Pediatric EM Morsels

JULY 19, 2024

DON’T forget to put on your Personal Protective Equipment as well! If bleeding, the only lab that is needed in the Emergency Department is a type and cross. Have traditional, direct laryngoscopes available as well. This is worth a shot in a well appearing child that is old enough to gargle and spit.

Pediatrics 286

Pediatrics Airway Management Wellness Administration 286

Broome Docs

APRIL 6, 2023

2023 Jan 21. Am J Emerg Med. 2023 Feb;64:206.e1-206.e3. 2023 Jan 30. A prospective cluster-randomized trial to implement the Canadian CT Head Rule in emergency departments. 2023 Jan 13;76(2):185-191. 2023 Feb 03;: PMID: 36367144 Justin’s excellent critical appraisal and Full write up here.

Sepsis 52

Sepsis Ultrasounds Hospitals Outcomes 52

PEMBlog

OCTOBER 18, 2023

The night prior to presentation, mom noticed he was not feeding as well and seemed fussy. Initially in the emergency department he was generally well-appearing with normal vital signs. Infants with NTED generally remain well-appearing and do not meet toxic shock syndrome (TSS) criteria. 2023; 40( 2): 349- 351.

Infectious Diseases 59

Infectious Diseases Shock Pediatrics Wellness 59

Broome Docs

FEBRUARY 22, 2024

2023 Mar 30;110(4):432-438. PMID: 36946338 Bottom line: This is a well done RCT that demonstrates pretty convincingly that you should not bother trying to but fingernails back on after nail bed repair (and my guess is you definitely shouldn’t be removing them either). 2023 Nov 11. 2023 Oct 1;80(10):1047-1054. 2023 Oct 12.

Emergency Department 103

Emergency Department Psychiatric Resuscitation Wellness 103

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. 7 The operators involved in the trial were mostly emergency medicine residents or critical care fellows, but this fact does not diminish the generalizability of these observations.

Research 52

Research Airway Management Stroke Outcomes 52

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

ALiEM

SEPTEMBER 13, 2024

A 32-year-old male with no significant past medical history presented to the emergency department (ED) from an outside hospital for further management of right eye pain and vision loss sustained after he was struck by a metal wire while at work. Consult ophthalmology emergently. 2023, March 23). Eye (Lond).

Emergency Department 64

Emergency Department Hospitals Academics Fractures 64

ALiEM

NOVEMBER 17, 2023

A 4-year-old female with no significant past medical history is brought to the Emergency Department by her grandmother for concern for two days of progressive vaginal bleeding. kg General : Well-appearing 4-year-old female acting appropriately with grandmother and mother at the bedside. C; Wt 18.2 link] Published 2021.

Pediatrics 100

Pediatrics Emergency Department Academics OB/GYN 100

ACEP Now

OCTOBER 3, 2023

At the most fundamental level, emergency physicians cannot change jobs if they are legally prevented from doing so by non-compete agreements. In March 2023, ACEP sent a letter to the Federal Trade Commission strongly supporting the FTC’s proposal to ban non-compete agreements from employment contracts. Published January 27, 2023.

Emergency Department 52

Emergency Department EMS Wellness 52

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)! You may not make the diagnosis, but detecting the clues is important for the family!

Dehydration 189

Dehydration Shock Pediatrics Emergency Department 189

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. as well as conversion to sinus rhythm (OR 1.75; 95 percent CI 1.08-2.84).7 In fact, few studies compare the two classes.

Emergency Department 105

Emergency Department Outcomes Research Wellness 105

ALiEM

OCTOBER 7, 2024

A 52-year-old female with a past medical history of hypertension and prediabetes presented to the emergency department with double vision that started one day prior to arrival. F; O2 saturation 96% on room air General : No acute distress, well-appearing Neurologic : AOx3; Following commands. 2023 Aug 24. PMID: 29489275.

Academics 64

Academics Emergency Department Pediatrics Wellness 64

EMDocs

SEPTEMBER 14, 2024

Source Use of Glucagon-Like Peptide-1-Agonists and Increased Risk of Procedural Sedation and Endotracheal Intubation in the Emergency Department. Ann Emerg Med. The AI performed well in both accuracy and in improving sensitivity. Ann Emerg Med. 2023-064364. 2024 Aug;84(2):226-227. DOI: 10.1016/j.annemergmed.2024.03.007.

Emergency Department 70

Emergency Department Resuscitation Pediatrics Research 70

ACEP Now

AUGUST 22, 2023

Regardless of the domain, somewhere an expert panel has convened to issue a pronouncement informing all of the ideal care of patients under their specialty umbrella, indirectly extending to their care in the emergency department. 2-4 A fourth is planned for publication in late 2023, and will address non-opioid substance dependence.

Emergency Department 98

Emergency Department Academics Critical Access Research 98

Don't Forget the Bubbles

OCTOBER 10, 2024

2023 Mar 30;110(4):432-438. Adopting this approach would reduce time in surgery for the child as well as the financial cost of nail bed repair. Exploring communication preferences and risk thresholds of clinicians and parents of febrile infants under 90 days presenting to the emergency department: a qualitative study.

Emergency Department 75

Emergency Department Outcomes Research Operations 75

ALiEM

SEPTEMBER 9, 2024

A 61-year-old female with a past medical history of hypertension, hyperlipidemia, type 2 diabetes, and normal pressure hydrocephalus s/p VP shunt (last revision nine months ago) presented to the Emergency Department (ED) for evaluation after noticing a “string” coming out of her anus today. Surg Neurol Int.

Sepsis 60

Sepsis Academics Wellness Operations 60

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. Ponmani C, Nijman RG, Roland D, Barrett M, Hulse T, Whittle V, Lyttle MD on behalf of PERUKI.

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

EMDocs

AUGUST 22, 2024

12 How do we address these disparities in the emergency department? Well-meaning providers who are not highly fluent may contribute to miscommunication and diagnostic errors. Providers should respect and utilize this mode of communication, as well as document the patient’s request for a non-certified interpreter.

Documentation/Coding 81

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

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

The Skeptics' Guide to EM

JULY 29, 2023

Date: July 21, 2023 Reference: McDonald et al. AEM July 2023 Guest Skeptic: Dr. Chris Bond is an emergency medicine physician and assistant Professor at the University of Calgary. Date: July 21, 2023 Reference: McDonald et al. Patterns of change in prehospital spinal motion restriction: a retrospective database review.

Head Injuries 77

Head Injuries EMS Research Emergency Department 77

Taming the SRU

MARCH 11, 2024

Acute knee dislocations are rare orthopedic injuries that have high morbidity and need to be recognized quickly by the emergency physician; if unrecognized or inadequately treated, these injuries can lead to vascular and limb compromise (1,2). Knee dislocations make up less than 0.5% No open wound. ABI’s were 1.1 bilaterally.

Dislocations 107

Dislocations Emergency Department Fractures Operations 107

The Skeptics' Guide to EM

JULY 8, 2023

Date: July 6, 2023 Reference: Hanula R et al. JAMA Int Med 2023. Guest Skeptic: Dr. Anand Swaminathan is an Assistant Professor of Emergency Medicine at Staten Island University Hospital. first appeared on The Skeptics Guide to Emergency Medicine. Date: July 6, 2023 Reference: Hanula R et al. JAMA Int Med 2023.

CDC 95

CDC Hospitals EMS Emergency Department 95

Taming the SRU

DECEMBER 11, 2023

1,2] Patients at risk for suicide often interact with emergency medical care. Suicide-related behavior (SRB) accounts for 1% of all Emergency Department (ED) visits; additionally, greater than 8% of patients visiting emergency departments are likely experiencing suicidal ideation at the time of the encounter.[3-5]

EMS 96

EMS Psychiatric Emergency Department Poisoning 96

ALiEM

OCTOBER 23, 2023

A 32-year-old man with a history of traumatic globe rupture from a stab wound two months ago, status post repair, presented to the emergency department for worsening right eye pain and green malodorous drainage for the past three days. There was a well-healed scar on the bottom eyelid. Indian J Otolaryngol Head Neck Surg.

Academics 111

Academics Emergency Department Ultrasounds Wellness 111

ACEP Now

MAY 10, 2024

Patients often seek care in the emergency department (ED) setting when flares of pain affect their ability to ambulate, climb stairs, or even stand up from sitting. We prefer an in-plane, superior to inferior approach, but an out-of-plane technique can be performed, as well. J Emerg Med. 2023 Jul;13(7):373-378.

Ultrasounds 92

Ultrasounds Emergency Department Hospitals Wellness 92

Taming the SRU

NOVEMBER 14, 2023

Chief complaints involving the ear are a common occurrence in Emergency Departments across the US and include presenting symptoms such as ear pain or fullness, hearing loss, redness, trauma, vertigo, and foreign bodies. A retrospective analysis of the Nationwide Emergency Department Sample (NEDS) from 2009 through 2011 identified 8.6

Emergency Department 92

Emergency Department Pediatrics Wellness Documentation/Coding 92

EMDocs

JULY 9, 2024

The emergency department takes care of some of the highest risk patients with the worst access to health care and social services Over the past 20 years, many researchers have created and validated social needs screeners Some examples: iHELP, WE CARE, SEEK, USDA 2-item food insecurity questionnaire Does screening make a difference?

Pediatrics 71

Pediatrics Emergency Department Research Burns 71

Don't Forget the Bubbles

AUGUST 7, 2023

2023 Mar;59(3):480-486 Who were the patients? This prospective cohort study included patients between 0-16 years old, who presented to one of four NHS hospital sites in Greater Manchester (a large metropolitan area in the North of England), consisting of an Urgent Care Centre and three Emergency Departments. Acad Emerg Med.

Sepsis 98

Sepsis Pediatrics Urgent Care Emergency Department 98

Don't Forget the Bubbles

JULY 19, 2023

Olivia, a previously well 13-year-old girl, is referred to the paediatric ED from the Ophthalmology ED. Trends and Clinical Characteristics of Pediatric Patients Presenting to an Ophthalmology Emergency Department with an Initial Diagnosis of Optic Nerve Head Elevation. 2023 and Kovarik et al., Clin Ophthalmol.

Pediatrics 98

Pediatrics Emergency Department Outcomes Wellness 98

ALiEM

JUNE 1, 2023

Are you using phenobarbital instead of benzodiazepines as the first-line monotherapy for patients in alcohol withdrawal in the Emergency Department (ED)? Well not exactly. The Journal of Emergency Medicine. Management of Alcohol Withdrawal in the Emergency Department: Current Perspectives. 2012.07.056.

Administration 98

Administration Emergency Department Seizures Hospitals 98

ALiEM

JANUARY 22, 2024

A 40-year-old male, tailor by occupation, was brought to the Emergency Department with complaints of high-grade fever for the past 11 days. The patient also complained of shortness of breath for one week associated with a dry cough, as well as an altered sensorium for one day. Epub 2011 Sep 12. PMID: 21911554; PMCID: PMC3193135.

Documentation/Coding 64

Documentation/Coding Academics Emergency Department Hospitals 64

ACEP Now

FEBRUARY 11, 2024

A 25-year-old Venezuelan male presented to a Chicago area emergency department (ED) in early November 2023. He noted spending about five days walking through a jungle, as well as traversing rivers. Discussion As the refugee crisis continues, and asylum seekers visit emergency departments all over the U.S.,

Infectious Diseases 52

Infectious Diseases CDC Military Emergency Department 52

Dr. Smith's ECG Blog

OCTOBER 20, 2024

The patient was rushed to the nearest emergency department (non-PCI facility) for stabilization. On arrival in the emergency department, invasive blood pressure was 35/15mmHg and the patient was in profound cardiogenic shock with severe confusion secondary to brain hypoperfusion. There is now some flow in the LMCA!

EKG/ECG 125

EKG/ECG Shock Emergency Department Ambulance Services 125

ALiEM

MAY 19, 2023

A heavy alcohol drinker, who is well known to your Emergency Department, presents with altered mental status, except that he looks different this time. In our emergency department, the RTs do not spend a lot of time going around measuring cuff pressures and usually save that until the patient reaches the ICU.

Emergency Department 98

Emergency Department Ultrasounds Wellness EMS 98

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. Accessed April 5, 2023. Accessed April 5, 2023 Afzal S, Zahid M, Rehan ZA, et al. emDOCs.net – Emergency Medicine Education.

Ultrasounds 103

Ultrasounds Emergency Department Resuscitation Wellness 103

ACEP Now

JANUARY 13, 2024

1 The questions raised by this tragedy are many: How did a gun make its way into the emergency department in the first place? Working in the emergency department, we are subject to high rates of burnout, depression, and anxiety that have all been exacerbated by the COVID-19 pandemic. Ann Emerg Med , 2021;78(4):S8.

Emergency Department 52

Emergency Department Resuscitation Patient Safety Hospitals 52

ALiEM

NOVEMBER 29, 2023

In patients with skin changes, consider topical wound care as well as further evaluation of deep tissue infections, osteomyelitis, and ischemia. Published May 2023. Published 2023 Mar 29. 2023 Jun 15;388(24):2209-2212. Epub 2023 Apr 26. Published 2023 June 30. 2023 Mar;61(3):173-180. N Engl J Med.

Forensics 67

Forensics Administration Poisoning Emergency Department 67