Pediatric EM Morsels

SEPTEMBER 22, 2023

McGraw Hill Education; 2019:104-109 Dave S, DAHLSTROM JJ. McGraw Hill Education; 2019:125-138 Ziu E, Mesfin FB. References Coleman-Satterfield, TT. Tenenbein M, Macias CG, Sharieff GQ, et al, eds. In: Strange and Schafermeyer’s: Pediatric Emergency Medicine. 5 th Edition. Neurogenic Shock. Updated 2022 Feb 10]. 5 th Edition.

Shock 300

Shock Pediatrics Hyperthermia / Hypothermia Dislocations 300

Ken Grauer, MD

JANUARY 13, 2024

The March 31, 2019 post in Dr. Smith's ECG Blog — My Comment ( at the bottom of the page ) illustrates the potentially misleading effect the pre-hospital ECG may have in patients with LVH , by cutting off S wave voltage in the anterior leads.

EKG/ECG 397

EKG/ECG Hospitals 397

Sensible Medicine

JANUARY 28, 2025

What factors were blamed for the 2019 Samoa measles outbreak in the peer reviewed literature and news coverage? ” Second, “ Robert F Kennedy was seldom held responsible for the Samoa measles outbreak between 2019 and 2023 (18.5% Then, RFK Jr visited the island in 2019, and the outbreak began a month or two later.

Academics 145

Academics CDC Administration 145

Pediatric EM Morsels

APRIL 5, 2024

Silva-Ramos 2021) Majority of cases arise from travel to South Africa. (Frean 2019) The classic triad described is fever, eschar and rash. Ricardi 2019) Tick-Borne Encephalitis has a biphasic pattern of symptoms. Ricardi 2019) Initial symptoms are nonspecific and include fever, malaise, headache, nausea, vomting and myalgias.

CDC 161

CDC Infectious Diseases Pediatrics Wellness 161

Pediatric EM Morsels

JULY 7, 2023

Horan, 2006 ] Anatomy of the PTF Joint [ Cunningham, 2019 ] The PTF joint is a synovial joint between the lateral condyle of the tibia and the head of the fibula. Cunningham, 2019 ] Treatment [ Horan, 2006 ] 1st option for Subluxation and Anterolateral Dislocation is Manual Reduction ( similar to reducing that Nursemaid’s Elbow ).

Dislocations 141

Dislocations Fractures Pediatrics EMS 141

Ken Grauer, MD

OCTOBER 29, 2023

For my clarifying Figure illustrating T-QRS-D ( 2nd bullet ) — See My Comment at the bottom of the page in Dr. Smith’s November 14, 2019 post. Smith’s ECG Blog with 20-minute video talk by Dr. Meyers on The O MI M anifesto.

EKG/ECG 195

EKG/ECG 195

The Trauma Pro

DECEMBER 20, 2024

Effective October 2019, Medicare agreed to reimburse a hospital about $18,000 for Andexxa over and above the DRG for the patient’s care. NEJM 380(14):1326-1335, 2019. Neurocrit Care epub ahead of print, 22 Oct 2019. So, we don’t really know how useful it is when treating bleeding after DOAC administration.

Head Injuries 113

Head Injuries Administration Hospitals 113

First 10 EM

MAY 27, 2024

Connolly 2019) At that point, I concluded that andexanet alfa should clearly not be used (although our pharmacies didn’t listen and wasted a lot […] The post Andexanet alfa: expensive and harmful?

EMS 110

EMS 110

Pediatric EM Morsels

JUNE 21, 2024

Chaganti 2019] Other studies have not shown a difference in infection rates between silver-containing creams and antimicrobial ointments.

Burns 169

Burns Pediatrics Hospitals Wellness 169

Pediatric EM Morsels

JULY 26, 2024

Epub 2019 Dec 19. Anti-N-methyl-D-aspartate receptor encephalitis with accompanying ovarian teratoma in female patients from East China: Clinical features, treatment, and prognostic outcomes. 2020 Feb;75:55-62. doi: 10.1016/j.seizure.2019.12.016. 2019.12.016. PMID: 31874360.

Psychiatric 269

Psychiatric Seizures Outcomes Pediatrics 269

The Trauma Pro

AUGUST 29, 2023

The University of Arizona at Tucson group analyzed the Trauma Quality Improvement Program (TQIP) database on withdrawal of care from 2017-2019. Is it possible to identify the common factors that predict appropriate withdrawal of care? The authors included only patients aged 65 and older.

181

181

RebelEM

MAY 25, 2023

Lancet 2019. JAMA Surgery 2019. Lancet 2010 [10] >20,000 adult trauma patients with SBP <90mmHg Patients randomized to TXA 1g over 10 min + 1g IV over 8hrs vs Placebo given within 8hrs of injury In-hospital mortality by 28d reduced (14.5% PMID: 31461138 Brotfain E et al. PMID: 31623894 Curry N et al. J Trauma Acute Care Surg.

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

Sensible Medicine

OCTOBER 18, 2023

2019 Nov 19;140(21):1706-1716. Epub 2019 Oct 21. Weissler-Snir A, Allan K, Cunningham K, Connelly KA, Lee DS, Spears DA, Rakowski H, Dorian P. Hypertrophic Cardiomyopathy-Related Sudden Cardiac Death in Young People in Ontario. Circulation. doi: 10.1161/CIRCULATIONAHA.119.040271. 119.040271. PMID: 31630535.

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102

Emergency Live

MARCH 26, 2024

In 2019, according to the International Diabetes Federation, approximately 59.3 Prevention: a major challenge for health Diabetes affects many people in Europe. million adults were diagnosed with diabetes. An even larger number of people are at risk of developing it.

95

95

NIOSH Science Blog

SEPTEMBER 27, 2023

As of 2019, more than 18 million people, 11.5 % of the United States workforce, were employed in healthcare settings. Everyday healthcare workers face hazardous work conditions due to exposures to infectious agents and hazardous drugs and chemicals.

Outcomes 108

Outcomes 108

Dr. Smith's ECG Blog

MAY 3, 2024

In Figure-1 — I reproduce major points that I've summarized from Dr. Smith's August 9, 2019 post on the subject. Figure-1: Reasons for the varied ECG presentation of acute LMain occlusion — excerpted from Dr. Smith’s 8/9/2019 post ( See text ). Quite literally — You can see almost anything!

Shock 130

Shock EKG/ECG Hospitals EMS 130

Don't Forget the Bubbles

NOVEMBER 11, 2024

explored the evidence in a 2019 systematic review, which forms part of the Brain Trauma Foundation Guidelines, as did Utsumi et al. 2019 Apr;20(4):404]. The injury is not uniform across the brain. There tends to be a mixture of localised and widespread components. What is the evidence behind targeted temperature management?

Hyperthermia / Hypothermia 117

Hyperthermia / Hypothermia Pediatrics Outcomes Resuscitation 117

Emergency Medicine Journal

NOVEMBER 21, 2024

In 2019, we conducted a survey using the Spanish-adapted Hospital Survey on Patient Safety Culture open to all staff (doctors, nurses and paediatric residents) in AED and PED. Results The 2019 questionnaire was completed by 125 AED workers and 65 PED workers. Methods A quasi-experimental study was performed.

Emergency Department 93

Emergency Department Teamwork Patient Safety Hospitals 93

Pediatric EM Morsels

MARCH 17, 2023

Judge 2019) Best when given within 4 hours of the bite, but still effective within 24 hours Always give an entire vial of antivenom, never a partial vial. Published November 13, 2019. as far west as Texas Cottonmouths/Water Moccasins live in the southeastern U.S. It’s expensive, so if you’re giving some of a vial, give it all.

CDC 130

CDC Poisoning Pediatrics Shock 130

The Trauma Pro

OCTOBER 1, 2024

Health Econ 28(7)L817-829, 2019. I would not encourage the general public to use these services for medical transport, and neither do the companies themselves! Reference: Did UberX Reduce Ambulance Volume?

Ambulance Services 130

Ambulance Services EMS Hospitals 130

RebelEM

SEPTEMBER 7, 2023

BACKGROUND: intracerebral hemorrhage (ICH) makes up 10-15% of all strokes and significantly contributes to overall stroke-related morbidity and mortality ( Hostettler 2019 ). 2019 Jul;19(7):679-694. Epub 2019 Jun 12. 2019 May;68:38-45. Intracerebral hemorrhage: an update on diagnosis and treatment. Expert Rev Neurother.

Seizures 119

Seizures Stroke Outcomes Research 119

Ken Grauer, MD

MARCH 11, 2024

The November 12, 2019 post in Dr. Smith's ECG Blog — in which I review my approach to a Regular SVT rhythm. ECG Blog #210 — for review of the Every-Other-Beat Method for rapi d estimation of heart rate ( See Video Pearl #27 in this post ). ECG Blog #229 — reviews distinction between AFlutter vs ATach.

EKG/ECG 387

EKG/ECG 387

Dr. Smith's ECG Blog

JANUARY 2, 2025

Applying my method to the March 19, 2019 case that I show in Figure-1 the rhythm in this Figure-1 ECG is regular, with an R-R interval just under 4 large boxes. Figure-1: My "correction factor" for QTc estimation when the QRS is not wide ( from My Comment in the March 19, 2019 post in Dr. Smith's ECG Blog ). J Am Coll Cardiol.

EKG/ECG 119

EKG/ECG Sepsis Wellness Documentation/Coding 119

Emergency Medicine Journal

AUGUST 21, 2024

Methods Qualitative study; informal interviews of junior doctors, consultants and nursing staff and direct observation of clinical interactions, induction and training in a single ED in an English Emergency Department between August and October 2019. We used constant comparison to identify and develop themes.

Patient Safety 98

Patient Safety Emergency Department Research 98

EM Literature of Note

SEPTEMBER 11, 2023

The population included for analysis is the Austrian Stroke Unit Registry from 2018 until 2019, an original cohort of 53,899 patients. Like MARISS, this is a retrospective dredge of patients selected by the treating clinicians to receive either intravenous thrombolysis or, in this case, dual-antiplatelet therapy with clopidogrel and aspirin.

Stroke 114

Stroke Outcomes Wellness 114

Pediatric EM Morsels

APRIL 7, 2023

Let’s take a minute to digest a morsel on another significant complication – Sickle Cell Disease and Stroke in Children : Sickle Cell Disease and Stroke: Basics Pathophysiology (Menaa, 2013, Webb, 2013) SCD causes sickling shape of red blood cells Vaso-occlusive Cascade: Sickling → vascular endothelium destruction → cytokine/ immune cell (..)

Stroke 130

Stroke Pediatrics Seizures Sepsis 130

PulmCCM

AUGUST 12, 2024

There was a terrible case in 2019 of a police officer who cracked his neck to relieve some discomfort and dissected his vertebral artery. He immediately felt and looked bad and his coworkers had an ambulance take him to the ED. The initial CT read suggested vertebral artery stenosis but used equivocal language.

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75

NIOSH Science Blog

APRIL 12, 2023

1] This issue is a result of discussions and collaborations from the 2019 NIOSH Working Hours, Sleep and Fatigue Forum and also pulls from reports by the National Institute for Occupational Safety and Health (NIOSH) on long work hours and shift work.

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87

Mind The Bleep

FEBRUARY 2, 2025

Document if anyone was with the patient when they died and who it was that first noted the patient was deceased Document your assessment in full The time of death which is when you completed the confirmation Include in your notes any conversations with family members and any concerns raised by either family members or staff looking after the patient (..)

Documentation/Coding 105

Documentation/Coding Resuscitation Hospitals EKG/ECG 105

Dr. Smith's ECG Blog

OCTOBER 20, 2024

Figure-1: Reasons for the varied ECG presentation of acute LMain occlusion — excerpted from Dr. Smith’s 8/9/2019 post ( This Table from My Comment in the January 16, 2020 post ). The ST-T wave appearance in lead aVR can be anything when there is acute LMain occlusion.

EKG/ECG 131

EKG/ECG Shock Emergency Department Ambulance Services 131

Science Based Medicine

APRIL 25, 2023

In 2019, Drs. John Mandrola, Adam Cifu, Vinay Prasad, and Andrew Foy wrote an article titled The Case for Being a Medical Conservative. They wrote that the “choice of the term ‘medical conservative’ does not imply a political philosophy.”

Outcomes 81

Outcomes 81

Emergency Medicine Journal

JULY 22, 2024

Methods This was a retrospective data linkage study on consecutive adult EMS patients discharged at scene by paramedics in Victoria, Australia, between 1 January 2015 and 30 June 2019.

Outcomes 98

Outcomes EMS Hospitals Research 98

Mount Sinai EM

JANUARY 11, 2023

McGraw Hill; 2019. In: Sherman SC. Simon’s Emergency Orthopedics, 8e. Accessed January 04, 2023. link] Feger J, Knipe H, El-Feky M, Tibiofibular overlap. Reference article, Radiopaedia.org (Accessed on 04 Jan 2023) [link] Gorton S, Jones J, Bell D, et al.

Radiology 130

Radiology Radiology Fractures Dislocations 130

RebelEM

DECEMBER 13, 2023

Goldfrank’s Toxicology 2019) Carboxyhemoglobin levels > 25% or >15% in pregnant patients are indications for hyperbarics, independent of signs/symptoms There is evidence that hyperbaric oxygenation reduces the risk of cognitive sequelae after acute carbon monoxide poisoning. Carbon Monoxide. Accessed November 6, 2023.

Poisoning 101

Poisoning EMS 101

Ken Grauer, MD

JUNE 6, 2023

The March 31, 2019 post in Dr. Smith's ECG Blog — My Comment ( at the bottom of the page ) illustrates the potentially misleading effect the pre-hospital ECG may have in patients with LVH ( ie, by cutting off S wave voltage in the anterior leads ).

EKG/ECG 195

EKG/ECG Hospitals Wellness Resuscitation 195

Dr. Smith's ECG Blog

FEBRUARY 18, 2024

The September 27, 2019 post — for the Rowlands & Moore article with the above-noted formulas for recognizing the “culprit” extremity. The September 22, 2019 post — intermittent ST-T wave artifact. The August 26, 2019 post — baseline artifact. The October 17, 2020 post — for a 70-year old woman with " Artifactual VT ".

EKG/ECG 111

EKG/ECG Stroke 111

Dr. Smith's ECG Blog

JUNE 14, 2024

The September 27, 2019 post — for the Rowlands & Moore article with the above-noted formulas for recognizing the “culprit” extremity. The September 22, 2019 post — intermittent ST-T wave artifact. The August 26, 2019 post — baseline artifact. The October 17, 2020 post — for a 70-year old woman with " Artifactual VT ".

EKG/ECG 82

EKG/ECG Wellness Hospitals 82