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. Third times the charm! Pediatr Clin N Am 69 (2022) 47–64. 8 Dec 2022.

Seizures 278

Seizures Pediatrics CDC Infectious Diseases 278

Pediatric EM Morsels

SEPTEMBER 22, 2023

” Children compensate for blood and volume loss very well… until they don’t. McGraw Hill Education; 2019:104-109 Dave S, DAHLSTROM JJ. McGraw Hill Education; 2019:125-138 Ziu E, Mesfin FB. Physical exam findings of occult shock in children can be subtle. Fortunately, there are screening tools for occult shock.

Shock 300

Shock Pediatrics Hyperthermia / Hypothermia Dislocations 300

Ken Grauer, MD

JUNE 26, 2023

That said — since today’s patient is a “young man” — and the rate of today’s rhythm is extremely fast ( ie, 250-260/minute — which is faster than is usually seen in a VT rhythm that maintains a well-defined QRS morphology ) — we clearly can not discount the possibility of an SVT rhythm.

EKG/ECG 366

EKG/ECG Wellness 366

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. Seen in sports that involved aggressive twisting of the knee (ex, snowboarding, soccer, horse-riding) as well as direct trauma. 2019 Apr;31(2):156-162. MANAGE PAIN!

Dislocations 141

Dislocations Fractures Pediatrics EMS 141

NIOSH Science Blog

AUGUST 29, 2022

Most research on the mental health and well-being of healthcare workers has focused on physicians and nurses, with less attention paid to other healthcare occupations. 1] Assessing Mental Health and Wellbeing Researchers evaluated data from the Behavioral Risk Factor Surveillance System (BRFSS) from 2017 to 2019.

Wellness 49

Wellness Research 49

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. Antibacterial ointments , like bacitracin, tend to be well tolerated and promote faster wound healing than silver sulfadiazine and other creams in partial thickness wounds. Get the Goop!

Burns 169

Burns Pediatrics Hospitals Wellness 169

Pediatric EM Morsels

JULY 26, 2024

These females should have imaging with either MRI or CT as well as abdominal or transvaginal ultrasound to assess for ovarian teratoma. Epub 2019 Dec 19. The prevalence ranges from 12.5%-61% 61% in females of reproductive age, with approximately 45% of females older than 18 years old with teratoma. 2020 Feb;75:55-62. 2019.12.016.

Seizures 269

Seizures Psychiatric Outcomes Pediatrics 269

Pediatric EM Morsels

OCTOBER 6, 2023

(Forster, 2021) Transmission is by Fecal-Oral route (Chiodini 2018) Incubation period 6-30 days after exposure (Chiodini 2018) Salmonella typhi produces an endotoxin although its clinical significance is not yet well understood (Gibani 2019) Two typhoid vaccines are available for those > 6 m/o and are 50-80% effective.

Pediatrics 161

Pediatrics CDC Seizures Documentation/Coding 161

Ken Grauer, MD

SEPTEMBER 6, 2024

Alternatively — when a portion of the reentry circuit is made up of an AP ( A ccessory P athway ) — the retrograde P wave will typically manifest a moderately long RP' interval ( that occurs well after the QRS — usually within the latter part of the ST segment ). The October 16, 2019 post in Dr. Smith's ECG Blog.

EKG/ECG 248

EKG/ECG Administration Wellness Operations 248

Ken Grauer, MD

JULY 29, 2023

This young woman did well for a year — but unfortunately suffered another cardiac arrest, from which she could not be resuscitated. The most specific diagnostic ECG sign of ARVD is the E psilon w ave ( Pérez-Riera et al — Ind Pacing Electrophys J 19:63-67, 2019 ). MRI confirmed ARVC. About A RVC/ A RVD. in these right-sided leads.

EKG/ECG 370

EKG/ECG Resuscitation Documentation/Coding Hospitals 370

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 112

Stroke Outcomes Wellness 112

Ken Grauer, MD

DECEMBER 23, 2023

This is perhaps best seen in lead V1 ( but also well seen in leads V3,V4,V6 ). The November 12, 2019 post in Dr. Smith's ECG Blog — in which I review my approach to a Regular SVT rhythm. Since the R-R interval is just under 2 large boxes in duration — I estimate the ventricular R ate to be just over 150/minute.

EKG/ECG 441

EKG/ECG Wellness 441

NIOSH Science Blog

MAY 14, 2020

This year has seen nurses all over the world step up and battle coronavirus disease 2019 (COVID-19) fearlessly, often while navigating evolving guidance and operating under difficult conditions with strained resources. The World Health Organization proclaimed 2020 the Year of the Nurse and Midwife.

Wellness 52

Wellness Operations 52

Ken Grauer, MD

FEBRUARY 15, 2024

The above said — On occasion, there may be focal triggered activity that results in the marked irregularity of the monomorphic VT seen in ECG #1 ( Zhang et al — Circulation 139:1750-1752, 2019 ).

EKG/ECG 323

EKG/ECG Wellness 323

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. In contrast, Kochanek reviewed each meta-analysis, as well as the RCT and secondary analyses, separately to assess overall results and potential moderators of effect. 2019 Apr;20(4):404].

Hyperthermia / Hypothermia 116

Hyperthermia / Hypothermia Outcomes Pediatrics Resuscitation 116

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

Ken Grauer, MD

APRIL 14, 2023

NOTE: Although the end of the QRS is not well seen in many of the leads in today's tracing — it is clearly delineated in leads II and aVR in the limb leads — and especially in lead V1 in the chest leads. PCI was successful — and this 90-year old patient did surprisingly well! There was no significant disease in the LCx or RCA.

EKG/ECG 195

EKG/ECG Wellness Hospitals 195

RebelEM

MAY 25, 2023

CRYSTALLOIDS Too much crystalloid resuscitation in traumatic hemorrhagic shock can increase dilutional coagulopathy, as well as increase morbidity and mortality Bickell WH et al. Lancet 2019. vs SBP target <90mmHg which resulted in a mortality of 33.4% NEJM 1994. [2] PMID: 31461138 Brotfain E et al. PMID: 31623894 Curry N et al.

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

Ken Grauer, MD

MARCH 18, 2023

PEARL # 5: We could probably get a better idea of the sequence of events in today's case with some additional history that correlates the timing of ECG #1 — with the timing of symptom onset — and — with the presence ( as well as relative severity ) of chest pain at the time the initial tracing in Figure-1 was done.

EKG/ECG 195

EKG/ECG Wellness 195

Pediatric EM Morsels

APRIL 7, 2023

Observation, interaction with patient, as well as parent information is key to bring the whole picture together!

Stroke 130

Stroke Pediatrics Seizures Sepsis 130

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 Wellness Resuscitation 195

The Trauma Pro

OCTOBER 4, 2024

And unfortunately, I’m not able to guess the numbers well enough to do the power calculation for this study. Be sure to follow with your performance improvement program to make sure that they actually do work as well as you think! J Ped Surg 54:335-339, 2019. Did they have the statistical power to show such a difference?

Pediatrics 113

Pediatrics Outcomes Operations Emergency Department 113

Dr. Smith's ECG Blog

FEBRUARY 2, 2024

He did well and was discharged. Osborn waves have been reported with hypercalcemia, brain injury, subarachnoid hemorrhage, Brugada syndrome, cardiac arrest from VFib — and — severe, acute ischemia resulting in acute MI ( See My Comment in the November 22, 2019 post on Dr. Smith’s Blog ). C), with Cardiac Echo -- A Pathognomonic ECG.

Hyperthermia / Hypothermia 137

Hyperthermia / Hypothermia EKG/ECG Wellness 137

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

Ken Grauer, MD

MARCH 7, 2023

C ONCLUSION of T oday's C ase : The subtle-but-real ST-T wave changes in today's initial tracing — as well as the equally subtle-but-real " dynamic " ST-T wave changes seen in the repeat tracing — went unrecognized for 9 hours. Fortunately — this patient did well, and was discharged with surprisingly good LV function.

EKG/ECG 195

EKG/ECG Wellness 195

33 Charts

NOVEMBER 5, 2021

Our patients are seen as collections of proteins, genes and markers (I was privileged to talk about this at DotMD 2019). It owns the space where technology, art, digital culture, creativity, wellness and human narrative collide for a broader view of the care experience. All of this neutralizes the texture of the human journey.

Wellness 91

Wellness 91

The Trauma Pro

JUNE 18, 2024

Objective MTP activation criteria have been developed and are well-supported by the literature. Epub 2019 Nov 1. All of the trauma professionals are busy with the patient and are rudely surprised when they ask for the first unit of blood. The ABC score and the shock index are two of the more common methods. J Pediatr Surg. 2019.10.008.

Pediatrics 113

Pediatrics Blood Transfusions Resuscitation Shock 113

Dr. Smith's ECG Blog

DECEMBER 19, 2023

The patient did well afterward without any recurrence of symptoms. From My Comment in the November 14, 2019 post in Dr. Smith's ECG Blog: A subject well worth periodic review — is the concept of Terminal QRS Distortion ( T-QRS-D ). Figure-4: I've labeled the first 2 ECGs shown in the November 14, 2019 post ( See text ).

EKG/ECG 124

EKG/ECG EMS Wellness Operations 124

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 September 22, 2019 post — intermittent ST-T wave artifact.

EKG/ECG 80

EKG/ECG Wellness Hospitals 80

Ken Grauer, MD

MAY 12, 2023

ECG Blog #240 — Reviews the definition of what an "SVT" is — as well as illustrating the different types of reentry SVT rhythms ( with assessment of the RP' interval ). Please check out the November 12, 2019 post in Dr. Smith's ECG Blog — in which I reviewed the case of a different kind of regular SVT Rhythm ( AFlutter ).

EKG/ECG 195

EKG/ECG Wellness 195

SheMD

JULY 30, 2023

According to ,, AAMC , there were 53,371 medical school applicants in the 2019-2020 application cycle, and only 21,869 matriculated. Remember, letter writers can talk about your intellectual strengths as well as your personal attributes and character. Ask your potential letter of recommendation writers well in advance.

Academics 104

Academics Leadership Research Wellness 104

Pediatric EM Morsels

AUGUST 18, 2023

Etminan 2019) In Belgium between 2010 – 2013, of the 262 children treated with fluroquinolones while hospitalized, only 17% were used for labelled indications. (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.

Pediatrics 130

Pediatrics Infectious Diseases Seizures Hospitals 130

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

Ken Grauer, MD

FEBRUARY 28, 2023

As a result — IF the 1 lead you are monitoring happens to be one in which P waves are not well seen — then you might assume the irregular rhythm in front of you was AFib. The September 30, 2019 post in Dr. Smith’s ECG Blog — for an example of “MAT”, but without the tachycardia. Remember — 12 leads are better than one!

EKG/ECG 195

EKG/ECG Documentation/Coding Sepsis COPD 195

Dr. Smith's ECG Blog

OCTOBER 20, 2024

This series of ECGs ( ECG #1 , #2 and #4 ) illustrate well that subtotal occlusion of the left main is usually associated with severe subendocardial ischemia (profound and diffuse ST depression), whereas an ECG recorded during total occlusion of the LMCA (ECG #2) will show widespread ST elevations. There is now some flow in the LMCA!

EKG/ECG 130

EKG/ECG Shock Emergency Department Ambulance Services 130

ALiEM

OCTOBER 21, 2024

F; RR 22; O2 Sat 100% RA General : Alert, interactive, well-appearing HEENT : Left ear with moderate redness, swelling, warmth, and tenderness of the auricle sparing the lobule. 2019 Aug;276(8):2199-2203. Epub 2019 May 11. Physical Exam Vitals : BP 130/68; HR 105; Temp 98.9°F; Superficial lineal abrasion over concha, hemostatic.

Academics 67

Academics Wellness 67