Don't Forget the Bubbles

NOVEMBER 29, 2023

You are the Paediatric doctor on call and receive a call for an incoming patient to the emergency department. Ben has a possible skull fracture and has been intubated, but his oxygen requirement is minimal. Tragically, several attempts at resuscitation upon arrival at the emergency department were unsuccessful.

Airway Management 135

Airway Management Emergency Department Resuscitation Psychiatric 135

RebelEM

FEBRUARY 24, 2025

RESUS SCENARIO Picture this: you just arrived at your shift at the local emergency department. just be careful with pelvic fractures or any femoral arterial punctures/ devices. Oct 2013; PMID: 24079262 Gohar E, et al. For more than just the correctness of terminology, the distensibility index should then be calculated.

Ultrasounds 74

Ultrasounds Shock Fluid Resuscitation Resuscitation 74

EMDocs

AUGUST 12, 2023

He presented to the emergency department because he is having numbness distal to the site of injury, as well as constant bleeding and some difficulty with flexing his finger. The value of ultrasound for detecting hand fractures: A meta-analysis. April 9, 2013. Examination reveals the following: What is the diagnosis?

EMS 95

EMS Fractures Operations Ultrasounds 95

Don't Forget the Bubbles

SEPTEMBER 30, 2024

In the UK, as in most developed countries, more patients are presenting to Emergency Departments (EDs) with minor illnesses or injuries. Emergency department overcrowding is a complex issue with multiple contributing factors. Learning about international trends sparked our curiosity about our own department.

Emergency Department 89

Emergency Department Research Pediatrics Hospitals 89

EMDocs

OCTOBER 9, 2023

Yoo, MD (Assistant Professor/Core Faculty, San Antonio, TX) // Reviewed by Brit Long, MD (@long_brit) Case An 18-year-old man with a history of asthma and medication noncompliance presents to the emergency department (ED) with acute onset shortness of breath. Published 2013 Aug 15. Which one do you select? 2013;9(1):30.

Basic Life Support 108

Basic Life Support CPR Fractures Emergency Department 108

Mind The Bleep

NOVEMBER 6, 2023

In this injury, there is a fracture of the orbital floor and the inferior orbital rim remains intact. The “teardrop sign” is a radiological sign of inferior orbital wall fractures in which intraorbital fat +/- inferior rectus muscle herniates through the fracture. Teardrop sign (inferior orbital wall fracture).

Fractures 52

Fractures Radiology Radiology Emergency Department 52

Taming the SRU

FEBRUARY 12, 2024

HISTORY OF PRESENT ILLNESS A female in her 30s arrives to the emergency department via emergency medical services. She arrives in the emergency department agitated and unable to answer questions appropriately. The patient is agitated on a backboard with C-collar in place. Blood Coagul Fibrinolysis. Cohen, AT et al.

Administration 80

Administration Fractures Anaphylaxis Head Injuries 80

EM Curious

JULY 24, 2015

It's a bit of a departure from what we've described above--he mainly goes right at a shaft fracture--but it's the same general idea: As always, these posts are for EDUCATIONAL PURPOSES ONLY. jps Sources Roberts and Hedges Clinical Procedures in Emergency Medicine. Academic Emergency Medicine, 20(6), 584–591. doi:10.1111/acem.12154

Fractures 52

Fractures Ultrasounds Emergency Department Dislocations 52

Don't Forget the Bubbles

OCTOBER 19, 2023

Over 1,500 children in EDs, aged 1 to 4 with acute hypoxemic respiratory failure needing hospital admission, across 14 emergency departments in Australia and New Zealand were randomly allocated 1:1 to high-flow oxygen therapy OR standard oxygen therapy (approximately 750 children in each group). An x-ray confirms a toddler’s fracture.

Head Injuries 81

Head Injuries Fractures Outcomes Hospitals 81

Taming the SRU

AUGUST 30, 2023

While PCT may be more specific for bacterial infections, it is flawed by still being rather non-specific and is not validated as a stand-alone diagnostic criteria for infection in the setting of the emergency department. In 7 studies with 4164 patients, PCT with a cut-off > 0.1 ng/mL (strongly recommended against antibiotics), 0.1-0.25

Infectious Diseases 89

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

EMDocs

JULY 11, 2023

A 2013 study found oral mucosal and head bleeding due to injury were most common in those < 6 months. Fractures and dislocations are indications for full dose factor replacement. 2013 Dec;163(6):1781-3. Other presenting bleeds were post-circumcision (27%) and heel-stick bleeds (17%). What medications should be avoided?

Head Injuries 75

Head Injuries Pediatrics Dislocations CDC 75

Mind The Bleep

NOVEMBER 6, 2023

Importance: the medial wall is thin and most easily fractured. Sight Threatening Conditions in the Emergency Department Open globe injury Key signs without needing a slit lamp: Prolapse of intraocular contents (e.g. Accessed 11.10.22 < [link] > Gardiner (2022) Overview of eye injuries in the emergency department.

Emergency Department 52

Emergency Department Dislocations Burns Fractures 52

Taming the SRU

SEPTEMBER 15, 2023

ETT onto a fiberoptic scope.

CPR 90

CPR Burns Airway Management Wellness 90

EM Guide Wire

MAY 19, 2019

Delayed Identification of Pediatric Abuse-Related Fractures. 2013; 131(4): 701-107. Detection of child abuse and neglect in the emergency room. Parents’ Opinions About a Routine Head-to-Toe Examination of Children as a Screening Instrument for Child Abuse and Neglect in Children Visiting the Emergency Department.

Pediatrics 40

Pediatrics Soft Tissue Injuries Fractures Emergency Nursing 40

The Skeptics' Guide to EM

AUGUST 5, 2023

Computerized tomography (CT) is commonly used in the emergency department in the diagnosis of TBI. Annals of Emergency Medicine 2014. Population: Children less than 18 years of age presenting with head injury to a level 2 pediatric trauma center in the United States between 2012-2013.

Head Injuries 40

Head Injuries Pediatrics Fractures Outcomes 40

Pediatric Emergency Playbook

FEBRUARY 1, 2016

Depending on the height of the child and the height of the car, the initial impact will cause a femur fracture, a pelvic fracture, or direct abdominal trauma. Pediatric emergency department thoracotomy: a large case series and systematic review. 2013 Sep;184(1):352-7. 2013 Jun;48(6):1377-83. J Pediatr Surg.

Resuscitation 40

Resuscitation Pediatrics Fractures Emergency Department 40

PEMBlog

JUNE 5, 2024

PECARN prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study. PECARN prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study.

Fractures 52

Fractures Pediatrics Radiology Radiology 52

ACEP Now

MARCH 11, 2025

A 16-year-old male presents to the emergency department (ED) with his mother with the chief complaint of intermittent abdominal pain and constipation for several weeks. Musculoskeletal complications include osteopenia with increased risk for long bone fractures. Pulmonary complications include pneumothorax and pneumomediastinum.

Emergency Department 83

Emergency Department Psychiatric Dehydration Pediatrics 83

EMDocs

NOVEMBER 16, 2024

6 Periprosthetic fracture Occurs at an estimated rate of 3.5-4.1%. 5 CT if concern for occult fracture. Periprosthetic Fractures Pain prior to injury may point toward underlying pathology like infection, implant loosening, etc. Unified classification system used to describe periprosthetic hip fractures. 10% of patients.

EMS 98

EMS Dislocations Fractures Operations 98

Pediatric EM Morsels

SEPTEMBER 1, 2023

One such vital aspect of pediatric emergency medicine is the appreciation of how psychosocial history impacts a patient’s life and care. As previously mentioned by Dr. Richardson , adolescents use the Emergency Department as their Primary Care resource often. Journal of Adolescent Health 2013; 53:S4-S12.

Pediatrics 164

Pediatrics Emergency Department Fractures EMS 164

Taming the SRU

MARCH 11, 2024

Acute knee dislocations are rare orthopedic injuries that have high morbidity and need to be recognized quickly by the emergency physician; if unrecognized or inadequately treated, these injuries can lead to vascular and limb compromise (1,2). Knee dislocations make up less than 0.5%

Dislocations 108

Dislocations Emergency Department Fractures Operations 108

Pediatric Emergency Playbook

JANUARY 1, 2017

The FPS-R uses more neutral and realistic faces and, unlike the Wong Baker scale, does not use smiling or crying faces to anchor the extremes of pain ( Tsze 2013 ). Ibuprofen may be more effective than acetaminophen (paracetamol) for odontogenic pain ( Bailey 2013 ). Author’s advice: take codeine off your formulary.

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

Don't Forget the Bubbles

JULY 22, 2024

There is an increased risk of pneumonia and sepsis in the 31-90 days after prescription and an increased risk of fractures, GI bleeds and sub-optimal growth. A Randomized Trial of Single-Dose Oral Dexamethasone Versus Multidose Prednisolone for Acute Exacerbations of Asthma in Children Who Attend the Emergency Department.

Outcomes 105

Outcomes Research Pediatrics Hospitals 105

EMDocs

NOVEMBER 13, 2023

The use of CTA (computed tomography angiography) in the emergency department (ED) has increased dramatically in the past 20 years. 23 Blunt vertebral artery injury has been found to be associated with older age, female sex, lower GCS, presence of neck pain, cervical spine fracture, and blunt carotid injury.

Stroke 105

Stroke Radiology Radiology Emergency Department 105

Taming the SRU

OCTOBER 28, 2024

Potential causes include: -Trauma: Blunt or penetrating thoracic injuries, rib fractures, esophageal rupture (Boerhaave syndrome). When should I get a consultant involved in the emergency department? 2013 Aug;5(8):460-4. 2013 Dec;206(6):1001-6; discussion 1006. West J Emerg Med. Pediatr Emerg Care.

COPD 79

COPD Pediatrics Emergency Department Ultrasounds 79

Don't Forget the Bubbles

SEPTEMBER 23, 2024

You are working in the paediatric emergency department of a busy District General Hospital. These centres have a close relationship with their patients, but this does not mean they may not turn up at your emergency department! Kidney transplant recipients have a higher risk of fractures. Any history of injury?

Pediatrics 52

Pediatrics Fractures Dehydration Sepsis 52

Mind The Bleep

SEPTEMBER 17, 2024

Introduction Patients regularly present to the emergency department with animal bites. Feel: Palpate the area of the bite to feel for areas of tenderness as this could indicate a fracture or infection. There should be a minimum of 2 views in the plain film, or 3 in the hands if there is a suspicion of a fracture.

Fractures 52

Fractures Infectious Diseases Documentation/Coding Hospitals 52