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Rebaked Morsel: Pediatric Buckle and Greenstick Forearm Fractures

Pediatric EM Morsels

Buckle Fractures: Evolving literature Multiple prospective studies have been performed using single posterior slabs, splints, braces and soft bulky bandages (Davidson, 2001. West, 2005. Plint, 2006.

Fractures 290
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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. 2001 Apr;68(4):311-4.

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Cerebral Edema and Diabetic Ketoacidosis: Rebaked

Pediatric EM Morsels

Factors associated with adverse outcomes in children with diabetic ketoacidosis-related cerebral edema. 2001 Jan 25;344(4):264-9. Is your patient hyperglycemic, acidotic, with ketonuria? Then we’ve likely got DKA. Triple bag, triple bag, triple bag! The Pediatric Emergency Medicine Collaborative Research Commitee. PMID: 12461495.

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Adjunctive Methylene Blue in Septic Shock?

RebelEM

Without larger studies and a patient centered outcome, the addition of methylene blue within 24 hours of septic shock should still not be part of a general approach but rather an adjunct in specific circumstances (i.e. NaCl over 6hrs once daily x3 doses Placebo: 500mL of 0.9% 95% CI 15.4 NaCl over 6hrs once daily x3 doses Placebo: 500mL of 0.9%

Shock 145
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Intensive blood glucose control in the ICU is not helpful (TGC-FAST trial)

PulmCCM

Hyperglycemia is associated with worse outcomes in the ICU (and in medical patients generally), so correcting it must improve outcomes … right?

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Video beats direct laryngoscopy for intubation--even for experts

PulmCCM

Video laryngoscopy was introduced in 2001 as a technique for orotracheal intubation. 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.

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An Herbal Hope: Is XBJ A Game-Changer in Sepsis Management?

RebelEM

This varies from the 2001 definition, which used SIRS criteria and was thought to overly focus on inflammation. Secondary Outcome Results: ICU mortality: placebo 20.0% The primary outcome was patient oriented. Many of the secondary outcomes were changed well after most of the data was acquired. vs. XBJ 14.4%

Sepsis 98