Pediatric Emergency Playbook

AUGUST 1, 2020

2008 Nov;36(11):2226-37. In: Pediatric Emergency Medicine, Baren JM, Rothrock SG, Brennan JA, Brown L (Eds), Saunders Elsevier, Philadelphia 2008. J Athl Train. 2013 Jul-Aug; 48(4): 546–553. DeFranco MJ et al. Environmental issues for team physicians. Am J Sports Med. Ishimine P. Hyperthermia. Jardine DS. Heat illness and heat stroke.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Stroke Best Practices Pediatrics 52

PulmCCM

OCTOBER 30, 2023

Professional Medical Societies Call for Elimination of SEP-1 The Infectious Diseases Society of America (IDSA), along with societies for emergency medicine physicians and hospitalists, are again speaking up about the ongoing policy experiment known as the Centers for Medicare and Medicaid Severe Sepsis/Septic Shock Management Bundle (SEP-1).

Sepsis 52

Sepsis Shock Hospitals Outcomes 52

ALiEM

JUNE 5, 2023

Glucocorticoid therapy should be considered in anthrax meningitis, cutaneous anthrax with extensive tissue edema involving the head and neck, or anthrax with vasopressor-resistant shock [9]. Geneva: World Health Organization; 2008. When should you administer post-exposure prophylaxis (PEP)? Emerg Infect Dis. 2014;20(2):e130687.

Infectious Diseases 102

Infectious Diseases CDC PPE Military 102

Sensible Medicine

JULY 17, 2023

COURAGE sent shocks through the cardiology world: No difference. A year later, in 2008, COURAGE trialists published a follow-up paper looking at quality of life. The choice to name the trial COURAGE was apt as this was the heyday for PCI and stents. Rare was a cardiologist who did not stent any severe narrowings. Here is the key graph.

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Shock Outcomes 93

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

The notes now refer to the patient being in cardiogenic shock, on pressors. hours from presentation, where he was found to have an acute thrombotic LAD occlusion which was stented with resulting TIMI 3 flow, but still the patient was in severe cardiogenic shock. Time = 3 hours: the next troponin returns at 60 ng/L.

EKG/ECG 86

EKG/ECG Shock Documentation/Coding Academics 86

Thinking Critical Care

MAY 18, 2023

In 1983 I was an Englishman abroad, the London anaesthetist who was appointed to be the English anaesthetist on the Shock Team only because the outstanding candidate from Oxford had preferred to take up a job doing muscle relaxant research with Kitz and Katz in the USA. 4] The research agenda at the time was broad.

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Shock Research Sepsis Resuscitation 40

PHEM Cast

APRIL 16, 2018

The outcomes from different resuscitative interventions in a haemorrhagic shock model in porcine model: From: Watts et al. Use of CPR in hemorrhagic shock, a dog model. 2008; 64: 9-14/ The heart of the matter: utility of ultrasound of cardiac activity during traumatic arrest. 2012; 73: 102-10. EMJ 2017; 34: 860-900.

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Resuscitation Shock Ultrasounds CPR 52

EMDocs

NOVEMBER 4, 2023

Published 2008 Sep 19. 2008) ISBN:0521871123. J Emerg Trauma Shock. Scrotal abscess as a complication of perforated appendicitis: A case report and review of the literature. 2008;1(1):165. Cureus 12(7): e8991. doi:10.7759/cureus.8991 8991 ​​Schlossberg D. Clinical Infectious Disease. Cambridge Univ Pr. Insights Imaging.

EMS 68

EMS Ultrasounds Emergency Department Infectious Diseases 68

PHEM Cast

JULY 14, 2016

British Orthopaedic Association Standards for Trauma (BOAST); 2008. 2008 Apr 15;5(3):214–9. Journal of Emergencies, Trauma, and Shock. 2008 Apr 22;178(9):1141–52. BOAST2: SPINAL CLEARANCE IN THE TRAUMA PATIENT. Hauswald M, Ong G, Tandberg D, Omar Z. Out-of-hospital spinal immobilization: its effect on neurologic injury.

Hospitals 52

Hospitals Fractures Shock Research 52

EMDocs

APRIL 22, 2024

However, as shock resolved and hemodynamic stability improved, RV strain and underfilling of the LV remained apparent 30 minutes after ROSC (Vid 4). Rockville (MD): Office of the Surgeon General (US); 2008. 2008 Mar;28(3):370-2. A thin wall (diameter <5mm) is suggestive of an acute etiology”. RV pressures > LV pressures.

Ultrasounds 81

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 81

Sensible Medicine

JUNE 24, 2024

One of the most common uses of LV assist devices is cardiogenic shock due to an acute MI. Complex Regulatory History Impella was first approved in 2008 through a lax pathway wherein it was deemed sufficiently similar to a cardiac bypass pump. As I covered in April , the DANGER-Shock trial produced positive results.

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Shock Hospitals 95

Dr. Smith's ECG Blog

OCTOBER 6, 2023

His included cardiogenic shock, V Tach, AV block. de Winter et al in N Engl J Med 359:2071-2073, 2008. This poor echo can be seen even after very good reperfusion because myocardium that is still viable can be "stunned" and take weeks to recover. But the ECG is telling us that the myocardium will probably not recover.

EKG/ECG 69

EKG/ECG Academics Shock Outcomes 69

Pediatric EM Morsels

JULY 21, 2023

2008 Apr;39(4):1347-8. Epub 2008 Feb 28. Pediatric adjusted reverse shock index multiplied by Glasgow Coma Scale as a prospective predictor for mortality in pediatric trauma. Fun fact for animal lovers!- cats and dogs have their own GCS scores [Lapsley 2019, Ash 2018] Moral of the Morsel Modified can make it Merrier!

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

Pediatric Emergency Playbook

OCTOBER 1, 2015

He is in compensated shock. Pediatr Clin N Am 55 (2008) 1343–1358 Garton HJ. Pediatr Clin N Am 55 (2008) 1299–1314 Munck A et al. The Huber needle is not a resuscitative line. Obtain proper access to give fluids -- do not rely on the port-a-cath. Vascular devices are notoriously troublesome. Hydrocephalus. J Am Coll Surg.

Pediatrics 40

Pediatrics Fractures Resuscitation Burns 40

Pediatric Emergency Playbook

DECEMBER 1, 2015

It’s a high-flow artery to the face, and if disrupted, the child may have significant bleeding and possibly hemorrhagic shock. 2008; 15:988-994. Electrical Injuries: Shocking or Subtle?” The labial artery is just deep to the burn, and as the eschar sloughs off, it can be exposed. J Pediatr Surg. 2004;39(8):1233-1237. Horeczko T.

Burns 40

Burns Emergency Department EKG/ECG Shock 40

EMDocs

MARCH 11, 2024

The clinical picture of this patient was consistent with hypovolemic shock secondary to acute cholera infection. 18 Patients with signs and symptoms of severe dehydration or shock, including stupor, coma, uncontrollable vomiting, extreme fatigue that prevents drinking, and unstable vital signs should receive IV fluid resuscitation.

Dehydration 89

Dehydration CDC Rapid Diagnostic Testing Fluid Resuscitation 89

EB Medicine

JULY 8, 2019

From the 80’s to 2008, the worldwide prevalence of obesity nearly doubled! Consider performing a RUSH exam (that is rapid ultrasound for shock and hypotension) to identify the cause. From the 80’s to 2008, the worldwide prevalence of obesity nearly doubled! Additionally, back in 2010, it was estimated that 6.6% million adults!!

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

Pediatric Emergency Playbook

JANUARY 1, 2017

Topical ethyl chloride vapo-coolant offers transient pain relief due to rapid cooling and may be used just prior to an IV start ( Farion 2008 ). Needleless lidocaine injectors may facilitate IV placement without obscuring the target vein ( Spanos 2008 , Lunoe 2015 ). Unexplained tachycardia may be the early signs of shock.

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

ACEP Now

MAY 8, 2023

Question I was shocked to see bank runs in March 2023. Homeowners doing this en masse with adjustable-rate mortgages contributed to the Global Financial Crisis of 2008. I thought those went away after regulatory changes in the Great Depression.

Administration 59

Administration Shock 59

EMDocs

JANUARY 4, 2024

Cardiogenic shock and hypotension can occur (systolic heart failure with reduced ejection fraction.) 10,12 Refractory shock or malignant arrhythmias occur in < 5% of patients. 2008 Apr;51(4):412-5, 415.e1. Cardiotoxicity: Overdose can cause prolonged QRS and QTc intervals. Ann Emerg Med. doi: 10.1016/j.annemergmed.2007.06.004.

Seizures 66

Seizures EKG/ECG Poisoning Shock 66

Taming the SRU

AUGUST 30, 2023

A 2008 review in the International Journal of Medicine on spinal epidural abscess (SEA) agreed that inflammatory markers (specifically ESR and CRP) are generally sensitive in the diagnosis of SEA, but are not specific. 2008 Aug;75(8):557-66. Notably, up to 40% of patients with native vertebral osteomyelitis had a normal WBC [33-34].

Infectious Diseases 81

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 81

Pediatric Emergency Playbook

AUGUST 1, 2017

J Med Genet 2008; 45:1. J Pediatr Gastroenterol Nutr 2008; 46:13. 2008; 15-21. 2008; 22-28. 2010; 149(3):386-391. Hirschprung Disease Amiel J, Sproat-Emison E, Garcia-Barcelo M, et al. Hirschsprung disease, associated syndromes and genetics: a review. Arshad A, Powell C, Tighe MP. Hirschsprung's disease. J Pediatr Surg.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

ACEP Now

SEPTEMBER 3, 2024

billion dollars in one of the largest leveraged buyouts since the 2008 financial crisis, of which over 7 billion dollars was new debt obligation.18 He was shocked when the hospital CEO took him up on it, but a year later, volumes increased 30 percent with his emphasis on quality rather than cost-cutting.

Hospitals 52

Hospitals Radiology Radiology Administration 52

PulmCCM

OCTOBER 16, 2023

For example, a patient who presented with shock and mitral regurgitation, received a central line for vasopressors on day 0, and was found to have bacteremia from blood cultures drawn on day 3 due to endocarditis would have a CLABSI, but not a CRBSI. Many states have instituted mandatory reporting of CLABSI.

CDC 52

CDC Hospitals Ultrasounds Documentation/Coding 52

ACEP Now

SEPTEMBER 13, 2023

Dr. Prescott, currently retired, was Chief Academic Officer of the Association of American Medical Colleges from 2008-2021 where he says he worked with “every single school of medicine in the U.S.,” There was no center at the NIH that looks at emergency care as a specialty.” Washington (DC): National Academies Press (US); 1966.

EMS 45

EMS Research Academics Military 45

ETM Course

MAY 3, 2017

2008 Feb;64(2 Suppl):S38-49 Tourniquet use for civilian extremity trauma. Ft Detrick, Maryland: Borden Institute; 2012. Practical use of emergency tourniquets to stop bleeding in major limb trauma. Kragh JF Jr, Walters TJ, Baer DG, Fox CJ, Wade CE, Salinas J, Holcomb JB. J Trauma Acute Care Surg. 2015 Aug;79(2):232-7

Military 52

Military Shock Hospitals Operations 52

EMDocs

JANUARY 20, 2024

Symptoms of heart failure and cardiogenic shock may develop in more severe cases. Patients with features of shock may require vasopressors, and the decision on the specific drug hinges on the presence or absence of left ventricular outflow tract (LVOT) obstruction.

EMS 74

EMS Fluid Resuscitation Shock EKG/ECG 74

EB Medicine

MAY 3, 2019

Jeff: If those figures seem a bit high, another CDC study found that in a general population survey of a quarter million people between 2006-2008, 9% met the criteria for major depression. Jeff: And while it seems crass to even mention the financial impact, the number is shocking - suicide has an estimated economic burden of $5.4

Emergency Department 40

Emergency Department Psychiatric Documentation/Coding Outcomes 40

RebelEM

MAY 15, 2024

2008 Sep;1138:329-50. Give appropriate fluids, vasopressors, and antibiotics. Application of the MASCC and CISNE Risk-Stratification Scores to Identify Low-Risk Febrile Neutropenic Patients in the Emergency Department. Ann Emerg Med. 2017 Jun;69(6):755-764. doi: 10.1016/j.annemergmed.2016.11.007. 2016.11.007. Epub 2016 Dec 29. Freifeld, A.

Infectious Diseases 80

Infectious Diseases Administration Sepsis Anaphylaxis 80

Advanced Emergency Nursing from AENJ

SEPTEMBER 13, 2015

The weight of the fetus upon the aorta and IVC, especially when supine, embarrasses return circulation, contributes to shock, and O 2 delivery to the fetus may be sluggish. Use the NODESAT technique. Monitor oximetry and capnography. Chandrasekhar, S., Bulich, L. Topulos, G. P., & Datta, S. Airway Changes during Labor and Delivery.

Airway Management 40

Airway Management Resuscitation Critical Access Emergency Nursing 40