Pediatric EM Morsels

NOVEMBER 3, 2023

Acute Kidney Injury Is Common in Pediatric Severe Malaria and Is Associated with Increased Mortality. Pediatric Malaria: Global and North American Perspectives. Pediatr Clin N Am 69 (2022) 47–64. Higher Rates of Misdiagnosis in Pediatric Patients versus Adults Hospitalized with Imported Malaria. Pediatr Emerg Care.

Seizures 281

Seizures Pediatrics CDC Infectious Diseases 281

EMDocs

DECEMBER 6, 2024

Ferrous sulfate tablets are radiopaque and can be visualized on radiographs, however not all preparations are radiopaque (pediatric chewable and liquid preparations). Blood transfusion for clinically significant blood loss. Arch Pediatr Adolesc Med. Pediatric Emergency Care, 27 (10), 978-985. Tenenbein M.

Poisoning 98

Poisoning Fluid Resuscitation Seizures Resuscitation 98

EMDocs

MAY 15, 2024

There are a variety of triggers, including infection (most common in pediatric patients), fat embolism, vaso-occlusive pain crisis, pulmonary embolism, and others. Pearls: Acute chest syndrome (ACS) is a form of acute lung injury defined by fever and/or new respiratory symptoms accompanied by a new radiodensity on imaging.

Blood Transfusions 104

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 104

Pediatric EM Morsels

MAY 24, 2024

One of the most difficult and most satisfying parts of pediatric emergency medicine is using one’s history, exam and clinical tools to make an informed decision and spare children from unnecessary pain , uncomfortable exams, painful procedures and medical imaging. Low Risk Inta-Adbominal Trauma: Pediatric Trauma is Dangerous!

Pediatrics 164

Pediatrics Blood Transfusions EMS Fractures 164

EMDocs

MAY 28, 2024

Blood transfusion Reduces the overall proportion of HbS. There are a variety of triggers, including infection (most common in pediatric patients), fat embolism, vaso-occlusive pain crisis, pulmonary embolism, and others. Use lung protective ventilation Tidal volume 6 ml/kg Peak airway and plateau pressures < 30 cmH 2 O.

Blood Transfusions 98

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 98

Don't Forget the Bubbles

JANUARY 10, 2024

Transfusion Decisions in Severe Anaemia Reducing child mortality remains high on the global health agenda. Let’s take the humble blood transfusion – used in emergency departments across the globe and playing a key role in critical care. However, there is a huge variation in transfusion practice globally.

Blood Transfusions 78

Blood Transfusions Research Outcomes Hospitals 78

ALiEM

MAY 29, 2023

Because he presumably had uremia-induced thrombasthenia (weak platelets), he received blood transfusions and IV TXA. We thus removed the anterior packing and instead inserted a Foley catheter into the posterior nasal space and inflated the balloon. Unfortunately, the bleeding still continued.

Blood Transfusions 98

Blood Transfusions Emergency Department Shock Hospitals 98

PulmCCM

MAY 8, 2023

Among 324 patients with trauma and life-threatening bleeding at 12 French hospitals who were randomized to receive 1ml/kg PCC or placebo, there was no reduction observed in 24-hour blood transfusion needs in the PCC group. PCC was associated with a significantly higher risk for thromboembolic complications (35% vs 24%).

Stroke 52

Stroke Blood Transfusions Hospice Anaphylaxis 52

Taming the SRU

MAY 30, 2023

Comiskey Hyperammonemia 10% of of patient presenting with hepatic encephalopathy do not have elevated ammonias Most commonly seen in adults is secondary to liver dysfunction with cirrhosis or portal venous system shunting.

OB/GYN 52

OB/GYN Ultrasounds Pediatrics Resuscitation 52

Don't Forget the Bubbles

OCTOBER 28, 2024

Studies involving children have shown mixed results regarding the data on transfusion ratios. recent systematic review on pediatric patients found no clear mortality benefit for using either a high/balanced or low/unbalanced transfusion ratio. In practice, achieving a balanced 1:1:1 transfusion ratio can be challenging.

Blood Transfusions 72

Blood Transfusions Hyperthermia / Hypothermia Shock Pediatrics 72

Pediatric EM Morsels

DECEMBER 6, 2024

Rashes are, as we know, a common complaint in the pediatric ER and one of the most difficult things to diagnose ( in my opinion ). As we sort through the potential concerning ailments, it is also good to keep in mind the stereotypic causes of mild pediatric rashes. Immunoglobulin therapy may be considered in severe cases.

Blood Transfusions 164

Blood Transfusions Infectious Diseases CDC Pediatrics 164

Broome Docs

DECEMBER 22, 2024

Restrictive vs Liberal Transfusion Strategy in Patients With Acute Brain Injury: The TRAIN Randomized Clinical Trial. Pediatr Emerg Care. 2024 Oct 9. doi: 10.1001/jama.2024.20424. 2024.20424. Barton MS, Chaumet MSG, Hayes J, Hennessy C, Lindsell C, Wormer BA, Kassis SA, Ciener D, Hanson H. 2024 Aug 15. doi: 10.1097/PEC.0000000000003244.

Blood Transfusions 52

Blood Transfusions Hospitals Outcomes Emergency Department 52

Pediatric EM Morsels

MARCH 7, 2025

While transfusing blood can be beneficial to those who have lost it or continue to lose it quickly, blood may not always be immediately available. Or maybe the family does not desire blood transfusions. Let’s take a moment to review TXA (Tranexamic Acid) in Pediatrics!

Pediatrics 231

Pediatrics Blood Transfusions Anaphylaxis Military 231

Don't Forget the Bubbles

NOVEMBER 18, 2024

Perinatal Blood Loss: Significant blood loss during delivery, whether due to placental abruption, vasa previa, or traumatic delivery, can result in anaemia and subsequent hypotension. If anaemia is confirmed, a blood transfusion may be necessary to restore adequate circulatory volume and improve oxygen-carrying capacity.

Sepsis 59

Sepsis Shock Hyperthermia / Hypothermia Administration 59

The Trauma Pro

DECEMBER 10, 2024

The only exception is pediatric patients, who seem to clot these on their own. This has a significant impact on how we view these injuries. I have always said that any patient with contrast extravasation is bleeding to death until we stop it.

Blood Transfusions 147

Blood Transfusions Radiology Radiology Emergency Department 147

EMDocs

JUNE 27, 2024

His medical history is significant for three prior admissions for vaso-occlusive crises that have responded well to appropriate therapy, including pain control with NSAIDs and opioids, blood transfusions, antibiotics, and intravenous (IV) crystalloids. Pediatr Allergy Immunol Pulmonol. Pediatr Blood Cancer.

Pediatrics 98

Pediatrics Dehydration EMS Hospitals 98

Don't Forget the Bubbles

JANUARY 1, 2024

This retrospective cohort study in JAMA Pediatrics looked at the impact of the COVID-19 pandemic on the socioemotional development of infants and toddlers. A randomized clinical trial, the Pediatric Adenotonsillectomy Trial for Snoring ( PATS ), evaluated adenotonsillectomies in children with snoring or mild obstructive sleep apnoea (OSA).

Pediatrics 98

Pediatrics Ultrasounds Blood Transfusions Sepsis 98

Sensible Medicine

JULY 8, 2024

I could pay 30k to get a blood transfusion from a 20 year old to improve my vitality, but that is snake oil. Masking 2 year olds in daycare with cloth masks made the American Academy of Pediatrics feel good. .” Sure, fertility matters, but the question is whether we are selling snake oil. Is oncofertility snake oil?

Blood Transfusions 64

Blood Transfusions Leadership Pediatrics Hospitals 64

Taming the SRU

JUNE 6, 2023

mg/kg of IBW Seek to match a patient's minute ventilation with TV and RR after intubation Intentionally match patient's intrinsic RR noted prior to intubation Note that healthy lungs can handle 8 mL/kg, based on IBW, if that is useful for compensation Secure your ETT Thomas Tube Holder is a new ETT holder on Air Care for ETT down to size 6.5

Documentation/Coding 64

Documentation/Coding Seizures Psychiatric Wellness 64

Don't Forget the Bubbles

JULY 5, 2023

Be careful if the patient has received a recent blood transfusion since it may be misinterpreted as sickle cell trait instead of sickle cell disease. In these cases, repeat the Hb electrophoresis three months after the last blood transfusion. Would you consider this patient for blood transfusion?

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

Don't Forget the Bubbles

FEBRUARY 24, 2025

Figure 1 shows the Rowlands leucodepletion protocol, image taken from Rowlands, Pediatrics 2010 The infants treated using the Rowlands strategy achieved a 90% survival rate , compared to 55% in the control group , which included historical patients and case mix-adjusted mortality data. Pediatr Crit Care Med J. Pediatrics.

Pediatrics 59

Pediatrics Outcomes Blood Transfusions Sepsis 59

EMDocs

JANUARY 6, 2025

A whole blood transfusion is initiated for the management of her anemia. BMC Pediatr. She receives IV antimalarials for severe malaria (as defined by AKI, anemia, electrolyte imbalance, and a history of convulsions). Hypoglycemia is managed with IV dextrose. Nat Rev Dis Primer. 2017;3:17067. doi:10.1038/nrdp.2017.67

Infectious Diseases 75

Infectious Diseases CDC PPE Rapid Diagnostic Testing 75