Pediatric EM Morsels

JULY 7, 2023

Evaluating the limping child , though, requires us to ponder not only the common (ex, Toddler’s Fracture ), but also to be vigilant for the severe (ex, Septic Arthritis ). Seen in sports that involved aggressive twisting of the knee (ex, snowboarding, soccer, horse-riding) as well as direct trauma. Epub 2021 Nov 2.

Dislocations 143

Dislocations Fractures Pediatrics EMS 143

The Skeptics' Guide to EM

MARCH 27, 2021

Date: March 17th, 2021 Guest Skeptic: Dr. Emil Ejersbo Iversen is an emergency medicine resident at the University Hospital of Zealand, Denmark. Date: March 17th, 2021 Guest Skeptic: Dr. Emil Ejersbo Iversen is an emergency medicine resident at the University Hospital of Zealand, Denmark. J Trauma Acute Care Surg.

Fractures 40

Fractures Outcomes Hospitals Emergency Department 40

PEMBlog

SEPTEMBER 26, 2024

She denies any associated redness, warmth, or bruising to the area as well as any trauma or falls. He has been doing well since discharge. On exam, the child has normal vital signs and is generally well appearing. Healing femur fracture C. No recent illnesses or any other symptoms. Labs Calcium 10.6 [Reference Range 8.7-10.7

Fractures 59

Fractures Pediatrics Wellness 59

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. Anesth Analg 2021. vs SBP target <90mmHg which resulted in a mortality of 33.4% NEJM 1994. [2] NEJM 1994. [2] Richards JE et al. J Trauma Acute Care Surg.

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

Sensible Medicine

NOVEMBER 21, 2023

Like Dr. Järvinen’s piece on the prevention of fractures in older people published here a couple of weeks ago, his submission highlights how difficult it can be to express opinions that challenge mainstream thinking these days. As children, we were often the ones who did not play well with others.

Leadership 128

Leadership Fractures Wellness 128

RebelEM

APRIL 29, 2024

CVC vs PIV The critically ill patient is often associated with pathology that makes IV access difficult such as shock state, hypovolemia, obesity, IV drug abuse, end-stage renal disease, cardiac arrest, as well as other conditions. 2021 PMID: 34273470 12 Petitpas F et al. Resusc Plus. 2023 PMID: 37502742 11 Schwalbach KT et al.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

The Skeptics' Guide to EM

JANUARY 8, 2022

Date: December 28th, 2021 Reference: Kulvatunyou et al. November 2021. Date: December 28th, 2021 Reference: Kulvatunyou et al. November 2021. CT scans reveal multiple right sided rib fractures and a hemothorax estimated to measure 500cc with no additional injuries. November 2021.

Fractures 52

Fractures Emergency Department Wellness 52

EMDocs

JUNE 8, 2024

Orbital wall fractures: palpate bony structures surrounding the eye, check extra ocular muscle movements to rule out entrapment, obtain CT imaging if suspected [7]. 2021 Oct 7. Complications : injuries to assess for when evaluating a patient with suspected traumatic iritis. High risk of re-bleeding and vision loss [7]. and John O.

EMS 98

EMS Allergic Reactions Poisoning Emergency Department 98

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 EMS 64

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. Blunt trauma can cause rib fracture or dislocation that may injure the visceral pleura. 89% of patients with PTX under this cutoff were successfully observed.

Fractures 96

Fractures COPD Hospitals Emergency Department 96

Don't Forget the Bubbles

AUGUST 2, 2023

We know that fractures are the precipitating event in about 5–14% of cases and surgical procedures in 10–15%. As well as nonpharmacological treatments included physiotherapy and psychological therapy, 79% were also prescribed medication, most commonly gabapentin. 2021 Jul 26;:]. More recently, Mesaroli et al. Audouin-Pajot C.,

Psychiatric 98

Psychiatric Pediatrics Outcomes Fractures 98

Taming the SRU

NOVEMBER 14, 2023

A thorough trauma history and physical exam should be performed including evaluation for bony fracture in the surrounding structures of the face. Therefore, both of these should be important considerations as well when evaluating swollen ears in the emergency department. Philadelphia PA: Elsevier/Saunders; 2021. Seventh ed.

Emergency Department 94

Emergency Department Pediatrics Wellness Fractures 94

ACEP Now

MAY 6, 2023

Vehicle occupants wearing seatbelts may sustain injury to the cervical spine as a result of abrupt deceleration as well as blunt trauma to the chest, abdomen, and pelvis. Clavicular and humeral fractures are more common in passengers than in drivers. Updated January 4, 2021. 1988;28:498–501. Medscape website. Dickinson E.

Forensics 52

Forensics Documentation/Coding Head Injuries Fractures 52

Broome Docs

APRIL 6, 2023

2022 Dec 16:emermed-2021-211946. doi: 10.1136/emermed-2021-211946. Immobilisation of torus fractures of the wrist in children (FORCE): a randomised controlled equivalence trial in the UK. Clinical risk factors for testicular torsion and a warning against falsely reassuring ultrasound scans: a 10-year single-centre experience.

Sepsis 52

Sepsis Ultrasounds Hospitals Fractures 52

Taming the SRU

AUGUST 30, 2023

As the name would suggest, inflammatory markers are biological markers of, well, inflammation. Despite these results, the 2021 Surviving Sepsis guidelines recommend against using PCT to guide initiation of antimicrobial therapy due to multiple meta-analyses demonstrating no improvement in outcomes using PCT-guided antibiotic therapy [46,54].

Infectious Diseases 89

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 89

Don't Forget the Bubbles

OCTOBER 2, 2024

A previously well 6-year-old boy is brought into the emergency department at a major trauma centre via HEMS following a road traffic accident, in which he was hit by a car while crossing the road. He is diagnosed with a traumatic brain injury and a fracture to his right tibia and fibula. A full primary survey is carried out.

Administration 49

Administration Pediatrics Outcomes Research 49

Northwestern EM Blog

DECEMBER 20, 2021

Physical examination should always include an attempt to ambulate the child unless there is an obvious contraindication noted immediately (eg open fracture). Typically well appearing with normal labs, however, this is a diagnosis of exclusion and a septic joint should be ruled out. 2021, Dec 20). Hip Pain in Pediatrics.

Pediatrics 52

Pediatrics Ultrasounds Emergency Department Radiology 52

Taming the SRU

MARCH 14, 2023

He appears well and is triaged to an ESI 4. Obtain shunt imaging (“shunt series,” CTH non-con) Shunt series shows no migration of the shunt catheters or fractures of the tubing. She was doing well, but recently has had the “stomach flu” with a couple weeks of abdominal pain, nausea and vomiting. Neurol Med Chir (Tokyo).

Seizures 52

Seizures Emergency Department Pediatrics Critical Access 52

Taming the SRU

FEBRUARY 22, 2023

Team Environment Own the Resuscitative Real Estate Set up how you want the resuscitation to go Organize your space in the way that will wrok best for you and the patient Patient Special circumstances Peds Pregnant Mechanical circulatory support Update Partner Priorities Clear and well defined Lesson 2 Lead with kindness Being liked is a powerful tool (..)

Hospice 40

Hospice EKG/ECG Resuscitation Seizures 40

EMDocs

FEBRUARY 22, 2025

Well keep it short, while you keep that EM brain sharp. Certain types of skull fractures can cause the dura mater to tear, creating communication between the subarachnoid space, the paranasal sinuses, and the middle ear. Epub 2021 Sep 9. Management of CSF leak in base of skull fractures in adults. Neurosurg Rev.

EMS 66

EMS Fractures Operations Wellness 66

EMDocs

JUNE 3, 2023

How should pelvic fractures be identified in unstable trauma patients? Pelvic fractures can involve disruptions in any of the bony or ligamentous structures of the pelvic ring. Due to the round shape of the pelvic ring, multiple fractures typically occur concurrently. 2 Vertical shear fractures are also unstable.

Fractures 64

Fractures Resuscitation Operations EMS 64

EMDocs

JULY 3, 2023

3 Common associated injuries may include skull fractures, intracerebral contusion, cervical spine injuries, and vascular injuries of the head and neck. All patients with concern for SAH need a rapid primary survey to assess the airway, breathing, and circulation as well as a comprehensive neurologic exam to create a baseline for the patient.

Seizures 98

Seizures Stroke Outcomes EMS 98

Don't Forget the Bubbles

JULY 22, 2024

Using a score that’s not used in clinical practice may seem like it reduces the applicability of the findings, but ultimately, the authors have translated the studies to the well-established PRAM score. 2021 Apr;106(4):339–44. 2021 Jul 1;175(7):723–9. Corticosteroids impact the child’s immune system. Arch Dis Child.

Outcomes 105

Outcomes Research Pediatrics Hospitals 105

EMDocs

NOVEMBER 4, 2024

Costochondritis, rib fractures, and pericarditis are common causes of chest pain that can be treated with multimodal regimens. 7 Rib and Sternal Fractures: Rib fractures are often caused by blunt chest trauma. Up to two-thirds of rib fractures are missed on initial chest radiographs. 2021 Apr;28(4):444-454.

Emergency Department 105

Emergency Department Fractures Burns EMS 105

EMDocs

NOVEMBER 13, 2023

2021) found that the top 5 reasons for ordering a CTA head/neck were suspected stroke, neurologic problem, dizziness, headache with new/concerning symptoms, and altered mental status. 23 BCVI should be suspected with any high-energy trauma or any fractures of the maxilla or mandible. 8 The data in Mayer et al.

Stroke 105

Stroke Radiology Radiology Emergency Department 105

Taming the SRU

MAY 22, 2023

Ankle fractures are the third most common fracture in the ED [2] and more than 20,000 patients are seen in the ED for ankle sprains each day [3]. traumatic axial loading with calcaneal fractures, pilons, and vertebral compression fractures) [5]. Gross deformities often suggest fracture or dislocation [Image 2].

Fractures 77

Fractures Dislocations Operations Radiology 77

EMDocs

SEPTEMBER 9, 2023

McGraw Hill; 2021. The value of ultrasound for detecting hand fractures: A meta-analysis. Rosh Review Website Link References Park CW, Juliano ML, Woodhall D. Tendon Lacerations. In: Knoop KJ, Stack LB, Storrow AB, Thurman R. The Atlas of Emergency Medicine, 5e. Accessed June 24, 2023. link] Dy CJ, Rosenblatt L, Lee SK. doi:10.1097/MD.0000000000017823

EMS 103

EMS Fractures Soft Tissue Injuries Ultrasounds 103

Don't Forget the Bubbles

SEPTEMBER 23, 2024

Kidney transplant recipients have a higher risk of fractures. This is particularly crucial in younger children who have received a large adult kidney and typically have relatively low creatinine levels when stable and well. Kidney transplant recipients are at higher risk of rickets and fractures. (13) Any history of injury?

Pediatrics 52

Pediatrics Fractures Dehydration Sepsis 52

Mind The Bleep

SEPTEMBER 17, 2024

Feel: Palpate the area of the bite to feel for areas of tenderness as this could indicate a fracture or infection. There should be a minimum of 2 views in the plain film, or 3 in the hands if there is a suspicion of a fracture. Sci Rep 11, 1767 (2021). Regular medications. Assess neurovascular status distal to the bite.

Fractures 52

Fractures Infectious Diseases Documentation/Coding Hospitals 52