnostic accuracy of SPEED is not good enough to fully exclude the diagnosis and you order a CTA to definitively rule out an AoD in this man.

ALS 52

ALS OR Emergency Department ED 52

ACEP Now

MAY 4, 2023

A 58-year-old male with a history of alcohol abuse presented to the emergency department (ED) as a category 2 trauma for a fall with a reported flail chest. Case FIGURE 1: Chest X-ray of multiple rib fractures (arrows). Click to enlarge.) Trauma imaging was performed including bedside X-rays of the chest and pelvis.

EMS 52

EMS Operating Room ICU Emergency Department 52

Don't Forget the Bubbles

OCTOBER 19, 2023

Babie Junior, or Bee for short, was the definition of a cute, delightful baby. You, however, are working an ED shift, and when you see the name “Barbie Junior” on your computer screen, your heart does a flutter. It can be in started in the ED, and many of us are already using it. What were Barbie and Ken to do?

E-9-1-1 81

E-9-1-1 OR ED Emergency Department 81

Don't Forget the Bubbles

MAY 6, 2024

Factors that impact second attempt success for neonatal intubation following first attempt failure: a report from the National Emergency Airway Registry for Neonates. Arch Dis Child Fetal Neonatal Ed. 807 patients between the ages of 7 days to 17 years, from the ED, ward and PICU, were included across ten hospitals in Switzerland.

E-9-1-1 75

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

EMDocs

SEPTEMBER 25, 2023

Also known as Facilitated intubation (FI), the use of intubating with only a sedative was an accepted alternative intubation technique prior to those definitive studies in the late 1990s but quickly was abandoned for RSI in all emergent endotracheal intubations (ETI) (8,9). To date, ketamine has been the agent of choice (12).

ED 65

ED Emergency Department ALS OR 65