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)! Allergy Asthma Clin Immunol 18, 54 (2022). Rare diseases are not confined to the pages of a textbook or computer screen.

Dehydration 189

Dehydration Shock Pediatrics Emergency Department 189

Ken Grauer, MD

MAY 20, 2023

In the October 15, 2022 post of Dr. Smith's ECG Blog — Drs. Smith and Meyers in their October 15, 2022 post on Precordial Swirl. Figure-3: Selected sets of V1,V2 leads from the examples of Precordial Swirl provided in the October 15, 2022 post in Dr. Smith's ECG Blog. What is P recordial S wirl ?

EKG/ECG 363

EKG/ECG Wellness 363

Pediatric EM Morsels

SEPTEMBER 22, 2023

” Children compensate for blood and volume loss very well… until they don’t. Updated 2022 Feb 10]. Updated 2022 Mar 3]. As our fearless leader likes to say: “children are not aliens, but they are a special population with unique anatomy and physiology.” Tenenbein M, Macias CG, Sharieff GQ, et al, eds.

Shock 300

Shock Pediatrics Hyperthermia / Hypothermia Dislocations 300

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). Some institutions developed a tier-based system for outpatient imaging as well which was updated in real-time.

Radiology 73

Radiology Radiology Emergency Department Hospitals 73

Pediatric EM Morsels

APRIL 5, 2024

CDC 2022) Testing for many of these illnessess can take time during the acute phase as many are ELISA or PCR tests. CDC 2022) Divided into Soft tick relapsing fever and Hard tick relapsing fever , depending on what type of ticks carry the Borrelia sp (CDC 2022) There is also a louse which carries a Borrelia sp.

CDC 161

CDC Infectious Diseases Pediatrics Wellness 161

The Trauma Pro

JANUARY 5, 2024

Bottom line: Well, this was a new one for me. The only prior study I could find was published in 2022 by a group at the University of Nevada at Las Vegas. Although still a relatively small and single-institution study, it was well done and could easily detect statistical significance. 2022 Nov;279:62-71. J Surg Res.

Hospitals 133

Hospitals Wellness Outcomes 133

Ken Grauer, MD

FEBRUARY 3, 2024

I’ve taken th e l ead V 3 examples in Figure-3 from previous cases posted on Dr. Smith’s ECG Blog : T OP in Figure-3 — Despite the marked ST elevation in this lead V3 — this is not T-QRS-D, because there is well-defined J-point notching ( BLUE arrow ). This patient had a repolarization variant as the reason for ST elevation.

EKG/ECG 411

EKG/ECG Resuscitation Hospitals Wellness 411

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. 2022 Jul 6;9(5):e200013. 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. doi: 10.1212/NXI.0000000000200013.

Psychiatric 269

Psychiatric Seizures Outcomes Pediatrics 269

Ken Grauer, MD

APRIL 18, 2023

This blog post reviews the basics for predicting the " C ulprit" A rtery ( as well as reviewing why the term "STEMI" — should replaced by " OMI" = O cclusion-based MI ). The April 17, 2022 post ( Leads V1,V2 misplacement ). The May 24, 2022 post ( LA-LL reversal ). The May 26, 2022 post ( LA-LL reversal ).

EKG/ECG 195

EKG/ECG Wellness 195

Don't Forget the Bubbles

MAY 31, 2023

2023 May 17:archdischild-2022-325280. doi: 10.1136/archdischild-2022-325280. The DIMPLES study by PERUKI sought to investigate the incidence of new-onset diabetes in the paediatric population across the UK and Ireland, as well as the characteristics of these ED presentations, and to determine if SARS-CoV2 infection was involved.

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

Pediatric EM Morsels

AUGUST 11, 2023

Having authored 575 ( well, now 576 ) of them, I am often quite convinced that there are no new topics to discuss. 2022 Sep;68(9):661-663. This is the 601st Ped EM Morsel ! Then July happens and we get 14 more amazing interns who help educate me and remind me that there is always more to learn. References: Kim MM, Goldman RD.

Burns 130

Burns Pediatrics EMS Outcomes 130

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.

CDC 130

CDC Poisoning Pediatrics Shock 130

The Trauma Pro

JUNE 14, 2024

The authors called out the usual culprits: Fluid between loops of bowel Active bleeding in the mesentery Bowel wall perfusion defects But they also noted that traumatic abdominal wall hernias were highly associated with seat belt sign as well. With newer scanners, radiologists are better able to detect subtle areas of hypoperfusion as well.

Operations 147

Operations Radiology Radiology Hospitals 147

RebelEM

SEPTEMBER 21, 2023

Up to 80% of patients will have at least one troponin sent ( Gabrielli 2022 ). Troponins are highly specific to cardiac myocytes but do exist in other muscle types as well. What The Evidence Says: Gabrielli and colleagues demonstrated that troponin testing in patients with SVT is common. Cardiol Rev. PMID: 35148534 Allen R, deSouza IS.

EKG/ECG 143

EKG/ECG Sepsis EMS Outcomes 143

RebelEM

JANUARY 18, 2024

It is well-established that earlier recognition and treatment can lead to better outcome for these patients . Health Sci Rep 2022. Health Sci Rep 2022. Background: Sepsis remains one of the leading causes of morbidity and mortality. Paper: Varney J et al. More evidence is needed before this becomes mainstream practice.

Sepsis 132

Sepsis Hospitals Administration Outcomes 132

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. 2022 Apr;54:328.e3-328.e4. Mechanism of dislocation : [ Horan, 2006 ] Typically, the injury occurs when: The Knee is in Flexion and The Foot is rotated and plantar flexed. References: Sacchetti A, Verbaro J.

Dislocations 141

Dislocations Fractures Pediatrics EMS 141

Stop and Think

NOVEMBER 19, 2023

Also well known—from old data—was that myocarditis is a cause of cardiac arrest during sport. In fact, the authors reported a decline in sudden cardiac death during the years 2021-2022. Notably, the authors reported only one case of myocarditis-related death during the 2020-2022 period. But it was real.

Documentation/Coding 128

Documentation/Coding Wellness Resuscitation 128

Ken Grauer, MD

JULY 29, 2023

This young woman did well for a year — but unfortunately suffered another cardiac arrest, from which she could not be resuscitated. As a result of a familial gene mutation — there is fatty infiltration of the RV free wall ( Shah et al — Stat Pearls-NCBI-2022 ). About A RVC/ A RVD. ARVD is a genetic disorder of the myocardium.

EKG/ECG 370

EKG/ECG Resuscitation Documentation/Coding Hospitals 370

Dr. Smith's ECG Blog

FEBRUARY 2, 2024

He did well and was discharged. Rituparna et al — as well as Chauhan and Brahma ( Int. We've discussed Osborn Waves ( both ischemic and hypothermic ) — on a number of occasions in Dr. Smith's ECG Blog ( Please check out My Comment at the bottom of the page in the February 8, 2022 post ).

Hyperthermia / Hypothermia 138

Hyperthermia / Hypothermia EKG/ECG Wellness 138

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

Systolic function normal by visual assessment only, unable to visualize well for further characterization. The patient did well and was discharged. Retrieved July 2, 2022, from [link] Moyé, D. Retrieved July 2, 2022, from [link] Sybrandy, K. RV: Cavity size normal. 1900: RBBB and LAFB are almost fully resolved.

EKG/ECG 114

EKG/ECG Wellness Fractures Hospitals 114

Pediatric EM Morsels

APRIL 7, 2023

Observation, interaction with patient, as well as parent information is key to bring the whole picture together! Updated 2022 Jul 18]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Atherosclerosis. 2013 Aug;229(2):496-503. doi: 10.1016/j.atherosclerosis.2013.05.006. 2013.05.006. Epub 2013 May 16. PMID: 23746538.

Stroke 130

Stroke Pediatrics Seizures Sepsis 130

Dr. Smith's ECG Blog

SEPTEMBER 11, 2024

Hope you’re doing well! You taught us well!" Most of these Q waves are unusually wide with respect to QRS amplitude in the lead being looked at — as well as fragmented in multiple leads, including lead V3 ( BLUE arrow ) and leads III, aVF, V2 and V4. A former resident texted me this case: "Hey Dr. Smith.

EMS 113

EMS CPR EKG/ECG Wellness 113

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. Lancet Haematol 2022. Cureus 2022. vs SBP target <90mmHg which resulted in a mortality of 33.4% NEJM 1994. [2] PMID: 35271808 Kronstedt S et al.

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

Pediatric EM Morsels

FEBRUARY 2, 2024

In one ED study, ALL cases of missed travel-related illness did not have a documented travel history in their ED note , whereas 90% of the identified travel-related illnesses had a provider documented travel history (Greenky 2022) Those who are visiting friends and relatives (VFR) are typically at highest risk. 2022 Jun:56:113-116.

Infectious Diseases 161

Infectious Diseases Pediatrics Sepsis Documentation/Coding 161

Dr. Smith's ECG Blog

OCTOBER 23, 2023

2022 Jul;27(4):e12939. Epub 2022 Feb 11. I last reviewed the phenomenon of electrical alternans in My Comment at the bottom of the page in the November 28, 2022 post of Dr. Smith's ECG Blog. Prolonged ST segment and T-wave alternans with torsade de pointes secondary to hypocalcemia due to hypoparathyroidism: A case report.

EKG/ECG 128

EKG/ECG Documentation/Coding Psychiatric EMS 128

Sensible Medicine

AUGUST 7, 2024

There is evidence that, for children and adults, elevated cortisol levels and chronic stress can lead to behavioral, mental-health, and mood issues, as well as changes in inflammation and immunity. In 2022 the CDC paid the AAP to form an expert working group to revise its developmental surveillance checklists.

CDC 110

CDC Documentation/Coding Research Pediatrics 110

Sensible Medicine

MAY 28, 2024

The adoption of depression screening is, of course, well-intentioned. In October 2022 , the USPSTF recommended childhood anxiety screening starting at eight years old. The benefit of screening is just too small to be detected by well-designed trials. She is brilliant, well-read, and excels in school.

Outcomes 139

Outcomes Military Psychiatric Wellness 139

Sensible Medicine

DECEMBER 18, 2023

That is my conclusion as well, and I favor large, pragmatic randomized trials in adults and kids with staggered starting times (adults first — to protect kids from harms we may not yet know). It is inappropriate in my mind to say pediatricians SHOULD prescribe these drugs for a 12 year old, and the USPSTF agrees.

Pediatrics 141

Pediatrics Documentation/Coding Burns Academics 141

Dr. Smith's ECG Blog

AUGUST 18, 2024

He did well. We've periodically reviewed cases regarding Pacemaker Troubleshooting ( See the February 18, 2024 post — the January 13, 2024 post — the October 19, 2022 post — the August 3, 2022 post — the May 21, 2023 post — the June 19, 2024 post — and the November 9, 2018 post , to name a number of them ).

EKG/ECG 98

EKG/ECG Fractures Burns Wellness 98

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 since 2022. Unionization of healthcare providers can create opportunities to improve staff’s financial and general well-being, but may also facilitate future strikes.

Hospitals 77

Hospitals Research Patient Safety Wellness 77

Ken Grauer, MD

SEPTEMBER 6, 2024

Alternatively — when a portion of the reentry circuit is made up of an AP ( A ccessory P athway ) — the retrograde P wave will typically manifest a moderately long RP' interval ( that occurs well after the QRS — usually within the latter part of the ST segment ). What is happening in today's case is different.

EKG/ECG 248

EKG/ECG Administration Wellness Operations 248

Pediatric EM Morsels

JUNE 21, 2024

Antibacterial ointments , like bacitracin, tend to be well tolerated and promote faster wound healing than silver sulfadiazine and other creams in partial thickness wounds. Ointment has shorter half-life, so should be cleansed and changed every 12 hours. Get the Goop! Halt the Hurt!

Burns 169

Burns Pediatrics Hospitals Wellness 169

ALiEM

NOVEMBER 17, 2023

kg General : Well-appearing 4-year-old female acting appropriately with grandmother and mother at the bedside. Accessed January 5, 2022. Accessed January 5, 2022. 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.

Pediatrics 100

Pediatrics Emergency Department Academics OB/GYN 100

Don't Forget the Bubbles

JUNE 30, 2023

Next of interest is a secondary analysis of the MATIC study – the MA ssive T ransfusion I n C hildren study, published in 2022. Well, one study in Kornelson’s systematic review and meta-analysis is interesting. 2022 May;55:103-110. Epub 2022 Feb 7. 2022; 29: 862– 873. Or is there a risk TXA could cause harm?”

Head Injuries 145

Head Injuries Seizures Outcomes Pediatrics 145

ALiEM

OCTOBER 11, 2023

Pufferfish, also known as fugu, is served as a delicacy and perioral numbness is a well-known effect [4]. 2022 Feb 8;14(2):123. Treasure Island (FL): StatPearls Publishing; August 8, 2022. 2022 Feb;60(2):262-266. 2022 Nov 8;19(22):146-8. Treasure Island (FL): StatPearls Publishing; November 3, 2022.

Poisoning 81

Poisoning Burns Wellness Outcomes 81

SheMD

JULY 30, 2023

Some of the interview information may not be relevant during the 2020-2021 & 2021-2022 academic years. We typically recommend medical school applicants to get letters of recommendation from: 2 professors who taught you in science courses, 1 professor who taught you in a non-science course, and 1 non-academic mentor who knows you well.

Academics 104

Academics Leadership Research Wellness 104

Mind The Bleep

SEPTEMBER 16, 2023

Mental health and well-being are taboo subjects for medical students and doctors, and something which is often not talked about enough. According to the BMA in 2022, up to 39% of junior doctors experienced a severe level of stress and burnout due to their work, a figure which is increasing each year. Accessed: 09 September 2023).

Wellness 75

Wellness 75