Pediatric Emergency Playbook

APRIL 1, 2016

used BNP in the emergency department to differentiate heart failure from respiratory causes in infants and children with heart failure and those with no past medical history. 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.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

This finding does not alter the need to pursue emergent reperfusion, although it might suggest a poorer prognosis.”[3] New insights into the use of the 12-lead electrocardiogram for diagnosing acute myocardial infarction in the emergency department. 2 cases of Aortic Stenosis: Diffuse Subendocardial Ischemia on the ECG.

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

Pediatric Emergency Playbook

AUGUST 1, 2017

One of our largest responsibilities in the Emergency Department is sorting out benign from surgical or medical causes of abdominal pain. Abdominal Surgical Emergencies in Children: A Relative Timeline General Advice Neonate (birth to one month) Necrotizing Enterocolitis Pneumatosis Intestinalis. J Pediatr Surg 2014; 49:1619.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

Pediatric EM Morsels

JULY 21, 2023

Interrater reliability of Glasgow Coma Scale scores in the emergency department. Ann Emerg Med. doi: 10.1136/archdischild-2014-306851. Epub 2014 Sep 8. 2014 Oct;29(10):1299-304. Epub 2014 Feb 13. Fun fact for animal lovers!- J Surg Res. 2019 Sep;241:112-118. doi: 10.1016/j.jss.2019.03.038. 107.498345.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

EMDocs

DECEMBER 18, 2023

Septic shock is high on the differential diagnosis for this patient’s presentation. Introduction Sepsis and septic shock are life-threatening conditions characterized by severe systemic inflammation and organ dysfunction due to a dysregulated host response to infection. The patient currently resides at a skilled nursing facility.

Sepsis 93

Sepsis Fluid Resuscitation Resuscitation Shock 93

RebelEM

MAY 15, 2024

Comparison of the MASCC and CISNE scores for identifying low-risk neutropenic fever patients: analysis of data from three emergency departments of cancer centers in three continents. Application of the MASCC and CISNE Risk-Stratification Scores to Identify Low-Risk Febrile Neutropenic Patients in the Emergency Department.

Infectious Diseases 101

Infectious Diseases Administration Sepsis Anaphylaxis 101

Taming the SRU

MAY 5, 2023

doi:10.1056/NEJMoa2212663 BACKGROUND Sepsis, including severe sepsis and septic shock, is a frequently encountered condition in the emergency department and carries a high mortality rate. Each subsequent one-hour delay in antimicrobial administration increases mortality by 35% in patients with septic shock (Im, Kang et al.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

EMDocs

JULY 15, 2023

However, it must be considered in toxic-appearing patients, those with prosthetic heart valves, artificial joints, or immunocompromised states Clinicians must keep a broad differential and consider other conditions such as necrotizing fasciitis, clostridial myonecrosis, compartment syndrome, toxic shock syndrome, etc. pneumoniae , S.

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EMS Infectious Diseases Shock Ultrasounds 93

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. In the undifferentiated sick neonate, always consider a surgical emergency such as malrotation with volvulus. J Emerg Med.

Head Injuries 40

Head Injuries Pediatrics Shock Sepsis 40

Don't Forget the Bubbles

JUNE 30, 2023

Ranulf went white with the shock. A recent review was conducted on Trauma Quality Improvement Program data between 2014 and 2016. Interim results presented earlier this year show that REBOA performed within the Emergency Department increased mortality. 2014 Sep;45(9):1287-95. c) Or, do both?

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

EMDocs

APRIL 22, 2024

4 In an emergency department (ED) presentation of cardiac arrest, the diagnosis of PE is challenging without the use of CT angiography. Point-of-Care-Ultrasound (POCUS) is a bedside modality that can assist Emergency Physicians (EPs) in differentiating PE from other causes of cardiac arrest. 2014 May;145(5):950-957.

Ultrasounds 98

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 98

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. 2014) Emergency Care Institute, New South Wales. 2014) Tiny Tip: PRE -eclampsia. Postpartum Emergencies.

OB/GYN 40

OB/GYN Ultrasounds Emergency Department Resuscitation 40

Pediatric Emergency Playbook

FEBRUARY 1, 2016

They used REBOA for refractory hemorrhagic shock due to either blunt or penetrating injury. Pediatric emergency department thoracotomy: a large case series and systematic review. 2014 Apr;133(4):e1104-16. Pediatric emergency department thoracotomy: A 40-year review. Brenner et al. J Pediatr Surg.

Resuscitation 40

Resuscitation Pediatrics Fractures Emergency Department 40

ACEP Now

OCTOBER 10, 2023

A 76-year-old female presents to the emergency department obtunded with left hemiplegia. External Validity: It is unclear if this data applies to patient you see in your emergency department. Goal-directed resuscitation for patients with early septic shock. Published November 10, 2014. EBM Commentary 1.

Outcomes 52

Outcomes Stroke Emergency Department Hospitals 52

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

EMDocs

FEBRUARY 12, 2024

First, there can be a poor correlation between venous and arterial gases in states of shock, hemodynamic instability, or extremes of acid-base disturbances, due to poor cardiac output/circulatory failure impairing venous and arterial flow, with associated poor gas exchange as well as hypercapnia and acidemia at the tissue level (8).

Emergency Department 98

Emergency Department Resuscitation COPD Shock 98

Don't Forget the Bubbles

JANUARY 10, 2024

Let’s take the humble blood transfusion – used in emergency departments across the globe and playing a key role in critical care. 3,950 children were recruited between September 2014 to May 2017. Transfusion Decisions in Severe Anaemia Reducing child mortality remains high on the global health agenda. Do you believe the results?

Blood Transfusions 78

Blood Transfusions Research Outcomes Hospitals 78

EMDocs

JANUARY 6, 2024

You review his chart and note that he had a heart transplant in 2014 but has not followed up with a cardiologist for at least 3 years. 10 Dysrhythmias (more commonly ventricular), chest pain, dyspnea, acute CHF and shock are all possible. A 63-year-old man presents to the emergency department for dyspnea on exertion.

EMS 90

EMS Infectious Diseases Shock Emergency Department 90

Pediatric Emergency Playbook

JANUARY 1, 2017

A special note on codeine : Tylenol with codeine (“T3”) has never been a very effective pain medication, as up to 10% of patients lack enzymatic activity to metabolize it into morphine, its active form ( Crews 2014 ). New evidence is emerging on the erratic and unpredictable individual metabolism of codeine. Acad Emerg Med.

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

Downeast Emergency Medicine

OCTOBER 21, 2021

Background Suicide is disturbingly prevalent among patients we care for in the Emergency Department. We chose this topic for Journal Club with the goals to raise awareness around these shocking statistics, discuss etiologies behind these high rates of suicide, and to normalize the discussion around physician mental health.

Documentation/Coding 52

Documentation/Coding Emergency Department Shock Research 52

RebelEM

NOVEMBER 11, 2024

compared cefepime to piperacillin-tazobactam in a cohort of 250 patients with septic shock and found a signal toward higher mortality in those receiving cefepime. What They Did: Investigators performed a retrospective cohort study in the Emergency Department at the University of Michigan between July 1, 2014 through December 31, 2018.

Sepsis 113

Sepsis Outcomes Administration Shock 113

Intensive Blog

FEBRUARY 9, 2023

Labs and Lytes 040 Author: Dr Nasreen Bahemia Peer reviewers: Dr Craig Johnston, A/Prof Chris Nickson A 56-year-old female presented to the Emergency Department (ED) with 2 days of severe nausea, vomiting and diarrhoea. 2014, Jan). She was also getting progressively drowsier while waiting in ED. Silibinin [link] Warrillow, S.

Poisoning 52

Poisoning Hyperthermia / Hypothermia Fluid Resuscitation Resuscitation 52

EMDocs

NOVEMBER 13, 2023

The use of CTA (computed tomography angiography) in the emergency department (ED) has increased dramatically in the past 20 years. American College of Emergency Physicians (ACEP) gave a level C recommendation that either LP or CTA could be used to rule out SAH after a negative NCCT. vs. 38.1%) with a good functional outcome.

Stroke 106

Stroke Radiology Radiology Emergency Department 106

Dr. Smith's ECG Blog

FEBRUARY 10, 2025

Acute hyperkalemia in the emergency department: a summary from a Kidney Disease: Improving Global Outcomes conference. Eur J Emerg Med 2020. West J Emerg Med 2017. BRASH syndrome: Bradycardia, Renal Failure, AV blockade, Shock, and Hyperkalemia. Durfey et al. Farkas et al.

EKG/ECG 118

EKG/ECG Shock Operations Emergency Department 118

Pediatric EM Morsels

FEBRUARY 2, 2024

2014 Dec;31(6):678-87. Internationally Acquired Severe Systemic Infections in Febrile Pediatric Travelers Presenting to the Emergency Department. Pediatr Emerg Care. Travel-associated disease among US residents visiting US GeoSentinel clinics after return from international travel. 2021 Dec 1;37(12):e1315-e1320.

Infectious Diseases 164

Infectious Diseases Pediatrics Sepsis Documentation/Coding 164

Mind The Bleep

JUNE 17, 2023

They may present in hypovalaemic shock On examination you may feel a sausage shaped mass in the right side of the abdomen which crosses the midline. Bluman J, 2014) The abdominal pain is colicky / crampy, intermittent and diffuse, the child may struggle to point to a single area of pain. Open Access Emergency Medicine , 283-291.

Shock 93

Shock Wellness Emergency Department Ultrasounds 93

Mind The Bleep

JUNE 17, 2023

They may present in hypovalaemic shock On examination you may feel a sausage shaped mass in the right side of the abdomen which crosses the midline. Bluman J, 2014) The abdominal pain is colicky / crampy, intermittent and diffuse, the child may struggle to point to a single area of pain. Open Access Emergency Medicine , 283-291.

Shock 52

Shock Wellness Emergency Department Ultrasounds 52

PEMBlog

JANUARY 17, 2024

Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis 2014; 59:e10. Full blown sepsis and toxic shock syndrome. Now, some facilities have a short stay unit, like in their emergency department.

Infectious Diseases 59

Infectious Diseases Sepsis Wellness Pediatrics 59

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 75

Dehydration Fluid Resuscitation Sepsis Resuscitation 75

EMDocs

JANUARY 16, 2025

Trajectory of Mortality and Health-Related Quality of Life Morbidity Following Community-Acquired Pediatric Septic Shock. Emerg Med J. 2014 Oct;31(e1):e19-24. Development and Validation of the Phoenix Criteria for Pediatric Sepsis and Septic Shock. but PPV ranges from 25.1-39.5% 0.38 (95% CI 0.20-0.39) 0.39) AUROC of 0.71-0.92

Sepsis 96

Sepsis Pediatrics Shock Hospitals 96

EMDocs

JUNE 27, 2024

2014 Feb;69(2):144-51. Intranasal fentanyl and discharge from the emergency department among children with sickle cell disease and vaso-occlusive pain: A multicenter pediatric emergency medicine perspective. Epub 2013 Aug 7. PMID: 23925645 Davila J, O’Brien SH, Mitchell WB, Manwani D. Am J Hematol.

Pediatrics 98

Pediatrics Dehydration EMS Hospitals 98

Don't Forget the Bubbles

OCTOBER 9, 2023

focussed on emergency departments. It shocked me how big an effect this expert had on the teams, especially given the studied teams usually worked together and had an average of seven years of neonatal experience. I was shocked by the way I had been spoken to, scared about breaking the baby, and felt out of my depth.

Seizures 116

Seizures Incident Reporting Emergency Department Research 116

Don't Forget the Bubbles

JULY 5, 2023

Symptoms may be non-specific in the beginning with patients quickly developing septic shock and disseminated intravascular coagulation. A 6-year-old girl from Saudi Arabia was referred by her General Practitioner to the local emergency department. 2014; 349–356. coli and Staphylococcus aureus. Macharia AW et al.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

EMDocs

JANUARY 6, 2025

Based on available hospital resources, the patient is treated for septic shock secondary to pneumonia and an infected wound using broad-spectrum antibiotics and IV crystalloid fluids. She is sent to the medical ward after three days in the ED with the diagnoses of resolving septic shock, severe malaria, and AKI. Ann Emerg Med.

Infectious Diseases 75

Infectious Diseases CDC PPE Rapid Diagnostic Testing 75