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. J Emerg Trauma Shock. as far west as Texas Cottonmouths/Water Moccasins live in the southeastern U.S. in wetlands, rivers, and lake areas Coral snakes inhabit the southern U.S.

CDC 130

CDC Poisoning Pediatrics Shock 130

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). While ABGs and VBGs usually correlate well, there are a few situations where this correlation is disturbed.

Emergency Department 94

Emergency Department Resuscitation COPD Shock 94

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. 2019, Bauer, Gerlach et al. 2019, Evans, Rhodes et al. 2019, Evans, Rhodes et al. N Engl J Med. 2023;388(6):499-510.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

Don't Forget the Bubbles

DECEMBER 11, 2023

Naturally, it can seem obvious to us now that abuse and trauma in childhood can affect your health and well-being quite significantly, but what was surprising at the time was not just that these events had an impact but how much of an impact these adverse childhood events had. Could there be an element of causation as well as correlation?

Wellness 104

Wellness Research Outcomes Shock 104

Emergency Medicine Ireland

OCTOBER 30, 2023

Well, that time has come and it’s time to run through vasopressin. Well this is where the fun beings. Nagendran 2019 in CCM. And lots of other reasonable people look at the data and say, well this is a catecholamine sparing agent and is a balanced approach to receptor manipulation and just might spare a few filters.

Shock 52

Shock Sepsis Wellness Outcomes 52

Dr. Smith's ECG Blog

JULY 21, 2024

The patient in today’s case presented in cardiogenic shock from proximal LAD occlusion, in conjunction with a subtotally stenosed LMCA. In this study — Procainamide was superior to Amiodarone for terminating monomorphic VT, as well as having fewer adverse effects than Amiodarone ( Ortiz et al — Eur Heart J 1;38 (17): 1329-1335, 2017 ).

EKG/ECG 108

EKG/ECG Shock Hospitals Sepsis 108

EMDocs

JUNE 25, 2024

Consider escharotomy if there is any issue with perfusion or neurologic deficit, as well as difficult ventilation in the intubated patient. National Burn Repository 2019 Update, Report of data from 2009–2018. link] (2019). American Burn Association Clinical Practice Guidelines on Burn Shock Resuscitation. J Burn Care Res.

Burns 74

Burns Fluid Resuscitation Resuscitation Poisoning 74

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 January 9, 2019 post in Dr. Smith's ECG Blog ( Please scroll down to the bottom of the page to see My Comment ).

EKG/ECG 248

EKG/ECG Shock Wellness 248

Dr. Smith's ECG Blog

JANUARY 15, 2024

Tachycardia is unusual for OMI, unless the patient is in cardiogenic shock (or getting close). While awaiting transfer to the cath lab, STAT echocardiogram was performed and showed LVEF 30-35%, as well as anterior, inferior, and apical hypokinesis, and apical thrombus. There are also diagonal branches which are not well visualized.

EKG/ECG 66

EKG/ECG Wellness Point-of-Care Testing Shock 66

Greater Sydney Area HEMS

APRIL 26, 2023

Both the stuff of legend and go by multiple names including harness hang syndrome and orthostatic intolerance, as well as bigfoot and the abominable snowman, respectively. See I told you this sounded a lot like crush injury… Let me put it another way: ST is a state of shock that can be rapidly induced by passive hanging. That’s it?

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Shock Research Operations 52

Ken Grauer, MD

FEBRUARY 28, 2023

These 2 settings are: i ) In patients with severe , often longstanding pulmonary disease ; and / or , ii ) In acutely ill patients with multi-system disease ( ie, sepsis, shock, electrolyte and/or acid-base disorders ). The September 30, 2019 post in Dr. Smith’s ECG Blog — for an example of “MAT”, but without the tachycardia.

EKG/ECG 195

EKG/ECG Documentation/Coding Sepsis COPD 195

The Skeptics' Guide to EM

DECEMBER 11, 2021

Back in 2019 we were talking about Vitamin C for sepsis ( SGEM#268 ). Fujii et al ( VITAMINS RCT) JAMA 2020: n=216 patients with septic shock. Moskowits et al ( ACTS RCT) JAMA 2020: n=205 patients with septic shock. Dr. Chris Carpenter knew Rakesh well and was asked to give a brief introduction to those who did not know him.

Sepsis 40

Sepsis Shock Outcomes Research 40

RebelEM

APRIL 22, 2024

Adverse events in the ICU within 90 days (new shock, cerebral ischemia, myocardial infarction, or intestinal ischemia). Multi-center, international study increases external validity Baseline characteristics were well-balanced between groups. Outcomes (secondary): 90-day all-cause mortality. days (0.2 – 11.5)

Outcomes 72

Outcomes Best Practices EMS Shock 72

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

Am J Med 2019, 132(5):622-630. An elderly man with sudden cardiogenic shock, diffuse ST depressions, and STE in aVR Literature 1. Now there is a paper published in 2019 that proves the point beyond doubt, though makes it clear that this pattern is associated with very high mortality. J Electrocardiol 2013;46:240-8 2. Left main?

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

Emergency Medicine Ireland

JULY 3, 2023

Type 1 is the acute deterioration in kidney function seen in cardiogenic shock from ACS. There are of course much more complex neurohumoral, inflammatory type cytokiney thingies going on but as you can tell they are well over my head so I’ve skipped them for now. Circulation 139, e840–e878 (2019). – Mullens, W.,

Sepsis 96

Sepsis Shock Wellness Documentation/Coding 96

ALiEM

JULY 17, 2023

as well as an analysis of the 2023 Match by Pupazan and Cook in Emergency Medicine News [3,4]. Match Data The unprecedented numbers of unfilled PGY-1 EM residency training positions in the NRMP Match results shocked the specialty these last two years. NRMP Program Results 2019-2023 Main Residency Match. Published May 2022.

EMS 52

EMS Burns Emergency Department Shock 52

Northwestern EM Blog

FEBRUARY 21, 2022

VitalTalk, 9 May 2019, www.vitaltalk.org/guides/transitionsgoals-of-care Expert Commentary This is a nice review of the steps of what can be a very difficult conversation from Drs. Anticipatory guidance is not just for well-child checks ! UpToDate, www.uptodate.com/contents/discussing-goals-of-care Ganta, Niharika, et al.

Dehydration 52

Dehydration Shock Hospitals Wellness 52

Mind The Bleep

JULY 15, 2023

As well as synthesising more albumin, the liver also increases its production of LDL and VDL and lipoprotein which causes hypercholesterolaemia and hypertriglyceridaemia. If a child presents acutely unwell with nephrotic syndrome they are likely to be in hypovalaemic shock, have an infection, or both. Nephrotic Syndrome in Childhood.

Allergic Reactions 52

Allergic Reactions Shock Hospitals Wellness 52

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! 2019 Jul;20(7):660-666. 2019 Sep;241:112-118. Epub 2019 Apr 22. 2019 Jul;20(7):682-683. Systematic review showed 85% of studies with substantial reliability with kappa statistic >0.6 J Surg Res.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

RebelEM

MAY 25, 2023

I recently gave a talk on the initial management of trauma patients with hemorrhagic shock. Clinical Take Home Point: In patients with TBI and hypovolemic shock, target a SBP or MAP ≥90mmHg, but know this is based on limited evidence. vs SBP target <90mmHg which resulted in a mortality of 33.4% NEJM 1994. [2]

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

Taming the SRU

MARCH 30, 2023

Diastolic shock index and clinical outcomes in patients with septic shock. O: There was an association between increased diastolic shock index score and mortality at 90 days and performed similarly to more advanced measures of morbidity and mortality in septic shock including lactate levels and SOFA scores.

Shock 52

Shock Outcomes Sepsis Resuscitation 52

Sensible Medicine

AUGUST 14, 2024

In popular (lay) understanding, SIDS represents a common danger that a well-cared for and apparently healthy baby will suddenly and terrifyingly be found dead in the morning. The sudden death of an apparently healthy child is a devastating tragedy, and if it’s preventable, the costs of supine sleep may be worthwhile.

CDC 75

CDC Sepsis Research Pediatrics 75

Dr. Smith's ECG Blog

MARCH 15, 2023

But when you see this, you should suspect that the AV node is not well. We designed a step-up protocol in which shocks at 50, 100, 200, 300, and 360 J were used for transthoracic cardioversion. Ballatore et al — Medicina (Kaunas) 55(8): 497, 2019 — and — Page et al — Circulation 107:1141-1145, 2003 ).

EKG/ECG 52

EKG/ECG Dehydration Stroke Wellness 52

Dr. Smith's ECG Blog

OCTOBER 7, 2019

When the physicians approached him, he was ashen, diaphoretic, and appeared in shock. Why is the patient in shock? He was in profound cardiogenic shock. Although the shock is no doubt partly a result of poor pump function, with low stroke volume, especially of the RV, it should be compensated for by tachycardia.

Seizures 52

Seizures EKG/ECG Shock EMS 52

EMDocs

JUNE 27, 2024

His medical history is significant for three prior admissions for vaso-occlusive crises that have responded well to appropriate therapy, including pain control with NSAIDs and opioids, blood transfusions, antibiotics, and intravenous (IV) crystalloids. 2019 Jan 24;14:263-292. C or 100.4 mg/kg, max 0.4 2020 Feb 12;10(1):2470.

Pediatrics 76

Pediatrics EMS Dehydration Hospitals 76

Pediatric EM Morsels

NOVEMBER 3, 2023

With concern for malaria, it is very important to identify who is non-immune and semi-immune as this can affect both the timeframe for illness after departure from the endemic country as well as severity of illness. 2019; 17: 98. 2019; 47(2): 183–193. falciparum parasitemia , and no other defined cause of AMS (WHO 2023).

Seizures 277

Seizures Pediatrics CDC Infectious Diseases 277

Taming the SRU

OCTOBER 1, 2023

This topic is additionally complicated by the development of multiple diagnostic tools now available for diagnosis as well as variable sizing algorithms used around the world. J Emerg Trauma Shock. Published 2019 Dec 3. doi:10.1155/2019/5271982 Lichtenstein D, Mezière G, Biderman P, Gepner A. Ann Emerg Med. Can Respir J.

Fractures 95

Fractures COPD Hospitals Emergency Department 95

EMDocs

APRIL 22, 2024

However, as shock resolved and hemodynamic stability improved, RV strain and underfilling of the LV remained apparent 30 minutes after ROSC (Vid 4). If RV pressure is extreme, it can exceed LV pressure causing paradoxical septal wall motion toward the LV as well. 2019 Oct-Dec;29(4):169-171. RV pressures > LV pressures.

Ultrasounds 82

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 82

Dr. Smith's ECG Blog

OCTOBER 24, 2019

On the other hand , high-risk lesions appear to do well with aggressive treatment. were pretty sick, with mostly LM/pLAD lesions and high rates of cardiogenic shock. She did well, and was ultimately discharged from her cardiologist’s care years later! JACC 2019 Sep 10;74(10):1290-1300. Lobo et al.

EKG/ECG 52

EKG/ECG Wellness Shock Ultrasounds 52

The Trauma Pro

JUNE 18, 2024

Objective MTP activation criteria have been developed and are well-supported by the literature. The ABC score and the shock index are two of the more common methods. The Shock Index (SI) uses the initial vital signs to perform a quick and dirty calculation by dividing the heart rate by the systolic blood pressure. 2019.10.008.

Pediatrics 147

Pediatrics Blood Transfusions Resuscitation Shock 147

Don't Forget the Bubbles

MAY 10, 2023

A shocked friend is being ushered out of the way. And then the debrief runs through STOP : Situation – a recap of the resuscitation, including the reasoning behind decisions made Things that went well Opportunities to improve Points of action – equipment issues, or whether a case review is needed And so after the hot debrief, you pause.

Emergency Department 91

Emergency Department Resuscitation Documentation/Coding Teamwork 91

Northwestern EM Blog

JANUARY 24, 2022

Written by: Elizabeth Stulpin, MD (NUEM ‘23) Edited by: Aaron Wibberly, MD (NUEM ‘22) Expert Commentary by : Joshua Zimmerman, MD (NUEM ‘17) Non-Response to Vasopressors Shock is defined as a state of cellular and tissue hypoxia resulting in end organ dysfunction. And for most forms, EM physicians are not typically shocked by shock.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

Downeast Emergency Medicine

APRIL 26, 2021

Lancet 2019; Vol 394, Iss 10210, P 1713-1723[ Full Text ]. When looking at the subgroups with severe shock, there was an 18.5% When stratifying TXA administration time after injury and qualifying shock incidence, there appeared to be a lower 30 d mortality if TXA was given within 1 hour of the incident. MI or stroke).

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

EB Medicine

DECEMBER 4, 2019

Well, with that, let’s get started on our final scheduled episode of EMplify ! Thanks as well to the peer editors, Dr. Knight, and Dr. Hill of the University of Cincinnati. Show More v Jeff: Well, this is a first! In 2019, of the 4 billion passengers expected to fly, there will be an estimated 60,000 medical emergencies.

Dehydration 40

Dehydration Wellness EMS Burns 40

EB Medicine

JULY 8, 2019

I’m Jeff Nusbaum and I’m back with Nachi Gupta for the 30 th episode of EMplify and the first Post-Ponte Vedra Episode of 2019. Jeff: Well that’s kind worrisome. Which again reiterates why this is such an important topic for us as EM clinicians to be well-versed in. I hope everybody enjoyed a fantastic conference.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

Mind The Bleep

JUNE 17, 2023

Examine for capillary refill, peripheral pulses, are they warm and well perfused? Leung AKC, 2019) Parents may say the urine is offensive smelling In older children they may complain of urinary symptoms + fever and suprapubic pain By the age of 16 years, 11.3% The child will be well in between episodes of pain.

Shock 93

Shock Wellness Emergency Department Ultrasounds 93

Dr. Smith's ECG Blog

APRIL 15, 2019

Here was his initial ED ECG: There is sinus tachycardia at a rate of about 140 There is profound ST Elevation across all precordial leads, as well as I and aVL. He presented very tachycardic with a very high fever. QTc was 374, and the formula value was quite high, consistent with LAD occlusion.

EKG/ECG 52

EKG/ECG Sepsis Documentation/Coding Shock 52