Pediatric Emergency Playbook

AUGUST 1, 2017

2012; 43(1):49-51. BMJ 2012; 345:e5521. 2012; 3:247-250. 2012; 92:527-39. Intestinal Malrotation – Not Just the Pediatric Surgeon’s Problem. J Am Coll Surg. 2004; 199(4):628-635. Lee HC et al. Intestinal Malrotation and Catastrophic Volvulus in Infancy. J Emerg Med. Martin V, Shaw-Smith C. Pediatr Surg Int. Dias SC et al.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

RebelEM

JANUARY 25, 2023

Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43 Absent bowel sounds Peritoneal signs (i.e. rebound and guarding) Diagnostics Laboratory Tests Commonly ordered lab tests (i.e. 2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

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.

Shock 40

Shock Research Sepsis Resuscitation 40

Pediatric Emergency Playbook

JANUARY 1, 2016

Be aware that later stages of malrotation may present as shock – they present in hypovolemic shock due to third-spacing from necrotic bowel and/or septic shock from translocation or perforation. Think meningitis, UTI, or sepsis. Effortless tachypnea may be a sign of acidosis or sepsis. 2012; 43(1): e49–e51.

Head Injuries 40

Head Injuries Pediatrics Shock Sepsis 40

Pediatric Emergency Playbook

MAY 1, 2017

He will be dehydrated – possibly in shock. Check the bilirubin in any neonate you are working up for sepsis. 2012; 129(4). 2012 Aug;130(2):e352-7. My take away: we now have some evidence basis for using filtered sunlight as an adjunct for babies well enough to go home. He will be irritable. J Clin Neonatol. Pediatrics.

Dehydration 52

Dehydration Pediatrics Wellness Seizures 52

Mind The Bleep

FEBRUARY 7, 2024

Lung perfusion can be decreased by pulmonary hypertension, high pulmonary vascular resistance, massive pulmonary embolus (very rare in neonates), air embolism, shock with reduced blood flow and bronchopulmonary dysplasia with pulmonary hypertension. References Biorender. 2023, December 20th). Alveolar Gas Exchange Template.

Wellness 52

Wellness Sepsis Stroke Shock 52

EMDocs

OCTOBER 5, 2024

4 The incidence of ESBL-E identified in bacterial cultures in the United States increased by 53% from 2012 to 2017. 8 Workup and Diagnosis Evaluation should be tailored to the patient presentation, but may include studies such as: CBC, CMP, UA, lactate (if concern for sepsis), Cultures (blood, urine, etc.)

EMS 97

EMS Infectious Diseases Sepsis Hospitals 97

Taming the SRU

APRIL 26, 2023

Classification of sepsis, severe sepsis and septic shock: the impact of minor variations in data capture and definition of SIRS criteria. Intensive Care Med 2012. Heat-Related Illnesses. Am Fam Physician 2019; 99:482. Klein Klouwenberg PM, Ong DS, Bonten MJ, Cremer OL. Pileggi DJ, Cook AM. Neuroleptic Malignant Syndrome.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Emergency Department Stroke Sepsis 52

PulmCCM

SEPTEMBER 23, 2021

Guarracino F, Ferro B, Morelli A, Bertini P, Baldassarri R, Pinsky MR: Ventriculoarterial decoupling in human septic shock. Landesberg G, Gilon D, Meroz Y, Georgieva M, Levin PD, Goodman S et al : Diastolic dysfunction and mortality in severe sepsis and septic shock. European heart journal 2012, 33(7):895-903.

Stroke 40

Stroke Sepsis Shock Ultrasounds 40

Don't Forget the Bubbles

FEBRUARY 24, 2025

Because of this possible diagnosis, they were commenced on a macrolide antibiotic (azithromycin) in addition to treatment for neonatal sepsis +/- meningitis (ceftriaxone and acyclovir). We know that vaccination is key for protection, as there were 63 deaths in just one year before the vaccination was recommended in pregnancy in 2012.

Pediatrics 59

Pediatrics Outcomes Blood Transfusions Sepsis 59

Sensible Medicine

AUGUST 14, 2024

In his work, Dr. Goldwater describes a kind of toxic-shock (cytokine) reaction in the body that results from the combination of a cold virus plus being infected with a common bacterium—each pathogen relatively harmless on its own but deadly together. This sort of sepsis would produce many of the common autopsy findings.

CDC 88

CDC Sepsis Research Pediatrics 88

RebelEM

DECEMBER 17, 2024

Bottom Line Up Top: There doesnt appear to be a morbidity or mortality benefit to treating fever in sepsis and fever may have a protective effect. A large observational study of > 2000 patients found an association with fever at presentation and ICU survival for patients with severe sepsis or septic shock ( Sunden-Culberg 2017 ).

Sepsis 75

Sepsis Shock EMS Emergency Department 75

Taming the SRU

OCTOBER 31, 2024

Development of a New Screening Tool for Pediatric Septic Shock. Ann Emerg Med 2024; Big Picture Current screening tools for pediatric septic shock and sepsis are highly specific but lack sensitivity. A Brief Sepsis Overview Sepsis is a topic that is ever changing in the literature.

Sepsis 72

Sepsis Shock Pediatrics Administration 72

EMDocs

JANUARY 20, 2025

Sepsis There has been much controversy over the last two decades around the various nuances of volume resuscitation in ED patients with suspected sepsis, much of which goes beyond the scope of this limited review. Patients were enrolled in these trials if they had signs of shock, with mortality ranging from 18-29%. Inwald et al.

Dehydration 75

Dehydration Fluid Resuscitation Sepsis Resuscitation 75

Don't Forget the Bubbles

FEBRUARY 17, 2025

He has received 20ml/kg in 5 to 10ml/kg aliquots in the ED, as his blood pressure keeps dropping, and the ED team is concerned about possible sepsis. Volume resuscitation has historically been the first-line therapy for patients in septic shock. septic shock, oncology patients), or where RV function may be compromised [19, 20] (e.g.

Pediatrics 78

Pediatrics Ultrasounds Shock Resuscitation 78

PulmCCM

MARCH 28, 2025

For patients in septic shock, norepinephrine has been recommended as the first vasopressor to be infused. In 2021, the Surviving Sepsis Campaign issued a weak recommendation that vasopressin also be infused when the dose of norepinephrine is between 0.25 and 0.5 µg/kg/min (17.5 to 35 mcg/min in a 70 kg person). doi: 10.1001/jama.2025.3046.

Shock 40

Shock Sepsis Administration Outcomes 40