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. 2021 Oct 9;22(20):10911. Prevalence decreases with decreasing age. Risk of teratoma is higher in African American and Asian women. Moral of the Morsel It’s NOT always psych! Int J Mol Sci.

Psychiatric 265

Psychiatric Seizures Outcomes Pediatrics 265

Taming the SRU

APRIL 14, 2024

You may place cold packs or ice packs to the hernia site to help reduce inflammation and swelling, as well as to assist in local analgesia. Symptoms include persistent tenderness in the area, as well as symptoms of obstruction including nausea, vomiting, and pain, despite reduction. (2) 1) In a study performed by Chen et al.

Ultrasounds 91

Ultrasounds Emergency Department Pediatrics Radiology 91

ACEP Now

SEPTEMBER 5, 2024

What Is the Sensitivity of Ultrasound for Detecting Volvulus in Infants When Compared to An Upper GI Study? But what about ultrasound? In cases where the clinical suspicion is lower for a midgut volvulus, but you feel it still needs to be explored, can ultrasound help? Not all studies included all of these ultrasound signs.

Ultrasounds 52

Ultrasounds Wellness Pediatrics Poisoning 52

RebelEM

FEBRUARY 12, 2024

Chang 2021 ) This systematic review was used as the basis for a 9 member panel to develop consensus guidelines on CT imaging for patients with suspected renal colic in 29 scenarios. 2021 Sep;47:70-73. Epub 2021 Mar 22. When you are using CT imaging, a CT with IV contrast is preferred. Moore CL, Carpenter CR, Heilbrun ME, et al.

Radiology 69

Radiology Radiology Emergency Department Ultrasounds 69

Don't Forget the Bubbles

JANUARY 17, 2024

2021 A plain abdominal X-ray shows multiple dilated loops of bo wel. Abdominal ultrasound, used in 34 cases, was able to visualize a rounded intraluminal image corresponding to a bead in 28 patients. 2021 These beads, once hydrated inside the body, reached considerable sizes. His abdominal X-ray looked a lot like this.

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111

PulmCCM

APRIL 1, 2024

That could (and should) change if improved functional outcomes, persisting for months after hospital discharge, are ever confirmed in large, well-conducted trials. ” But less than half of the included studies used ultrasound guidance during central line placements.

Ultrasounds 40

Ultrasounds Operations Outcomes Research 40

Core Ultrasound

MARCH 25, 2024

Old IVC Vid (2021) TEE VTI Here are Dr. Spiegel’s Notes: 1. If one is going to access the collapsibility of the IVC one should probably look at it in the transverse plane as well 3. It is our job as clinicians to interpret what that means.

Administration 98

Administration Sepsis Ultrasounds Outcomes 98

Don't Forget the Bubbles

JANUARY 1, 2024

While adenotonsillectomy may not directly impact cognitive functions, it can benefit other aspects of health and well-being in children with mild sleep-disordered breathing. During the COVID-19 pandemic (2020-2021), the incidence of IPD reached its lowest level in 20 years. You will find the list is broken down into four sections: 1.Reviews

Pediatrics 98

Pediatrics Ultrasounds Blood Transfusions Sepsis 98

Sensible Medicine

NOVEMBER 6, 2023

The original SWISS APERO trial results came in 2021. The more typical way to evaluate for leaks is with echocardiography (ultrasound). The second reason to highlight SWISS APERO is that it surprised us in showing that neither device performed well. This study report included only 45-day outcomes.

Stroke 131

Stroke Outcomes Ultrasounds Wellness 131

EMDocs

APRIL 22, 2024

Point-of-Care-Ultrasound (POCUS) is a bedside modality that can assist Emergency Physicians (EPs) in differentiating PE from other causes of cardiac arrest. Multiorgan POCUS The diagnostic power of POCUS often resides in combining multiple ultrasound exams. 1-3 As many as 25% of acute PE cases present as sudden cardiac death.

Ultrasounds 82

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

Taming the SRU

JUNE 24, 2024

Conduction Abnormalities AV blocks, which can also be seen in patients with MI, may require pacing as well, due to ischemia affecting the electrical pathways of the heart. Published on November 4, 2021. Anteroposterior pacer pad position is better than anterolateral for transcutaneous cardiac pacing.” EMCrit Blog.

Advances Cardiac Life Support (ACLS) 87

Advances Cardiac Life Support (ACLS) CPR Burns Resuscitation 87

EMDocs

AUGUST 12, 2023

He presented to the emergency department because he is having numbness distal to the site of injury, as well as constant bleeding and some difficulty with flexing his finger. McGraw Hill; 2021. November 9, 2021. The patient states they were cutting an avocado when the knife pierced through and punctured his hand. In: StatPearls.

EMS 69

EMS Fractures Operations Ultrasounds 69

Dr. Smith's ECG Blog

OCTOBER 1, 2023

This is a re-post of an excellent case from 2021. You can see that she is not only "looking" at the ST segment, but the majority of the T wave itself, and factoring in the QRS as well (just like expert humans do). Gallbladder ultrasound was negative for stones. See it again now, along with our new Queen of Hearts functionality.

EKG/ECG 129

EKG/ECG EMS Ultrasounds Wellness 129

ALiEM

MARCH 7, 2024

Given her pain with a history of intermittent hematuria and dysuria, you perform a renal and bladder point of care ultrasound (POCUS) examination. Pre-warmed ultrasound gel is helpful when available. Then test your skills on the ALiEMU course page to receive your PEM POCUS badge worth 2 hours of ALiEMU course credit.

Ultrasounds 70

Ultrasounds Pediatrics Emergency Department Radiology 70

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. minutes compared to a mean placement time of 10.7 Resusc Plus.

Resuscitation 102

Resuscitation Administration Emergency Department Hospitals 102

ALiEM

MAY 19, 2023

A heavy alcohol drinker, who is well known to your Emergency Department, presents with altered mental status, except that he looks different this time. Additional trick: If the x-ray is delayed, you can pre-check with ultrasound [7]. Accessed December 17, 2021. PulmCrit Wee: Ultrasound-guided blakemore tube placement.

Emergency Department 98

Emergency Department Ultrasounds Wellness EMS 98

The Skeptics' Guide to EM

SEPTEMBER 18, 2021

Date: September 16th, 2021 Reference: Sippola et al. JAMA 2021 Guest Skeptic: Dr. Rob Leeper is an assistant professor of surgery at Western University and the London Health Sciences Center. Date: September 16th, 2021 Reference: Sippola et al. The APPAC II Randomized Clinical Trial. The APPAC II Randomized Clinical Trial.

Operations 52

Operations Academics Ultrasounds Hospitals 52

The Skeptics' Guide to EM

JULY 31, 2021

Date: July 29th, 2021 Reference: Azizi et al. Injury 2021 Guest Skeptic: Dr. Robert Edmonds is an emergency physician in the Air Force in Ohio. Date: July 29th, 2021 Reference: Azizi et al. Injury 2021 Guest Skeptic: Dr. Robert Edmonds is an emergency physician in the Air Force in Ohio.

Military 52

Military Ultrasounds EMS Wellness 52

Taming the SRU

MAY 5, 2023

2021, Jarczak, Kluge et al. 2021, Im, Kang et al. 2021), although this is based on low-quality evidence rather than high-quality randomized trials and has remained a controversial aspect of treatment of patients with sepsis given the potential harms of large-volume fluid administration. N Engl J Med. 2023;388(6):499-510.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

Over some time and the pain moved into her other arm as well as her jaw. The problem is difficult to study because angiographic visualization of arteries is not perfect, and not all angiograms employ intravascular ultrasound (IVUS) to assess for unseen plaque or for plaque whose rupture and ulceration cannot be seen on angiogram.

EKG/ECG 103

EKG/ECG Ultrasounds Wellness Stroke 103

The Skeptics' Guide to EM

FEBRUARY 6, 2021

Date: January 20th, 2021 Guest Skeptics: Dr. Thorben Doll and Dr. Johannes Pott. Date: January 20th, 2021 Guest Skeptics: Dr. Date: January 20th, 2021 Guest Skeptics: Dr. Thorben Doll and Dr. Johannes Pott. An ultrasound does not show any free fluids or any signs of an Ileus, appendicitis or gallbladder disease.

Hospitals 40

Hospitals Emergency Department Ultrasounds EMS 40

Pediatric Education

NOVEMBER 19, 2023

They felt he was breastfeeding well and had only mild jaundice. His examination was normal and the diagnosis of a well newborn infant was made. mg/dL which was well below treatment threshold. Some infants may need car seat tolerance screening as well. 2021-055554 Shaw MA, Liu A. BMC Pediatr. 2021;21(Suppl 1):350.

Infectious Diseases 40

Infectious Diseases Administration Pediatrics Wellness 40

PulmCCM

JANUARY 8, 2024

But apparently, few centers use them, because … well, no one can give a good reason why. Twenty-five ICUs in Canada were switched to small-volume blood collection tubes at randomly assigned times (a so-called stepped-wedge cluster design) from 2019-2021. With Doppler ultrasound measures (e.g., What is fluid responsiveness?

Blood Transfusions 96

Blood Transfusions Hospitals Outcomes Operations 96

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 78

EMS Fractures Soft Tissue Injuries Ultrasounds 78

Dr. Smith's ECG Blog

DECEMBER 19, 2023

Two thirds of MINOCA cases are due to atherosclerotic causes One way to prove the diagnosis in this case would have been with intravascular imaging such as optical coherence tomography (OCT) or intravascular ultrasound (IVUS). The patient did well afterward without any recurrence of symptoms. Fortunately, that is exactly what happened.

EKG/ECG 122

EKG/ECG EMS Wellness Operations 122

Dr. Smith's ECG Blog

JULY 21, 2024

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 ). The decision was made to try Quinidine ( as this case was felt to represent conditions consistent with Quinidine-responsive PMVT ).

EKG/ECG 116

EKG/ECG Shock Hospitals Sepsis 116

Pediatric EM Morsels

AUGUST 4, 2023

England, 2021) The third portion of the duodenum courses between the SMA and the aorta, which can lead to external compression of the duodenum. England, 2021) In SMA syndrome the angle is decreased to < 22 o and the normal distance <8 mm. England, 2021) This condition is often attributed to rapid weight loss.

Pediatrics 246

Pediatrics Burns Operations Ultrasounds 246

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. Accuracy of Ultrasound in Diagnosis of Pneumothorax: A Comparison between Neonates and Adults-A Systematic Review and Meta-Analysis. Published 2021 Jun 24.

Fractures 94

Fractures COPD Hospitals Emergency Department 94

Northwestern EM Blog

DECEMBER 20, 2021

Typically well appearing with normal labs, however, this is a diagnosis of exclusion and a septic joint should be ruled out. Management includes imaging studies, typical ultrasound to assess for a joint effusion, then a diagnostic arthrocentesis & antibiotics. 2021, Dec 20). Affects ages 3-8, males to females 2:1 [3].

Pediatrics 52

Pediatrics Ultrasounds Emergency Department Radiology 52

Taming the SRU

MAY 22, 2023

Use your exam to guide your initial management as well as your imaging decisions and differential diagnosis. Point-of-care ultrasound (POCUS) can evaluate for Achilles tendon rupture with a high sensitivity (96-100%) and specificity (83-100%) [8,9]. Respect, but do not rely upon, the mechanism. MRI can be used in place of CT.

Fractures 75

Fractures Dislocations Operations Radiology 75

Dr. Smith's ECG Blog

OCTOBER 18, 2023

A majority (62.5%) of those presenting with ‘normal’ ECGs had the cath lab activated without any ECG being labeled ‘STEMI’ by automated interpretation – based on signs of Occlusion MI including ECG changes, regional wall motion abnormality on bedside ultrasound, or refractory ischemia. 2021 ; 46 : 23 - 26 4. Am J Emerg Med.

EKG/ECG 121

EKG/ECG Documentation/Coding Emergency Department Outcomes 121

RebelEM

JANUARY 25, 2024

Background: Point-of-care ultrasound (PoCUS) is a valuable clinical tool in the assessment of acute dyspnea. Impact of serial cardiopulmonary point-of-care ultrasound exams in patients with acute dyspnoea: a randomized, controlled trial. PoCUS evaluations included lung ultrasound (LUS) and focused cardiac ultrasound (FoCUS).

Ultrasounds 122

Ultrasounds Outcomes COPD Hospitals 122

Dr. Smith's ECG Blog

MAY 30, 2023

Case continued A bedside ultrasound showed diminished LV EF and of course bradycardia. The RV is supplied during systole as well as diastole. The November 27, 2021 post ( LA-RA reversal ). When narrow (above His bundle), it is likely to be atropine responsive. RVMI explains part of the shock. RV MI can cause hypotension.

Shock 81

Shock EKG/ECG Academics Stroke 81

Don't Forget the Bubbles

JANUARY 31, 2024

Edelman J, Taylor H, Goss A, et al Point-of-care ultrasound as a diagnostic tool in respiratory assessment in awake paediatric patients: a comparative study Archives of Disease in Childhood Published Online First: 14 December 2023 What’s it about? Scand J Trauma Resusc Emerg Med 29, 170 (2021) What’s it about? the pre-hospital setting.

Hospitals 72

Hospitals Ultrasounds Emergency Department Pediatrics 72

Northwestern EM Blog

DECEMBER 27, 2021

Congratulations to all of the authors with the most popular posts of 2021! Take-Home Point: Bedside pericardiocentesis is a rare but important procedure that can be performed emergently using ultrasound or landmark guidance. Consider exchanging the needle for a drain once the pericardium is accessed to bridge to definitive therapy.

Dislocations 52

Dislocations Emergency Department Burns Shock 52

Don't Forget the Bubbles

NOVEMBER 8, 2023

Tilly is normally fit and well, with no significant past medical history. The Shera Score Children with a low Shera score (less than 3) who are otherwise systemically well may be suitable for discharge home with safety netting advice , whereas patients with high scores (8 or more) warrant immediate surgical referral. Bachur, R.G.,

Emergency Department 104

Emergency Department Ultrasounds Pediatrics Best Practices 104

Downeast Emergency Medicine

APRIL 26, 2021

2021 Jan 1;32(1):37-43. The primary outcome was 30-day mortality with secondary outcomes of 1-year functional neurological outcome based on GCS as well as hospital length of stay. If the trauma center performed screening ultrasounds to evaluate for asymptomatic DVTs, they were not included in this study. 67% received TXA.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52