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Neurogenic Shock in Children

Pediatric EM Morsels

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. Both norepinephrine and epinephrine can be used. 2011;46(9):1771. J Pediatr Surg. 5 th Edition.

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Post-Tonsillectomy Hemorrhage: ReBaked Morsel

Pediatric EM Morsels

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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The Broselow-Luten System

Pediatric EM Morsels

Most emergency drugs except for amiodarone and succinylcholine are based on ideal body weight [Emergency Medical Services for Children, Luten 2007] Epinephrine, dopamine, fentanyl, ketamine based on what child should weigh. 2007-2902 Wells M, Coovadia A, Kramer E, Goldstein L. 2020;13(1):9. 2016;23(1):21-28.

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ToxCard: Local Anesthetic Systemic Toxicity

EMDocs

1-5] Since then, many more medications have been developed and deployed. 1-5] This post focuses on the identification and management of Local Anesthetic Systemic Toxicity (LAST). 3-5,7] Symptom onset is usually within 1 minute of intravascular injection but can be delayed if multiple injections or continuous infusion. [5]

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REBEL Core Cast 108.0 – Angioedema

REBEL EM

Features Urticaria and pruritis Rapid onset (1-2 hours) IgE Dependent (Type I Hypersensitivity) Reactions An allergen cross-links two or more IgE molecules on mast cells or basophils and initiates a signal cascade leading to degranulation. J Allergy Clin Immune Tract 2017; 5(5): 1402-9. of people who take NSAIDs ( Nzeako 2010 ).

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Anaphylaxis, chest pain, and ST elevation in aVR

Dr. Smith's ECG Blog

In the ED he received methylprednisolone, diphenhydramine, and epinephrine for possible anaphylaxis. Shortly after receiving epinephrine, the patient developed new leg cramps and chest pain. ST depression will not always be present in 9/12 leads — as is seen in Figure-1.

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A Relatively Narrow Complex Tachycardia at a Rate of 180.

Dr. Smith's ECG Blog

Vittinghoff, E. Metoprolol and atenolol are overwhelmingly beta-1 cardioselective. Beta-1 blockade decreases inotropy and chronotropy and has no vasoconstrictive effects. The prohibition against beta blockade in cocaine toxicity, causing "unopposed alpha" stimulation, needs to be re-examined. is intuitive, and not surprising.

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