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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! Get a hold of ENT early as OR management and/or admission are common. Set up suction x2 in the room!

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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. Thought to be a “stunning” of the spinal cord.

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emDOCs Revamp: Left Ventricular Outflow Tract Obstruction

EMDocs

General: Intubated sedated CV: Tachycardic, regular rhythm, systolic murmur Pulm: Clear to auscultation bilaterally Skin: Mottled and cool Neuro: GCS 3T What is the underlying this patient’s vasopressor and inotrope refractory shock? m/s)—problematic and elevated > 50 mm Hg (2.5 m/s)—problematic and elevated > 50 mm Hg (2.5

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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. Reduces dosing errors during resus, up to 33.88%. Recommended by ATLS and PALS. Broselow does not. x exp[0.02

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EM@3AM: Bacterial Tracheitis

EMDocs

to 1 case per 100,000 children. to 1 case per 100,000 children. Question: What’s the next step in your evaluation and treatment, and what is the potentially life-threatening diagnosis? 2] Bacterial infection usually preceded by viral infection. Typically in children less than 6 years of age. [3] The epiglottis will appear normal. [2][3]

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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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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. A "STEMI alert" was called and soon cancelled.