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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Pediatric EM Morsels

OCTOBER 27, 2023

Sinha 2012] It is useful in the prehospital setting , correlating well with actual weight and ED Broselow weight. 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.

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EMDocs

FEBRUARY 26, 2024

1 While PJP gained significant recognition among HIV-positive adults during the early AIDS epidemic, the growing utilization of immunosuppressants has resulted in an increased incidence of the disease in individuals who are HIV-negative. 9 The signs and symptoms of PJP infection are non-specific. for detecting pulmonary opacities.

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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

DECEMBER 11, 2023

The neighbor recorded a systolic blood pressure again above 200 mm Hg and advised her to come to the ED to address her symptoms. 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. Peterson, E.

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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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REBEL EM

MAY 27, 2024

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? Duration of Antiarrhythmic Effect: MVM group: 35.44 seconds (range: 22.5,

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EMDocs

APRIL 10, 2024

1-5] Since then, many more medications have been developed and deployed. These medications are a vital tool in the care of ED patients, from simple local analgesia for a laceration repair to regional analgesia for painful procedures. 1] CV manifestations include: Bradycardia, tachycardia, ventricular dysrhythmias, cardiac arrest. [1-5]

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Don't Forget the Bubbles

NOVEMBER 29, 2023

Intensive Care Research , 1 (3-4), pp.60-64. Even though sedation after endotracheal intubation (ETI) reduces the risk of self-extubation, uncontrolled pain, and awakening awareness, several small single-centre studies demonstrate low rates of sedative drug administration after ETI in the emergency department (ED). Epub 2014 Sep 9.

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EMDocs

JANUARY 17, 2024

She had return of spontaneous resuscitation (ROSC) and was subsequently intubated and transported to the emergency department (ED). Upon ED arrival, she had a heart rate (HR) of 160 and blood pressure (BP) of 80s/40s. 9) The safety announcement highlighted the mortality risk of exploratory ingestions in children under 10 years.

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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. If this EKG were handed to you to screen from triage without any clinical information, what would you think? found normal ECGs in only 3 of 50 patients with massive PE, and 9 of 40 with submassive PE. What do you think?

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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. 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 ).

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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. Exposure impairs information sharing and overall team collaboration. Here are ten things to think about: 1. Churruca K, Pavithra A, McMullan R, Urwin R, Tippett S, Cunningham N, Loh E, Westbrook J.

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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. Critical information such as HR, SBP, drug administration times were occasionally missing.

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EMDocs

SEPTEMBER 23, 2023

A 36-year-old female presents to the ED after experiencing an episode of sudden syncope. Answer : Brugada Syndrome Epidemiology and Etiology Rare genetic disorder that affects approximately 1 in 5,000 individuals worldwide 1. More common in males than females, with a male-to-female ratio of approximately 8:1 1.

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REBEL EM

JANUARY 30, 2023

PSA, also referred to as intravenous sedation in this paper, requires considerable resources, including 1:1 nursing observation, and burdens the emergency department (ED). Researchers contacted authors of RCT trials for additional information and access to raw data when required. vs. 91.4%; RR 0.93; 95% CI 0.86–1.01,

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EMDocs

OCTOBER 30, 2023

” – Musings of an American ED resident in July 2022 when US healthcare was affected simultaneously by supply chain issues from GE Healthcare (contrast media) and Abbott Laboratories (Similac baby formula). 3 A study of CT use trends in the ED has shown increasing use of CTs by almost 60% from 2005 to 2013. 11 Table 1.

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ACEP Now

AUGUST 29, 2023

Understanding how and why our biases work is an important first step in improving our decision-making, determining information we’re willing to trust, and building relationships. 9—Kickoff Party with a speakeasy theme at the Old Reading Terminal Oct. 8—NFL Watch Party featuring the Dallas Cowboys vs. the San Francisco 49ers Oct.

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EMDocs

AUGUST 22, 2024

1 However, we recognize that many patients prefer to speak a language other than English regardless of their English proficiency, and this does not indicate a deficiency. 6 24% more likely to return to the ED within 72 hours of their initial visit in an urban ED with >50,000 annual visits.

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EMDocs

MAY 11, 2024

A 74-year-old female with a past medical history of hypertension, diabetes, recent basilar artery stent placement with a 20 pack-year smoking history presents to the ED via EMS for altered mental status and episodes of apnea. CT head without contrast 1 is performed and reveals the following: Question: What is the diagnosis?

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Don't Forget the Bubbles

JANUARY 17, 2024

Closer to home, the New South Wales Poisons Information Centre (NSWPIC) reported 129 incidents involving water-absorbing beads since 2004. ” ( Ed. Around 80% of those reported pass spontaneously, with another 10-20% requiring endoscopic removal and only 1% requiring surgical intervention. 2012 Jan;3(1):6.

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Don't Forget the Bubbles

SEPTEMBER 16, 2023

You will find the list is broken down into four sections: 1.Reviews 2023 Aug 9. ’: The ethics of information sharing with parents in paediatric care. Bouthry E, et al. Screen Time at Age 1 Year and Communication and Problem-Solving Developmental Delay at 2 and 4 Years. Arch Dis Child Fetal Neonatal Ed.

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EMDocs

MARCH 4, 2024

Case: A 45-year-old woman presents to the emergency department (ED) with itching to bilateral palms. A wide variety of conditions can result in either type of cholestasis (Figure 1). 9 How are cholestatic labs defined? 1 In cholestatic injury, increased reflux of bile salts into hepatocytes causes increased translation of ALP.

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REBEL EM

OCTOBER 26, 2023

1–4 Antimicrobial resistance is a global health crisis, underscoring the importance of antibiotic stewardship. After consent, children were randomized 1:1 to receive 5 additional days of antibiotics or 5 days of a matching placebo. 933 children did not receive 1 of the accepted antibiotics. 9 excluded after randomization.

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REBEL EM

MAY 8, 2023

Paper: Smith JA, Secombe P, Aromataris E. 95% Confidence Interval) Strengths: The study addresses a patient-centered clinical question that is relevant to ED practice. 95% Confidence Interval) Strengths: The study addresses a patient-centered clinical question that is relevant to ED practice. J Trauma Acute Care Surg.

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Don't Forget the Bubbles

AUGUST 13, 2023

Febrile seizure is one of the common presentations in the paediatric ED, causing significant parental anxiety (especially following the first episode). Some common misconceptions such as use of antipyretics to prevent febrile convulsions or it leading to epilepsy in future can be prevented by good parental education during ED visit.

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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. Giannoni, E., Acad Pediatr. doi:10.1016/j.acap.2023.06.023 Epub ahead of print.

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Don't Forget the Bubbles

FEBRUARY 26, 2024

A 6-year-old known asthmatic presents to ED with a two-day history of cough and coryza, worsening wheeze and work of breathing over the last day. 2007 Jan 1;25(1):6-9. uk/document-library/clinical-information/asthma/btssign-asthma-guideline-2019. Beers SL, Abramo TJ, Bracken A, Wiebe RA. Frontiers in Pediatrics.

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Dr. Smith's ECG Blog

APRIL 22, 2022

But these cases show the potential dangers of delayed recognition and treatment of inferior reperfusion Take away 1. ECG’s can be labeled as ‘normal’ by the computer (and confirmed by cardiology) even with diagnostic signs of occlusion or reperfusion References 1. JAMA Intern Med 2019 9. Am J Med [Internet] 2017;130(9):1076–83.e1.

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Dr. Smith's ECG Blog

NOVEMBER 15, 2023

[link] Case continued She arrived in the ED and here is the first ED ECG. IMPRESSION: 1. We know that most type 1 acute MI due to plaque rupture and thrombosis occurs in lesions that are less than 50% (see Libby reference). I don't know if her pain was getting better or not. The Queen no longer thinks it is OMI.

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Dr. Smith's ECG Blog

SEPTEMBER 10, 2023

I texted this ECG with no information to Dr. Smith, who immediately said: "If CP, then anterior OMI until proven otherwise." References: 1) See this study showing an association between morphine and mortality in Non-STE-ACS: Meine TJ, Roe M, Chen A, Patel M, Washam J, Ohman E, Peacock W, Pollack C, Gibler W, Peterson E.

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Dr. Smith's ECG Blog

JULY 21, 2019

These are reasons why it does not look like OMI: 1. Serial Troponins remained in the 9-11 range, w/o any large rise and/or fall, also atypical for OMI. The patient is a 30-ish year old man, who presented to the ED with a 1-week history of chest pain that was mostly right-sided — and improved with sitting up.

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Dr. Smith's ECG Blog

DECEMBER 13, 2019

On review of systems the patient reported back pain for approximately 1 week which he was treating with NSAIDs with minimal relief. I texted this to Dr. Smith without any information, and this was his reply: "This could be pericarditis but probably is normal variant." 15-9/6/2017 ).

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Don't Forget the Bubbles

JULY 5, 2023

Figure 1: Clinical manifestations and long-term consequences of sickle cell disease Training and education on sickle cell disease: Training and education are crucial to improve morbidity and mortality. with thanks A 15-month-old Kenyan boy presents to ED with right hand swelling. Blood culture is pending.

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Dr. Smith's ECG Blog

SEPTEMBER 30, 2019

Meyers comment: Ryan texted me this ECG with no information and my response was "Tough one. No further follow up information is available. For clarity — I’ve put these 2 tracings together in Figure-1. Figure-1: The initial ED ECG ( = E CG # 1) — with comparison to the patient’s baseline ECG done 4 years earlier ( = E CG # 3).

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Dr. Smith's ECG Blog

SEPTEMBER 27, 2019

. == MY Comment by K EN G RAUER, MD ( 9/27/2019 ): == As suggested by the title of this Blog post — confirmation of the diagnosis in this case was made not by ECG — but instead by chest aorta CT ! For clarity — I’ve put these first 2 tracings together in Figure-1. Figure-1: The first 2 ECGs in this case ( See text ).

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Dr. Smith's ECG Blog

MARCH 9, 2023

He had episodes of chest pain off and on all night, until about 1 hour prior to arrival when the pain became constant, crushing, 10/10 chest pain that radiated to both arms. Proven STEMI has an open artery in 19% to 36% of cases, depending on whether it is TIMI −1, −2, or −3 flow. 25] Stone et al found that 72% have TIMI 0 or 1 flow.

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