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! Chest Pain in Children is a great example of one of these complaints. Have you ever had chest pain or shortness of breath in exercise?

E-9-1-1 271

E-9-1-1 OR EMS 271

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.

E-9-1-1 284

E-9-1-1 ED EMS OR 284

Core EM

JANUARY 25, 2024

2017;17(1):129. doi:10.1186/s12876-017-0686-6 Proulx E, Glass C. 2018;34(9):e159-e160. Stercoral Colitis. American Journal of Roentgenology. 2005;184(4):1189-1193. doi:10.2214/ajr.184.4.01841189 184.4.01841189 Naseer M, Gandhi J, Chams N, Kulairi Z. Stercoral colitis complicated with ischemic colitis: a double-edge sword.

E-9-1-1 246

E-9-1-1 OR 246

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

E-9-1-1 290

E-9-1-1 Epinephrine Emergency Department OR 290

Core EM

JANUARY 25, 2024

REFERENCES: Castleberg E, Jenson N, Dinh VA. 2014;15(1):111-113. 2020;12(1). Accessed March 9, 2022. EVALUATION: Scan the affected and contralateral body part for comparison with a sterile cover (or Tegaderm) overlying a high frequency linear probe. Western Journal of Emergency Medicine. Clark ML, Fisher KL.

E-9-1-1 246

E-9-1-1 Emergency Department OR 246

Pediatric EM Morsels

JULY 28, 2023

Rates of type 1 diabetes have increased since the COVID-19 pandemic. Kendra Jackson and Rebecca Raffler While we’ve gotten to snack on a Morsel on this subject before , new guidelines and research surrounding DKA and cerebral edema have come to light since the first go ‘round! Neuroimaging is NOT required. GCS score is not sensitive enough.

E-9-1-1 246

E-9-1-1 ALS OR Critical Care 246

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% Reduces dosing errors during resus, up to 33.88%. Recommended by ATLS and PALS. Broselow-Luten System: Supportive Data Physician estimates of weight can underdose children by 49% or overdose by up to 116%. x exp[0.02

E-9-1-1 271

E-9-1-1 Emergency Medical Services Life Support ALS 271

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.

E-9-1-1 132

E-9-1-1 OR Coronary ACS 132

ALiEM

APRIL 12, 2024

Traditionally large-bore tube thoracostomy has been the standard of care for treating many acute intrathoracic pathologies [1]. Pigtails provide a less invasive and often better tolerated alternative to traditional chest tubes and allow for adequate treatment of pneumothoraces and uncomplicated pleural effusions [1-5]. 1999;3(1):57-61.

E-9-1-1 183

E-9-1-1 ALS Critical Care Emergency Department 183

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. 4 Survival rate for all burn injuries is around 97%, which is a notable increase from 75% in the 1960’s.

ED 246

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

ALiEM

NOVEMBER 1, 2023

Iron toxicity treated with deferoxamine Background Deferoxamine is the treatment for severe iron toxicity [1]. Deferoxamine 1] Initial dosing starts at 5 mg/kg/hr intravenously. 1, 3, 4] Hypotension is generally the rate-limiting factor for the infusion rate. McGraw-Hill Education; 2019 Madiwale T, Liebelt E. 2023 May 22.

E-9-1-1 161

E-9-1-1 ALS OR ED 161

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. Refers to the Spinal Cord Function and Reflexes, not specifically hemodynamic issues. Basics are the Best!

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E-9-1-1 Epinephrine ALS EMS 304

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.

E-9-1-1 245

E-9-1-1 Emergency Department ICU OR 245

REBEL EM

MAY 27, 2024

No significant differences in heart rate 1 minute after cardioversion were observed between the three groups. What they did: Prospective randomized controlled trial, unblinded, multicenter study Conducted from January 2017 to December 2022 Patients with confirmed PSVT were randomly assigned to receive MVM, IV Adenosine, or combined therapy.

OR 134

OR E-9-1-1 ED ALS 134

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).

E-9-1-1 246

E-9-1-1 Emergency Department ALS OR 246

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.

E-9-1-1 204

E-9-1-1 ALS OR 204

This Podcast Will Kill You

FEBRUARY 11, 2025

Journal of Zoological Systematics and Evolutionary Research, 46(1), pp.19-23. Anais da Academia Brasileira de Cincias, 96(1), p.e20230706. Gompper, Matthew E., Diseases of Aquatic Organisms, 66(1), pp.87-90. Just there, hanging out, forever. How are you feeling? Hey, we get it. But at least youll never be alone again.

E-9-1-1 97

E-9-1-1 ALS OR 97

ACEP Now

DECEMBER 17, 2024

1 His tragic loss underscores the urgent need for mental health support for residents and fellows. Accessed December 9, 2024. Accessed 9 December 2024. Other demands included increased time for parental leave and childcare, clean resident call rooms, reimbursement for board exam fees, and improved medical benefits coverage.

E-9-1-1 105

E-9-1-1 Emergency Department ALS OR 105

Pediatric EM Morsels

AUGUST 9, 2024

Worldwide, congenital syphilis complicates about 1 million pregnancies / year. Usually in 1st week of lif e Copious, white-ish drainage Teeming with spirochetes! gross ) Rash Occurs 1-2 weeks after rhinitis. 2024 Jan 16;17(1):e257694. 2024 Jan;24(1):e24-e35. Is this scalp swelling normal? May be on soles of feet !

E-9-1-1 154

E-9-1-1 Plasma Emergency Department OR 154

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. Pre-warmed ultrasound gel is helpful when available.

E-9-1-1 177

E-9-1-1 Emergency Department ALS ED 177

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.

E-9-1-1 161

E-9-1-1 ALS Emergency Department OR 161

Pediatric EM Morsels

AUGUST 4, 2023

Oka, 2023) A systematic review linked SMA syndrome to the immediate post-operative period after surgery for scoliosis in pediatric patients, and found the mean days to onset of symptoms was 9. PMID: 33905850 Ganss A, Rampado S, Savarino E, Bardini R. 15(1):74-78. Oka, 2023) Female to male predominance with a ratio of 3:2.

E-9-1-1 246

E-9-1-1 ED OR EMS 246

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.

E-9-1-1 145

E-9-1-1 Plasma ALS OR 145

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.

E-9-1-1 128

E-9-1-1 Coronary ACS BLS 128

ACEP Now

DECEMBER 7, 2024

1 A wide spectrum of severity exists in PE presentations, ranging from mild shortness of breath to cardiac arrest. Approximately 60,000 to 100,000 patients die from pulmonary embolism (PE) each year in the United States, and PE is the third leading cause of cardiovascular mortality.

E-9-1-1 52

E-9-1-1 ALS Critical Care OR 52

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-9-1-1 125

E-9-1-1 Coronary ALS ED 125

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-9-1-1 112

E-9-1-1 OR ALS 112

ALiEM

OCTOBER 30, 2023

It should be no surprise that academic clinical educators are at high risk for burnout, stalled career advancement, and abandonment of academic medicine altogether [1, 2]. After spending her first year acclimating to the new department and achieving board certification, Dr. Garcia finds herself at a bit of a crossroad. In short, no.

E-9-1-1 161

E-9-1-1 ALS OR 161

Pediatric EM Morsels

NOVEMBER 17, 2023

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. On this 10 year anniversary, we chose to throw this one back in the oven to include some even more delicious data on cuffed endotracheal tube (ETT) use. 1.70) and 0.78 (0.46–1.35),

E-9-1-1 187

E-9-1-1 Operating Room Emergency Department ALS 187

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 ACS Coronary STEMI 124

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. What are the symptoms of Methemoglobinemia? doi:10.1053/j.jvca.2013.02.005.

E-9-1-1 130

E-9-1-1 ALS OR 130

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.

E-9-1-1 114

E-9-1-1 ALS Defibrillator OR 114

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 ). Answer : Bedside ultrasound!

E-9-1-1 129

E-9-1-1 Coronary STEMI ALS 129

Don't Forget the Bubbles

JUNE 30, 2023

He has already climbed Ben Nevis in Scotland, visited the Gobi desert (possibly from the comfort of his parents 4 x 4, but who’s judging) and has his bronze D of E nailed. She calls out her findings: A – OK B – 1 puncture mark to the anterior left chest wall, covered with a three-sided dressing. RR 25-30. Actively oozing.

E-9-1-1 139

E-9-1-1 FFP Plasma Emergency Department 139

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-9-1-1 108

E-9-1-1 Overdose ED OR 108

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 119

EMS E-9-1-1 OR ED 119

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? —

E-9-1-1 114

E-9-1-1 STEMI ED OR 114