Pediatric Emergency Playbook

APRIL 1, 2016

Brain natriuretic peptide (BNP) In adults, we typically think of a BNP Luckily, we have data in children with congenital heart disease as well. This has been studied in children as well, and an elevated lactate in children – typically above 4 – was a predictor of prolonged ICU course and mortality in septic patients.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Dr. Smith's ECG Blog

OCTOBER 8, 2023

There are well formed R-waves with good voltage/amplitude which is uncommon for ischemia. There again are well for med R-waves. The patient died of cardiogenic shock within 24 hours despite mechanical circulatory support. There are also J-waves. The ECG just doesn't look ischemic. How did the Queen of Heart AI model perform?

Hyperthermia / Hypothermia 124

Hyperthermia / Hypothermia EKG/ECG Shock Wellness 124

Pediatric Emergency Playbook

OCTOBER 1, 2016

Well appearing? Consider allergic proctocolitis if the child is well. It is important to note that 15% of necrotizing enterocolitis occurs in full-term babies; malrotation can present simply in shock, without initial overt bleed. Think -- pink stain, without clot: Infants and Young Children Well appearing?

Pediatrics 52

Pediatrics Wellness Shock Resuscitation 52

Pediatric Emergency Playbook

AUGUST 1, 2017

2012; 43(1):49-51. BMJ 2012; 345:e5521. 2012; 3:247-250. 2012; 92:527-39. 2012; 30:426-431. 2012; 29:231-236 Blakely ML et al. 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.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

Don't Forget the Bubbles

JULY 26, 2023

A cardiac family history should of course be sought, but think a little outside the box as well. For anyone approaching a structured ABC would be a priority to establish whether shock was present or not. We now have a patient who is in sustained SVT but with no features of shock. Family history. What if this does not work?

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

PHEM Cast

JULY 14, 2016

Crane T, Cooke MW, Wellings R, Wayte S, Higgins J. 2012 May;37(11):937–42. Journal of Emergencies, Trauma, and Shock. Elsevier Ltd; 2015 Apr 1;46(4):528–35. Smyth M, Cooke MW. Value of a rigid collar: in need of more research and better devices. Emergency Medicine Journal. 2013 May 13;30(6):516–6. The University of Warwick.

Fractures 52

Fractures Hospitals Shock Research 52

Pediatric Emergency Playbook

JUNE 1, 2017

This child is at risk for expected complications, as well as overdiagnosis and iatrogenia. These children depend on their preload to run blood passively into the pulmonary circuit; afterload reduction is also important to compensate for a poor left ejection fraction, as well as to avoid the development of pulmonary hypertension.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

RebelEM

JANUARY 25, 2023

J Trauma Acute Care Surg 2012; 73(5): S362-9. 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. 3.6 – 55.6) (-) LR: 0.13 (0.08 – 0.20) ED US (+) LR: 9.5 (2.1

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

Pediatric Emergency Playbook

MAY 1, 2017

Home care The neonate who is safe to go home is well appearing, and not dehydrated. Make sure to enlist the family's help and support to keep Mom hydrated, eating well, and resting whenever she can. My take away: we now have some evidence basis for using filtered sunlight as an adjunct for babies well enough to go home.

Dehydration 52

Dehydration Pediatrics Wellness Seizures 52

The Skeptics' Guide to EM

MARCH 10, 2018

She has epistaxis that has not resolved despite twenty minutes of well applied anterior pressure. The American College of Chest Physicians published some evidence-based recommendations in 2012 on anticoagulation therapy [1]. shock, a bleeding visible vessel, renal disease, or lack of consent.

Blood Transfusions 40

Blood Transfusions Emergency Department Shock Hospitals 40

Don't Forget the Bubbles

OCTOBER 10, 2024

The others, such as respiratory rate, heart rate, and decompensated shock, were excluded due to the presumed difficulty for non-healthcare professionals to assess them accurately. Adopting this approach would reduce time in surgery for the child as well as the financial cost of nail bed repair. 2012 Aug 15;(8):CD004872.

Emergency Department 75

Emergency Department Outcomes Research Operations 75

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. Consider surgical causes of forceful vomiting, especially if the child does not look anything other than well. J Emerg Med.

Head Injuries 40

Head Injuries Pediatrics Shock Sepsis 40

ETM Course

MAY 3, 2017

Ft Detrick, Maryland: Borden Institute; 2012. Tourniquets also cause compression and ischaemia of the tissues directly under the cuff, which can cause neuropraxia (which may be permanent) and prolonged muscle weakness, although these are also rare complications. References: Kragh J, Kirby J, Ficke J. Extremity Injury.

Military 52

Military Shock Hospitals Operations 52

Advanced Emergency Nursing from AENJ

FEBRUARY 29, 2016

Perhaps, not insignificantly, they were accustomed to receiving systematized government-supplied medical and trauma care, with "shock rooms" receiving an influx of victims, as contrasted to those later who opposed "socialized medicine." Committee on Shock. 1950s & 1960s Resuscitation Research. Trimble, Tom, RN CEN.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

Downeast Emergency Medicine

APRIL 26, 2021

When looking at the subgroups with severe shock, there was an 18.5% When stratifying TXA administration time after injury and qualifying shock incidence, there appeared to be a lower 30 d mortality if TXA was given within 1 hour of the incident. Arch Surg 2012; 147:113-119.[ MI or stroke). J Thromb Haemost 2019;17:852-862.[

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

Dr. Smith's ECG Blog

MAY 8, 2023

There is concordant ST elevation in I, aVL with reciprocal concordant STD in inferior leads, as well as excessively discordant TE in V2-V4. Annals of Emergency Medicine 2012; 60(12):766-776. Code STEMI was activated by the ED physician based on the diagnostic ECG for LAD OMI in ventricular paced rhythm. He expired 4 days later.

EKG/ECG 52

EKG/ECG Documentation/Coding Outcomes Shock 52

Dr. Smith's ECG Blog

MARCH 15, 2023

But when you see this, you should suspect that the AV node is not well. We designed a step-up protocol in which shocks at 50, 100, 200, 300, and 360 J were used for transthoracic cardioversion. I do not know why she did not have a rapid rate.

EKG/ECG 52

EKG/ECG Dehydration Stroke Shock 52

PEMBlog

JUNE 5, 2024

2012 Jan 13;61(RR-1):1-20. Infants can get a cervical spine injury during breech delivery or, unfortunately, during non accidental trauma as well. You should also consider the possibility of quote unquote spinal shock. than it is spinal shock. MMWR Recomm Rep. PMID: 22237112. Resuscitate with volume and blood.

Fractures 52

Fractures Pediatrics Radiology Radiology 52

Mind The Bleep

FEBRUARY 7, 2024

After a red cell transfusion they have some adult Hb which shifts the curve to the right and you then need a high partial pressure of oxygen to saturate well. Well, a baby in a prone position can better equally inflate both lungs, overall compliance of the chest wall is better and the alveoli are better inflated.

Wellness 52

Wellness Sepsis Stroke Shock 52

EB Medicine

MARCH 1, 2019

Nachi: This month’s team parsed through roughly 1200 articles as well as guidelines from the eastern association for surgery in trauma also known as EAST. Consider valvular injury in any patient who appears to be in cardiogenic shock, has hypotension without obvious hemorrhage, or has pulmonary edema. Nachi: Definitely.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

Taming the SRU

AUGUST 30, 2023

As the name would suggest, inflammatory markers are biological markers of, well, inflammation. Raised inflammatory markers BMJ 2012; 344 :e454 doi:10.1136/bmj.e454 Gabay C, Kushner I. 2012 Jul 23;2(1):32. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Oncotarget.

Infectious Diseases 89

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

EMDocs

FEBRUARY 12, 2024

ABG and VBG Correlation The correlation between venous and arterial blood gases is well-documented for standard differences (Table 1), and the data obtained from the VBG can be acted on as if it were an ABG (1, 3-6). While ABGs and VBGs usually correlate well, there are a few situations where this correlation is disturbed.

Emergency Department 98

Emergency Department Resuscitation COPD Shock 98

Don't Forget the Bubbles

DECEMBER 11, 2023

Naturally, it can seem obvious to us now that abuse and trauma in childhood can affect your health and well-being quite significantly, but what was surprising at the time was not just that these events had an impact but how much of an impact these adverse childhood events had. Could there be an element of causation as well as correlation?

Wellness 104

Wellness Research Outcomes Shock 104

EMDocs

OCTOBER 5, 2024

ESBL are found exclusively in Gram-negative organisms, including: Klebsiella pneumoniae Klebsiella oxytoca Escherichia coli Proteus mirabilis Pseudomonas aeruginosa The first reported beta-lactamase enzyme was reported in 1963, and today there are well over 350 ESBL enzyme variants. IV fluid resuscitation as needed.

EMS 93

EMS Infectious Diseases Sepsis Hospitals 93

Pediatric Emergency Playbook

JANUARY 1, 2017

For example, a very anxious caregiver can easily transmit his or her anxiety to the child, which may either inhibit or amplify presentation of symptoms ( Bearden 2012 ). Tachycardia, tachypnea, and a change in behavior can be indicators not only to the presence of pain, but possibly to its etiology as well.

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

EB Medicine

AUGUST 1, 2018

Jeff: There are a shocking 22 million past-month users of marijuana in the US, followed by pain relievers at 3.8 Jeff: And the etiology of CHS is not well understood. Nachi: There is a well-studied theory here and it relates to the TRPV1 receptor that we talked about earlier. million, and cocaine at 1.9

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

Dr. Smith's ECG Blog

DECEMBER 5, 2019

J Electrocardiology 45 (2012):433-442. How well does the computer interpretation perform? -- in this case, the computer diagnosed STEMI but the patient had Fever with Brugada _ _ Fever and Brugada-- Important articles The literature below shows that fever-induced Brugada is indeed a high risk for an arrhythmic event.

EKG/ECG 52

EKG/ECG Hyperthermia / Hypothermia Seizures Documentation/Coding 52

EB Medicine

JANUARY 2, 2019

It’s noteworthy that a 2012 Cochrane review failed to find clear superiority for one strategy over another. HDS patients who are well-appearing with a pregnancy of undetermined location should be discharged with a 48h beta hcg recheck and ultrasound. Jeff: Let’s talk about the Rh status and prevention of alloimmunization.

Ultrasounds 40

Ultrasounds Radiology Radiology Infectious Diseases 40

EMDocs

JANUARY 20, 2024

Symptoms of heart failure and cardiogenic shock may develop in more severe cases. The most common findings on ECG are ST elevation , most often in the anterior precordial leads, as well as sinus tachycardia and QT interval prolongation.

EMS 93

EMS Fluid Resuscitation Shock EKG/ECG 93

EMDocs

NOVEMBER 13, 2023

2019) argue against a minimum NIHSS score to trigger the use of CTA, instead purporting that clinical suspicion of acute ischemic stroke presenting within 24 hours of the last known well was sufficient evidence to order the study. However, IgE-mediated or not, anaphylactic shock is possible in either case. 8 The data in Mayer et al.

Stroke 103

Stroke Radiology Radiology Emergency Department 103

Don't Forget the Bubbles

FEBRUARY 24, 2025

They were a well-grown, term infant born in good condition. 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. 2012 May 7;11(1):70 Berger et al. The other investigations are unremarkable, including a normal CT head.

Pediatrics 59

Pediatrics Outcomes Blood Transfusions Sepsis 59

Sensible Medicine

AUGUST 14, 2024

In popular (lay) understanding, SIDS represents a common danger that a well-cared for and apparently healthy baby will suddenly and terrifyingly be found dead in the morning. The sudden death of an apparently healthy child is a devastating tragedy, and if it’s preventable, the costs of supine sleep may be worthwhile.

CDC 94

CDC Sepsis Research Pediatrics 94

RebelEM

DECEMBER 17, 2024

You order antibiotics, an initial fluid bolus as well as blood cultures. 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 ). Am J Resp Crit Care Med 2012; 185(10): 1088-1095. Sat 93% on RA.

Sepsis 71

Sepsis Shock EMS Emergency Department 71

Don't Forget the Bubbles

FEBRUARY 17, 2025

Volume resuscitation has historically been the first-line therapy for patients in septic shock. Venous Congestion in Adult Critical Care In adults, venous congestion is a well-recognized contributor to organ dysfunction in many conditions, including septic shock and heart failure. Is more fluid the answer?

Pediatrics 78

Pediatrics Ultrasounds Shock Resuscitation 78

EMDocs

JANUARY 20, 2025

1,2 For hypervolemia in heart failure patients, orthopnea >2 pillows is the most reliable clinical finding, 3,4 though an increase in peripheral edema and increased weight can be useful as well. 6-8 In patients who are on long-term hemodialysis, typical non-invasive signs of volume assessment seem to be unreliable as well.

Dehydration 73

Dehydration Fluid Resuscitation Sepsis Resuscitation 73

Dr. Smith's ECG Blog

MARCH 8, 2025

Several 200 J shocks did not terminate the VF, so a second defibrillator was applied for double sequential defibrillation with 400 J. It is now well recognized that acute MI can precipitate takotsubo. The catheter was out of the body and the arteriotomy had been closed, so there is no pressure waveform. link] Mostofsky, E., Maclure, M.,

EKG/ECG 77

EKG/ECG CPR Resuscitation Wellness 77