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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Pediatric EM Morsels

JUNE 30, 2023

References Dessole F, Virdis G, Andrisani A, Vitagliano A, Cappadona R, Dessole S, Cosmi E, Capobianco G. Leblanc C, Baron M, Desselas, E, Phan, MH, Rybak A, Thouvenin G, Lauby C, Irtan S. Dec: 9 (12): 1830. Fetal Congenital Cystic Adenomatoid Malformation (CCAM): Pathogenesis, Diagnosis, and Clinical Management: A Case Report.

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Pediatric EM Morsels

JULY 19, 2024

Since tonsillectomy is one of the most common pediatric surgeries in the US (~500,000 per year) and the rate of post-tonsillectomy hemorrhage is about 1-5% , it is a good idea that we all are familiar with how to manage this issue! 2020 Sep;38(9):1943. Rohe E, Gresham M, Rohde R, Cass L, Brinkmeier JV, Childers A. 2020.01.042.

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Broome Docs

SEPTEMBER 3, 2024

In a surprise to no one who reads First10EM, clinical judgment is better than all decision tools for sepsis Knack SKS, Scott N, Driver BE, Prekker ME, Black LP, Hopson C, Maruggi E, Kaus O, Tordsen W, Puskarich MA. Epub 2024 Apr 9. 2024 Mar;27(1):26-29. 2024 Jul 4;391(1):9-20. doi: 10.1016/S0140-6736(24)00700-1.

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Pediatric EM Morsels

OCTOBER 27, 2023

Initially tested in Johannesburg, South Africa: 1 month old to 12 years old Broselow predicted within 10% of weight in 63.6% 2007-2902 Wells M, Coovadia A, Kramer E, Goldstein L. 2020;13(1):9. 2016;23(1):21-28. 2019 Jan;22(1):147-156. There are other systems that account for body habitus. Broselow does not.

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ALiEM

OCTOBER 11, 2023

Most pufferfish contain tetrodotoxin , a dangerous marine toxin up to 1200 times more toxic to humans than cyanide [1]. 4, 9-12] Consider activated charcoal for patients presenting within 60 minutes of ingestion if the patient’s airway is not an imminent threat or has been secured. 2022;20(1):47. 2007;48(9):830-833.

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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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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

JULY 28, 2023

Rates of type 1 diabetes have increased since the COVID-19 pandemic. Insulin (in Bag #1) is for the Acidosis. 2010 Dec;1(2):103-20. 2001 Jan 25;344(4):264-9. PubMed] [Read by QxMD] [link] Weiss A, Donnachie E, Beyerlein A, Ziegler A, Bonifacio E. Is your patient hyperglycemic, acidotic, with ketonuria?

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Core EM

JANUARY 25, 2024

7 86% of burn injuries are thermal burns (as opposed to chemical or electric), with 43% resulting from a direct exposure to fire, 34% from scalding liquid, and 9% from a hot object. 9 Apply a topical antimicrobial (eg. 2004 Jun 19;328(7454):1487-9. 2 After 5 minutes there is a risk of vasoconstriction and further tissue damage.

ED 246

ED E-9-1-1 First Aid OR 246

ALiEM

MAY 13, 2024

Her symptoms started 1 week ago as a scratch which progressively got more red and painful. Pediatric Soft Tissue POCUS Ultrasound Technique Figure 1. Cellulitis with cobblestoning Video 1. Abscess with irregular borders and surrounding cellulitis E. Superficial abscess with well-circumscribed borders Table 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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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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EMDocs

OCTOBER 29, 2024

Chu CK, Delia E, Mograder A, Dwyer EM. 2017;45(1):12-20. 2015;7(9):E365-E369. 2018;12(1). 20594 MOZELL D, SHAH N, CASTILLON JJR, GONUGUNTLA VT, AWERBUCH E. J Saudi Hear Assoc. 2018;30(4):336. doi:10.1016/J.JSHA.2018.07.001 2018.07.001 Sherrid M V., J Am Coll Cardiol. 1993;22(3):816-825. Anaesth Intensive Care.

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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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ALiEM

MAY 19, 2023

The SB tube was created in 1950 in order to help tamponade variceal bleeds [1]. Apply traction to the tube by tying a roller bandage to the end of it and then the other end to a 1 L bag of IV fluids. Pearl 1: Check the units of pressure being used. The conversion rate is: 1 cmH2O = 0.74 1950 May;131(5):781-9.

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EMDocs

NOVEMBER 13, 2024

Commonly a monomicrobial infection with gram-negative bacteria like E. Paracentesis is a safe procedure with a low complication rate (< 1%). For the remaining fluid inject 1 mL into a purple top EDTA blood tube for cell count; send 2-3 mL for Gram stain in a red-top tube or sterile urine container. coli (50-90% of cases).

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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

NOVEMBER 3, 2024

Below in Figure-1 is a tracing obtained from the in-house telemetry. The rhythm strip in Figure-1 shows four ECG leads. Figure-1: The initial rhythm strip in today’s case. Figure-1: The initial rhythm strip in today’s case. Beat #9 is wide, and manifests a different QRS morphology than the other wide beats.

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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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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. 4, 8 Paper: Dahyot-Fizelier, C.,

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ALiEM

AUGUST 16, 2023

Common agents include local anesthetics, dapsone, quinones, sulfonamides, phenazopyridine, and nitrites [1, 2]. Treatment for methemoglobinemia in G6PD deficiency may consist of ascorbic acid, exchange transfusion, and hyperbaric oxygen [7, 9]. PMID 23953868 Mack E. Rosen PJ, Johnson C, McGehee WG, Beutler E. 2013.02.005.

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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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EMDocs

NOVEMBER 6, 2024

2004;141(1):17-21. What are important clinical features differentiating strychnine and tetanus toxicity to aid with diagnosis? How does the clinical management of strychnine and tetanus differ? Site of action of strychnine and tetanus. red X = target of strychnine = target of tetanus Adapted from: Stephan J. Neurotransmitter.

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ALiEM

AUGUST 9, 2023

Technique Positioning and Probe Figure 1: Younger children can sit in their parent’s lap and give a hug for lateral and posterior lung scanning. The patient should be in a position of comfort: supine, sitting, or in parent’s lap (Figure 1). Identify anatomical landmarks on ultrasound (Figure 3, Video 1). Tsou et al.,

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Broome Docs

MAY 31, 2024

Freund Y, Viglino D, Cachanado M, Cassard C, Montassier E, Douay B, Guenezan J, Le Borgne P, Yordanov Y, Severin A, Roussel M, Daniel M, Marteau A, Peschanski N, Teissandier D, Macrez R, Morere J, Chouihed T, Roux D, Adnet F, Bloom B, Chauvin A, Simon T. PMID: 37019501 Pulmonary primatology is harder than you may think Drew T, Võ ML, Wolfe JM.

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Pediatric EM Morsels

APRIL 5, 2024

Time from tick bite to onset of symptoms generally ranges from 1 week to 4 weeks but can start within 2 days (CDC 2022) Tick-Borne Encephalitis can also be transmitted in unpasturized dairy. These resolve within 1 week. 2004 Nov 15;39(10):1493-9. 2018 Mar; 3(1): 8. 2024 Jan 25;78(1):80-89. 2019 Apr:62:1-6.

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Dr. Smith's ECG Blog

DECEMBER 11, 2023

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. Case continued She was loaded with aspirin 325 mg, and repeat troponin drawn around the time of EKG 1 resulted at 267 ng/L. Peterson, E.

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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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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

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] 2017;7(1):16-23. Rev Infect Dis.

EMS 87

EMS E-9-1-1 Epinephrine OR 87

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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REBEL EM

NOVEMBER 6, 2024

1998 Jan-Feb;6(1):15-23. PMID: 32644703 Robinson PM, Griffiths E, Watts AC. 2017 Jul;9(3):195-204. PMID: 29681420 Gottschalk HP, Eisner E, Hosalkar HS. 1999 Jan;13(1):58-9. 2015 Jan;38(1):42-4. J Am Acad Orthop Surg. doi: 10.5435/00124635-199801000-00002. PMID: 9692937 Decker N, Norse A. 2022 Aug 2.

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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. 2011;46(9):1771. McGraw Hill Education; 2019:125-138 Ziu E, Mesfin FB. J Pediatr Surg.

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This Podcast Will Kill You

JULY 23, 2024

Official journal of the American College of Gastroenterology| ACG , 118 (1), pp.59-76. Annals of internal medicine , 172 (1), pp.ITC1-ITC16. ” BMC medicine 17 (2019): 1-20. . ” BMC medicine 17 (2019): 1-20. Gastroenterology , 160 (1), pp.63-75. ” Internal and emergency medicine 9 (2014): 249-256.

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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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