Pediatric EM Morsels

OCTOBER 27, 2023

Taking care of a critically ill child can be nerve-racking to say the least, and downright petrifying for those who don’t do it frequently, even if they are well-trained and brilliant clinicians. Sinha 2012] It is useful in the prehospital setting , correlating well with actual weight and ED Broselow weight. Broselow does not.

Pediatrics 271

Pediatrics Resuscitation Documentation/Coding Wellness 271

Pediatric EM Morsels

JULY 21, 2023

cats and dogs have their own GCS scores [Lapsley 2019, Ash 2018] Moral of the Morsel Modified can make it Merrier! 2018 Jun;128(6):1612-1620. 2018): 192–200. Fun fact for animal lovers!- Brennan PM, Murray GD, Teasdale GM. Simplifying the use of prognostic information in traumatic brain injury. J Neurosurg.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

Emergency Medicine Ireland

DECEMBER 3, 2020

All that being said it’s worth being aware that there are some major pieces of guidance out there and you would do well to have a passing correspondence with them. Epub 2018 Sep 29. I would highly recommend attending an excellent lecture given by your ICU dietician which is just possibly where this entire summary came from.

Burns 52

Burns Sepsis EMS Wellness 52

Ken Grauer, MD

APRIL 18, 2023

This blog post reviews the basics for predicting the " C ulprit" A rtery ( as well as reviewing why the term "STEMI" — should replaced by " OMI" = O cclusion-based MI ). For review — Check Out My Comment — at the bottom of the page in the following posts on Dr. Smith's ECG Blog: The June 4, 2018 post ( LA-LL reversal ).

EKG/ECG 195

EKG/ECG Wellness 195

EM Literature of Note

SEPTEMBER 11, 2023

Well, PRISMS demonstrated unfavorable results. The population included for analysis is the Austrian Stroke Unit Registry from 2018 until 2019, an original cohort of 53,899 patients. The remaining ~4,000 were analyzed both in their unadjusted cohorts, as well as propensity scored cohorts comprised of roughly 20% of the original.

Stroke 114

Stroke Outcomes Wellness 114

The Skeptics' Guide to EM

FEBRUARY 15, 2020

Case: A 32-year-old woman with no previous medical history calls you while a passenger on a […] The post SGEM#284: Might as Well Jump, but We would Recommend a Parachute first appeared on The Skeptics Guide to Emergency Medicine. Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial.

Wellness 52

Wellness Outcomes Emergency Department Research 52

Ken Grauer, MD

JUNE 6, 2023

That said — lack of a well defined P wave in lead II makes assessment of the PR interval difficult — and — the QRS looks a little wide in lead V3, albeit QRS duration does not appear to exceed 0.10 This explains the marked increased in QRS amplitude in the lateral chest leads — as well as some of the ST-T wave depression in these leads.

EKG/ECG 195

EKG/ECG Hospitals Resuscitation Wellness 195

Pediatric EM Morsels

JULY 7, 2023

Cunningham, 2018 ] Account for less than 1% of all knee injuries. Seen in sports that involved aggressive twisting of the knee (ex, snowboarding, soccer, horse-riding) as well as direct trauma. Epub 2018 Apr 19. The PTF joint is inherently stable with good ligamentous support, especially when the knee is in extension.

Dislocations 143

Dislocations Fractures Pediatrics EMS 143

Pediatric EM Morsels

AUGUST 18, 2023

Wirth 2018) One study including 4.4 Meesters 2018) Resistance is growing (likely from inappropriate / overuse)! (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. 451 pediatric patients were included.

Pediatrics 130

Pediatrics Infectious Diseases Seizures Hospitals 130

The Trauma Pro

OCTOBER 25, 2024

Authors from several well-known trauma centers collaborated to re-analyze data from the CLOTT study. Here are the factoids: The original data were derived from a 17-center study conducted from 2018-2020; this study only included 1,387 patients who had pelvic fractures (as well as other injuries).

Fractures 113

Fractures Head Injuries Operations Ultrasounds 113

The Trauma Pro

AUGUST 22, 2023

The patient is doing well but has an unexplained pressure dip. They found that they both worked well with the following results: Shock index > 1 – 68% sensitive 81% specific ABC > 2 – 47% sensitive, 90% specific The study suggests that shock index is more sensitive, and takes less technical skill to calculate. It happens again.

Shock 100

Shock Wellness EMS 100

Sensible Medicine

JUNE 17, 2024

Europeans do PFA ablation in well under an hour. Proponents wrote back in 2018 that longer-term safety studies are needed that specifically assess…”cerebral microemboli assessed by magnetic resonance imaging.” Fortunately, we now know about the complication, and have active avoidance measures.

Shock 126

Shock Stroke Operations Ultrasounds 126

ACEP Now

SEPTEMBER 5, 2024

It is important to evaluate for both the position of the SMA in relationship to the SMV as well as for the “whirlpool” sign. 2018; 88(11):1108-1116. The post How Well Does Ultrasound Detect Volvulus in Infants? Enyuma COA, Adam A, Aigbodion SJ, et al. ANZ J Surg. appeared first on ACEP Now.

Ultrasounds 40

Ultrasounds Wellness Pediatrics Poisoning 40

Ken Grauer, MD

OCTOBER 21, 2023

P EARL # 2: As noted above — ECG #1 is remarkable for the presence of diffuse ST depression ( in more than 7 leads! ) — with ST elevation in lead aVR ( as well as in lead V1 ). The July 31, 2018 post in Dr. Smith's ECG Blog ( Please scroll down to the bottom of the page to see My Comment ).

EKG/ECG 245

EKG/ECG Shock Wellness 245

RebelEM

JANUARY 18, 2024

It is well-established that earlier recognition and treatment can lead to better outcome for these patients . Background: Sepsis remains one of the leading causes of morbidity and mortality.

Sepsis 130

Sepsis Hospitals Administration Outcomes 130

Greater Sydney Area HEMS

FEBRUARY 20, 2024

The evidence for improved safety and quality with the use of ultrasound for CVC implementation is well established [i]. Its use in the prehospital environment is not well known or studied and may be an interesting area for future research. [i] Anesthesiology 2018; 128 : 38–43. [v] Medicine 2018; 97 : e13661. Green et al.

Ultrasounds 98

Ultrasounds Shock Research Operations 98

The Trauma Pro

SEPTEMBER 14, 2023

” This guideline was implemented in 2018-2019, and patients presenting before implementation were compared to those arriving after. The Medical College of Wisconsin trauma group performed a retrospective review of 391 patient charts to test a new 300cc rule defining when a hemothorax is “too big.”

Resuscitation 124

Resuscitation Hospitals Wellness 124

EM Literature of Note

SEPTEMBER 13, 2024

These authors compare the burden of lower respiratory tract infections and bronchiolitis admissions at 15 pediatric emergency departments across 2018 to 2024, with 2023-24 being the first season where nirsevimab was in wide usage. The two “COVID seasons” of 2020-21 and 2021-22 were excluded from their comparisons.

Emergency Department 87

Emergency Department Pediatrics Administration Wellness 87

Dr. Smith's ECG Blog

JANUARY 6, 2024

In the 500+ Comments I have written on Dr. Smith's ECG Blog since becoming an Associate Editor in 2018 — I do not believe we have had a case of RA-LL lead reversal. Even when a low atrial rhythm is present — the P wave will typically be positive in lead I ( as well as in lead aVL ). The July 29, 2018 post ( LA-RA reversal ).

EKG/ECG 114

EKG/ECG Wellness 114

Dr. Smith's ECG Blog

JUNE 14, 2024

But artifact is "alive and well" — and learning to recognize it will amaze many of your colleagues ( and may serve to avoid an unnecessary defibrillation or two ). KEY Point: As per Dr. Frick: i ) Artifact is "alive and well" in 2024. The January 30, 2018 post — for PTA. The August 26, 2019 post — baseline artifact.

EKG/ECG 82

EKG/ECG Wellness Hospitals 82

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 134

Research Psychiatric CDC Best Practices 134

Don't Forget the Bubbles

AUGUST 23, 2023

Definitive emotional support is critical to our emotional and psychological well-being. 2018) “Benefits of using the pause after death in emergency departments: a Delphi study”. 2018) “Sacred Pause Imitative in the ICU: A survey of ICU physicians and nurses”. Psychological harm occurs. & Liska, H. Journal of Trauma Nursing.

Emergency Department 98

Emergency Department Resuscitation Documentation/Coding Best Practices 98

EMDocs

DECEMBER 11, 2023

There are multiple criteria systems for diagnostic an acute myocardial infarction in this population, as well as patients with ventricular-paced rhythms. Fourth Universal Definition of Myocardial Infarction (2018). 2018 Oct 30;72(18):2231-2264. J Am Coll Cardiol. Meyers, S.D. Weingart, S.W. The OMI manifesto.

EKG/ECG 119

EKG/ECG Emergency Department Academics Operations 119

Dr. Smith's ECG Blog

AUGUST 18, 2024

He did well. We've periodically reviewed cases regarding Pacemaker Troubleshooting ( See the February 18, 2024 post — the January 13, 2024 post — the October 19, 2022 post — the August 3, 2022 post — the May 21, 2023 post — the June 19, 2024 post — and the November 9, 2018 post , to name a number of them ).

EKG/ECG 113

EKG/ECG Fractures Burns Wellness 113

Taming the SRU

MAY 13, 2024

The patient is a well-appearing male who is awake, alert, and oriented. There is also a well-appearing, healed surgical scar. There is also a well-appearing, healed surgical scar. The skin is warm and well perfused with brisk capillary refill. World J Emerg Surg 13, 22 (2018). Notable diagnostics CBC : WBC 19.2,

Ultrasounds 98

Ultrasounds Emergency Department Wellness Operations 98

Don't Forget the Bubbles

JANUARY 24, 2024

The first human trials for children with SRSE were conducted in 2014 where 2 patients responded well to the treatment and there have been encouraging results in open label adult trials more recently. 2018 May 17;378(20):1888-1897. 2018 Dec;84(6):940-945. Epub 2018 Nov 30. N Engl J Med. doi: 10.1056/NEJMoa1714631.

Seizures 111

Seizures Pediatrics Outcomes Hyperthermia / Hypothermia 111

EMDocs

JUNE 8, 2023

and 9 hours of symptom onset; stroke symptoms that started during sleep were assumed to have started halfway between the actual last known well and the time of wake-up. Of note, the authors declared that their groups were well balanced, but they do not report on the baseline mRS of each group. Intervention: Alteplase 0.9

Stroke 95

Stroke Administration Documentation/Coding Outcomes 95

RebelEM

JUNE 26, 2023

4F-PCC contains factors II, VII, IX, X as well as Proteins S and C. J Trauma Acute Care Surg 2018. Some clinicians have advocated for early administration of 4-factor prothrombin complex concentrate (4F-PCC) based on limited observational data. High-quality studies are needed to determine the utility of this intervention.

Administration 139

Administration Outcomes Resuscitation Radiology 139

ACEP Now

JULY 7, 2023

1 Ventricular tachycardia (VT) and ventricular fibrillation (VF) represent the most common initial rhythms for patients presenting to the ED in out-of-hospital cardiac arrest, as well as for patients who develop cardiac arrest while in the ED. Heart disease and stroke statistics—2018 update: A report from the American Heart Association.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

Dr. Smith's ECG Blog

NOVEMBER 29, 2023

But he did well. PEARL #2: The automatic EMS truncation effect is most likely to cause confusion in chest pain patients who manifest marked LVH with deep anterior S waves ( just as we saw for Patient #1 in today's case — and as I describe in the December 27, 2018 post , as well as in the above posts that I cited in Pearl #1 ).

EKG/ECG 128

EKG/ECG EMS Outcomes Wellness 128

Sensible Medicine

AUGUST 7, 2024

There is evidence that, for children and adults, elevated cortisol levels and chronic stress can lead to behavioral, mental-health, and mood issues, as well as changes in inflammation and immunity. Research by Collett et al (2018) shows that, despite some improvement in PP by 18 months, the deformations persist beyond 36 months.

CDC 113

CDC Documentation/Coding Research Pediatrics 113

EMDocs

JULY 9, 2024

Epub 2018 Nov 22. Addressing social determinants of health at well child care visits: a cluster RCT. 2018 Jul;84(1):10-21. Epub 2018 May 23. Community Resource Needs Assessment Among Families Presenting to a Pediatric Emergency Department. Acad Pediatr. 2019 May-Jun;19(4):378-385. doi: 10.1016/j.acap.2018.11.009.

Pediatrics 70

Pediatrics Emergency Department Research Burns 70

RebelEM

APRIL 17, 2023

However, It is unclear how well POCUS performs in ruling in or ruling out the diagnosis of PTA. Question: How well does the US perform in diagnosing PTA compared to CT, needle aspiration, or Incision and Drainage? Article: Kim DJ et al. Acad Emerg Med. 2023 Jan 10. Epub ahead of print. PMID: 36625850.

Ultrasounds 129

Ultrasounds Radiology Radiology Operations 129

EMDocs

DECEMBER 4, 2023

The Wells’ Criteria for DVT can help risk stratify [2,3]. If the patient’s Wells score is ≤ 0, DVT is nearly clinically excluded and no further immediate lab or ultrasound is necessary. In patients with a Wells’ score of 1-2 (moderate risk), DVT can be ruled out with a negative d-dimer rather than an US. Published 2020 Feb 11.

Ultrasounds 90

Ultrasounds Documentation/Coding Wellness EMS 90

Sensible Medicine

MARCH 27, 2024

Peter Attia - From Surgeon to Longevity Guru I first encountered Peter Attia online while researching ketosis , the Atkins diet and low carb diets in 2012 and found his writing to be incredibly well-researched and helpful. The 2018 American guidelines recommend an LDL-C level <100 mg/dl for primary prevention.

Research 113

Research Documentation/Coding Wellness 113

Ken Grauer, MD

JANUARY 26, 2023

That said — this laddergram serves well to illustrate what generally occurs with interpolated PVCs. This blog post reviews the basics for predicting the " C ulprit" A rtery ( as well as reviewing why the term "STEMI" — should replaced by " OMI" = O cclusion-based MI ).

EKG/ECG 195

EKG/ECG Wellness 195

PulmCCM

JUNE 26, 2023

After the 2018 MIND-USA trial found neither haloperidol nor ziprasidone reduced delirium in the ICU, critical care guidelines advised against their wide use. Cervical and pancreatic cancer patients often do as well with less invasive surgery, and some patients with rectal cancer or Hodgkin lymphoma can safely get less radiation.

Outcomes 98

Outcomes Ultrasounds Hospitals Wellness 98