Pediatric EM Morsels

JUNE 2, 2023

Our patients have varied past medical histories that require us to be well-versed in even the most uncommon disorders (or know where to look things up in a pinch)! 2021 Nov 29;92(S7):e2021518. Rare diseases are not confined to the pages of a textbook or computer screen. Update on Food protein-induced enterocolitis syndrome (FPIES).

Dehydration 189

Dehydration Shock Pediatrics Emergency Department 189

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. 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. Wu CY, Wu JD, Chen CC.

Seizures 269

Seizures Psychiatric Outcomes Pediatrics 269

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

Pediatric EM Morsels

MARCH 17, 2023

In the US, the venomous snakes include rattlesnakes , copperheads, cottonmouths/water moccasins , and coral snakes [ CDC, 2021 ] Rattlesnakes live all across the United State s Copperheads inhabit the eastern U.S. If you are managing a snake bite from a snake that does not typically reside in the U.S.,

CDC 130

CDC Poisoning Pediatrics Shock 130

Stop and Think

NOVEMBER 19, 2023

Also well known—from old data—was that myocarditis is a cause of cardiac arrest during sport. His cardiac arrest occurred months after the vaccine was released in 2021. In fact, the authors reported a decline in sudden cardiac death during the years 2021-2022. Young males had the highest risk of this adverse effect.

Documentation/Coding 130

Documentation/Coding Wellness Resuscitation 130

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. Travel Medicine and Infectious Disease 44 (2021) 102196. Third times the charm!

Seizures 278

Seizures Pediatrics CDC Infectious Diseases 278

RebelEM

JULY 1, 2024

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. Comparison of BPAP S/T and Average Volume-Assured Pressure Support Modes for Hypercapnic Respiratory Failure in the Emergency Department: A Randomized Controlled Trial. AVAPS: 0.07

COPD 127

COPD Emergency Department Outcomes EMS 127

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%

Administration 94

Administration Emergency Department Wellness Pediatrics 94

ALiEM

APRIL 10, 2023

Additional Images Physical Exam General: Well appearing, no distress. Skin: Large, serpiginous rash on the left forehead and scalp with central clearing and peripheral erythema as well as areas of erythematous plaques. Updated 2021 Jun 30]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. In: StatPearls [Internet].

Pediatrics 98

Pediatrics EKG/ECG Academics Wellness 98

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

PulmCCM

JANUARY 23, 2025

Overly general case definitions and sloppy EMR algorithms result in a high rate of overtreatment with antibiotics due to false positives, as well as delayed treatment from false negatives. Septicyte was cleared by FDA in 2021 for use in hospitalized patients with suspected sepsis. It does not identify pathogens. they looked very ill).

Sepsis 45

Sepsis Wellness Emergency Department Research 45

RebelEM

APRIL 17, 2023

However, It is unclear how well POCUS performs in ruling in or ruling out the diagnosis of PTA. Question: How well does the US perform in diagnosing PTA compared to CT, needle aspiration, or Incision and Drainage? A repeat search was completed in May 2021 & November 2022. 2021 May 12:34894211015590. Acad Emerg Med.

Ultrasounds 129

Ultrasounds Radiology Radiology Operations 129

SheMD

JULY 30, 2023

Some of the interview information may not be relevant during the 2020-2021 & 2021-2022 academic years. 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

ALiEM

FEBRUARY 9, 2024

Pulses are well felt in all four limbs. She would be low risk by gestalt or structured scoring systems (Wells or revised Geneva), and a negative D-dimer would essentially rule out pulmonary embolism here. This is endorsed in the 2022 ACC pathway [1] and the 2021 AHA chest pain guidelines [7]. 2021 May 13;:]. Eur Heart J.

EKG/ECG 110

EKG/ECG Emergency Department Burns Wellness 110

The Trauma Pro

MARCH 8, 2024

The literature on this topic was searched from 1960 to 2021, and only observational and randomized studies were included. They decrease handoff errors and reduce preventable adverse events as well. The EMS to trauma team handoff is well-received and is subjectively valuable.

EMS 113

EMS Wellness 113

EMergucate

JANUARY 12, 2021

His symptoms had spontaneously resolved and he currently feels well. The following ECG is taken from a 28 year old man who presented with palpitations and presyncope. Describe and interpret his ECG…

EKG/ECG 52

EKG/ECG Wellness 52

ACEP Now

SEPTEMBER 5, 2024

A 2021 systematic review and meta-analysis also explored the diagnosis of malrotation and midgut volvulus via ultrasound. It is important to evaluate for both the position of the SMA in relationship to the SMV as well as for the “whirlpool” sign. The post How Well Does Ultrasound Detect Volvulus in Infants? ANZ J Surg.

Ultrasounds 40

Ultrasounds Wellness Pediatrics Poisoning 40

Sensible Medicine

AUGUST 12, 2024

Surely you do as well. You can improve your chances by eating well, exercising, avoiding smoking and too much alcohol. And that was the result of screening for just 5 cancers (breast, cervical, colorectal, lung and prostate) in the year 2021. My thinking aligns well with his. I would like to live a long life.

Outcomes 122

Outcomes Research Wellness Hospitals 122

American Medical Compliance

MARCH 18, 2024

Requirements Specific to Missouri By August 28, 2021, any hospital licensed under the Missouri chapter, excluding any department of mental health-operated psychiatric hospital, must implement a workplace violence prevention plan to protect healthcare employees and other hospital personnel from aggressive and violent behavior.

Psychiatric 105

Psychiatric Operations Hospitals Wellness 105

ALiEM

NOVEMBER 17, 2023

kg General : Well-appearing 4-year-old female acting appropriately with grandmother and mother at the bedside. link] Published 2021. link] Published 2021. Of note, the patient’s father took her to a trampoline park with her younger sister two days ago. C; Wt 18.2 Abdomen : Soft, nontender, nondistended. Laufer M, Emans S.

Pediatrics 100

Pediatrics Emergency Department Academics OB/GYN 100

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 ). Figure-2: I've labeled some findings from Figure-1. T oday's C ASE C ontinues: The worrisome findings in ECG #1 were recognized.

EKG/ECG 245

EKG/ECG Shock Wellness 245

RebelEM

JANUARY 18, 2024

It is well-established that earlier recognition and treatment can lead to better outcome for these patients . Background: Sepsis remains one of the leading causes of morbidity and mortality. to 0.97; p = 0.02 Length of ICU Stay 906 patients Prehospital Abx: 300 pts No Prehospital Abx: 606 pts Pooled Mean Difference 0.11; 95% CI -1.85

Sepsis 129

Sepsis Hospitals Administration Outcomes 129

Taming the SRU

MARCH 12, 2024

In the context of increasing ED and hospital crowding as well as limited ICU availability, this study aimed to evaluate the impact of a subcutaneous insulin (SQuID) protocol in the treatment of DKA on emergency department length-of-stay (EDLOS) and ICU admissions. as well as patients less than 18 years old were excluded from analysis.

Operations 96

Operations Hospitals Best Practices Wellness 96

Sensible Medicine

APRIL 14, 2024

For instance, CAR-T was given to myeloma patients in 2014, but we only learned it can cause Parkinsonism in 2021. A few companies will get rich doing this, and many well-intentioned people will be cheering us over the cliff. It can take several years for the full safety profile of drugs to be known.

Patient Safety 144

Patient Safety Academics Outcomes Wellness 144

EMDocs

FEBRUARY 7, 2024

there were 31 recorded healthcare strikes in 2021, 39 recorded healthcare strikes in 2022, and 37 healthcare strikes in 2023 as of November 3rd. months between 1993 and 2021 to one strike every 1.4 months between 1993 and 2021 to one strike every 1.4 Trends in labor unionization among US health care workers, 2009-2021.

Hospitals 89

Hospitals Research Patient Safety Wellness 89

RebelEM

SEPTEMBER 21, 2023

Troponins are highly specific to cardiac myocytes but do exist in other muscle types as well. A troponin is a protein (not an enzyme) that is detected when there is breakdown of muscle in the body. Who should have troponins sent? After conversion to sinus rhythm, do a good history, physical and analysis of the ECG.

EKG/ECG 143

EKG/ECG Sepsis EMS Outcomes 143

Pediatric EM Morsels

JULY 7, 2023

Seen in sports that involved aggressive twisting of the knee (ex, snowboarding, soccer, horse-riding) as well as direct trauma. Epub 2021 Nov 2. Mechanism of dislocation : [ Horan, 2006 ] Typically, the injury occurs when: The Knee is in Flexion and The Foot is rotated and plantar flexed. Am J Emerg Med. 2022 Apr;54:328.e3-328.e4.

Dislocations 141

Dislocations Fractures Pediatrics EMS 141

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). See it again now, along with our new Queen of Hearts functionality. We've come a long way in 2 years!

EKG/ECG 130

EKG/ECG EMS Ultrasounds Wellness 130

PulmCCM

AUGUST 7, 2023

In early 2021, as hospitals overflowed, deaths mounted, and the economy languished, these felt like vital national goals. We didn’t know all this in 2021. But well after it became clear in 2022, Covid vaccine mandates persisted, and continue at a large number of U.S. university campuses. Can this be justified?

CDC 98

CDC Hospitals Administration Research 98

The Skeptics' Guide to EM

APRIL 20, 2024

The evidence was not robust enough back in 2021 to confidently use this potential tool. An attempt was made to externally validate this tool in New Zealand by Murkerji et al 2021 [4]. It did not perform as well which is not unusual for a clinical decision instrument [5]. It risks stratified older patients with blunt trauma.

Fractures 82

Fractures Ultrasounds Emergency Department CDC 82

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

EM Literature of Note

SEPTEMBER 13, 2024

Most regions used a strategy in which nirsevimab was provided to new births during RSV season, as well as other young infants born prior to the onset of the season. 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 Trauma Pro

NOVEMBER 21, 2023

A group of investigators from Jackson Memorial in Miami and Denver Health published a paper earlier this month that critically reviewed 187 trauma surgery RCTs published from 2000 to 2021. Basically, a lot of well-intentioned but poorly designed research gets published. Bottom line: What does it all mean?

Research 113

Research Outcomes Wellness 113

EMDocs

FEBRUARY 7, 2024

Multiple well-designed, multicenter, multinational studies suggest GLP-1 agonists are associated with improved glucose control in diabetes type 2 and approximately a 15% reduction in weight over 1-2 years (around 2/3s of patients regain weight if treatment is stopped). Published June 04, 2021. 2021 Mar 18;384(11):989-1002.

Allergic Reactions 87

Allergic Reactions Anaphylaxis Dehydration Wellness 87

Sensible Medicine

DECEMBER 8, 2023

A discomfiting fact about obituaries (as well as the Wikipedia pages of the deceased) is that they usually include a cause of death. It is legal in eleven states and recent numbers suggest that at least 1300 people ended their life in this way in 2021. We seem to have a macabre, voyeuristic, fascination with how people died.

Wellness 114

Wellness 114

ACEP Now

MAY 10, 2024

We prefer an in-plane, superior to inferior approach, but an out-of-plane technique can be performed, as well. 52, 196 (2021). 2021 Oct;61(4):416-419. Epub 2021 Jun 25. Ensure that anechoic fluid spreads along the femur. Ragab, A.R., Egypt J Radiol Nucl Med. How I do it: genicular nerve blocks for acute pain. J Emerg Med.

Ultrasounds 92

Ultrasounds Emergency Department Hospitals Wellness 92

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. The adhesive cover itself serves as a sterile barrier and a slick surface to improve probe maneuverability. Accessed April 5, 2023. 2022 Jan 6;8(1):42.

Ultrasounds 103

Ultrasounds Emergency Department Resuscitation Wellness 103