Pediatric EM Morsels

NOVEMBER 17, 2023

Cuffed Endotracheal Tubes show no difference in immediate post-extubation adverse events (i.e Bibl K, Pracher L, Küng E, Wagner M, Roesner I, Berger A, Hermon M, Werther T. 1994 Jul;125(1):57-62. 2019 Sep;74(9):1186-1190. 2016 Feb;30(1):3-11. In a systematic review of 10 RCTs comparing cuffed vs. uncuffed ETTs.

E-9-1-1 183

E-9-1-1 Operating Room Emergency Department ALS 183

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]. A variety of xenobiotics can act as oxidizing agents, inducing methemoglobinemia.

E-9-1-1 130

E-9-1-1 ALS OR 130

Pediatric EM Morsels

AUGUST 18, 2023

Myth #1: Musculoskeletal Adverse Events (MAE) This concern is likely the most common reason fluoroquinolones are rarely used in children. Musculoskeletal Adverse Events include: Articular cartilage damage causing arthralgias or arthritis , Tendonitis , and Tendon rupture. Which is a risk of 1 event for 62.5

E-9-1-1 130

E-9-1-1 ACS OR ALS 130

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. This was sent to me from Sam Ghali ( @EM_Resus ) with no other information. I assumed it was a patient with acute chest pain. Real or just fake?"

E-9-1-1 113

E-9-1-1 Coronary ALS ED 113

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. At midnight. At midnight.

E-9-1-1 124

E-9-1-1 Coronary ACS STEMI 124

EMDocs

MARCH 2, 2024

Answer : Pneumocephalus 1-21 Background: Pneumocephalus is defined by the presence of air within the cranial cavity. 1-3] The most common location is the frontal region, followed by the occipital and temporal regions. [4] 1-3] The most common location is the frontal region, followed by the occipital and temporal regions. [4]

EMS 114

EMS E-9-1-1 OR ED 114

EMS 12-Lead

APRIL 28, 2022

This particular facility is situated for independent living, thus no medical providers are on site to provide pertinent details for medical history, medication intake, or remarkable events prior to the incident at hand. Beats #1-thru-7 manifest the same morphology as we saw in the 12-lead tracing (A) for leads I and II.

E-9-1-1 130

E-9-1-1 ALS Coronary EMS 130

Don't Forget the Bubbles

JUNE 30, 2023

E – Temp 37.2 Survival was better, both at 24 hours and six months, in the TXA group, although the primary outcome, a quality of life score at six months, called the Glasgow Outcome Scale Extended (GOS-E), was the same in both groups ( 53.7% Pupils are equal and reactive. This is not good. This is not good. This is not good.

E-9-1-1 145

E-9-1-1 OR ALS Critical Care 145

Dr. Smith's ECG Blog

NOVEMBER 14, 2023

Learning Point: 1. link] = My Comment by K EN G RAUER, MD ( 11/14 /2023 ): = One of the most helpful clinical clues in support that an acute cardiac event is ongoing — is the finding of " dynamic " ECG changes. No wall motion abnormality identified. Normal LV cavity size with moderately increased wall thickness.

E-9-1-1 109

E-9-1-1 Coronary EMS ED 109

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). Janssen, P. & Fedorov, V. link] Li, N., Hansen, B. Ignozzi, A. Zakharkin, S.

E-9-1-1 95

E-9-1-1 OR ALS 95

REBEL EM

JANUARY 25, 2024

What They Did: Design: Randomized, controlled, blinded-outcome trial Sites: Three emergency departments in Denmark Duration: October 9, 2019 to May 26, 2021. Patients : Compared standard of care to serial US plus stand care in patients with dyspnea. to −0.66) and −1.66 (95% CI −2.09 to −0.78) and -1.97 (95% CI −2.70

ED 128

ED E-9-1-1 Emergency Department ALS 128

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.

E-9-1-1 90

E-9-1-1 Overdose ED OR 90

Don't Forget the Bubbles

NOVEMBER 22, 2023

Of these signs, mortality in children is associated with hepatomegaly and fever; meanwhile, mortality in adults is associated with hyperkalaemia, traumatic brain injury, propofol infusion rates >5mg kg -1 h -1 and ECG changes. 1998;8(6):491-9. What are the clinical features of PRIS? Why does PRIS occur? References Bray RJ.

E-9-1-1 126

E-9-1-1 Critical Care Operating Room ALS 126

REBEL EM

FEBRUARY 5, 2024

Sites: Investigators recruited patients at 31 French emergency departments at university and nonuniversity hospitals Duration : June 1, 2009 to March 31, 2015. Recurrence of pneumothorax within 1 year. Adverse events at 24 hours and 7 days, including major and minor complications.

E-9-1-1 103

E-9-1-1 ALS Emergency Department OR 103

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).

E-9-1-1 79

E-9-1-1 ALS OR ED 79

EMS 12-Lead

AUGUST 22, 2022

Question 1: What is the rhythm? Beat 1 : Sinus, narrow QRS complex. The assumption is that a premature complex discharged prior to Beat 1, which prolonged its respective refractory period in the same manner as Beat 5. A 12 Lead ECG was recorded secondary to bizarre telemetry findings at bedside. Said differently, it’s a mess.

E-9-1-1 130

E-9-1-1 Coronary ALS ICU 130

Dr. Smith's ECG Blog

JULY 22, 2023

A prior ECG from 1 month ago was available: The presentation ECG was interpreted as STEMI and the patient was transferred emergently to the nearest PCI center. Patients that develop a Type 1 pattern without any precipitating or provoking factors have a risk of SCD of 0.5-0.8% He denied chest pain or shortness of breath.

E-9-1-1 69

E-9-1-1 CAD OR STEMI 69

EMDocs

APRIL 10, 2024

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]

E-9-1-1 94

E-9-1-1 Plasma Epinephrine Life Support 94

Don't Forget the Bubbles

JULY 22, 2024

study from 200 9. However, there was no difference in LOS (83 minutes for placebo vs 79 minutes for prednisolone) in participants who were discharged straight from the ED ( 32% ). Compare this with the Panickar et al. The children were younger (10-72 months, mean 25 months) were younger.

E-9-1-1 105

E-9-1-1 ALS ACS ED 105

EMDocs

SEPTEMBER 23, 2023

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. Type 1 “Brugada sign” The only type that is considered diagnostic.

E-9-1-1 84

E-9-1-1 EMS ALS Defibrillator 84

Don't Forget the Bubbles

JUNE 17, 2024

Once a sufficiently high level is achieved, modelling of behaviours and episodes of retaliation can perpetuate the behaviours far beyond the initial event. Here are ten things to think about: 1. Churruca K, Pavithra A, McMullan R, Urwin R, Tippett S, Cunningham N, Loh E, Westbrook J. 2014 Jun 26;23(12):653-9. 2020 Aug 20.

E-9-1-1 105

E-9-1-1 Critical Care CPR ICU 105

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. Investigations : Bloods show Hb of 8 g/L, White cell count 13x 10 9 /L, Platelets 570 x10 9 /L, CRP 35mg/L.

E-9-1-1 126

E-9-1-1 ACS OR ICU 126

Don't Forget the Bubbles

JANUARY 17, 2024

The vast majority were managed at home, with no adverse events reported. Around 80% of those reported pass spontaneously, with another 10-20% requiring endoscopic removal and only 1% requiring surgical intervention. Roy was less than impressed when young Kendall tried to eat his Orbeez. Here, a water bead had been aspirated.

E-9-1-1 111

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

Dr. Smith's ECG Blog

DECEMBER 29, 2024

The Queen of Hearts also knows which large T-waves are hyperacute and which are not: She knows that it is not OMI (Unfortunately, most providers no longer have access to the Queen of Hearts because 1) it is not yet FDA approved and 2) thus a provider can only use it in the context of research.) Here are 9 cases that involve re-occlusion.

E-9-1-1 69

E-9-1-1 STEMI Critical Care OR 69

REBEL EM

SEPTEMBER 13, 2023

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. of people who take NSAIDs ( Nzeako 2010 ). of people who take NSAIDs ( Nzeako 2010 ).

Frozen Plasma 104

Frozen Plasma Allergic Reaction FFP Plasma 104

Don't Forget the Bubbles

JULY 17, 2023

You will find the list is broken down into four sections: 1.Reviews 2023 Jun 1. 2023 Jun 1 Adverse Effects of α-2 Adrenergic Agonists and Stimulants in Preschool-age Attention-deficit/Hyperactivity Disorder: A Developmental-Behavioral Pediatrics Research Network Study. 2023 Jun 9. 2023 Jun 6:1-11. 2023 Jun 9.

E-9-1-1 98

E-9-1-1 ALS Emergency Department Emergency Medical Services 98

EMDocs

JANUARY 17, 2024

1) There are a limited number of antitussives on the US market which include benzonatate, codeine, dextromethorphan, diphenhydramine, and hydrocodone. 3, 7) The accumulating post marketing adverse event reports led to the FDA release of a Drug Safety Communication (DSC) in 2010, over 50 years after initial approval. (9)

E-9-1-1 67

E-9-1-1 Overdose Emergency Medical Services Life Support 67

EMDocs

MARCH 30, 2024

Comprehensive physical exam is unremarkable, but she does have pain at the T-12/L-1 region of her back. Her patellar reflexes are 1+ bilaterally, no ankle clonus is noted, and she denies any saddle anesthesia or bowel/bladder incontinence. CT of lower spine is ordered and shows the following: 1 What is the diagnosis?

EMS 90

EMS E-9-1-1 Emergency Department Ambulance 90

Don't Forget the Bubbles

MAY 6, 2024

Article 1: Positive urine cultures without pyuria Wang ME, Jones VG, Kane M, et al. 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. Acad Pediatr. doi:10.1016/j.acap.2023.06.023

E-9-1-1 75

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

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

Post cath ECG: Now there are hyperacute T-waves again, and recurrent ST depression in V2 This ECG would normally diagnostic of OMI until proven otherwise No further troponins were measured, but it looks like there is recurrent OMI Next day: A CT Coronary Angiogram was done (CTCA) CARDIAC MORPHOLOGY AND FUNCTION: 1. IMPRESSION: 1.

Coronary 102

Coronary E-9-1-1 STEMI ACS 102

EMDocs

JUNE 27, 2024

Abdomen : ND, NT, no guarding or rebound MSK : Tenderness to palpation over L ribs 7-9 Derm : No rashes Imaging: Image 1: Case courtesy of Miriam Leiderer, Radiopaedia.org, rID: 81468 Chest radiograph (CXR) shows new left lower lobe opacity What’s most likely diagnosis? Other lung fields unremarkable. C or 100.4 mg/kg, max 0.4

E-9-1-1 76

E-9-1-1 ICU ACS EMS 76

REBEL EM

JULY 3, 2023

Investigators enrollend 660 patients in 9 years in 5 EDs; or approximately 6 patients per month; or 1 patient per /month for each ED. The primary purpose of Table 1 is to provide a summary of baseline characteristics and demographics of the study population, presenting data in a clear and organized manner.

E-9-1-1 96

E-9-1-1 EMR Emergency Department ED 96

EMDocs

MAY 11, 2024

CT head without contrast 1 is performed and reveals the following: Question: What is the diagnosis? On exam, the patient opens eyes to voice, has extraocular movements intact, is unable to speak, and has 0/5 strength in all extremities. The patient was intubated for acute hypercapnic and hypoxic respiratory failure and airway protection.

EMS 89

EMS E-9-1-1 ALS OR 89

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. Problem How should his pain be managed?

E-9-1-1 52

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

REBEL EM

OCTOBER 5, 2023

1-6 We now have the Community-Acquired Pneumonia: Evaluation of Corticosteroids (CAPE COD) Trial. Patients admitted to the ICU with severe community-acquired pneumonia were randomized in a 1:1 ratio to receive hydrocortisone or a placebo. However, except for one trial, none showed a between-group difference regarding mortality.

Critical Care 94

Critical Care ICU E-9-1-1 ALS 94

Dr. Smith's ECG Blog

JANUARY 30, 2019

The pattern of STE and STD reminded us of Brugada Type 1 morphology. Smith comment: 1) Brugada ECG may have ST shifts in limb leads as well as precordial leads. Patients that develop a Type 1 pattern without any precipitating or provoking factors have a risk of SCD of 0.5-0.8% The article is edited by Smith. F (rectal).

E-9-1-1 52

E-9-1-1 CAD STEMI OR 52

Don't Forget the Bubbles

AUGUST 13, 2023

There is a 1:3 or 30% risk of recurrence of the febrile convulsions and occur within 2 years of the first episode. There is a very low risk of developing epilepsy following febrile convulsions (approximately 2% following simple seizures and 5% following complex seizures as compared to 1% in the general population).

E-9-1-1 97

E-9-1-1 ED OR First Aid 97