Pediatric Emergency Playbook

OCTOBER 1, 2017

2010; 30:76–81. Outcomes of Children Bridged to Heart Transplantation With Ventricular Assist Devices: A Multi-Institutional Study. Predictors of In-Hospital Mortality in Children After Long-Term Ventricular Assist Device Insertion. 2010; 6: 46-53. Journal of Chemical Neuroanatomy; 2011; 42: 288–296. J Pediatr Orthop.

Pediatrics 52

Pediatrics Seizures Stroke Ultrasounds 52

Taming the SRU

OCTOBER 30, 2024

female patients; those with atypical symptoms that were not abrupt or did not include chest, back, or any pain; patients with an absence of pulse deficit or hypotension; or those who initially presented to a nontertiary care hospital. Despite adherence to strict ACLS protocols, neurologic outcomes remain poor.​ R2 CPC: WITH drs.

Hospitals 52

Hospitals Emergency Department EKG/ECG Documentation/Coding 52

PHEM Cast

APRIL 10, 2016

This was the same principle as in the Rivers trial: the standard care group is the ‘control’ group against which changes in outcome for the ‘intervention’ group are compared. Severe Sepsis in Pre-Hospital Emergency Care. 2010 Apr;38(4):1045–53. 2010 Apr;14(2):145–52. 2009;13(5):R167. Am J Respir Crit Care Med.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

SheMD

MAY 11, 2023

In medical emergencies, provider qualities which lead to greater performance and patient outcomes include leadership and teamwork. What were their outcomes: Of the 182 teams analyzed, females contributed significantly less leadership statements (53% vs 76%, p=0.001) and critical treatment decisions (57% vs 76%, p=0.018). Crit Care Med.

Leadership 52

Leadership Documentation/Coding CPR Teamwork 52

Broome Docs

APRIL 6, 2023

Renal outcomes following intravenous contrast administration in patients with acute kidney injury: a multi-site retrospective propensity-adjusted analysis. 2010 Oct 5;182(14):1527-32. Epub 2010 Aug 23. Clinical Outcomes After Intensifying Antihypertensive Medication Regimens Among Older Adults at Hospital Discharge.

Sepsis 52

Sepsis Ultrasounds Hospitals Fractures 52

Don't Forget the Bubbles

JUNE 26, 2023

Staged reconstructions are a topic in itself (click here for a nice summary by Children’s Hospital of Philadelphia), but here we focus on Stage 1. These cases illustrate some of the common issues associated with each shunt type, but what does the evidence say about outcomes? Stage 1 is performed in the first days of life.

Operations 128

Operations Research Hyperthermia / Hypothermia Hospitals 128

RebelEM

JANUARY 19, 2023

However, management continues to be debated and may lead to unnecessary hospitalization. PMID: 32622394 Clinical Question: Can ambulatory management of patients with primary spontaneous pneumothorax reduce the length of hospitalization? Control: Standard treatment as per the 2010 BTS Pleural Guidelines. 2020;396(10243):39-49.

Outcomes 52

Outcomes Hospitals Research EMS 52

RebelEM

MARCH 23, 2023

REBEL Cast Ep115 – Phenobarbital vs Lorazepam in Alcohol Withdrawal Click here for Direct Download of the Podcast Clinical question : Is a phenobarbital-based or lorazepam-based alcohol detoxification protocol associated with a lower hospital length of stay compared to Ativan for alcohol withdrawal? Paper : Hawa F et al.

Emergency Department 52

Emergency Department Outcomes Burns Hospitals 52

Pediatric Emergency Playbook

AUGUST 1, 2017

2010; 26:769-781. 2010; 149(3):386-391. Does Functional Outcome Improve with Time Postsurgery for Hirschsprung Disease? Single-stage versus multi-stage pull-through for Hirschsprung's disease: practice trends and outcomes in infants. Management of the child after enema-reduced intussusception: hospital or home?

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

ACEP Now

NOVEMBER 7, 2023

Out-of-hospital cardiac arrest unfortunately occurs relatively commonly and emergency physicians must be equipped to diagnose and treat this rapidly. The primary outcome was survival to hospital discharge. Improvement of out-of-hospital cardiac arrest survival rate after implementation of the 2010 resuscitation guidelines.

Resuscitation 52

Resuscitation Hospitals Shock CPR 52

PulmCCM

JANUARY 24, 2024

Background Therapeutic hypothermia, later rebranded as targeted temperature management, became a standard post-cardiac arrest therapy for comatose patients after two 2002 NEJM trials ( n=273 and n=77 ) suggested reducing core temperature to 32°C to 34°C markedly improved neurologic outcomes and survival.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Outcomes Hospitals Stroke 52

RebelEM

JANUARY 23, 2023

Despite being highly effective in treating acute allergic reactions, first-generation H1 antihistamines cross the blood-brain barrier and bind to H1 receptors, which can lead to undesirable side effects, including drowsiness, sedation, fatigue, and decreased cognition (Church MK 2010). 2010 Apr;65(4):459-66. Epub 2010 Feb 8.

Allergic Reactions 52

Allergic Reactions Anaphylaxis Emergency Department Urgent Care 52

Taming the SRU

JANUARY 29, 2024

Hospital Course The patient was initiated on a therapeutic heparin drip in the emergency department with vascular surgery consultation. She had improvement of the swelling in her left arm with return of sensation and function during her five-day hospital course. Epub 2010 Feb 6. Vasc Endovascular Surg. 2016 Feb;50(2):98-101.

Emergency Department 94

Emergency Department Fractures Hospitals Operations 94

RebelEM

MARCH 27, 2023

Ventilator-associated lung injury and inflammation can occur even during short-term mismanagement can worsen patient outcomes. 2 Finally the settings initiated early in a patient’s care are often carried forward unchanged into their hospital and ICU stay. J Crit Care. REFERENCES: Acute Respiratory Distress Syndrome Network et al.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

Northwestern EM Blog

FEBRUARY 14, 2022

The primary outcome of the study was the response in MAP three hours after the start of angiotensin II infusion. It showed improvement in blood pressure which is a clinically important parameter but not a patient-oriented outcome. However, one limitation of the study was that it was underpowered to demonstrate a mortality difference.

Shock 52

Shock Resuscitation Fluid Resuscitation Sepsis 52

Don't Forget the Bubbles

MAY 28, 2024

Advances in understanding the pathophysiology and treatment have improved outcomes, yet PPHN is still associated with significant morbidity and mortality. Great Ormond Street Hospital. Ongoing research and innovation are critical to develop strategies to reduce disease burden further. Early identification is key! References Keller, R.

Sepsis 52

Sepsis Ultrasounds Pediatrics Research 52

Dr. Smith's ECG Blog

FEBRUARY 8, 2015

There was a good outcome. We believe this represents a form of “toxicomythology” given the millions of doses of beta -blockers administered in the past to patients with hyperadrenergic states, and a paucity of evidence of adverse outcomes (12). Henry Ford Hospital. Henry Ford Hospital. Hollander, J. de Lemos, J.

Seizures 52

Seizures Administration Outcomes Hospitals 52

Pediatric Education

APRIL 24, 2023

He had been born at another hospital and this was his first visit. 50 per 10,000 live births from various time periods including 1964-2010. Long-term outcome of urethral and genital reconstruction in hypospadias and exstrophy-epispadias complex. Patient Presentation A 2-week-old male came to clinic for his well-child care.

Pediatrics 40

Pediatrics Wellness Outcomes Hospitals 40

Taming the SRU

FEBRUARY 19, 2024

This has been the central question of many research projects with variable outcomes. Arterial lines require specialized monitoring and nursing resources which are not available in all hospital settings. Additionally, environmental factors such as movement, noise, vibrations can make these readings less accurate. link] Lucet, J.

Shock 59

Shock Resuscitation Ultrasounds Research 59

Taming the SRU

AUGUST 30, 2023

In a small study involving 79 hospitalized children, PCT was found to be elevated in bacterial infections, with a decrease after appropriate antibiotic therapy, and decreased in viral infections [24]. Critical Care Medicine 38():p S26-S34, February 2010. | . + Procalcitonin (PCT) Etiology: PCT was first discovered in 1984.

Infectious Diseases 89

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 89

EB Medicine

AUGUST 6, 2019

Nachi: However, in 2010, the FDA approved the first DOAC, a real game-changer. In the end, they reported similar rates of recurrence and bleeding outcomes for acute treatment. Interestingly, one retrospective study found limited agreement between EMS records and hospital documentation on current DOAC usage. of patients per year.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

Pediatric EM Morsels

SEPTEMBER 20, 2024

HUS findings: Microangiopathic hemolytic anemia , Renal failure , and Thrombocytopenia The most dreaded outcomes of HUS include need for renal replacement therapy both short and long term and unfortunately death. It is critical to detect HUS early in its disease course to ensure the best outcomes. 2010 May;49(5):418-21.

Pediatrics 164

Pediatrics Ultrasounds Dehydration Emergency Department 164

The Skeptics' Guide to EM

JULY 2, 2023

Emergency Medical Services (EMS) calls in ahead of time to warn the facility that they are 20 minutes out, to give report about the patient, and ask whether they should give tranexamic acid (TXA) pre-hospital. Most of the times the RCTs we critically appraised did not demonstrate superiority for their primary outcome.

EMS 145

EMS Outcomes Hospitals Research 145

RebelEM

MAY 25, 2023

vs 3U) but no difference in mortality (Study not powered for this outcome) Clinical Take Home Point: The use of vasopressors is controversial and requires a nuanced approach SUMMARY OF MINIMIZING IATROGENIC INJURY RESTORE PERFUSION VOLUME REPLACEMENT Blood Products >>> Crystalloids Holcomb JB et al. NEJM 1994. [2]

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

RebelEM

JANUARY 29, 2024

in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 to 4.0mg/hr typically given in EKOS therapy (See Below). to 4.0mg/hr typically given in EKOS therapy (See Below).

Stroke 136

Stroke Outcomes Hospitals Administration 136

Taming the SRU

OCTOBER 1, 2023

As these patients are typically already at a high risk for poor health outcomes, secondary spontaneous PTX is often more serious in presentation and management more complex [11]. May be considered first line in the future however results may be dependent upon provider training and hospital resources [17].

Fractures 96

Fractures COPD Hospitals Emergency Department 96

EMDocs

JUNE 8, 2023

and 9 hours after onset of symptoms, with non-infarcted brain tissue, does the administration of alteplase improve functional outcome at 90 days? and 9 hours of symptom onset; stroke symptoms that started during sleep were assumed to have started halfway between the actual last known well and the time of wake-up. Intervention: Alteplase 0.9

Stroke 98

Stroke Administration Documentation/Coding Outcomes 98

ACEP Now

SEPTEMBER 3, 2024

Hahnemann University Hospital in Philadelphia closed in 2019, a year and a half after it was acquired along with St. Christopher’s Hospital for Children by private equity (PE) firm Paladin Healthcare Capital for 170 million dollars. Christopher’s was able to find a buyer prior to bankruptcy but Hahnemann could not.

Hospitals 113

Hospitals Radiology Radiology Emergency Department 113

RebelEM

MAY 22, 2023

In 2010, the United States Food and Drug Administration (FDA) granted approval for intravenous (IV) acetaminophen as a pain management option. The Canadian Journal of Hospital Pharmacy. Background: The geriatric patient population is at high risk for undertreatment of pain (Hwang et al. 2015;68(3).

Emergency Department 90

Emergency Department Administration Dislocations Hospitals 90

RebelEM

MAY 15, 2024

Follow your hospital’s protocol (if available). High Risk Patients will need hospitalization and IV antibiotics. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america, Clinical Infectious Diseases, 2011, 52(4):e56-93.

Infectious Diseases 98

Infectious Diseases Administration Sepsis Anaphylaxis 98

RebelEM

JUNE 19, 2023

PMID: 37314244 Clinical Question: In advanced trauma systems, does prehospital administration of TXA increase the rate of survival with a favorable neurologic outcome in patients at risk for trauma-induced coagulopathy? Primary Results Patients enrolled from 15 emergency medical services at 21 hospitals across 3 countries over 7 years.

Blood Transfusions 105

Blood Transfusions Outcomes Administration Hyperthermia / Hypothermia 105

ACEP Now

AUGUST 28, 2024

John Hospital in Detroit, MI, did not resolve their concerns about working conditions, staffing levels, or patient safety. But emergency doctor Michelle Wiener, MD, president of the striking union, Greater Detroit Association of Emergency Physicians, said she quickly started to notice some changes around the hospital. Markey (D-Mass.)

Emergency Department 98

Emergency Department Hospitals Patient Safety Leadership 98

EMDocs

JUNE 1, 2023

Take Aways: The data do not suggest that targeted hypothermia improves neurological function, reduces death, or reduces hospital length of stay as compared to normothermia. Bradycardia: 18.8% Average ventilator days (8.3 Bradycardia: 18.8% Average ventilator days (8.3 Bradycardia: 18.8% Average ventilator days (8.3 Bradycardia: 18.8%

Hyperthermia / Hypothermia 83

Hyperthermia / Hypothermia Outcomes Hospitals Emergency Department 83

Dr. Smith's ECG Blog

JUNE 27, 2024

A reliable study would keep track of all patients with shockable arrest and analyze the ones who were not enrolled to see their outcomes. Do not disregard the initial 12 lead ECG after out-of-hospital cardiac arrest: It predicts angiographic culprit despite metabolic abnormalities. This study failed to do so. 5% vs. 58%!!

Resuscitation 112

Resuscitation EKG/ECG Outcomes Hospitals 112

Sensible Medicine

APRIL 16, 2024

The only problem is that all these people were smokers, and they were not being followed for major adverse cardiovascular events (cardiovascular death, nonfatal MI, nonfatal stroke, or hospitalization for unstable angina -- MACE) which is what we use ASCVD to predict.

Radiology 97

Radiology Radiology Stroke Hospitals 97

The Skeptics' Guide to EM

OCTOBER 17, 2020

Effect of Out-of-Hospital Tranexamic Acid vs Placebo on 6-Month Functional Neurologic Outcomes in Patients With Moderate or Severe Traumatic Brain Injury. Background: The CRASH-2 trial, published in 2010, showed a 1.5% Reference: Rowell et al. Other injuries appear minimal with some abrasions from the fall.

EMS 52

EMS Head Injuries Outcomes Hospitals 52

RebelEM

SEPTEMBER 26, 2022

There was no statistically significant difference in failure to control bleeding by day 5 or failure to prevent rebleeding after day 5, total hospital length of stay in the first admission, total ICU and hospital length of stay up to 42 days, or 5 and 42-day mortality rates between the two groups.

Resuscitation 52

Resuscitation Blood Transfusions Outcomes Hospitals 52