Pediatric EM Morsels

AUGUST 9, 2024

Neonates presenting to the Emergency Department often cause a lot of uncertainty. Let’s review how Congenital Syphilis may present to our Emergency Departments: Congenital Syphilis : Basics Occurs when the spirochete Treponema pallidum is transmitted from mother to fetus. 2022 Dec 27;14(12):e33009.

Hyperthermia / Hypothermia 152

Hyperthermia / Hypothermia Emergency Department Seizures Pediatrics 152

Emergency Medicine Journal

DECEMBER 30, 2024

Background Calls to emergency departments (EDs) from ambulances to alert them to a critical case being transported to that facility that requires a special response (‘pre-alerts’) have been shown to improve outcomes for patients requiring immediate time-critical treatment (eg, stroke).

Emergency Department 52

Emergency Department Stroke Documentation/Coding Outcomes 52

EMDocs

OCTOBER 30, 2023

” – Musings of an American ED resident in July 2022 when US healthcare was affected simultaneously by supply chain issues from GE Healthcare (contrast media) and Abbott Laboratories (Similac baby formula). A baby formula milk shortage for adults.” 11 Table 1.

Radiology 73

Radiology Radiology Emergency Department Hospitals 73

ACEP Now

MAY 9, 2024

These questionable practices led to a rash of bad outcomes. When seven South Florida gluteal AFT patients died tragically in one year alone, the Florida Board of Medicine issued an emergency regulation restricting fat injection to the subcutaneous space rather than injecting into muscle. units per patient.

Emergency Department 52

Emergency Department Operations Ultrasounds Hospitals 52

RebelEM

DECEMBER 23, 2024

There has been ongoing study about the clinical significance of these effects, as well as whether and for whom LR might provide meaningfully better clinical outcomes ( Myburgh 2013 , Self 2018 , Semler 2018 , Self 2020 ). The enrollment was multicenter, large, and adequately powered for clinically meaningful changes in outcome.

Fluid Resuscitation 123

Fluid Resuscitation Resuscitation Documentation/Coding Outcomes 123

RebelEM

JANUARY 25, 2024

In many emergency departments (ED), US machines are readily available and can be used to rapidly assess and monitor patients with acute dyspnea at the bedside. What They Did: Design: Randomized, controlled, blinded-outcome trial Sites: Three emergency departments in Denmark Duration: October 9, 2019 to May 26, 2021.

Ultrasounds 126

Ultrasounds Outcomes COPD Hospitals 126

RebelEM

MARCH 27, 2023

Ventilator-associated lung injury and inflammation can occur even during short-term mismanagement can worsen patient outcomes. Over the past few years, there has been an increase in emergency department (ED) volumes and lengths of stay. This is a critical error that leads to poorer outcomes for patients in need of critical care.

Emergency Department 52

Emergency Department Operations Documentation/Coding Academics 52

The Skeptics' Guide to EM

SEPTEMBER 9, 2023

Case: It is a steady Saturday afternoon in your rural emergency department (ED). Tessa Davis covered the FORCE trial on SGEM #372 which looked at buckle fractures and compared immobilization in a cast or splint vs. a soft bandage and they found no difference in pain scores or functional outcomes. Reference: Snelling et al.

Fractures 122

Fractures Ultrasounds Pediatrics Outcomes 122

Broome Docs

OCTOBER 6, 2024

Can acutely ill patients predict their outcomes? Emerg Med J. doi: 10.1136/emermed-2022-213000. PMID: 39025092 Is early CT actually 100% sensitivity for SAH (Of course not) Roberts et al, Subarachnoid haemorrhage in the emergency department (SHED): a prospective, observational, multicentre cohort study.

Emergency Department 112

Emergency Department EMS Research Outcomes 112

RebelEM

FEBRUARY 2, 2023

Background Information: Atrial fibrillation with rapid ventricular rate (RVR) is one of the many tachydysrhythmias we encounter in the Emergency Department (ED). Amiodarone versus digoxin for acute rate control of atrial fibrillation in the emergency department. Am J Emerg Med. Am J Emerg Med. 2022 Sep 7.

Emergency Department 52

Emergency Department Administration EMS Dehydration 52

ACEP Now

JULY 11, 2024

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. This medication has limited outcomes data and multiple contraindications. West J Emerg Med.

Emergency Department 98

Emergency Department Psychiatric Outcomes Wellness 98

Taming the SRU

MARCH 27, 2024

The parent trial was conducted from October 2020 to July 2022 in the capital region of Denmark. The primary outcome was cumulative norepinephrine use during the first 48 hours of admission. That said, outcomes for these patients are generally poor and the use of steroids as a one-time dose likely has little risk. Hill, J.

Resuscitation 97

Resuscitation Outcomes CPR Hospitals 97

Taming the SRU

SEPTEMBER 22, 2023

Several single-center and moderately-sized studies have compared the outcomes of these two methods with varying results. Trial personnel reviewed the medical record to collect each patient's baseline characteristics, periprocedural care, and clinical outcomes. BMI was around 26.5 for both groups.

Operations 103

Operations Outcomes Emergency Department Academics 103

RebelEM

JUNE 8, 2023

Am J Emerg Med. 2022 Sep 5. Assessed clinical practice, outcome, length of stay, safety, and efficacy of both phenylephrine and epinephrine peripherally administered through a push dose. Paper: Singer S, et al. The safety and efficacy of push dose vasopressors in critically ill adults.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

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.

EKG/ECG 118

EKG/ECG Documentation/Coding Emergency Department Outcomes 118

The Skeptics' Guide to EM

DECEMBER 28, 2024

Emergency department staff compassion is associated with lower fear of enacted stigma among patients with opioid use disorder. She is anAssistant Professor and Director of Research in theDepartment of Emergency Medicine at the NYU Grossman Long Island Hospital Campus. Date: December 26, 2024 Reference: Steinhauser S et al.

Emergency Department 76

Emergency Department Research Academics Outcomes 76

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives Research in the Emergency Department needs to be delivered in real time, within a specific clinical time-frame, and on a wide variety of conditions and states of emergency, on participants presenting in an unscheduled manner at any time.

Emergency Department 40

Emergency Department Research Outcomes Hospitals 40

RebelEM

JULY 24, 2023

This approach has been shown to benefit patients when agents like propofol and midazolam are used. ( Russotto 2022 , Choi 2004 ). Population: Patients > 14 years of age who underwent RSI with either etomidate or ketamine from the National Emergency Airway Registry (NEAR). Emerg Med J. Paper: Driver BE et al. mg/kg 1.33

Resuscitation 98

Resuscitation Outcomes Emergency Department EMS 98

Emergency Medicine Journal

JUNE 20, 2024

Emergency departments (ED) represent a promising setting to address preventive health measures like CRC screening. We enrolled ED patients, 45–75 years old, in the Greater Rochester, NY region into a randomised controlled pilot from January to May 2022. The primary outcome was patient CRC screening or scheduling.

Emergency Department 40

Emergency Department Documentation/Coding Outcomes 40

Don't Forget the Bubbles

JULY 17, 2023

Clinical Outcomes of COVID-19 in Newborns and Infants: A Multicenter Experience of 576 Cases. 2023 Jun Oral food challenge outcomes in children and adolescents in a tertiary centre: A 5-year experience. Effects of size at birth on health, growth and developmental outcomes in children up to age 18: an umbrella review. 2023 Jun 9.

Pediatrics 98

Pediatrics Emergency Department Outcomes Fractures 98

RebelEM

NOVEMBER 6, 2024

2022 Aug 2. Elbow Dislocations in the Emergency Department: A Review of Reduction Techniques. J Emerg Med. Acute elbow dislocation: evaluation and management. J Am Acad Orthop Surg. 1998 Jan-Feb;6(1):15-23. doi: 10.5435/00124635-199801000-00002. PMID: 9692937 Decker N, Norse A. Anterior Elbow Dislocation. Shoulder Elbow.

Dislocations 109

Dislocations Fractures Soft Tissue Injuries Outcomes 109

ACEP Now

JULY 7, 2023

emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. 2,3 In general, patients who develop cardiac arrest with an initial rhythm of VT or VF tend to have favorable outcomes compared to patients who develop cardiac arrest from either asystole or pulseless electrical activity.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives In recent years there has been a large increase in demand for emergency care across the country, particularly during winter. This study utilised 12 months’ of routinely collected data from Emergency Departments (EDs) and acute Admitted Patient Care Episodes (APCs) to understand trends in demand for emergency care.

Emergency Department 40

Emergency Department Hospitals Outcomes Research 40

Taming the SRU

SEPTEMBER 25, 2023

Musculoskeletal injuries are a common occurrence, representing a substantial number of Emergency Department visits on an annual basis. 1) Oftentimes, Emergency Physicians are the first provider patients encounter after an injury. 2022 May 16;10(14):4684-4690. screws for medial malleolus. References 1. World J Clin Cases.

Fractures 100

Fractures Operations Emergency Department EMS 100

RebelEM

APRIL 29, 2024

Given AHA guidelines recommend early epinephrine administration in cardiac arrest, obtaining access is imperative for resuscitative efforts ( 9) When evaluating over 300,000 out-of-hospital cardiac arrests, a meta-analysis found no significant change in primary outcomes when IV and IO access were compared ( 10 ). 2022 PMID: 35206981 2.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

Don't Forget the Bubbles

DECEMBER 2, 2024

This single-centre prospective study focused on a quality improvement (QI) project to reduce the overuse of chest X-rays (CXR) in paediatric patients with acute asthma exacerbations (AAE) arriving at the emergency department (ED ). Arch Acad Emerg Med. Pediatric Emergency Medical Journal 2023;10(4):109-117. 95% CI 1.01

Documentation/Coding 98

Documentation/Coding Pediatrics Emergency Department Fractures 98

RebelEM

NOVEMBER 25, 2024

2 Moreover, the American Society of Anesthesiologists’ 2022 Practice Guidelines for Management of the Difficult Airway recommend the use of adjuncts like bougies in anticipated difficult airways but stop short of endorsing their routine universal use. Randomized controlled trials or comparative non-randomized observational studies.

Outcomes 76

Outcomes Emergency Department Operations Hospitals 76

The Skeptics' Guide to EM

AUGUST 10, 2024

He is an assistant professor in Emergency Medicine, Neurology, and Neurosurgery at the School of Medicine at the University of Washington. Case: A 65-year-old man is brought into the emergency department (ED) by emergency medical services (EMS) after his family saw him slump over at the dinner table.

Stroke 69

Stroke Airway Management Documentation/Coding Outcomes 69

The Skeptics' Guide to EM

APRIL 2, 2022

Date: March 31st, 2022 Reference: Butt et al. Take-Pause: Efficacy of mindfulness-based virtual reality as an intervention in the pediatric emergency department. Date: March 31st, 2022 Reference: Butt et al. Take-Pause: Efficacy of mindfulness-based virtual reality as an intervention in the pediatric emergency department.

Pediatrics 52

Pediatrics Emergency Department Outcomes Research 52

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives Chest drains are commonly inserted in the Emergency Department (ED) with a complication rate of 30-40%. Training in chest drain insertion is essential in Emergency Medicine (EM) as approximately 25,000 patients undergo in England and Wales undergo this procedure annually.

Emergency Department 40

Emergency Department EMS Research Operations 40

Don't Forget the Bubbles

JULY 19, 2023

Trends and Clinical Characteristics of Pediatric Patients Presenting to an Ophthalmology Emergency Department with an Initial Diagnosis of Optic Nerve Head Elevation. 2022 May 18;16:1525-1528. 2022 [cited 2023 May 14];16:1525–8. Outcome of pediatric patients referred for papilledema. Clin Ophthalmol.

Pediatrics 98

Pediatrics Emergency Department Outcomes Wellness 98

EMDocs

AUGUST 22, 2024

12 How do we address these disparities in the emergency department? Certified interpreter use can improve communication and patient outcomes. An implementation science approach improves language access in the emergency department. One cohort study in a public ED found that 84.5% 45:446-458. Taira B, et al.

Documentation/Coding 82

Documentation/Coding Emergency Department Federal Emergency Management Agency Best Practices 82

Broome Docs

MARCH 28, 2024

Emerg Med J. PMID: 38050078 Bottom line: High dose nitroglycerin seems to result in better outcomes in SCAPE, at least according to this small, single center, unblinded trial. Am J Emerg Med. 2022 Feb;52:85-91. 2024 Jan 22;41(2):96-102. doi: 10.1136/emermed-2023-213285. Is our PPE evidence-based? doi: 10.1016/j.ajem.2021.11.030.

PPE 107

PPE Ultrasounds Resuscitation Administration 107

The Skeptics' Guide to EM

SEPTEMBER 10, 2022

Date: August 25th, 2022 Reference: Martin et al. Single-dose dexamethasone is not inferior to 2 doses in mild to moderate pediatric asthma exacerbations in the emergency department. Pediatr Emerg Care. 2022 Guest Skeptic: Dr. Harrison Hayward is a Pediatric Emergency Medicine fellow at Children’s National Hospital.

Pediatrics 52

Pediatrics Emergency Department Urgent Care Hospitals 52

PulmCCM

JULY 3, 2023

emergency departments and ICUs were randomized to undergo either DL or VL for intubation. More than 90% of the intubations were performed by emergency medicine residents (~70%) or critical care fellows (~23%). At six months of followup, there was no difference in the rate of good neurologic outcome (43.5%

Airway Management 105

Airway Management Outcomes Hospitals Emergency Department 105

The Skeptics' Guide to EM

JANUARY 29, 2022

Date: January 25th, 2022 Reference: Beyde et al. Efficacy of empiric antibiotic management of septic olecranon bursitis without bursal aspiration in emergency department patients. AEM January 2022 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. Reference: Beyde et al.

Emergency Department 52

Emergency Department Academics Hospitals Outcomes 52

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

Written by Pendell Meyers A teenager was involved in a motor vehicle collision and presented to the Emergency Department via EMS altered and potentially critically ill. Atrial fibrillation is also a predictor of worse outcomes in this case (Alborzi). Retrieved July 2, 2022, from [link] Moyé, D. References Alborzi, Z.,

EKG/ECG 103

EKG/ECG Wellness Fractures Hospitals 103