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. Is this scalp swelling normal?

Hyperthermia / Hypothermia 152

Hyperthermia / Hypothermia Emergency Department Seizures Pediatrics 152

Broome Docs

APRIL 6, 2023

2023 Jan 21. Am J Emerg Med. 2023 Feb;64:206.e1-206.e3. Renal outcomes following intravenous contrast administration in patients with acute kidney injury: a multi-site retrospective propensity-adjusted analysis. 2023 Jan 30. 2023 Jan 13;76(2):185-191. Acad Emerg Med. 2023 Feb;30(2):144-146.

Sepsis 52

Sepsis Ultrasounds Hospitals Outcomes 52

Broome Docs

JANUARY 30, 2023

Association of Chest Pain Protocol-Discordant Discharge With Outcomes Among Emergency Department Patients With Modest Elevations of High-Sensitivity Troponin. Does wound eversion improve cosmetic outcome?: Outcomes of patients discharged from the pediatric emergency department with abnormal vital signs.

Emergency Department 52

Emergency Department Outcomes Ultrasounds Pediatrics 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

Pediatric EM Morsels

NOVEMBER 17, 2023

Differences in intubation outcomes for pediatric patients between pediatric and general Emergency Departments. Intubation practice and outcomes among pediatric emergency departments: A report from National Emergency Airway Registry for Children (NEAR4KIDS). Acad Emerg Med. West J Emerg Med.

Pediatrics 183

Pediatrics Emergency Department Outcomes Sepsis 183

ACEP Now

MARCH 6, 2024

The Sisyphean task remains to try to keep up—and, in that vein—here is a light round of the emergency medicine literature from 2023. 4 Repeated trials have not shown alteplase to have any signal of better outcomes, nor tenecteplase to have an association with increased adverse events. How Best to Stop the Bleeding in Trauma?

Research 52

Research Airway Management Stroke Outcomes 52

Don't Forget the Bubbles

OCTOBER 10, 2024

Reviewed by: Isabella Davenport Article 2: Does it improve outcomes if you replace the nail in nail bed repair? 2023 Mar 30;110(4):432-438. Children with nail bed injuries were randomly assigned to nail replacement or discarding , with the primary outcomes being secondary infection in 7 days and cosmetic outcome in four months.

Emergency Department 75

Emergency Department Outcomes Research Operations 75

The Skeptics' Guide to EM

OCTOBER 21, 2023

Date: October 20, 2023 Reference: Cai et al. AEM October 2023. Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. Date: October 20, 2023 Reference: Cai et al. AEM October 2023. AEM October 2023. Reference: Cai et al.

Emergency Department 105

Emergency Department Radiology Radiology Hospitals 105

The Skeptics' Guide to EM

JUNE 17, 2023

Date: June 15, 2023 Reference: Rees CA et al. Intranasal fentanyl and discharge from the emergency department among children with sickle cell disease and vaso-occlusive pain: A multicenter pediatric emergency medicine perspective. Date: June 15, 2023 Reference: Rees CA et al. Reference: Rees CA et al.

Emergency Department 73

Emergency Department Pediatrics Administration Head Injuries 73

The Skeptics' Guide to EM

SEPTEMBER 9, 2023

New England Journal of Medicine June 2023 Date: July 19, 2023 Guest Skeptic: Dr. Casey Parker is a Rural Generalist that includes in his practice emergency medicine, anesthesia, and critical care. Case: It is a steady Saturday afternoon in your rural emergency department (ED). Reference: Snelling et al.

Fractures 124

Fractures Ultrasounds Pediatrics Outcomes 124

EMDocs

MAY 4, 2024

Consequently, emergency physicians must remain vigilant to identify signs of OMI regardless of the initial computer ECG interpretation. Source Emergency department Code STEMI patients with initial electrocardiogram labeled “normal” by computer interpretation: A 7-year retrospective review. Acad Emerg Med.

Documentation/Coding 77

Documentation/Coding Stroke Emergency Department Pediatrics 77

The Skeptics' Guide to EM

JANUARY 20, 2024

Aug 2023 Date: October 30, 2023 Guest Skeptic: Dr. Ellie Hill is a pediatric emergency medicine physician at Children’s National Hospital in Washington, DC and Assistant Professor of Pediatrics and Emergency Medicine at George Washington University School of Medicine and Health Sciences. Reference: Zaoutis T, et al.

Pediatrics 71

Pediatrics Anaphylaxis Emergency Department Outcomes 71

ACEP Now

AUGUST 14, 2024

Rate Versus Rhythm in the ED The 2023 AHA/ACC guideline doesn’t give explicit recommendations or preference regarding initial rate or rhythm control strategy for new-onset AF patients who are hemodynamically stable. In fact, few studies compare the two classes. 2 Heart failure, however, is a different story.

Emergency Department 105

Emergency Department Outcomes Research Wellness 105

EMDocs

SEPTEMBER 30, 2024

Inhaled Corticosteroids Rarely Prescribed at Emergency Department Discharge Despite Low Rates of Follow-Up Care. J Emerg Med. 2023 May;64(5):555-563. Guidelines – Global Initiative for Asthma (GINA) 2023 The 2019 Global Initiative for Asthma (GINA) guidelines recommend that all patients with asthma be prescribed ICS.

Outcomes 82

Outcomes Academics Documentation/Coding Administration 82

ALiEM

JULY 17, 2023

The Study In an Annals of Emergency Medicine paper , Preiksaitis et al. sought to identify program factors associated with unfilled post-graduate year 1 (PGY-1) emergency medicine (EM) positions in the 2023 Match [1]. as well as an analysis of the 2023 Match by Pupazan and Cook in Emergency Medicine News [3,4].

EMS 52

EMS Burns Emergency Department Shock 52

Don't Forget the Bubbles

JULY 17, 2023

2023 Jun;38(6):1733-1751. 2023 May 16;28(3):172-183. 2023 Jun 6;28(4):205-251. 2023 Jun 6;28(4):252-266. 2023 Jun 1;177(6):559-560. 2023 Jun;182(6):2785-2792. 2023 May 16;28(3):184-202. 2023 Jun 15. 2023 Jun 1;42(6):456-460. 2023 Jun;182(6):2567-2575. 2023 Jun 29.

Pediatrics 98

Pediatrics Emergency Department Outcomes Fractures 98

Broome Docs

SEPTEMBER 3, 2024

As loud as a construction site: Noise levels in the emergency department. Australas Emerg Care. Epub 2023 Jul 31. PMID: 37532590 Bottom line: Emergency departments are noisy, although not ridiculously so. Epub 2023 Oct 26. … Adams C, Walsan R, McDonnell R, Schembri A. 2024 Mar;27(1):26-29.

Sepsis 109

Sepsis Emergency Department Outcomes Hospitals 109

Don't Forget the Bubbles

NOVEMBER 13, 2023

X-ray (radiography) is the standard imaging technique used in emergency departments. To determine the effectiveness of ultrasound, a recent study compared its diagnostic capabilities to radiography for distal forearm fractures in children and adolescents, with the primary outcome of functional recovery of the arm. N Engl J Med.

Fractures 64

Fractures Ultrasounds Emergency Department Pediatrics 64

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 81

Documentation/Coding Emergency Department Best Practices Federal Emergency Management Agency 81

Don't Forget the Bubbles

MAY 31, 2023

Children presenting with diabetes and diabetic ketoacidosis to Emergency Departments during the COVID-19 pandemic in the UK and Ireland: an international retrospective observational study. 2023 May 17:archdischild-2022-325280. What outcomes did they look at? Was the outcome accurately measured to minimise bias?

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

ACEP Now

AUGUST 13, 2024

Studies consistently show that having a diverse physician workforce leads to improved patient outcomes, lower mortality, reduced morbidity rates, and, ultimately, a more robust health care system. Dr. Kendall is the chief of clinician engagement at US Acute Care Solutions and has 15 years of emergency department leadership experience.

Leadership 111

Leadership Outcomes Academics Emergency Department 111

The Skeptics' Guide to EM

OCTOBER 14, 2023

Time to change the reference ranges of children’s physiological observations in emergency care? March 2023 Date: July 12th, 2023 Guest Skeptic: Dr. Vicki Currie is a paediatric emergency medicine registrar in the West Midlands in the United Kingdom. Reference: Brennan L et al. A prospective study. J Paediatr Child Health.

Pediatrics 88

Pediatrics Sepsis Urgent Care Emergency Department 88

Taming the SRU

SEPTEMBER 21, 2023

2023) doi:10.1016/j.annemergmed.2023.05.014. Background Rapid sequence intubation (RSI) is frequently performed under emergent conditions in acutely ill patients. Exclusion criteria were pre-intubation hypotension, use of topical anesthesia, or missing data including primary outcome, patient weight, etomidate / ketamine dose.

Outcomes 92

Outcomes Emergency Department Shock 92

Broome Docs

MARCH 28, 2024

Emerg Med J. doi: 10.1136/emermed-2023-213285. 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. 2023 Sep 21:ciad571. Ann Emerg Med. 2023 Sep 19:S0196-0644(23)00671-6. 2023 Dec;193:109991.

PPE 107

PPE Ultrasounds Resuscitation Administration 107

The Skeptics' Guide to EM

JUNE 22, 2024

December 2023 Guest Skeptic: Dr. Anireddy Reddy is a pediatric intensive care attending physician in the Department of Anesthesiology and Critical Care Medicine at Children’s Hospital of Philadelphia. Dr. Anireddy Reddy Case: A 3-year-old girl presents to the emergency department (ED) with fever and respiratory distress.

Pediatrics 53

Pediatrics Outcomes Emergency Department Resuscitation 53

The Skeptics' Guide to EM

NOVEMBER 11, 2023

Date: November 2, 2023 Reference: Coventry et al. Emerg Med J. Aug 2023 Guest Skeptic: Dr. Matt Schmitz is an Orthopaedic Surgeon who sub-specializes in adolescent sports and hip preservation. first appeared on The Skeptics Guide to Emergency Medicine. Date: November 2, 2023 Reference: Coventry et al. Emerg Med J.

Fractures 97

Fractures Military Radiology Radiology 97

RebelEM

NOVEMBER 6, 2024

Elbow Dislocation Definition: Disarticulation of the proximal radius & ulna bones from the humerus Epidemiology: Incidence Second most common joint dislocation (after shoulder) in adults Most commonly dislocated joint in children Accounts for 10-25% of all injuries to the elbow ( Cohen 1998 ) Posterolateral is the most common type of dislocation (..)

Dislocations 59

Dislocations Fractures Soft Tissue Injuries Outcomes 59

The Skeptics' Guide to EM

APRIL 29, 2023

Date: April 26, 2023 Reference: Han et al. The effect of telemental versus in-person mental health consults in the emergency department on 30-day utilization and processes of care. AEM April 2023 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. Reference: Han et al.

Psychiatric 40

Psychiatric Emergency Department Urgent Care Academics 40

The Skeptics' Guide to EM

FEBRUARY 3, 2024

March 2023 Date: January 30, 2024 Guest Skeptic: Dr. Alexandra (Ali) Espinel is an Associate professor of pediatrics and otolaryngology at Children’s National Hospital and George Washington University. For Pediatric Oropharyngeal Trauma first appeared on The Skeptics Guide to Emergency Medicine. Reference: Curry SD, et al.

Pediatrics 66

Pediatrics Radiology Radiology Head Injuries 66

Taming the SRU

SEPTEMBER 22, 2023

389, 418–429 (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. Prekker, M. Background More than 1.5

Operations 104

Operations Outcomes Emergency Department Academics 104

The Skeptics' Guide to EM

APRIL 22, 2023

Date: April 20, 2023 Reference: Franklin D, et al. JAMA 2023 Guest Skeptic: Dr. Michael Falk is a Pediatric Emergency Medicine attending at Mount Sinai Medical Center […] The post SGEM #401: Hey Ho! Date: April 20, 2023 Reference: Franklin D, et al. He is interested in simulation and medical education.

Hospitals 52

Hospitals Pediatrics Emergency Department Outcomes 52

The Skeptics' Guide to EM

MAY 11, 2024

March 2023 Date: May 7, 2024 Guest Skeptic: Dr. Brian Lee is a pediatric emergency medicine attending at the Children’s Hospital of Philadelphia and Assistant Professor of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania. Reference: Jain A, et al. Comparison: No fingernail replacement.

Outcomes 61

Outcomes Pediatrics Emergency Department Hospitals 61

RebelEM

JULY 17, 2023

Background: Standard rapid sequence intubation (RSI) in the emergency department involves administration of an induction agent and a neuroblocking agent in quick succession. RSI inherently carries with it risks of complications such as post-intubation hypotension and cardiac arrest in the most extreme cases.

Outcomes 98

Outcomes Administration Emergency Department Resuscitation 98

Pediatric EM Morsels

JULY 21, 2023

Motor Fingernail bed pressure with a pencil first If flexion outcome, then apply painful stimulus to neck or head (trapezius or supraorbital notch) to look for localization Spinal reflex can result in a falsely elevated score if lower extremity pain induced Verbal Orientated- Able to answer all questions. Ann Emerg Med. PMID: 57446.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

Don't Forget the Bubbles

MAY 8, 2024

An interesting study (JAMA Pediatrics) shows the benefits of newborn screening for spinal muscular atrophy (SMA), as initiating disease-modifying therapy earlier improves clinical outcomes. These findings advocate for expanding newborn screening programs to enhance outcomes for children with SMA. 2024 Apr 25:archdischild-2023-326533.

Pediatrics 69

Pediatrics Emergency Department Outcomes Research 69

ACEP Now

OCTOBER 15, 2023

1 The emergency department remains an important frontier for work in judicious prescribing, but opiate analgesia remains a valuable tool for the initial treatment of a variety of presentations. The treatment response for any six-week program is of limited relevance to the acute treatment provided in the emergency department.

Emergency Department 52

Emergency Department Outcomes CDC Research 52

The Skeptics' Guide to EM

APRIL 8, 2023

Date: April 4th, 2023 Reference: Vaughan and Browne. Reconfiguring emergency and acute services: time to pause and reflect. 2023 Apr Guest Skeptics: Dr. Louella Vaugh is an internist practising as a hospitalist physician at an academic centre in London, UK with a special interest in smaller, rural and remote healthcare.

Stroke 55

Stroke Emergency Department Academics COPD 55