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SGEM#471: Are ESI Levels Accurate for Triage of Pediatric Patients?

The Skeptics' Guide to EM

His research interests include AI in healthcare, medical education, and social determinants of health. JAMA Pediatrics, October 2024 Population: Pediatric patients (aged 0-18 years) presenting to 21 Kaiser Permanente Northern California EDs from January 1, 2016, to December 31, 2020.

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ECG Blog #394 — Is QRS Morphology Disguised?

Ken Grauer, MD

ECG Criteria for the diagnosis of MBBB are described by Dhanse et al ( J Clin Diag Research: 10(9), 2016 ) — and Buttner and Cadogan ( LITFL, 2021 ) — and include the following: An ECG pattern consistent with RBBB in the chest leads ( ie, with a widened, predominantly positive QRS in lead V1 ).

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"Sepsis bundles": No good evidence of benefit

PulmCCM

The Infectious Diseases Society of America (IDSA) has consistently opposed SEP-1 since at least 2016. But not completely prohibited: CMS has the authority to grant exceptions to SEP-1 reporting for the purposes of research. “thoracic” society has not taken a formal position that we are aware of.

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Pediatric Cervical Spine Injury Risk Stratification: Rebaked Morsel

Pediatric EM Morsels

References Babcock L, Olsen CS, Jaffe DM, Leonard JC; Cervical Spine Study Group for the Pediatric Emergency Care Applied Research Network (PECARN). 2016; Published June 20, 2016. Leonard JR, Jaffe DM, Kuppermann N, Olsen CS, Leonard JC; Pediatric Emergency Care Applied Research Network (PECARN) Cervical Spine Study Group.

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Closed Head Injury – PECARN for < 3 Months: Rebaked Morsel

Pediatric EM Morsels

However clinical judgement was more specific in this same group (54% vs 92%) [ Atabaki, 2016 ]. 2016 May;23(5):566-75. Epub 2016 Apr 20. When we discussed this topic previously , we concluded with “Clinical Guidelines are never perfect, but this one is pretty good”. Acad Emerg Med. doi: 10.1111/acem.12923. PMID: 26825755.

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ToxCard: Second Generation Antipsychotic Overdose

EMDocs

2 Lipid emulsion has been considered due to the lipophilic nature of atypical antipsychotics; however, studies are limited on this topic, and this is an area that could benefit from further research. 2016 Dec;54(10):899-923. Consider agents with α 1 -adrenergic activity such as norepinephrine or phenylephrine. Clin Toxicol (Phila).

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When Do Pediatric Ventriculoperitoneal Shunts Fail?

ACEP Now

A 2016 multicenter prospective study evaluated 1,036 pediatric patients for shunt failure who received CSF shunts over a four-year period. 3 This study was conducted at six institutions in the Hydrocephalus Clinical Research Network. Similarly, 70 percent of VP revisions occurred within the first six months after surgery.