Pediatric EM Morsels

APRIL 5, 2024

Jensenius 2004) Complications: pneumonitis, acute respiratory distress syndrome (ARDS), myocarditis, septic shock, meningoencephalitis, pericarditis, and disseminated intravascular coagulation (Xu 2017) Fatality can reach up to 70% if untreated depending on the strain. Global Change Research Program. Kyasanur Forest Disease (KFD).

CDC 161

CDC Infectious Diseases Pediatrics Wellness 161

RebelEM

SEPTEMBER 28, 2023

The STREAM-1 trial found that for [2] patients with STEMI presenting within 3 hours of symptom onset and unable to attain PCI within 1 hour of first medical contact, a pharmaco-invasive strategy resulted in similar rates of death, shock, heart failure, or reinfarction compared to primary PCI. Primary PCI: 95.7% Primary PCI: 95.7%

EKG/ECG 137

EKG/ECG Allergic Reactions Shock Stroke 137

PulmCCM

OCTOBER 14, 2024

CRISTAL , another large international randomized trial (Annane et al JAMA 2013) did not show a benefit of colloids as compared to crystalloids. Some of its initial results were presented at a 2011 conference but were never published in a journal.

Resuscitation 52

Resuscitation Shock Wellness 52

EMDocs

DECEMBER 1, 2024

Flea-Borne Typhus: Epidemiology Summary 2013-2019. Ischemic Hepatitis and Septic Shock Secondary to Murine Typhus Infection in Pregnancy. The RUSH exam: Rapid Ultrasound in SHock in the evaluation of the critically lll. Rosh Review Website Link References: Texas Department of State Health Services. Flea-Borne Typhus. Blanton LS.

EMS 82

EMS Infectious Diseases Shock Airway Management 82

Pediatric EM Morsels

FEBRUARY 2, 2024

While there is no “right” work up for these patients, hopefully this morsel will help illuminate your evaluation of Travel-Related Illness in Children: Travel-related Illness: Basics International travel has been significantly increasing since commercial airlines made travel much easier.

Infectious Diseases 161

Infectious Diseases Pediatrics Sepsis Documentation/Coding 161

Stop and Think

MARCH 31, 2024

Our main finding was that industry paid doctors more than $12 billion dollars between 2013-2022. His list of device approvals despite dodgy evidence is shocking. The influential Journal of the American Medical Association published our data this week. The numbers surprised me. B as in billions. Let me make two points. We use devices.

Research 138

Research Shock Hospitals 138

ETM Course

JUNE 28, 2015

Resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct for hemorrhagic shock. Intra-Aortic Balloon Occlusion to Salvage Patients with Life-Threatening Hemorrhagic Shocks from Pelvic Fractures J Trauma 2010; 68(4): 942–8 (full article free text) 3. J Trauma Acute Care Surg 2013; 75(3): 506–11 5.

Hospitals 52

Hospitals Resuscitation Shock Military 52

EMDocs

AUGUST 17, 2023

mL/kg/hr for 2 consecutive hours OR Decrease in serum lactate by more than 10% from initial level Primary outcome – Early norepinephrine group vs. the control group demonstrated higher rates of shock control at 6 hours: 76.1% vs 48.4% (OR 3.4, vs 48.4% (OR 3.4, vs 48.4% (OR 3.4, vs 48.4% (OR 3.4, vs 48.4% (OR 3.4,

Sepsis 67

Sepsis Shock Resuscitation Fluid Resuscitation 67

PHEM Cast

APRIL 27, 2023

– Wiles – 2017 – Anaesthesia Blood pressure management in trauma: from feast to famine?

Resuscitation 52

Resuscitation Shock Operations Hospitals 52

PEMBlog

OCTOBER 18, 2023

Neonatal Toxic Shock Syndrome C. Neonatal Toxic Shock Syndrome-Like Exanthematous Disease E. Neonatal Toxic Shock Syndrome-Like Exanthematous Disease The patient was diagnosed with Neonatal Toxic Shock Syndrome-Like Exanthematous Disease (NTED). Neonatal toxic shock syndrome-like exanthematous disease (NTED).

Infectious Diseases 59

Infectious Diseases Shock Pediatrics Wellness 59

EMDocs

NOVEMBER 13, 2024

Management: Patients can rapidly progress to septic shock and multiorgan failure. C (100° F), or if the ascitic fluid ANC is > 250 cells/mm 3 Mortality increases by 8-10% for every hour delay in antibiotics for patients with cirrhosis and septic shock. A 2013 meta-analysis found IV albumin was associated with 22.3%

Hyperthermia / Hypothermia 79

Hyperthermia / Hypothermia Ultrasounds Shock Hospitals 79

RebelEM

DECEMBER 4, 2024

PMID: 25701296 The SGEM: Shock Through the Heart (Ottawa Aggressive Atrial Fibrillation Protocol) ALiEM: Atrial Fibrillation Rate Control in the ED: Calcium Channel Blockers or Beta Blockers. Eur J Emerg Med 2013; 20: 151-9. REBEL Core Cast 132.0 – Recent-Onset AFib Click here for Direct Download of the Podcast.

Emergency Department 86

Emergency Department Stroke EMS Shock 86

Mind The Bleep

DECEMBER 19, 2023

Majority of DKA patients are in a fluid deficit and present acutely with shock. Signs of shock to be mindful for are tachycardia, hypotension, prolonged CRT, pallor, and a weak thready pulse. Fluid boluses are given according to local guidelines, but generally shocked patients should receive a 10ml/kg 0.9% Marcdante, R.

Dehydration 98

Dehydration Fluid Resuscitation Shock Resuscitation 98

PHEM Cast

JULY 14, 2016

2013 May 13;30(6):516–6. 2013 Jul 19;30(8):679–82. 2013 Dec 22;31(1):86–6. Journal of Emergencies, Trauma, and Shock. Elsevier Ltd; 2013 Jan 1;44(1):122–7. 2013 Dec 1;30(12):1067–9. 2013 May 23. : A systematic review. Elsevier Ltd; 2015 Apr 1;46(4):528–35. Smyth M, Cooke MW. The University of Warwick.

Fractures 52

Fractures Hospitals Shock Research 52

PHEM Cast

APRIL 10, 2016

One year mortality of patients treated with an emergency department based early goal directed therapy protocol for severe sepsis and septic shock: a before and after study. Arriving by Emergency Medical Services Improves Time to Treatment Endpoints for Patients With Severe Sepsis or Septic Shock. 2013 Jun;44(6):1116–25.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

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. 2013; 74: 634-8. The heart of the matter: utility of ultrasound of cardiac activity during traumatic arrest. 2012; 73: 102-10. EMJ 2017; 34: 860-900.

Resuscitation 52

Resuscitation Ultrasounds Shock CPR 52

Pediatric Emergency Playbook

APRIL 1, 2016

There are two main reasons for an elevated lactate: the stress state and the shock state. The shock state is due to tissue hypoxia, seen in septic shock. We should use lactate to detect occult shock. Children compensate so well for shock, that subtle tissue hypoxia may not be detected until later. 23: 353–360.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

EMDocs

JANUARY 11, 2025

2, 8-10, 14 The clinical symptoms range from vague abdominal pain to florid septic shock and peritonitis secondary to bowel perforation. If sepsis or septic shock is present, aggressive fluid resuscitation and empiric antibiotics covering intra-abdominal flora should be administered. Abdominal pain may be absent in up to 60%.

EMS 72

EMS Sepsis Shock Fluid Resuscitation 72

RebelEM

JANUARY 29, 2024

Am J Cardiol 2013. in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 A Randomized Trial of the Optimum Duration of Acoustic Pulse Thrombolysis Procedure in Acute Intermediate-Reisk Pulmonary Embolism: The OPTALYSE PE Trial. JACC Cardiovasc Interv 2018. PMID: 30025734 Sharifi M et al. PMID: 23102885 Aykan AC et al.

Stroke 134

Stroke Outcomes Hospitals Administration 134

EMDocs

OCTOBER 9, 2023

6 However, due to the vasoconstrictive effects, hydrocortisone may be useful in refractory shock. Published 2013 Aug 15. Corticosteroids in septic shock: a systematic review and network meta-analysis. Given its mineralocorticoid properties, hydrocortisone is traditionally used for adrenal insufficiency. 2013;9(1):30.

Basic Life Support 82

Basic Life Support CPR Fractures Emergency Department 82

Pediatric Emergency Playbook

AUGUST 1, 2020

2013 Jul-Aug; 48(4): 546–553. Pediatrics 2011; 128:e741. Casa DJ et al. The Inter-Association Task Force for Preventing Sudden Death in Secondary School Athletics Programs: Best-Practices Recommendations. J Athl Train. DeFranco MJ et al. Environmental issues for team physicians. Am J Sports Med. 2008 Nov;36(11):2226-37. Ishimine P.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Stroke Best Practices Burns 52

Taming the SRU

FEBRUARY 19, 2024

A recent observational study was performed to pragmatically assess clinically meaningful differences in BP in a diverse critically ill cohort with shock. In general, radial artery readings in patients with shock likely underestimate central pressure which can lead to increasing vasopressor dosing. PMID: 35338337. Keville, M.

Shock 59

Shock Resuscitation Ultrasounds Research 59

RebelEM

AUGUST 12, 2024

Contemp Clin Trials. Epub 2022 Aug 28. PMID: 36038001 Levi TM, et al. Comparison of the RIFLE, AKIN and KDIGO criteria to predict mortality in critically ill patients. Rev Bras Ter Intensiva. PMID: 24553510 Iacone R, et al. Macronutrients in Parenteral Nutrition: Amino Acids.

Outcomes 81

Outcomes Hospitals Operations Shock 81

PHEM Cast

FEBRUARY 23, 2017

Scand J Trauma Resusc Emerg Med 21(Suppl1):S27, 2013. In patients with penetrating trauma permissive hypotension may remain useful for longer or at least until a patient can be differentiated and the bleeding controlled. Lots to think about! References: RePhill Trial Homepage: [link] Smith IM, James RH, Dretzke J, Midwinter MJ.

Blood Transfusions 52

Blood Transfusions Head Injuries Resuscitation Radiology 52

RebelEM

JANUARY 25, 2023

Acad Emerg Med 2013; 20(6): 528-44. 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

EMDocs

JANUARY 20, 2025

Patients were enrolled in these trials if they had signs of shock, with mortality ranging from 18-29%. 13 While there is good data that early antibiotics for patients in septic shock reduce mortality 18-19 the role of early and aggressive volume resuscitation and its impacts on patient-centered outcomes remain unclear. Inwald et al.

Dehydration 40

Dehydration Fluid Resuscitation Sepsis Resuscitation 40

EMDocs

JUNE 27, 2024

Critical Care Medicine 41(12):p A191, December 2013. 2013 Jan-Mar;16(1):91-5. Epub 2013 Aug 7. May substitute levofloxacin if allergic to cephalosporin Anti-viral medications if indicated Oseltamivir for influenza Patients >14 days old Remdesivir for COVID Patients >28 days old and at least 7lbs (3.2 Niger J Clin Pract.

Pediatrics 76

Pediatrics Dehydration EMS Hospitals 76

Resus Review

FEBRUARY 14, 2015

So for typical patients, EBF/CO is not usually a problem unless the patient has a very high cardiac output as seen in liver failure, septic shock, hyperthyroidism, or severe anemia. Intensive Care Med 2013. If EBF/CO can be consistently maintained >60%, then oxygenation saturation (SaO2) is almost always >90%. References 1.

Shock 52

Shock 52

Advanced Emergency Nursing from AENJ

JANUARY 26, 2015

Holbrook MD September 01, 2013 Umbilical Cord Prolapse and Other Cord Emergencies Marybeth Lore, MD Complications of Labor and Delivery by Jeanie Ward Pulmonary Embolism: Evaluation in the pregnant patient Journal of Emergencies, Trauma and Shock, 3(1), 39. Emergency medicine international, 2013. Phelan MD, Bradley D.

OB/GYN 40

OB/GYN Ultrasounds Emergency Department Resuscitation 40

Pediatric Emergency Playbook

AUGUST 1, 2017

2013; 95(6): 474-477. 2013; 48:1789-1793. 2013; 44(1):53-57. 2013; 200:969-973. 2013; 50:54-86 Intestinal Obstruction Babl FE et al. Mercer AE, Phillips R. Can a conservative approach to the treatment of hypertrophic pyloric stenosis with atropine be considered a real alternative to pyloromyotomy? Arch Dis Child.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

Taming the SRU

SEPTEMBER 15, 2023

Limited availability of radiology-performed US services in certain hospitals, especially overnight Can avoid unnecessary anticoagulation in patients Reduce time in ED to disposition In terms of workflow, when there is suspicion for a DVT, you need to first calculate a Wells’ Score for a DVT If low/moderate risk, can start with a D-dimer prior to committing (..)

CPR 88

CPR Burns Airway Management Wellness 88

Don't Forget the Bubbles

JUNE 26, 2023

But, they may present postnatally with cyanosis/hypoxaemia due to insufficient pulmonary blood flow, cardiogenic shock due to insufficient systemic blood flow, or both. 2014;129(20):2013-2020. Affected babies are often diagnosed antenatally when they should have a fetal echocardiogram and a plan for management after birth. Circulation.

Operations 128

Operations Research Hyperthermia / Hypothermia Hospitals 128

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

An elderly man with sudden cardiogenic shock, diffuse ST depressions, and STE in aVR Literature 1. ST elevation (STE) in lead augmented vector right (aVR), coexistent with multilead ST depression, was endorsed as a sign of acute occlusion of the left main or proximal left anterior descending coronary artery in the 2013 STEMI guidelines.

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

RebelEM

JANUARY 25, 2024

R I Med J (2013). POCUS in dyspnea, nontraumatic hypotension, and shock; a systematic review of existing evidence. Emerg Med J. 2023;40(10):700-707. PMID: 37595984. Arabiat M, Foderaro AE, Levinson AT. Lung Ultrasound for Diagnosing Patients with Severe Dyspnea and Acute Hypoxic Respiratory Failure. 2019 Dec 2;102(10):34-38.

Ultrasounds 126

Ultrasounds Outcomes COPD Hospitals 126

Dr. Smith's ECG Blog

AUGUST 9, 2019

Hint: patient is in shock and was put on ECMO ST depression in aVR Here is the angiogram from Rohin's case: Case 5. 7) The 2013 ACC/AHA STEMI guidelines consider this a “STEMI equivalent,” where thrombolytic therapy is not contraindicated (Evidence level B, no specific class of recommendation).(16) Which artery? Knotts et al.

EKG/ECG 52

EKG/ECG Shock Emergency Department Wellness 52

Taming the SRU

AUGUST 30, 2023

Similarly, a 2013 meta-analysis of 6 studies with 1,006 patients published in the American Journal of Emergency Medicine showed neither CRP nor PCT are sufficient to rule-in or rule-out infective endocarditis, with PCT having a pooled sensitivity of 64% and specificity of 73% and CRP having a pooled sensitivity of 75% and specificity of 73% [40].

Infectious Diseases 87

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 87

Pediatric Emergency Playbook

FEBRUARY 1, 2016

They used REBOA for refractory hemorrhagic shock due to either blunt or penetrating injury. 2013 Sep;184(1):352-7. 2013 Jun;48(6):1377-83. Resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct for hemorrhagic shock. Brenner et al. J Surg Res. Moore HB, Moore EE, Bensard DD. J Pediatr Surg.

Resuscitation 40

Resuscitation Pediatrics Fractures Emergency Department 40