Pediatric EM Morsels

OCTOBER 27, 2023

Taking care of a critically ill child can be nerve-racking to say the least, and downright petrifying for those who don’t do it frequently, even if they are well-trained and brilliant clinicians. Sinha 2012] It is useful in the prehospital setting , correlating well with actual weight and ED Broselow weight. Broselow does not.

Pediatrics 271

Pediatrics Resuscitation Documentation/Coding Wellness 271

Ken Grauer, MD

DECEMBER 29, 2023

The "good news" — is that after an extended hospitalization, the patient was finally discharged home, and doing well. = The ECG in Figure-1 — was obtained following successful resuscitation. A C loser L ook at Today's ECG: The rhythm in Figure-1 is sinus — with regular upright P waves with a constant and normal PR interval in lead II.

EKG/ECG 434

EKG/ECG Resuscitation Hospitals Wellness 434

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

Pediatric EM Morsels

JULY 19, 2024

DON’T forget to put on your Personal Protective Equipment as well! 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. Well… sometimes it starts again. 2023 Aug;171:111644. Epub 2023 Jul 6. Get IV access!

Airway Management 290

Airway Management Pediatrics Wellness Operations 290

The Trauma Pro

SEPTEMBER 13, 2023

Unfortunately, losing any limb has a significant psychological impact on our patients’ physical and mental well-being. It does take some extra effort to apply a well-fitted early prosthesis. AAST 2023, Plenary paper #21. This typically takes a month or two. This paper makes it clear that IPOP makes a very real difference.

Soft Tissue Injuries 113

Soft Tissue Injuries Operations Wellness 113

Emergency Live

JULY 27, 2023

This year, the summer firefighting campaign is well equipped with a fleet of 34 […] The post REAS 2023: Drones, aerial vehicles, helicopters against fires appeared first on Emergency Live. A key part of firefighting involves the use of aerial means, helicopters and drones.

Wellness 98

Wellness 98

Ken Grauer, MD

AUGUST 16, 2024

See ECG Blog #435 — ECG Blog #313 — as well as My Comment at the bottom of the page in the June 17, 2024 post in Dr. Smith's ECG Blog ). Acute PE remains one of the most commonly overlooked diagnoses. As per links that I provide below — IF the diagnosis of acute PE is not thought of, this entity will be missed! (

EKG/ECG 391

EKG/ECG Wellness Shock 391

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 304

Shock Pediatrics Dislocations Hyperthermia / Hypothermia 304

Ken Grauer, MD

JUNE 14, 2024

The above said, when for whatever reason sinus P waves are not well seen in lead II — the 2nd -best lead when looking to determine if sinus rhythm is present, is lead V1. ECG Blog #193 — Reviews the basics for predicting the "culprit" artery ( as well as reviewing why the term "STEMI" should be replaced by "OMI" = O cclusion-based MI ).

EKG/ECG 402

EKG/ECG Wellness Hospitals 402

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

EMDocs

JANUARY 11, 2025

Well keep it short, while you keep that EM brain sharp. Admission allows for close monitoring, given the risks of perforation, ischemic bowel, and ulceration, as well as appropriate management of the condition and patient symptoms. 2023 Oct;48(10):3050-3062. Epub 2023 Jun 27. link] Morano, C., & Sharman, T.

EMS 98

EMS Sepsis Shock Fluid Resuscitation 98

EMDocs

NOVEMBER 19, 2024

1,2 Neuroleptic malignant syndrome (NMS) (hyperthermia, autonomic instability, rigidity, altered mental status [AMS]) can occur as well and is most often seen with clozapine but has been observed with other atypicals. Published 2023. Accessed October 23, 2023. Accessed October 23, 2023. Accessed October 23, 2023.

Poisoning 111

Poisoning Hyperthermia / Hypothermia EKG/ECG Seizures 111

The Skeptics' Guide to EM

MARCH 8, 2025

December 2023 Date: February 7, 2025 Dr. Lauren Rosenfeld Guest Skeptic: Dr. Lauren Rosenfeld is a PGY-3 emergency medicine resident at George Washington University. She was born full-term and seemed to be doing very well after the family returned home. Reference: Pessano S, et al. Positioning for lumbar puncture in newborn infants.

Outcomes 72

Outcomes Emergency Department Wellness 72

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. Epsilon waves are best seen in leads V1 , V2 — and a bit less well seen in V3,V4. A DDENDUM ( 7/29/2023 ) : I summarize KEY features regarding Idiopathic VT in Figure-4. MRI confirmed ARVC.

EKG/ECG 370

EKG/ECG Resuscitation Documentation/Coding Hospitals 370

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.

Psychiatric 271

Psychiatric Seizures Outcomes Pediatrics 271

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 145

CPR EMS Documentation/Coding Outcomes 145

Dr. Smith's ECG Blog

JANUARY 2, 2025

Clinically, it is well to remember that this variation in QTc estimation is greater at faster heart rates ( with faster heart rates being common in "sicker" patients, for whom we are most likely to need to assess the QTc ). This tells us that universal agreement for QTc estimation is not perfect.

EKG/ECG 116

EKG/ECG Sepsis Wellness Documentation/Coding 116

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 115

Poisoning Hyperthermia / Hypothermia Seizures Administration 115

EMDocs

JANUARY 25, 2025

Well keep it short, while you keep that EM brain sharp. 0000000000000305 Kazumi Y (2023) The Epidemiology and Outcomes of Leukopenia in Different Populations and Regions. 10^9/L) Moderate (0.50.9 10^9/L) Severe (< 0.5 10^9/L) Generalized leukopenia (i.e. Most common causes of leukopenia Infections: 36.4% Medications: 25.6%

EMS 95

EMS Infectious Diseases Allergic Reactions Fluid Resuscitation 95

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

DECEMBER 11, 2024

A patients first attack may not occur until well into his or her 30s. Updated Jan 20, 2023. Although abdominal pain is its hallmark, it can also provoke psychosis, tachycardia, anxiety, muscle weakness, chest pain and/or constipation. Triggers of acute attacks include carbohydrate starvation (e.g., References : 1. DeLoughery TG.

Hospitals 97

Hospitals Patient Safety EMS Wellness 97

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 145

EMS Outcomes Hospitals Research 145

Sensible Medicine

FEBRUARY 17, 2025

But you cannot use placebo if there are proven or well accepted alternatives. This trial strikes me as a classic example where investigators are more interested in their own careers rather than the well-being of their cancer patients. If there is no standard of care, you can use placebo. How can we defend the status quo in oncology?

Hospice 102

Hospice Wellness Research 102

Taming the SRU

DECEMBER 17, 2024

Out of 18 patients receiving ORT, 4 failed to respond well and were escalated to IV therapy. Hospitals can purchase ORT packets for use in EDs as well as giving patients the formula to make their own at home. Updated 2023 Oct 22]. AtherlyJohn et al. A systematic review by Freedman et al. References Castera MR, Borhade MB.

Dehydration 84

Dehydration Fluid Resuscitation Administration Resuscitation 84

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 127

Research Wellness 127

ACEP Now

AUGUST 1, 2023

A rural ED staffed by a well-trained EP is an essential resource in small communities that may be otherwise lacking in readily available healthcare resources. The post 2023 ACEP Elections Preview: Meet the President-Elect and Council Officer Candidates appeared first on ACEP Now.

Emergency Department 98

Emergency Department EMS Critical Access Hospitals 98

The Skeptics' Guide to EM

JUNE 8, 2024

WJEM December 2023 Date: May 30, 2024 Guest Skeptic: Dr. Kay Dingwell is a rural emergency physician working in Prince County, PEI with a special interest in gender-affirming care and improving the care of trans and gender-diverse patients. Background: In North America, trans and gender diverse (TGD) people make up 0.3%

Best Practices 144

Best Practices Emergency Department Research Outcomes 144

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

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 141

Poisoning Airway Management Seizures Shock 141

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 408

EKG/ECG Resuscitation Hospitals Wellness 408

Pediatric EM Morsels

JULY 21, 2023

Treasure Island (FL): StatPearls Publishing; 2023 Jan-. 1976 May 15;1(7968):1031-4. doi: 10.1016/s0140-6736(76)92215-7. PMID: 57446. Jain S, Iverson LM. Glasgow Coma Scale. Updated 2022 Jun 21]. In: StatPearls [Internet]. Available from: [link] Reilly PL, Simpson DA, Sprod R, Thomas L.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

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 135

EKG/ECG Wellness 135

ALiEM

OCTOBER 30, 2024

The Wounds Common among patients who use xylazine, the necrotic and exudative wounds are still not fully understood [5-8], but are likely due in part to direct cytotoxic effects of the drug and its impurities, as well as possible nutritional deficiencies common in those with dependence. 2023 Jan 1;53(1):140-2. 2022; 06/26/2023.

Emergency Department 64

Emergency Department Operations Psychiatric Hospitals 64

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

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 108

CDC Hospitals EMS Emergency Department 108

Dr. Smith's ECG Blog

MARCH 4, 2024

I have often written about how an ECG interpreted as "normal" by a conventional algorithm may well be manifesting OMI, or even long QT or hyperkalemia. I have collected 51 OMI cases that were diagnosed as completely normal by the conventional automated computer algorithm.

EKG/ECG 128

EKG/ECG Documentation/Coding Wellness Resuscitation 128