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Cerebral Edema and Diabetic Ketoacidosis: Rebaked

Pediatric EM Morsels

Cerebral edema is the most feared emergent complication of pediatric diabetic ketoacidosis. The exact mechanism is not known… It was previously believed that it was due to rapid changes in serum osmolality during initial fluid resuscitation. Pediatr Diabetes. The mortality rate for cerebral edema is 21%–24%. PMID: 23499379.

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But Can You Just PO?

Taming the SRU

Fluid management in the Emergency Department (ED) is crucial in the adequate resuscitation of the acutely ill and decompensating patient. Patients present to the ED with hypovolemia secondary to a plethora of causessome requiring IV fluid resuscitation and others requiring none.

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Grand Rounds Recap 11.8.23

Taming the SRU

airway grand rounds - r1 clinical knowledge: heavy metals - consultant corner: acute leukemia - pediatric sim - pediatric cases airway grand rounds WITH dr. carleton Difficult airway algorithm: when should we RSI? Abdominal pain, nausea, vomiting, and dehydration are common. given 60 (half KPhos and KCl) K < 2.5:

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ToxCard: Iron

EMDocs

6 Can see subsequent electrolyte disturbances and dehydration related to severity of GI symptoms. Ferrous sulfate tablets are radiopaque and can be visualized on radiographs, however not all preparations are radiopaque (pediatric chewable and liquid preparations). Arch Pediatr Adolesc Med. 1 Obtain a single view abdominal x-ray.

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emDOCs Revamp – Acute Chest Syndrome

EMDocs

Pediatr Allergy Immunol Pulmonol. smoke, high ozone levels, smog) Asthma/reactive airway disease (RAD) Diagnostic criteria 7,8 Respiratory symptoms +/- fever (at least 38.0 C or 100.4 2 mcg/kg, max 100 mcg) while obtaining IV access 20 IV/IM ketorolac (1 mg/kg, max 15 mg) Morphine (05-0.1 mg/kg, max 0.4 C or 100.4 mg/kg, max 0.4 C or 100.4

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emDOCs Podcast – Episode 100: Acute Chest Syndrome Part 1

EMDocs

Other causes of sickling: acidosis, dehydration, inflammation, infection, fever, and blood stasis Sickling leads to vascular occlusion, end-organ ischemia, and decreased RBC lifespan, which, in turn, leads to pain crisis, acute anemia, sequestration, infection, and acute chest syndrome (ACS.) times maintenance.

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Maintenance Fluids in Critical Illness

Don't Forget the Bubbles

In a PICU setting, sodium can come from various sources (resuscitation fluids, IV drugs and infusions, enteral feed), not just the maintenance fluids we prescribe. There is growing interest in giving no maintenance fluid and using the input from drug infusions and resuscitative boluses only. Pediatrics. sodium chloride.