Pediatric EM Morsels

SEPTEMBER 20, 2024

Diarrhea is one of the most common complaints in the pediatric emergency department, especially in the summer and early fall. Though most children recover well after STEC is cultured from their stool, some will go on to display the findings that make up HUS. 2021 May;232:200-206.e4. Epub 2021 Jan 5. 2020.12.077.

Pediatrics 164

Pediatrics Ultrasounds Dehydration Emergency Department 164

ACEP Now

NOVEMBER 7, 2024

About three percent of emergency department (ED) visits are due to skin and soft tissue infections, but data are lacking on the contribution of chronic wounds to this number. Emergency Medicine News 2004;26(13):19. 2020;95(9):2021-2034. The post How to Best Inspect, Protect, and Dress Wounds in the Emergency Dept.

Burns 97

Burns Documentation/Coding Outcomes Emergency Department 97

EMDocs

JANUARY 11, 2025

Well keep it short, while you keep that EM brain sharp. Admission allows for close monitoring, given the risks of perforation, ischemic bowel, and ulceration, as well as appropriate management of the condition and patient symptoms. Stercoral colitis in the emergency department: a review of the literature. In StatPearls.

EMS 98

EMS Sepsis Shock Fluid Resuscitation 98

RebelEM

JULY 1, 2024

Comparison of BPAP S/T and Average Volume-Assured Pressure Support Modes for Hypercapnic Respiratory Failure in the Emergency Department: A Randomized Controlled Trial. Balkan Med J 2021. AVAPS may be useful, but we still need a well conducted RCT to find out if it is (i.e Balkan Med J 2021. Cureus 2021.

COPD 133

COPD Emergency Department Outcomes EMS 133

EMDocs

NOVEMBER 19, 2024

of exposures reported to poison control centers in 2021 were related to antipsychotics or sedative-hypnotics with the majority of those exposures occurring in patients 20 years of age or older. 2021 Annual Report of the National Poison Data System © (NPDS) from America’s Poison Centers: 39th Annual Report. Front Psychiatry.

Poisoning 111

Poisoning Hyperthermia / Hypothermia EKG/ECG Seizures 111

Pediatric EM Morsels

JULY 21, 2023

Gag reflex is much better predictor (45% vs 6%) [Conzelmann 2021] Positive predictive value of GCS indicating aspiration in intoxication was only 3%. Interrater reliability of Glasgow Coma Scale scores in the emergency department. Ann Emerg Med. BMJ Open 2021; 11: e053619. 2021 Jan 1;90(1):21-26. J Surg Res.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

EM Literature of Note

AUGUST 25, 2024

Well, yes to all of the above, in the appropriate clinical context – But, most prominently, as featured in this brief report, for asthma – particularly childhood asthma. It’s NHAMCS – so it is representative data being transformed into rough weighted estimates – between 2010-2021, but we see its use increasing from 3.5%

Emergency Department 94

Emergency Department Administration Wellness Pediatrics 94

Don't Forget the Bubbles

MAY 31, 2023

Children presenting with diabetes and diabetic ketoacidosis to Emergency Departments during the COVID-19 pandemic in the UK and Ireland: an international retrospective observational study. During the COVID-19 pandemic , we noticed a change in the type of patients presenting to the Emergency Department. Arch Dis Child.

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

Northwestern EM Blog

MARCH 1, 2025

In this study, they found that prone positioning resulted in significant improvement in oxygenation, as well as a 50% decrease in mortality at 28 days (Guerin et. The PROSEVA study is the most recent and famous randomized control trial. This maneuver improves oxygenation and gas exchange via three main mechanisms (Malhotra, 2022): 1.

Emergency Department 52

Emergency Department Fractures EKG/ECG Wellness 52

Downeast Emergency Medicine

DECEMBER 1, 2021

Background Recent data from the National Center for Health Statistics reveal that in the 12-month period ending in April 2021, more than 100,000 Americans died of an overdose, a staggering increase of nearly 30% the prior year. Emergency Department-Initiated Buprenorphine/Naloxone Treatment for Opioid Dependence: A Randomized Clinical Trial.

Emergency Department 52

Emergency Department Documentation/Coding Leadership Administration 52

EMDocs

JANUARY 25, 2025

Well keep it short, while you keep that EM brain sharp. A 45-year-old outdoor enthusiast presents to the emergency department with fever, headache, myalgias, and malaise. 10^9/L) Moderate (0.50.9 10^9/L) Severe (< 0.5 10^9/L) Generalized leukopenia (i.e. Most common causes of leukopenia Infections: 36.4% Medications: 25.6%

EMS 95

EMS Infectious Diseases Allergic Reactions Fluid Resuscitation 95

ACEP Now

NOVEMBER 13, 2023

Physicians, nurses, and staff in emergency departments (EDs) across the country have encountered workplace violence for years. 1,2 In a 2018 study by ACEP, nearly half of emergency physicians polled reported a physical assault while at work. J Emerg Nurs. J Am Coll Emerg Physicians Open. 2021;(7):1278-1287.

Emergency Department 52

Emergency Department Documentation/Coding Psychiatric Best Practices 52

Northwestern EM Blog

DECEMBER 27, 2021

Congratulations to all of the authors with the most popular posts of 2021! Despite previous black box warnings on droperidol causing it to fall out of favor, it is safe and well-tolerated at the doses typically used in an emergency department setting.

Dislocations 52

Dislocations Emergency Department Burns Shock 52

EM Literature of Note

SEPTEMBER 13, 2024

These are each awful, of course, in their own way from a patient- and parent-oriented standpoint, but they’re also quite awful at the population level, overburdening limited pediatric and emergency department resources. The two “COVID seasons” of 2020-21 and 2021-22 were excluded from their comparisons.

Emergency Department 87

Emergency Department Pediatrics Administration Wellness 87

The Skeptics' Guide to EM

APRIL 20, 2024

Efficacy and safety of ultrasound-guided erector spinae plane block compared to sham procedure in adult patients with rib fractures presenting to the emergency department: A randomized controlled trial. Background: We have covered rib fractures once before on the Skeptics’ Guide to Emergency Medicine.

Fractures 87

Fractures Ultrasounds Emergency Department CDC 87

Emergency Medicine Journal

AUGUST 21, 2024

The Clinical Frailty Scale (CFS) is a 9-point frailty assessment instrument that has shown promise to identify frail emergency department (ED) patients at increased risk of adverse outcomes. days versus 2.7 days, a difference of 2.2 days (95% CI 1.2 Trial registration number NCT04877028.

Emergency Department 52

Emergency Department Hospitals Outcomes Wellness 52

ALiEM

NOVEMBER 17, 2023

A 4-year-old female with no significant past medical history is brought to the Emergency Department by her grandmother for concern for two days of progressive vaginal bleeding. kg General : Well-appearing 4-year-old female acting appropriately with grandmother and mother at the bedside. link] Published 2021. C; Wt 18.2

Pediatrics 100

Pediatrics Emergency Department Academics OB/GYN 100

EMDocs

AUGUST 22, 2024

12 How do we address these disparities in the emergency department? Well-meaning providers who are not highly fluent may contribute to miscommunication and diagnostic errors. Providers should respect and utilize this mode of communication, as well as document the patient’s request for a non-certified interpreter.

Documentation/Coding 104

Documentation/Coding Emergency Department Federal Emergency Management Agency Best Practices 104

ACEP Now

MARCH 13, 2024

Emergency departments (EDs) provide the essential service of evaluating patients with unscheduled, acute, undifferentiated, and decompensated conditions. Consequences of this are well documented and include delayed treatment, exposure to error, increased length of stay, and increased mortality. Academic Emergency Medicine 22.2

Ethical Issues 52

Ethical Issues Emergency Department Operations Hospitals 52

ALiEM

FEBRUARY 9, 2024

Intermediate-risk patients may be further stratified based on recent stress testing or coronary angiogram findings plus a modified HEART or Emergency Department Assessment of Chest Pain (EDACS) score. Pulses are well felt in all four limbs. This is endorsed in the 2022 ACC pathway [1] and the 2021 AHA chest pain guidelines [7].

EKG/ECG 110

EKG/ECG Emergency Department Burns Wellness 110

ACEP Now

MAY 10, 2024

Patients often seek care in the emergency department (ED) setting when flares of pain affect their ability to ambulate, climb stairs, or even stand up from sitting. We prefer an in-plane, superior to inferior approach, but an out-of-plane technique can be performed, as well. 52, 196 (2021). J Emerg Med. Ragab, A.R.,

Ultrasounds 92

Ultrasounds Emergency Department Hospitals Wellness 92

The Skeptics' Guide to EM

AUGUST 21, 2021

Date: August 19th, 2021 Reference: Pantell et al. Evaluation and management of well-appearing febrile infants 8 to 60 days old. Pediatrics 2021 Guest Skeptic: Dr. Dennis Ren is a pediatric emergency medicine fellow at Children’s National Hospital in Washington, DC. Date: August 19th, 2021 Reference: Pantell et al.

Wellness 52

Wellness Pediatrics Emergency Department Hospitals 52

EMDocs

MARCH 9, 2025

Well keep it short, while you keep that EM brain sharp. Infectious disease expertise is useful as the optimum duration of treatment is not well established. Clinical Presentation of Acute Osteomyelitis in the Pediatric Emergency Department. Pediatr Emerg Care. vancomycin for Staphylococcus and Salmonella ).

Pediatrics 52

Pediatrics EMS Infectious Diseases Fractures 52

ALiEM

OCTOBER 30, 2024

The Wounds Common among patients who use xylazine, the necrotic and exudative wounds are still not fully understood [5-8], but are likely due in part to direct cytotoxic effects of the drug and its impurities, as well as possible nutritional deficiencies common in those with dependence. 2021 Aug 1;94:103086. 2023 Jan 1;53(1):140-2.

Emergency Department 64

Emergency Department Operations Psychiatric Hospitals 64

ACEP Now

JULY 11, 2024

Deaths from drinking increased 25 percent from 2019 to 2020 and another 10 percent in 2021. 2 Although the opiate epidemic is certainly worthy of attention, it accounts for only about half of the number of deaths annually and only around a quarter of the number of emergency department visits annually relative to alcohol use.

Emergency Department 98

Emergency Department Psychiatric Outcomes Wellness 98

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. 2021; 9:e04871. Respiratory and cardiovascular exams are normal.

Ultrasounds 98

Ultrasounds Emergency Department Wellness Operations 98

Don't Forget the Bubbles

OCTOBER 12, 2024

doi: 10.1136/archdischild-2023-326773 Two-year-old Moyo is brought to the emergency department because her parents were concerned about noisy breathing. Most children can be discharged from the emergency department after a dose of corticosteroids and an appropriate safety net. Croup, Don’t Forget the Bubbles, 2021.

Airway Management 85

Airway Management Emergency Department Administration Hospitals 85

EMDocs

JULY 9, 2024

The emergency department takes care of some of the highest risk patients with the worst access to health care and social services Over the past 20 years, many researchers have created and validated social needs screeners Some examples: iHELP, WE CARE, SEEK, USDA 2-item food insecurity questionnaire Does screening make a difference?

Pediatrics 74

Pediatrics Emergency Department Research Burns 74

ALiEM

APRIL 12, 2023

The thin alcohol layer serves to eliminate any air bubbles under the adhesive cover as well as minimizes residual adhesive material sticking to the probe when removing the cover. emDOCs.net – Emergency Medicine Education. The adhesive cover itself serves as a sterile barrier and a slick surface to improve probe maneuverability.

Ultrasounds 103

Ultrasounds Emergency Department Resuscitation Wellness 103

PulmCCM

NOVEMBER 6, 2023

Intuitively, plasma seemed even less likely to help the very sickest of the sick— those mechanically ventilated with ARDS from Covid-19, whose mortality rate was well over 50% at many centers. patients infected with the Wuhan/Delta variants in 2020-2021). Only it turns out, it did help. Or could, anyway.

Blood Transfusions 98

Blood Transfusions Operations Resuscitation Infectious Diseases 98

EMDocs

JUNE 2, 2023

You should always follow your local practice guidelines and recommendations as well as adhere to approved medications in your facility. Document what you gave and why, as well as the impact. If a patient has a PRN on their med list do that! Route of administration If the patient is cooperative, offer oral medications first.

Psychiatric 93

Psychiatric Pediatrics Emergency Department Administration 93

RebelEM

FEBRUARY 12, 2024

There are greater than 2 million annual emergency department visits for suspected renal colic in the US, and Ct scanning is performed for more than 90% of patients who receive a diagnosis of kidney stone. Am J Emerg Med. 2021 Sep;47:70-73. Epub 2021 Mar 22. ” The Journal of Urology 199.4S (2018): e683-e684.

Radiology 77

Radiology Radiology Emergency Department Ultrasounds 77

Don't Forget the Bubbles

NOVEMBER 8, 2023

7-year-old Tilly is brought to your emergency department at 11 p.m. Abdominal pain in children is common, accounting for over 1 in 20 attendances to paediatric emergency departments [1]. Tilly is normally fit and well, with no significant past medical history. NHS Digital 2021-22; Available from: [link].

Emergency Department 105

Emergency Department Ultrasounds Pediatrics Best Practices 105

Dr. Smith's ECG Blog

OCTOBER 18, 2023

If you were working in a busy emergency department, would you like to be interrupted to interpret these ECGs or can these patients safely wait to be seen because of the normal computer interpretation? Emergent cardiac outcomes in patients with normal electrocardiograms in the emergency department. Am J Emerg Med.

EKG/ECG 119

EKG/ECG Documentation/Coding Emergency Department Outcomes 119

EMDocs

DECEMBER 11, 2023

In October 2022, the American College of Cardiology released an updated expert consensus decision regarding the evaluation of chest pain in the emergency department. This included the addition several new STEMI equivalents [4] on ECG that warrant “prompt evaluation for emergency coronary angiography.” J Emerg Med.

EKG/ECG 119

EKG/ECG Emergency Department Academics Operations 119

Broome Docs

FEBRUARY 22, 2024

PMID: 36946338 Bottom line: This is a well done RCT that demonstrates pretty convincingly that you should not bother trying to but fingernails back on after nail bed repair (and my guess is you definitely shouldn’t be removing them either). Doctors who treat one must be experts in the other as well. Ann Emerg Med. 2023 Oct 12.

Emergency Department 89

Emergency Department Psychiatric Resuscitation Wellness 89

Don't Forget the Bubbles

MARCH 31, 2025

The value of white blood cell count in predicting serious bacterial infections in children presenting to the emergency department: a multicentre observational study Archives of Disease in Childhood 2025;110:191196. Am J Emerg Med. The sepsis screening tool in paediatric emergency departments can help. 2025.01.054.

Sepsis 59

Sepsis Fluid Resuscitation Shock Resuscitation 59