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Glasgow Coma Scale in Children

Pediatric EM Morsels

Motor Fingernail bed pressure with a pencil first If flexion outcome, then apply painful stimulus to neck or head (trapezius or supraorbital notch) to look for localization Spinal reflex can result in a falsely elevated score if lower extremity pain induced Verbal Orientated- Able to answer all questions. Fun fact for animal lovers!-

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What I Read Last Week

Sensible Medicine

The authors obtained incidence data for 34 types of cancer and mortality data for 25 types of cancer for individuals aged 25–84 years for the period Jan 1, 2000, to Dec 31, 2019 from the North American Association of Central Cancer Registries and the US National Center for Health Statistics, respectively.

Academics 103
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REBEL Cast Ep116: The CLOVERS Trial – Restrictive vs Liberal Fluids in Sepsis-Induced Hypotension

RebelEM

The secondary outcome of mortality was not statistically different however numerically favored the early use of norepinephrine. It is unclear if outcomes would have differed with different targets or allowing for lower blood pressure values Trial protocol was only for 24 hours after randomization. Liberal: 14.9% Liberal: 14.9%

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Video beats direct laryngoscopy for intubation--even for experts

PulmCCM

This outcome measure was less robust than intubation attempts, because the “failure” definition included simply switching devices, which the intubator was permitted to do at any time for any reason. Patients randomized to direct laryngoscopy were four times more likely to require multiple intubation attempts (7.6%

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The Private Equity Wave in Health Care

ACEP Now

Hahnemann University Hospital in Philadelphia closed in 2019, a year and a half after it was acquired along with St. Private equity investment in health care has increased more than 20-fold since 2000, with 70 percent of this activity since 2010. Published September 5, 2019. Published July 22, 2019. J Hosp Med.

Hospitals 113
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REBEL Cast Ep117: Low Dose vs Standard Dose Take-Home Buprenorphine From the ED

RebelEM

from 2019 to 2021 (from 48,000 to 81,400 annual deaths), which includes prescription opioids (natural and semi-synthetic opioids and methadone), heroin, and synthetic opioids other than methadone including fentanyl (1). Background Information: Opioid overdose deaths have been increasing in the past twenty years.

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Electrical injuries

Don't Forget the Bubbles

Prolonged CPR should be considered as outcomes are generally good, even if asystole is the presenting rhythm. 2000 Aug;46(1–3). The high voltage can cause direct thermal injuries, as well as mechanical injuries from falls or secondary trauma. Electrical Injuries. Chen P, Bukhman AK. Electrical and lightning injuries. In: Walls RM, ed.

Burns 80