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

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. Resistance provided by this pathway will have a marked bearing on how well-balanced the circulation is – it is the primary determinant of PVR. 2014;129(20):2013-2020.

Operations 128

Operations Research Hyperthermia / Hypothermia Hospitals 128

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. Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

RebelEM

JANUARY 25, 2024

CHF, in particular, lends itself well to diagnosis and treatment with PoCUS, as it readily reveals the presence of B lines. R I Med J (2013). POCUS in dyspnea, nontraumatic hypotension, and shock; a systematic review of existing evidence. Furthermore, the serial US group included more patients with conditions detectable with US.

Ultrasounds 129

Ultrasounds Outcomes COPD Hospitals 129

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

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

The Skeptics' Guide to EM

MARCH 10, 2018

She has epistaxis that has not resolved despite twenty minutes of well applied anterior pressure. Zahed et al did a randomized control trial (RCT) in 2013 on using TXA for the treatment of anterior epistaxis [2]. shock, a bleeding visible vessel, renal disease, or lack of consent.

Blood Transfusions 40

Blood Transfusions Emergency Department Shock Hospitals 40

Taming the SRU

AUGUST 30, 2023

As the name would suggest, inflammatory markers are biological markers of, well, inflammation. A 2013 meta-analysis of 30 studies including 3,244 patients published in The Lancet found PCT to have a pooled sensitivity of 77% and specificity of 79% for sepsis in critically ill patients [52]. 2013 Jun 15;13:272. Epub 2013 Feb 1.

Infectious Diseases 89

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

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Authors' commentary: Cardiogenic shock in the setting of severe aortic stenosis. This patient’s severe aortic stenosis (AS) and associated severe cardiogenic shock likely created the ECG pattern, resulting in a very difficult challenge for our inpatient team. Fundamentally, cardiogenic shock is an issue of decreased cardiac output.

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

Dr. Smith's ECG Blog

JUNE 1, 2020

COMPARE ECG #1 with ECG #2: I think the easiest way to make the case for Pleomorphic VT is to compare the 2 tracings in Figure-3: I took ECG #2 in Figure-2, from the October 12, 2013 post in Dr. Smith’s ECG Blog. Pleomorphic VT is less well known than the other morphologic forms of VT. WHY CARE about QRS Morphology with VT?

EKG/ECG 52

EKG/ECG Resuscitation Shock Outcomes 52

Pediatric Emergency Playbook

SEPTEMBER 1, 2015

The combination of abnormalities determines the category of pathophysiology: respiratory distress, respiratory failure, CNS or metabolic problem, shock, or cardiopulmonary failure. Does this child look volume depleted? Endocrine Emergencies - Could this be congenital adrenal hyperplasia with low sodium, high potassium, and shock?

Seizures 40

Seizures Sepsis Pediatrics Shock 40

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

EB Medicine

JULY 8, 2019

Jeff: Well that’s kind worrisome. Which again reiterates why this is such an important topic for us as EM clinicians to be well-versed in. Jeff: Do note, however that 2013 guidelines do not recommend one procedure over another and leave that decision up to local surgical expertise, patient specific risk factors, and treatment goals.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

PEMBlog

OCTOBER 2, 2024

2013-0421 Tighe M, Afzal NA, Bevan A, et al. Children with respiratory conditions and chronic lung disease like asthma are more prone to GERD as well. So, the parents may say, well, he Doesn’t ever seem full. Well, baby doesn’t know how to be full. So celiac disease can cause dyspepsia symptoms as well.

Pediatrics 52

Pediatrics Emergency Department Ultrasounds Wellness 52

Mind The Bleep

APRIL 20, 2024

Cyanosis can be peripheral, central or both and it can be seen in cases of shock and cyanotic congenital heart disease. [see Figure 2] Colour: Observe for any cyanosis, pallor, or mottling Cyanosis is when there is a blue discolouration of the skin and mucous membranes either due to poor circulation or poor oxygenation of the blood.

Shock 52

Shock Wellness 52

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

Given her tachycardia and episodes of syncope, the patient was judged to be in compensated obstructive shock with very high risk of imminent decompensation. 2013 Sep;26(9):965-1012.e15. There appears to be some ST elevation in leads II and aVF, as well as to a lesser extent in the lateral chest leads. J Am Soc Echocardiogr.

EKG/ECG 40

EKG/ECG Ultrasounds Documentation/Coding COPD 40

EB Medicine

AUGUST 6, 2019

Nachi: Well, I’m sure more of those studies are still coming. Nachi: Well that was a ton of information and background on the DOACs. Jeff: That is simply shocking! Nachi: But do note that the literature directly comparing the DOACs is far more limited and mostly of poor quality. Jeff: Agree. Let’s get started with some basics.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

Pediatric EM Morsels

NOVEMBER 3, 2023

With concern for malaria, it is very important to identify who is non-immune and semi-immune as this can affect both the timeframe for illness after departure from the endemic country as well as severity of illness. 2013 Sep 4; 89(3): 527–530. falciparum parasitemia , and no other defined cause of AMS (WHO 2023). Am J Trop Med Hyg.

Seizures 281

Seizures Pediatrics CDC Infectious Diseases 281

Taming the SRU

MARCH 30, 2023

Diastolic shock index and clinical outcomes in patients with septic shock. O: There was an association between increased diastolic shock index score and mortality at 90 days and performed similarly to more advanced measures of morbidity and mortality in septic shock including lactate levels and SOFA scores.

Shock 52

Shock Outcomes Sepsis Resuscitation 52

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 138

EKG/ECG Allergic Reactions Shock Stroke 138

RebelEM

MAY 15, 2024

The loss of these cells leads to immunosuppression as well as decreased responsiveness of the immune system as a whole Patients with neutropenia will not only get very sick very quickly, but also will have blunted immune response and may not localize signs of infection well Fever or malaise may be their only presenting symptoms.

Infectious Diseases 101

Infectious Diseases Administration Sepsis Anaphylaxis 101

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

AUGUST 12, 2024

Thus further adding to the well known safety of amino acid infusions The lack of a diversified patient population in combination with having used only one type of amino acid formulary greatly limits this study’s generalizability. Contemp Clin Trials. Epub 2022 Aug 28. PMID: 36038001 Levi TM, et al. Rev Bras Ter Intensiva.

Outcomes 81

Outcomes Hospitals Operations Shock 81

Dr. Smith's ECG Blog

AUGUST 9, 2019

His comments/questions are inserted below the ECG: A 50-something woman presented with 3 days of intermittent chest pain that became worse on the day of presentation, with diaphoresis and radiation to the left arm, as well as abdominal pain. baseline LVH, demand ischemia secondary to respiratory failure, aortic stenosis, hemorrhagic shock).

EKG/ECG 52

EKG/ECG Shock Emergency Department Wellness 52

Advanced Emergency Nursing from AENJ

JANUARY 26, 2015

All went well. 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.

OB/GYN 40

OB/GYN Ultrasounds Emergency Department 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. Consider surgical causes of forceful vomiting, especially if the child does not look anything other than well.

Head Injuries 40

Head Injuries Pediatrics Shock Sepsis 40

Pediatric Emergency Playbook

FEBRUARY 1, 2016

Protocols work well for adults, but trauma in children requires that we exercise our clinical muscles just a bit more. 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. Traumatized children need your full attention. Brenner et al.

Resuscitation 40

Resuscitation Pediatrics Fractures Emergency Department 40

PEMBlog

JUNE 5, 2024

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. And hypotension, bradycardia, or temperature instability can result from hemorrhagic and or spinal shock.

Fractures 52

Fractures Pediatrics Radiology Radiology 52

ACEP Now

OCTOBER 10, 2023

Goal-directed resuscitation for patients with early septic shock. link] Published June 30, 2013. ARISE Investigators; ANZICS Clinical Trials Group; Peake SL, et al. N Engl J Med. 2014;371(16):1496-506. The adventure of the cardboard box. EMCrit website. Accessed September 17, 2023. Spiegel R. Published November 10, 2014.

Outcomes 52

Outcomes Stroke Emergency Department Hospitals 52

Pediatric Emergency Playbook

MARCH 1, 2016

On arrival, he was in compensated shock, with tachycardia. Adults tolerate hypotension relatively well, and is sufficient until we send them to the OR or interventional radiology suite. 2013 Sep;184(1):352-7. 2013 Nov;206(5):655-60. 2013 Jun;48(6):1377-83. He decompensates and needs blood. J Surg Res.

Resuscitation 40

Resuscitation Pediatrics Hyperthermia / Hypothermia Operations 40

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. 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

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." 10/20/2013. Committee on Shock. 1950s & 1960s Resuscitation Research.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

PHEM Cast

SEPTEMBER 6, 2017

Qvigstad et al showed in again in Resuscitation in 2013, confirming inter-individual variation in effectiveness of CPR using ETCO2 as a surrogate for CO Trauma Deakin et al. (J. H Spontaneously breathing carbon dioxide waveforms where phase III is not well delineated. I Dual capnogram in one lung transplantation patient.

CPR 52

CPR Resuscitation Operations Wellness 52

Rural Doctors Net

AUGUST 30, 2013

I’d raise here the concept of his ‘anticipated clinical course’ – he’s going to OT and has airway injury that will likely progress – so you might as well intubate on these grounds alone. Sure he’s got a traumatic amputation – your tourniquet has arrested the bleeding, but there may well be more blood loss.

Burns 52

Burns Hospitals Wellness Ambulance Services 52

Don't Forget the Bubbles

JANUARY 10, 2024

These were presented as hazard ratios and included fever at presentation, previous transfusion ever, haemoglobinuria, malaria, sickle cell disease on enrolment, HIV, evidence of sepsis, malnutrition, shock, hypothermia, and dehydration. Groups were well matched at baseline. Geneva: World Health Organization; 2013.

Blood Transfusions 78

Blood Transfusions Research Outcomes Hospitals 78

Advanced Emergency Nursing from AENJ

MAY 3, 2014

Although told several times, the story of the development by Henning Ruben of the prototypical modern manual resuscitator, the self-refilling bag with unidirectional non-rebreathing valves which now dominate the world of resuscitation, is still not well-known. Committee on Shock. What were its recent antecedents? National Academies.

Resuscitation 40

Resuscitation Military Operations Emergency Nursing 40

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