Pediatric EM Morsels

MARCH 29, 2024

Pediatr Rev (2022) 43 (7): 371–383. link] The post Rebaked: Inborn Errors of Metabolism presenting in the ED appeared first on Pediatric EM Morsels. Pediatrics. 2000; 105:e 10. Inborn Errors of Metabolism: Becoming Ready for Rare. Samantha A. Schrier Vergano.

Dehydration 297

Dehydration Pediatrics Sepsis EMS 297

RebelEM

NOVEMBER 6, 2023

Background Information: Vasoplegic shock is defined as hypotension with normal or increased cardiac output and can commonly occur in post-cardiac surgery patients having received cardiopulmonary bypass. Hydroxocobalamin Versus Methylene Blue for the Treatment of Vasoplegic Shock Associated With Cardiopulmonary Bypass. 2023 Jul 19.

Shock 71

Shock Administration Academics Hospitals 71

Dr. Smith's ECG Blog

JULY 9, 2024

His family started CPR and called EMS, who arrived to find him in ventricular fibrillation. 15 minutes after EMS arrival, after at least 6 defibrillations, the patient achieved sustained ROSC. Meyers and Smith in the October 15, 2022 post of Dr. Smith's ECG Blog ). 15, 2022 post). As per My Comment in the above-cited Oct.

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EKG/ECG Resuscitation Shock CPR 116

Emergency Medicine Cases

JANUARY 2, 2023

Based on a blend of number of listens, feedback from listeners, website visits and my personal faves, here is EM Cases Top 10 of 2022. The post Top 10 of 2022 – EM Cases Podcasts & Blogs Highlights of the Year appeared first on Emergency Medicine Cases.

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EMS Stroke Shock 52

RebelEM

JANUARY 18, 2024

Health Sci Rep 2022. septic shock) earlier antibiotics most likely makes a difference in morbidity and mortality, however earlier antibiotics in all patients who meet SIRS criteria may not be a good thing and potentially cause more harms than good. Health Sci Rep 2022. appeared first on REBEL EM - Emergency Medicine Blog.

Sepsis 132

Sepsis Hospitals Administration Outcomes 132

ACEP Now

JULY 7, 2023

However, between four and five percent of cases of VT or VF will be refractory to standard management, with nonperfusing arrhythmia persisting despite repeated shocks. Initial guidelines defined “refractory” as VT or VF occurring despite three shocks from a cardiac defibrillator. amiodarone or lidocaine). References Tsao CW, et al.

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Resuscitation Shock Stroke Hospitals 98

ALiEM

OCTOBER 30, 2024

Case A patient arrives via EMS from the bus station complaining of fever, vomiting, and back pain. Our experience: It was not long ago that we instructed our staff that: ‘COWS >8, give ’em 8 (mg of buprenorphine).’ Drug Checking Quarterly Report (Q3 2022). 2022; 06/26/2023. 2022 May;14(5). 2011 Dec;6:1-4.

Emergency Department 64

Emergency Department Operations Psychiatric Hospitals 64

Dr. Smith's ECG Blog

SEPTEMBER 23, 2024

When EMS found her, she was dyspneic and diaphoretic. Taking a step back , remember that sinus tachycardia is less commonly seen in OMI (except in cases of impending cardiogenic shock). As per Dr. Frick — sinus tachycardia is usually not seen with acute OMI unless the patient is in cardiogenic shock. Both were wrong.

EKG/ECG 128

EKG/ECG Ultrasounds Shock EMS 128

RebelEM

APRIL 29, 2024

2022 PMID: 35206981 2. Healthcare 2022 PMID: 35206981 Post Peer Reviewed By: Frank Lodeserto, MD & Salim R. Rezaie, MD (Twitter/X: @srrezaie ) The post Don’t Forget About the IO in the Critically Ill Patient appeared first on REBEL EM - Emergency Medicine Blog. References: 1 Astasio-Picado Á et al. Healthcare.

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Resuscitation Administration Emergency Department Ultrasounds 105

Taming the SRU

JUNE 24, 2024

Follow this algorithm in patients with unstable bradycardia with acute heart failure, change in mental status, or concern for shock, physicians should start with atropine, 1 mg and may be continued every 3 to 5 minutes if effective. The American Journal of Emergency Medicine , vol. 2090–2093, [link] Moayedi, Siamak, et al. Circulation , vol.

Advances Cardiac Life Support (ACLS) 90

Advances Cardiac Life Support (ACLS) CPR Burns Resuscitation 90

RebelEM

JUNE 8, 2023

2022 Sep 5. 2022 2022 Sep 5. Nontraumatic hypotension and shock in the emergency department and the prehospital setting, prevalence, etiology, and mortality: a systematic review. Paper: Singer S, et al. The safety and efficacy of push dose vasopressors in critically ill adults. Am J Emerg Med. Am J Emerg Med.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

RebelEM

DECEMBER 19, 2022

This procedure involves applying another set of pads attached to a second defibrillator to a patient and shocking them in hopes of terminating the rhythm. At REBEL EM, we’ve done an extensive write up that details some of the different types of DED and the electrophysiology behind it. N Engl J Med.

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EMS CPR Shock Resuscitation 52

ALiEM

JULY 17, 2023

sought to identify program factors associated with unfilled post-graduate year 1 (PGY-1) emergency medicine (EM) positions in the 2023 Match [1]. Many of these findings were similar to a study of the 2022 EM Match results by Murano et al., What does this mean for the future of EM? Is student disinterest the problem?

EMS 52

EMS Burns Emergency Department Shock 52

EM Literature of Note

MARCH 2, 2023

There are only four effective interventions in Emergency Medicine An incorrect report on Emergency Department diagnostic errors Finally, not every article relevant to Emergency Medicine lands in an EM journal – hence the Annals of Emergency Medicine Journal Club.

Emergency Department 52

Emergency Department Resuscitation Shock EMS 52

The Skeptics' Guide to EM

NOVEMBER 12, 2022

Date: November 10th, 2022 Reference: de-Madaria E et al. Date: November 10th, 2022 Reference: de-Madaria E et al. Salim is also the creator and founder of REBEL EM and REBEL Cast, a free, critical appraisal blog and podcast that try to cut down knowledge translation gaps of research to bedside clinical practice.

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Fluid Resuscitation Resuscitation Emergency Department Shock 52

The Skeptics' Guide to EM

JUNE 18, 2022

Date: June 18th, 2022 Reference: Crombie et al. Resuscitation with blood products in patients with trauma-related haemorrhagic shock receiving prehospital care (RePHILL): a multicentre, open-label, randomised, controlled, phase 3 trial. Date: June 18th, 2022 Reference: Crombie et al. What do you advise him?

Shock 40

Shock Resuscitation Administration Emergency Department 40

RebelEM

JANUARY 25, 2024

POCUS in dyspnea, nontraumatic hypotension, and shock; a systematic review of existing evidence. 2022 Dec;106:9-38. Epub 2022 Aug 1. Published on February 28, 2022. appeared first on REBEL EM - Emergency Medicine Blog. Epub 2014 Jul 3. PMID: 24998674. Kok B, Wolthuis D, Bosch F, van der Hoeven H, Blans M.

Ultrasounds 129

Ultrasounds Outcomes COPD Hospitals 129

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

Queen of Hearts now thinks that this one looks like posterior OMI, since the STD does appear worst in V3-4: None of this seems to have been understood by the EM doctor or the cardiologist who was consulted. The notes now refer to the patient being in cardiogenic shock, on pressors. Published 2022 Feb 20. J Cardiol Cases.

EKG/ECG 83

EKG/ECG Shock Documentation/Coding Academics 83

Dr. Smith's ECG Blog

JANUARY 8, 2024

Think of this diagnosis when a patient with CP and SOB again calls EMS for CP the day after acute coronary occlusion is ruled out (ie, by cath done the day before ) — especially when O2 saturation is reduced. Think of this diagnosis when a patient with CP and SOB + elevated troponin — has normal coronary arteries on cardiac cath.

EKG/ECG 71

EKG/ECG Resuscitation Hospitals EMS 71

Dr. Smith's ECG Blog

OCTOBER 17, 2024

The paramedic notes called STEMI into question: “EMS disagree with monitor for STEMI callout. With both EMS and ED computer interpretations reading ‘STEMI’, the emergency physician activated the cath lab. Comparing J-point between leads noted no significant ST elevation or depression, with QRS prolongation from RBBB.”

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EKG/ECG EMS Shock Ultrasounds 73

Dr. Smith's ECG Blog

MAY 14, 2022

I am sure you already shocked it, right?" See this post: Idiopathic Ventricular Tachycardias for the EM Physician. I've reproduced the summarizing Table from my discussion of this topic in the February 14, 2022 post in Dr. Smith's Blog in Figure-1. Or, of course, you can always use electrical cardioversion. Antidromic WPW).

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EKG/ECG Shock Operations EMS 52

Dr. Smith's ECG Blog

DECEMBER 10, 2022

Per EMS report, the patient had a syncopal episode at work. MY Comment, by K EN G RAUER, MD ( 12/10 /2022 ): == Sometimes an ECG raises more questions than it answers! But we have no idea if ECG #2 truly represents this patient's "baseline" ECG — or merely an improvement from his ECG when he presented to the ED in shock.

EKG/ECG 52

EKG/ECG Operations Shock EMS 52

RebelEM

MARCH 27, 2023

4 Using factors such as shock, pneumonia, and sepsis this score allows an accurate prediction of developing ARDS. 2022 Feb 8; PMID: 35156050 Higgins TL et al. 2022 Feb 24;7(1):29603. Reason for intubation, severity of illness, ARDS risk score, and ventilator settings were extracted from the electronic medical record (EMR).

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

RebelEM

NOVEMBER 3, 2022

Matchett 2022). Indian J Crit Care Med 2022. 2/3rds of the population were trauma patients, and more patients in the ketamine arm had shock, hypoxemia, extremes of size, and anatomic challenges, potentially biasing the results to favor etomidate. in the ketamine cohort compared to 12.4% in the etomidate cohort.

Outcomes 52

Outcomes Emergency Department Sepsis Operations 52

Dr. Smith's ECG Blog

DECEMBER 18, 2022

Submitted and written by Quinton Nannet, MD, peer reviewed by Meyers, Grauer, Smith A woman in her 70s recently diagnosed with COVID was brought in by EMS after she experienced acute onset sharp midsternal chest pain without radiation or dyspnea. She felt nauseous and lightheaded with no neurologic deficits.

Ultrasounds 40

Ultrasounds EKG/ECG EMS Radiology 40

Dr. Smith's ECG Blog

MARCH 15, 2023

We designed a step-up protocol in which shocks at 50, 100, 200, 300, and 360 J were used for transthoracic cardioversion. 25, 2022 ). One hundred patients who had had atrial fibrillation for a mean (±SD) of 117±201 days were randomly assigned to undergo transthoracic cardioversion with or without pretreatment with 1 mg of ibutilide.

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EKG/ECG Dehydration Stroke Shock 52

Pediatric EM Morsels

NOVEMBER 3, 2023

More specifically they have seen this trend continue to rise in the era of post-COVID travel (Choy 2022). Another change is the CDC approved the use of IV artesunate for malaria treatment in the US in May 2022. WHO 2022) In a previous PEM morsel, we mentioned Sickle Cell Trait is only protective against P. falciparum.

Seizures 281

Seizures Pediatrics CDC Infectious Diseases 281

Pediatric EM Morsels

JULY 21, 2023

We had just received a young child from EMS who was post-ictal with decreased mentation. Jain 2022] Now used for critically ill trauma and medical patients in >75 countries. Jain 2022] Now used for critically ill trauma and medical patients in >75 countries. Less than 8, intubate!

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

RebelEM

MAY 29, 2023

septic shock). Limited, small studies on its use in septic shock do not make a clear argument for use. Early Adjunctive Methylene Blue in Patients with Septic Shock: A Randomized Controlled Trial. Background: Sepsis can induce numerous physiologic derangements. Paper: Ibarra-Estrada, M et al. Crit Care 2023. 95% CI 15.4

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Shock Fluid Resuscitation Sepsis Resuscitation 145

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

Given her tachycardia and episodes of syncope, the patient was judged to be in compensated obstructive shock with very high risk of imminent decompensation. Comment by K EN G RAUER, MD ( 11/28 /2022 ): = Today's case is remarkable for the presence of 2 important ECG findings: i ) Low Voltage ; and , ii ) Electrical Alternans.

EKG/ECG 40

EKG/ECG Ultrasounds Documentation/Coding COPD 40

EMDocs

JULY 15, 2023

We’ll keep it short, while you keep that EM brain sharp. Updated 2022 Aug 8]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. aureus (including MRSA), Klebsiella pneumoniae , influenzae , E. pneumoniae , S. Retrieved March 2, 2023, from [link] Levine, B. Cellulitis and Abscess. In EMRA antibiotic guide (p.

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EMS Infectious Diseases Shock Ultrasounds 92

Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

Shocked x 2 without effect. Warning: if this is VT, a calcium channel blocker can result in shock and death. Read this post: Idiopathic Ventricular Tachycardias for the EM Physician 2. We are told that " the Patient was Shocked X2 Without Effect." The choice was to use electrical cardioversion with sedation. K returned 3.6

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EKG/ECG Shock Academics Documentation/Coding 139

RebelEM

MAY 25, 2023

I recently gave a talk on the initial management of trauma patients with hemorrhagic shock. Clinical Take Home Point: In patients with TBI and hypovolemic shock, target a SBP or MAP ≥90mmHg, but know this is based on limited evidence. vs SBP target <90mmHg which resulted in a mortality of 33.4%

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

EMDocs

DECEMBER 16, 2023

We’ll keep it short, while you keep that EM brain sharp. A 34-year-old male is brought via EMS after collapsing during an outdoor adventure race. EMS reports the patient was conscious but altered, with slurred speech and confusion. Updated 2022 Oct 24]. Point of care glucose in the field was 102 mg/dL. 2012;11(3):115–123.

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Hyperthermia / Hypothermia EMS Stroke Seizures 94

Dr. Smith's ECG Blog

JUNE 23, 2024

His daughter immediately started CPR and another family member called EMS. When EMS arrived the patient was in ventricular fibrillation. They shocked him twice before return of spontaneous circulation. He was intubated in the field and sedated upon arrival at the hospital.

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EKG/ECG CPR EMS Hospitals 118

EMDocs

DECEMBER 18, 2023

Today, she would not get out of bed, prompting the facility to call EMS. Septic shock is high on the differential diagnosis for this patient’s presentation. 3,4 Prompt recognition and management of sepsis and septic shock are paramount for the ED clinician. The patient currently resides at a skilled nursing facility.

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Sepsis Fluid Resuscitation Resuscitation Shock 91

Pediatric EM Morsels

MARCH 17, 2023

Ahmed 2008, Meyers 2022) Of course, treat any other systemic symptoms (like respiratory failure, hypotension) as you typically would. If you are managing a snake bite from a snake that does not typically reside in the U.S., please utilize other resources and local Toxicology experts for help with management protocols.

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CDC Poisoning Pediatrics Shock 130