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. 2016; 417: 54–56.

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Pediatrics Sepsis Shock Outcomes 52

ACEP Now

MARCH 14, 2024

Electrical injuries—excluding lightning injuries—account for roughly 10,000 nonfatal shock incidents a year and 500 deaths a year. McGraw Hill; 2016. Documentation with coronary arteriography within 12 1/2 hours of the onset of symptoms in two cases (three episodes). Click to enlarge.) and five percent workplace-related deaths.

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Burns Fluid Resuscitation EKG/ECG EMS 52

Pediatric Emergency Playbook

JUNE 1, 2017

The best documented cormorbidity is sickle cell disease, although other pro-thrombotic conditions also put the child at risk. The infant in shock after a ‘cold’: myocarditis Beware of the poor feeding, tachycardic, ill appearing infant who “has a cold” because everyone else around him has a ‘cold’. 2016; 203:138-140. 2016; 17:2.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

RebelEM

SEPTEMBER 26, 2022

What They Did Single-center randomized controlled study design performed by the Department of Hepatology & Liver transplantation in New Delhi Study participants, investigator clinicians, data collectors, and data analysts were blinded Investigators recruited participants from February 27, 2016 – March 3, 2018.

Resuscitation 52

Resuscitation Blood Transfusions Outcomes Hospitals 52

Dr. Smith's ECG Blog

FEBRUARY 28, 2020

Tachycardia is unusual in ACS unless there is cardiogenic shock or a second simultaneous pathology. Finally — Note that the S1Q3T3 pattern is missing in ECG #2 , despite documentation of a massive PE. Remember that is the odds ratio comparing all patients without PE to those with PE.

EKG/ECG 52

EKG/ECG COPD Documentation/Coding Shock 52

EB Medicine

JULY 8, 2019

While it was < 15% in 1990, by 2016 it reached 40%. Vitamin D, B12, Calcium, foate, iron, and thiamine deficiencies are all well documented complications. Consider performing a RUSH exam (that is rapid ultrasound for shock and hypotension) to identify the cause. Jeff: Well that’s kind worrisome. million adults!!

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Emergency Department Sepsis Operations Dehydration 40

EB Medicine

JUNE 6, 2019

Nachi: For more information on HIV and its management, check out the February 2016 issue of Emergency Medicine Practice , which covered this and more in depth. Nachi: Moving on to blood pressure: frank hypotension should make you immediately think of a ruptured AAA or septic shock 2/2 an intra abd infection. Jeff: As for the lactate.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

EB Medicine

AUGUST 1, 2018

Jeff: There are a shocking 22 million past-month users of marijuana in the US, followed by pain relievers at 3.8 In fact, cannabis use has been documented for medical use dating as far back as 600 BC in West and Central Asia. Marijuana actually maintains the highest lifetime use of an illicit drug used within the US. Subst Abus.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 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). Trauma: In the trauma setting, metabolic acidosis often occurs secondary to hypoperfusion from hemorrhagic shock.

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Emergency Department Resuscitation COPD Shock 98

RebelEM

MAY 15, 2024

Epub 2016 Dec 29. Coding for Mucositis. Give appropriate fluids, vasopressors, and antibiotics. Default to using whichever score your oncologist is more comfortable with. Application of the MASCC and CISNE Risk-Stratification Scores to Identify Low-Risk Febrile Neutropenic Patients in the Emergency Department. Ann Emerg Med.

Infectious Diseases 101

Infectious Diseases Administration Sepsis Anaphylaxis 101

Downeast Emergency Medicine

OCTOBER 21, 2021

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. All other applications were coded as “not consistent.”

Documentation/Coding 52

Documentation/Coding Emergency Department Shock Research 52

Dr. Smith's ECG Blog

DECEMBER 5, 2019

Thus, Brugada is the likely diagnosis _ A very nice explanation of this is given in the document quoted below on current ECG criteria for Brugada pattern. 2016) in the presence of spontaneous BrS ECG or drug-induced ECG. Heart Rhythm 2016. Bayes de Luna, A et al. The prognostic significance of fever-induced Brugada syndrome.

EKG/ECG 52

EKG/ECG Hyperthermia / Hypothermia Seizures Documentation/Coding 52

EB Medicine

JANUARY 2, 2019

For a completed abortion, you would expect a closed OS with no IUP on ultrasound with a previously documented IUP. Jeff: It’s worth noting, however, that a 2016 systematic review found no reliable evidence supporting routine screening for asymptomatic bacteriuria, so send a urinalysis and culture only if there is suspicion for a UTI.

Ultrasounds 40

Ultrasounds Radiology Radiology Infectious Diseases 40

Sensible Medicine

AUGUST 14, 2024

In his work, Dr. Goldwater describes a kind of toxic-shock (cytokine) reaction in the body that results from the combination of a cold virus plus being infected with a common bacterium—each pathogen relatively harmless on its own but deadly together.

CDC 94

CDC Sepsis Research Pediatrics 94

Sensible Medicine

JANUARY 13, 2025

Yet, still, the vast majority (≈13 of 14) of patients implanted with an ICD for primary prevention never receive a shock, and therefore gain no benefit. In the DANISH trial (2016), which recruited only patients with heart failure not due to CAD, the ICD no longer reduced death over optimal heart failure therapy. I think there is.

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Evidence-Based Practice Shock Academics Documentation/Coding 98

Dr. Smith's ECG Blog

MARCH 17, 2025

There is very scarce documentation, but the next ECG was obtained around 1 PM. Summary of RIDDLE-NSTEMI: RIDDLE-NSTEMI, JACC: Cardiovascular Interventions 2016 Limitations of conventional angiography: This patient was very lucky that the interventional cardiologist who responded to the cath lab activation is evidence based and thorough.

EKG/ECG 81

EKG/ECG Documentation/Coding Burns Research 81

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.

Infectious Diseases 75

Infectious Diseases CDC PPE Rapid Diagnostic Testing 75