Pediatric EM Morsels

SEPTEMBER 22, 2023

” Children compensate for blood and volume loss very well… until they don’t. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Physical exam findings of occult shock in children can be subtle. Fortunately, there are screening tools for occult shock.

Shock 300

Shock Pediatrics Hyperthermia / Hypothermia Dislocations 300

Stop and Think

DECEMBER 29, 2023

For an older patient with stroke risk factors and 3 hours of AF on a cardiac device, pre-2023 thinking would have us leaning toward anticoagulation. In this case, the industry incentives (to hopefully gain a larger market share) aligned well with patients’ incentives. These were well-conducted trials that taught us a lot.

Stroke 92

Stroke EKG/ECG Research Wellness 92

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. 2023 Jul 17. UpToDate , June 2023, www.uptodate.com/contents/autoimmune-including-paraneoplastic-encephalitis-clinical-features-and-diagnosis?search=anti+nmda+receptor+encephalitis&source=search_result&selectedTitle=1~29&usage_type=default&display_rank=1#H2973236366.

Seizures 269

Seizures Psychiatric Outcomes Pediatrics 269

RebelEM

JUNE 29, 2023

Back on June 1 st , 2023, Swami wrote a blog post on REBEL EM titled, The CT FIRST Trial, Should We Pan-CT After ROSC? REBEL EM Blog, June 1, 2023. Resus 2023. Back on June 1st, 2023, Swami wrote a blog post on REBEL EM titled, The CT FIRST Trial, Should We Pan-CT After ROSC? Available at: HERE Branch KHR et al.

CPR 142

CPR EMS Documentation/Coding Outcomes 142

The Trauma Pro

SEPTEMBER 1, 2023

But unless we have a discussion with the patient and their family well in advance, the opportunity will be missed and may result in unwanted and futile care. J Trauma 94(3):385-391, 2023. Reference: Are we waiting for the sky to fall?

Hospitals 198

Hospitals Wellness 198

EMDocs

NOVEMBER 6, 2023

Author: Brit Long, MD (@long_brit) // Reviewed by Alex Koyfman, MD (@EMHighAK) The American Heart Association 2023 Guideline for managing cardiac arrest or life-threatening toxicity due to poisoning was recently released. This post will focus on the key parts of the guideline that affect ED evaluation and management. COR 2b, LOE C-EO.

Poisoning 106

Poisoning Hyperthermia / Hypothermia Seizures Administration 106

Emergency Medicine Journal

DECEMBER 30, 2024

The concept of well-being interventions for ED staff is a growing area of interest and research worldwide. Various interventions are described in the literature, yet little is known about the experience of ED staff in the UK of interventions designed to support their well-being.

Emergency Department 52

Emergency Department Wellness Research 52

Emergency Medicine Journal

JANUARY 21, 2025

This study analyses the patterns of emergency service utilisation of the May 2023 flood in Romagna, Italy, and specifically investigates the differences in emergency department (ED) visits and mortality between individuals exposed and not exposed to the flood. to 0.92) and general disorders and minor problems (OR 0.85; 95% CI 0.78

Emergency Department 52

Emergency Department Wellness 52

Pediatric EM Morsels

MARCH 31, 2023

They like to pretend to be well when they are truly sick ( remember to check that Cap Refill and to never trust a Neonate! ) 2023 Feb 4;38:102122. Children love to trick us! Sometimes it is all in good fun and other times it is quite serious! They like to keep us on our toes so much, that even their cervical bones can deceive us.

Fractures 130

Fractures Dislocations Pediatrics Radiology 130

The Skeptics' Guide to EM

JULY 2, 2023

Date: July 1, 2023 Reference: PATCH-Trauma Investigators and ANZICS Clinical Trial Group. Date: July 1, 2023 Reference: PATCH-Trauma Investigators and ANZICS Clinical Trial Group. His Glasgow Coma Scale (GCS) score is 13 with obvious head trauma as well. Prehospital Tranexamic Acid for Severe Trauma.

EMS 123

EMS Outcomes Hospitals Research 123

RebelEM

FEBRUARY 15, 2024

Additionally, intubation can risk hemodynamic instability as well as hypoxemia from the procedure itself. It is unclear, though, if the risks of intubation (including ventilator associated pneumonia) outweighs the benefits. Paper: Freund Y et al. References: Freund Y et al.

Poisoning 137

Poisoning Airway Management Seizures Shock 137

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. Updated 2023 May 29]. Ointment has shorter half-life, so should be cleansed and changed every 12 hours. Get the Goop! Halt the Hurt! J Burn Care Rehabil.

Burns 169

Burns Pediatrics Hospitals Wellness 169

Pediatric EM Morsels

DECEMBER 20, 2024

pneumoniae re-emgerged in 2023 after the COVID pandemic. Keep in mind, there can be extrapulmonary manifestations as well! Mycoplasma Pneumonia: Epidemiology According to the CDC , infections from Mycoplasma pneumnoniae have increased in the US, especially in young children. After a prolonged period of low incidence , M.

CDC 161

CDC Seizures Pediatrics EMS 161

Sensible Medicine

APRIL 30, 2024

For her research, in 2023, she was awarded a Gairdner Early Career Investigator Award. Dr. Zeraatkar is well-spoken, clear and she explains a complicated topic in simple terms. She often works in areas in which the evidence is complex or conflicting, examples of which include nutrition and COVID-19 therapeutics.

Research 117

Research Wellness 117

Dr. Smith's ECG Blog

SEPTEMBER 15, 2023

K en G rauer gives a thorough explanation here: A 60 year old with chest pain == MY Comment , by K EN G RAUER, MD ( 9/15 /2023 ): == The 1st time that I saw APTA ( A rterial P ulse T ap A rtifact ) — I did not know what it was. Awareness of the mathematical relationships discussed in this Jan.

EKG/ECG 138

EKG/ECG Wellness 138

The Trauma Pro

OCTOBER 6, 2023

At the time, there was a debate about whether the procedure should be done immediately versus waiting until the patient was well-resuscitated. 2023 Jun 28;15(6):e41078. Ann Surg 278:e848-e854, 2023. This was a big procedure, with the possibility of several major complications, with postop paraplegia being one of them.

Head Injuries 147

Head Injuries Research Hospitals Resuscitation 147

Ken Grauer, MD

OCTOBER 21, 2023

PEARL # 1: Although seeing an elevated Troponin would provide additional support for immediate cardiac catheterization — the clinical reality is that the initial Troponin reading will not always be elevated in patients with acute coronary occlusion ( See March 24, 2023 post in Dr. Smith's ECG Blog ).

EKG/ECG 245

EKG/ECG Shock Wellness 245

RebelEM

JUNE 22, 2023

Lancet Infect Dis 2023 PMID: 37302406 Clinical Question: Does outpatient treatment with ivermectin, fluvoxamine or metformin soon after SARS-CoV-2 infection reduce the risk of developing long-COVID in overweight patients? Blinding procedures were well constructed as to mask group allocation. Lancet Infect Dis 2023.

Outcomes 135

Outcomes Research Documentation/Coding Wellness 135

Ken Grauer, MD

MARCH 7, 2023

C ONCLUSION of T oday's C ase : The subtle-but-real ST-T wave changes in today's initial tracing — as well as the equally subtle-but-real " dynamic " ST-T wave changes seen in the repeat tracing — went unrecognized for 9 hours. Fortunately — this patient did well, and was discharged with surprisingly good LV function.

EKG/ECG 195

EKG/ECG Wellness 195

PulmCCM

JANUARY 23, 2025

Overly general case definitions and sloppy EMR algorithms result in a high rate of overtreatment with antibiotics due to false positives, as well as delayed treatment from false negatives. Bands 2 and 3 did not discriminate well and did not provide useful or actionable information. This was seen in about 1/4 of the patients.

Sepsis 45

Sepsis Wellness Emergency Department Research 45

The Skeptics' Guide to EM

JULY 8, 2023

Date: July 6, 2023 Reference: Hanula R et al. JAMA Int Med 2023. Date: July 6, 2023 Reference: Hanula R et al. JAMA Int Med 2023. She looks well enough to go home but asks if she should be prescribed oseltamivir (Tamiflu) because some of her friends have been given it recently by their doctors.

CDC 96

CDC Hospitals EMS Emergency Department 96

The Skeptics' Guide to EM

JUNE 3, 2023

Date: June3, 2023 Reference: Kotani et al. Journal of Critical Care April 2023 Guest Skeptic: Dr. Amber Gombash is an emergency physician in Concord, NC. Date: June3, 2023 Reference: Kotani et al. Journal of Critical Care April 2023 Guest Skeptic: Dr. Amber Gombash is an emergency physician in Concord, NC.

Outcomes 101

Outcomes Wellness 101

RebelEM

JUNE 1, 2023

Resus 2023. Costs include actual cost of the scans as well as delaying other patients’ scans but also includes time taken away from resuscitation to move the patient to and from CT. The cost difference may be modest here as many of the patients in the standard care cohort were getting CTs as well. Resus 2023.

Outcomes 142

Outcomes Resuscitation Hospitals CPR 142

Don't Forget the Bubbles

JANUARY 1, 2024

Data from the Nurse-Family Partnership program involving 60,171 families were analysed across four cohorts, including pre-pandemic and three pandemic cohorts (from July 2022 to October 2023). 2023 Dec 22. 2023 Dec 21. 2023 Dec 19. 2023 Dec 12 Pediatric Sepsis Diagnosis, Management, and Sub-phenotypes. Pediatrics.

Pediatrics 98

Pediatrics Ultrasounds Blood Transfusions Sepsis 98

RebelEM

APRIL 17, 2023

However, It is unclear how well POCUS performs in ruling in or ruling out the diagnosis of PTA. 2023 Jan 10. Question: How well does the US perform in diagnosing PTA compared to CT, needle aspiration, or Incision and Drainage? 2023 Feb 9;15(2):e34820. Article: Kim DJ et al. Acad Emerg Med. Epub ahead of print.

Ultrasounds 129

Ultrasounds Radiology Radiology Operations 129

Ken Grauer, MD

FEBRUARY 28, 2023

As a result — IF the 1 lead you are monitoring happens to be one in which P waves are not well seen — then you might assume the irregular rhythm in front of you was AFib. A DDENDUM ( 3/1/2023 ) — Additional material relevant to today's case: How Covid-positivity in today's case may affect the heart. Additional material on MAT.

EKG/ECG 195

EKG/ECG Documentation/Coding Sepsis COPD 195

ALiEM

OCTOBER 23, 2023

There was a well-healed scar on the bottom eyelid. The hyperdense foreign body is again seen on CT, as well as a small focus of air within the anterior chamber. Additional Images Physical Exam General : Nontoxic appearing but seemed quite uncomfortable. The lateral canthus appeared inferiorly displaced. 2022;74(Suppl 2):1334-1343.

Academics 111

Academics Emergency Department Ultrasounds Wellness 111

EMDocs

FEBRUARY 7, 2024

Despite a plateau in overall union membership of around 10% in 2023 1 , major labor actions shook the U.S. there were 31 recorded healthcare strikes in 2021, 39 recorded healthcare strikes in 2022, and 37 healthcare strikes in 2023 as of November 3rd. October 16, 2023. 2023 October 9. 11 October 2023.

Hospitals 89

Hospitals Research Patient Safety Wellness 89

The Trauma Pro

SEPTEMBER 20, 2023

These low numbers and the nature of this particular registry could inject significant bias as well. Stay with the room temp platelets for now, and wait for a well-powered prospective analysis before changing your MTP. AAST 2023 Plenary paper #29. Reference: An analysis of the use of cold-stored platelets in combat trauma.

Military 113

Military Blood Transfusions Administration Outcomes 113

Sensible Medicine

MAY 28, 2024

The adoption of depression screening is, of course, well-intentioned. In June 2023 , the same was recommended to adults. The benefit of screening is just too small to be detected by well-designed trials. She is brilliant, well-read, and excels in school. Sensible Medicine is a reader-supported publication.

Military 139

Military Outcomes Psychiatric Wellness 139

Don't Forget the Bubbles

AUGUST 7, 2023

2023 Mar;59(3):480-486 Who were the patients? However, that guidance needs to take into account the influence of emotion, environment, body temperature, as well as the underlying disease process, on vital signs, especially in younger infants. cited 2023 Mar 19]. cited 2023 Mar 28]. cited 2023 Mar 28].

Sepsis 98

Sepsis Pediatrics Urgent Care Emergency Department 98

Dr. Smith's ECG Blog

AUGUST 16, 2024

See My Comments at the bottom of the page in the October 6, 2023 and April 17, 2023 posts for review of deWinter T wave patterns ). Perhaps that prior tracing would explain the extra-"fat" hyperacute T waves in ECG #1 — as well as the remarkably flat ST segments and T waves that we see in the chest leads of ECG #2.

EKG/ECG 114

EKG/ECG Wellness 114

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 80

Head Injuries EMS Research Emergency Department 80

Don't Forget the Bubbles

NOVEMBER 11, 2024

in a 2023 systematic review and meta-analysis. In contrast, Kochanek reviewed each meta-analysis, as well as the RCT and secondary analyses, separately to assess overall results and potential moderators of effect. Treasure Island (FL): StatPearls Publishing; June 25, 2023. 2023; 173:158-166.e2. Kochanek et al.

Hyperthermia / Hypothermia 117

Hyperthermia / Hypothermia Pediatrics Outcomes Resuscitation 117

Dr. Smith's ECG Blog

OCTOBER 3, 2024

Smith : "Gestalt, but if I must explain: well formed J-waves and high voltage R waves." While statistical likelihood of acute OMI is clearly lower in younger adults — nothing is ruled out by age alone ( as per My Comment in the January 9, 2023 and December 5, 2023 posts in Dr. Smith's ECG Blog ). Sam : "why do you say fake?"

EKG/ECG 127

EKG/ECG Wellness 127

Dr. Smith's ECG Blog

APRIL 30, 2024

I fully acknowledge some speculation — given that we lack precise timing of these serial tracings, as well as not knowing the corresponding serum K+ level at the time each tracing was recorded. I focus my comments on: i ) The initial rhythm; and , ii ) Reasons for the dramatic changes in ST-T wave appearance between ECG #1 and ECG #2.

EKG/ECG 110

EKG/ECG CPR EMS Resuscitation 110

Pediatric EM Morsels

MARCH 17, 2023

Accessed March 13, 2023. Accessed March 17, 2023. Ahmed 2008) Tetanus toxoid booster is usually recommended. Ahmed 2008, Meyers 2022) Of course, treat any other systemic symptoms (like respiratory failure, hypotension) as you typically would. J Emerg Trauma Shock. 2008;1(2):97-105. Centers for Disease Control and Prevention.

CDC 130

CDC Poisoning Pediatrics Shock 130