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. Third times the charm! Am J Trop Med Hyg. PMID: 23857021 Centers for Disease Control.

Seizures 281

Seizures Pediatrics CDC Infectious Diseases 281

Emergency Medicine Cases

NOVEMBER 7, 2017

Yet according to a 2013 Medscape survey, 40% of physicians reported burnout in U.S. In this episode, Sara Gray and Chris Trevelyan present an honest approach to preventing burnout and promoting wellness, outlining strategies both at the individual and systems levels.

Wellness 52

Wellness EMS 52

EMDocs

DECEMBER 18, 2024

2013; 88(9): 589-595. fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold Alcohol withdrawal syndrome in medical patients. Cleve Clin J Med. 2016; 83(1): 67-79. Muncie H, Yasinian Y, Oge L. Outpatient management of alcohol withdrawal syndrome. Am Fam Physician. 2014; 28(5): 401-410.

Seizures 105

Seizures Hyperthermia / Hypothermia Emergency Department EMS 105

RebelEM

FEBRUARY 24, 2025

Well, the established cutoff for the distensibility index is 18%. July 2013; PMID: 23774337 Cavallaro, F et al: Diagnostic accuracy of passive leg raising for prediction of fluid responsiveness in adults: systematic review and meta-analysis of clinical studies. Oct 2013; PMID: 24079262 Gohar E, et al. Why does it matter?

Ultrasounds 74

Ultrasounds Shock Fluid Resuscitation Resuscitation 74

EMDocs

JANUARY 11, 2025

Well keep it short, while you keep that EM brain sharp. Admission allows for close monitoring, given the risks of perforation, ischemic bowel, and ulceration, as well as appropriate management of the condition and patient symptoms. A 73-year-old female is brought in by EMS for abdominal pain, vomiting, and weakness for two days.

EMS 98

EMS Sepsis Shock Fluid Resuscitation 98

Ken Grauer, MD

AUGUST 18, 2023

The premature P waves preceding each of the even-numbered beats in Figure-3 are not well seen in the long lead II rhythm strip. A DDENDUM ( 8/19/2023 ) In the following 3 Figures — I post written summary from my ACLS-2013-ePub regarding the basics of Aberrant Conduction. PEARL # 4: Twelve leads are better than one.

EKG/ECG 195

EKG/ECG Dehydration Wellness 195

The Trauma Pro

OCTOBER 4, 2024

years from 2013 to 2016. And unfortunately, I’m not able to guess the numbers well enough to do the power calculation for this study. Be sure to follow with your performance improvement program to make sure that they actually do work as well as you think! Did they have the statistical power to show such a difference?

Pediatrics 113

Pediatrics Outcomes Operations Emergency Department 113

Ken Grauer, MD

JULY 22, 2023

Not only is this slight ST elevation missing from leads V2,V3 in ECG #1 — but the ST segment in these leads ( as well as in neighboring leads V1; and V4,V5 ) is distinctly flat! PEARL # 1: Normally, there will be slight, upward sloping ST elevation in anterior leads V2 and V3. I wish we had cath confirmation on these 2 cases. =

EKG/ECG 195

EKG/ECG Burns EMS Wellness 195

The Skeptics' Guide to EM

JULY 8, 2023

She looks well enough to go home but asks if she should be prescribed oseltamivir (Tamiflu) because some of her friends have been given it recently by their doctors. Safety issues popped up soon after widespread use of the drug including neuropsychiatric effects as well as the more common adverse effects of nausea and vomiting.

CDC 108

CDC Hospitals EMS Emergency Department 108

Ken Grauer, MD

APRIL 23, 2023

S T- T Wave Changes — There is coved ST elevation in high-lateral leads I and aVL — as well as in lead V2 ( and to a much lesser extent in lead V1 ). The patient did well with conservative management — and both ECG and the rhythm abnormality resolved as his clinical condition improved.

EKG/ECG 195

EKG/ECG Wellness Operations Hospitals 195

Mind The Bleep

OCTOBER 29, 2024

Alkali burns result in liquefaction necrosis, allowing for deeper tissue injury as well as vascular injury that can lead to both local and systemic toxicity [1]. These systemic effects can include central nervous system (agitation, seizures , and coma), as well as cardiac ( hypotension and dysrhythmias) [10, 11]. 2013 May;74(5):1363-6.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

Sensible Medicine

NOVEMBER 14, 2023

Criticism of these programs is both well-deserved and unfair. Despite these well-deserved criticisms, I’ve found that residential treatment programs and therapeutic communities can be essential to my patients, and there’s evidence to support that. Confrontational interventions are inhumane and ineffective.

Research 132

Research Psychiatric CDC Best Practices 132

RebelEM

MAY 29, 2024

VS abnormalities can drive this as well Strongly consider reversal of AC (this will typically come after control) Stopping the Bleeding PPE: these things bleed like stink. Laryngoscope 2013; 123: 2928-9. Posterior epistaxis: clinical features and acute complications. Acad Emerg Med 1995; 25(5): 592-6.

PPE 104

PPE EMS Hospitals Wellness 104

Ken Grauer, MD

MARCH 12, 2023

PEARL # 1: An additional ( less well known ) feature of QRS morphology in today’s initial tracing that favors aberrant conduction — is the finding of the mirror -image opposite morphology for the QRS in lead I and/or lead V6 — compared to the rSR’ complex just described for lead V1.

EKG/ECG 195

EKG/ECG Administration Wellness 195

EMergucate

OCTOBER 11, 2013

A fit and well 24y.o man presents with chest pain and this ECG

EKG/ECG 40

EKG/ECG Wellness EMS 40

EMDocs

SEPTEMBER 23, 2023

Physical exam reveals a well-appearing female in no acute distress. HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes: document endorsed by HRS, EHRA, and APHRS in May 2013 and by ACCF, AHA, PACES, and AEPC in June 2013. Heart Rhythm. Circulation.

EMS 105

EMS EKG/ECG Documentation/Coding Emergency Department 105

Ken Grauer, MD

OCTOBER 27, 2023

A cknowledgment : My appreciation to Hans Helseth ( from Minnesota, USA ) for the case and this tracing ( and CREDIT to Hans for his well-drawn laddergram that I have slightly modified ). = As always — I welcome questions and/or comments on today's ECG Blog post! THANK YOU for your interest! =

EKG/ECG 257

EKG/ECG Resuscitation Hospitals Wellness 257

Pediatric EM Morsels

AUGUST 18, 2023

Etminan 2019) In Belgium between 2010 – 2013, of the 262 children treated with fluroquinolones while hospitalized, only 17% were used for labelled indications. (Jackson 2016) It can also be used in UTIs , but is typically reserved for special cases where the infectious bacteria is found to be multidrug resistant or in complicated UTIs.

Pediatrics 130

Pediatrics Infectious Diseases Seizures Hospitals 130

Don't Forget the Bubbles

OCTOBER 2, 2023

This American single-centre retrospective review of 145 previously-well children referred to endocrinology to evaluate hypoglycaemia (<3.9 mmol/L) with acute illness between 2013 and 2018. Previously well children presenting with acute illness are often thought hypoglycaemic due to prolonged fasting. Why does it matter?

Outcomes 138

Outcomes Research Wellness Emergency Department 138

PulmCCM

OCTOBER 14, 2024

How well does it work? CRISTAL , another large international randomized trial (Annane et al JAMA 2013) did not show a benefit of colloids as compared to crystalloids. This increases mean arterial pressure. Albumin has thus been a physiologically attractive therapy as a resuscitation fluid for hypotensive critically ill patients.

Resuscitation 52

Resuscitation Shock Wellness 52

PHEM Cast

JULY 14, 2016

2013 May 13;30(6):516–6. Crane T, Cooke MW, Wellings R, Wayte S, Higgins J. 2013 Jul 19;30(8):679–82. 2013 Dec 22;31(1):86–6. Elsevier Ltd; 2013 Jan 1;44(1):122–7. 2013 Dec 1;30(12):1067–9. 2013 May 23. Elsevier Ltd; 2015 Apr 1;46(4):528–35. Smyth M, Cooke MW. Emergency Medicine Journal. J Emerg Med.

Fractures 52

Fractures Hospitals Shock Research 52

Don't Forget the Bubbles

JUNE 30, 2023

CRASH 2 , published in 2013 – was huge. Well, one study in Kornelson’s systematic review and meta-analysis is interesting. 2013 Mar;17(10):1-79. But, there’s always been a worry that giving TXA could cause clotting in the cerebral vessels. This is not good. There have been a couple of landmark trials. Spinella, Philip C.

Head Injuries 145

Head Injuries Seizures Pediatrics Outcomes 145

EMDocs

FEBRUARY 7, 2024

Unionization of healthcare providers can create opportunities to improve staff’s financial and general well-being, but may also facilitate future strikes. Trainees and attending providers should be informed about both the opportunities that come with unionization, as well as the challenges that come with managing strikes.

Hospitals 98

Hospitals Research Patient Safety Wellness 98

EMDocs

AUGUST 22, 2024

Well-meaning providers who are not highly fluent may contribute to miscommunication and diagnostic errors. Providers should respect and utilize this mode of communication, as well as document the patient’s request for a non-certified interpreter. The limited English proficiency population in the United States in 2013.

Documentation/Coding 105

Documentation/Coding Emergency Department Federal Emergency Management Agency Best Practices 105

RebelEM

SEPTEMBER 28, 2023

Primary PCI: 95.7% Stents Placed: Pharmaco-Invasive Treatment: 97.4% Primary PCI: 95.7% ECG Results: Repeat ECG 90min after tenecteplase indicated 70.3% of patients in the pharmaco-invasive treatment achieved ≥50% resolution in the lead with the greatest ST-segment elevation Median decline from 3.0 Primary PCI: 78.4% Primary PCI: 13.3%

EKG/ECG 138

EKG/ECG Allergic Reactions Shock Stroke 138

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 90

CPR Burns Airway Management Wellness 90

Don't Forget the Bubbles

AUGUST 7, 2023

However, that guidance needs to take into account the influence of emotion, environment, body temperature, as well as the underlying disease process, on vital signs, especially in younger infants. 2013 Apr 1;131(4):e1150–7. References Bonafide CP, Brady PW, Keren R, Conway PH, Marsolo K, Daymont C. Pediatrics. Acad Emerg Med.

Sepsis 98

Sepsis Pediatrics Urgent Care Emergency Department 98

Taming the SRU

DECEMBER 11, 2023

8] While there is no standardized screening tool for SRB, there are well established trends that emergency medical providers may use to identify patients at risk.[9] 8] While there is no standardized screening tool for SRB, there are well established trends that emergency medical providers may use to identify patients at risk.[9]

EMS 97

EMS Psychiatric Emergency Department Poisoning 97

PEMBlog

FEBRUARY 8, 2024

Well-appearing Get a CBC and Blood Culture and admit those under 2 months of age on IV antibiotics. 2013 Nov;32(11):1295-6. This is a skin and soft tissue infection of the breast tissue in a newborn. The treatment is directed towards S. aureus and you should never squeeze or incise this tissue in the ED. Pediatr Infect Dis J.

Pediatrics 52

Pediatrics Wellness 52

Dr. Smith's ECG Blog

AUGUST 14, 2024

For more re "My Take" on SA block — Please check out my Summary below in Figures-3 and -4 of today's ADDENDUM — as well as My Comments on SA block in the May 25, 2022 post and the August 30, 2023 post in Dr. Smith's ECG Blog ). Figure-3: Essentials of SA Block ( Modified from Grauer: ACLS-2013-ePub ). A DDENDUM — regarding SA Block.

EKG/ECG 110

EKG/ECG Outcomes Wellness 110

Ken Grauer, MD

APRIL 29, 2023

Although this " Imbalance " of precordial T waves is not seen very often — in the “right” clinical setting, it has been associated with recent OMI ( O cclusion-based MI ) from a LCx culprit artery ( See Manno et al: JACC 1:1213, 1983 — and the July 17, 2013 post by Salim Rezaie in ALiEM — and ECG Blog #350 ).

EKG/ECG 195

EKG/ECG Wellness 195

Taming the SRU

FEBRUARY 14, 2024

She endorsed low grade fevers and chills as well as odynophagia, dysphagia, and some shortness of breath. Severe complications of peritonsillar abscesses include infection spreading to additional deep spaces of the neck as well as mediastinitis (2). 2013; 31(1):267.e1-3. Otolaryngol Head Neck Surg. 2018;158(2):280-286.

Ultrasounds 97

Ultrasounds Emergency Department Wellness 97

EMDocs

JULY 25, 2024

Do them well and document the process, preferably at the bedside. Blogpost, June 2013. Assure and document the patient’s resources and safety net if discharged. If PA-C’s are allowed to care for suicidal patients, their privileges should so specify. Handoffs are a high-risk exchange. Ronquillo L et al. Oct 04, 2012.

Documentation/Coding 105

Documentation/Coding Hospitals Patient Safety Emergency Department 105

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. April 9, 2013. The patient states they were cutting an avocado when the knife pierced through and punctured his hand. Medicine (Baltimore). 2019;98(44):e17823.

EMS 96

EMS Fractures Operations Ultrasounds 96

EMDocs

JANUARY 29, 2024

However, other sources suggest that the optimal blood pressure target is not well established and may vary depending on the individual patient’s characteristics and the type of hemorrhagic transformation [7]. 2013 Jul;44(7):1846-51. Epub 2013 May 23. This includes intraparenchymal hemorrhage and subarachnoid hemorrhage (SAH).

Stroke 101

Stroke Outcomes EMS Seizures 101

ALiEM

DECEMBER 18, 2023

2013 Jun;6(6):31-7. Of note, she reported that her dose of lamotrigine has been slowly uptitrated, most recently two days prior changing from 50 mg BID to 75 mg BID. Additional Images Physical Exam Vitals : T 39.6°C; PMID: 28598363; PMCID: PMC5486066. Choudhary S, McLeod M, Torchia D, Romanelli P. J Clin Aesthet Dermatol.

Academics 70

Academics Emergency Department Wellness 70

ACEP Now

SEPTEMBER 11, 2023

The First Six It was with his first wilderness medicine fellow, Joseph Schneider, MD, that he reached the first of the Seven Summits, Aconcagua in Argentina, in January 2013. At that point I was like, well hell, I’ve done five of them,” Dr. Mattingly remembered. Dr. Mattingly summiting Mount Everest in May 2023. Click to enlarge.)

Wellness 126

Wellness 126