Pediatric EM Morsels

AUGUST 9, 2024

Neonates presenting to the Emergency Department often cause a lot of uncertainty. We have previously discussed hypothermia presentations , GBS infections , and HSV infections. Is this scalp swelling normal? Is this bloody stool concerning? Are this odd movements part of normal development?

Hyperthermia / Hypothermia 154

Hyperthermia / Hypothermia Emergency Department Seizures Pediatrics 154

EMDocs

JUNE 12, 2024

Previous triad of death = hypothermia, acidosis, and coagulopathy. Liver dysfunction, secondary cirrhosis, critical illness, trauma, and hypothermia reduce citrate metabolism. Hypothermia also leads to hypoCa. Ionised calcium levels in major trauma patients who received blood in the Emergency Department.

Hyperthermia / Hypothermia 104

Hyperthermia / Hypothermia Resuscitation Administration Blood Transfusions 104

The Skeptics' Guide to EM

NOVEMBER 16, 2019

Laura Melville (@lmelville535) is an emergency physician in Brooklyn, New York, is a part of the New York ACEP Research Committee, ALL NYC EM, and is the NYP-Brooklyn Methodist Resident Research Director. Case: A 59-year-old woman comes is brought into your emergency department (ED) by EMS in cardiac arrest.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia EMS Research Documentation/Coding 40

The Skeptics' Guide to EM

MAY 20, 2023

Kat Priddis is a paediatric emergency medicine consultant and trauma director at Watford General Hospital. She is part of the Don’t Forget the Bubbles team and faculty at Queen Mary University in London where she teaches part of the Paediatric Emergency Medicine MSc. Date: May 10, 2023 Reference: Harhay MO, et al. N Engl J Med.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Pediatrics CPR Hospitals 52

The Skeptics' Guide to EM

DECEMBER 16, 2017

Hypothermia for Neuroprotection in Convulsive Status Epilepticus. NEJM Dec 2016 Guest Skeptic: Dr. Neal Little is an Emergency Physician who works at Chelsea Hospital in Chelsea, Michigan. He is also a Faculty member of the Emergency Medicine and Acute Care Series 1986 to present. He is known to have poorly controlled epilepsy.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Seizures Hospitals Stroke 40

PulmCCM

JUNE 12, 2023

Induced hypothermia after cardiac arrest is also called “active temperature control” or “targeted temperature management.” Temperature management (or fever avoidance) should begin immediately after cardiac arrest (ideally in the emergency department, for out-of-hospital arrests) and continued for at least 72 hours.

Hyperthermia / Hypothermia 105

Hyperthermia / Hypothermia Academics Documentation/Coding Outcomes 105

Northwestern EM Blog

MAY 9, 2022

There is no gold standard with respect to its definition, and it requires a medication history (which we typically don't do very well in the emergency department). Any life-threatening hyperthermia should be treated immediately with an ice bath.[2] A tricky cause of NMS is the removal of a dopamine agonist.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Fluid Resuscitation Psychiatric Administration 52

ACEP Now

NOVEMBER 6, 2024

A gravid woman presents to your emergency department (ED). 3 In the post-resuscitative state, the patient should be transferred to a higher level of care, where they can be monitored for further complications and undergo therapeutic hypothermia. Before you can obtain any history, she gives birth in your waiting room.

Resuscitation 98

Resuscitation Pediatrics Hyperthermia / Hypothermia EMS 98

Taming the SRU

AUGUST 27, 2024

Mortality rates related to bullous skin lesions are typically related to disruption of the skin barrier and include subsequent dehydration, electrolyte imbalances, hypothermia, increased metabolic needs, and secondary infection leading to bacteremia and/or sepsis. What can you do from the Emergency Department if suspected?

Emergency Department 83

Emergency Department Dehydration Burns Sepsis 83

Taming the SRU

NOVEMBER 4, 2023

Yates Foot Infection NSTIs are rare but deadly pathology that need to be considered with any soft tissue infection NSTI is a clinical diagnosis, but there are many imaging and laboratory assessments to help increase clinical suspicion Expedited disposition to the OR for NSTIs under 12 hours from ED presentation significantly decreases mortality Emesis (..)

Hyperthermia / Hypothermia 84

Hyperthermia / Hypothermia Resuscitation Burns Emergency Department 84

The Skeptics' Guide to EM

FEBRUARY 27, 2021

Rapid Administration of Methoxyflurane to Patients in the Emergency Department (RAMPED): A Randomised controlled trial of Methoxyflurane vs Standard care. […] The post SGEM#320: The RAMPED Trial – It’s a Gas, Gas, Gas first appeared on The Skeptics Guide to Emergency Medicine. Reference: Brichko et al. Reference: Brichko et al.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Administration Emergency Department Research 52

Dr. Smith's ECG Blog

OCTOBER 12, 2024

A man in his 90s with a history of HTN, CKD, COPD, and OSA presented to the emergency department after being found unresponsive at home. Vital signs were within normal limits on arrival to the Emergency Department. Written by Bobby Nicholson What do you think of this “STEMI”? Blood glucose was not low at 162 mg/dL.

EKG/ECG 117

EKG/ECG Documentation/Coding Emergency Department COPD 117

ACEP Now

OCTOBER 11, 2024

Optimally, bystander CPR, including the administration of rescue breaths, should be initiated prior to arrival of emergency medical services. 3 Once the patient arrives in your emergency department, a rapid review of the patient’s status and results of resuscitative efforts should be performed. Am J Emerg Med.

Pediatrics 52

Pediatrics Hyperthermia / Hypothermia Emergency Department Resuscitation 52

EM Curious

MAY 6, 2015

DVT ULTRASOUND CONTROVERSY [PODCAST]: There has been an emerging collection of literature that two-point compression ultrasound may be inadequate to rule out DVT. IS IT TIME TO START USING THE HEART PATHWAY IN THE EMERGENCY DEPARTMENT? Check out the podcast here @ Ultrasound Podcast. Watch here.

Dislocations 52

Dislocations Hyperthermia / Hypothermia Airway Management Ultrasounds 52

Taming the SRU

APRIL 13, 2023

Vaishnav Hyperthermia: abnormally high body temperature due to thermoregulatory failure Severe hyperthermia: temp greater than 40.5C stent, percutaneous nephrostomy) by urology or IR Hypokalemia evaluate for EKG changes assess for underlying cause and factors that may influence ability to replete (i.e.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Poisoning EKG/ECG Seizures 52

EM Literature of Note

JANUARY 9, 2022

The Annals of Emergency Medicine Podcast continues apace, with free monthly updates from the original research published in the journal: iTunes Link SoundCloud Link Likewise, the Annals of Emergency Medicine Journal Club has published several monthly installments: Predicting Outcomes in Pediatric Pneumonia: Are We Omnipotent or Incompetent?

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Stroke Emergency Department Outcomes 40

Broome Docs

OCTOBER 31, 2022

Non-sterile gloves and dressing versus sterile gloves, dressings and drapes for suturing of traumatic wounds in the emergency department: a non-inferiority multicentre randomised controlled trial. Emerg Med J. 2022 Jul 26:emermed-2021-211540. doi: 10.1136/emermed-2021-211540. Epub ahead of print.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Fluid Resuscitation Seizures Emergency Department 52

Taming the SRU

MAY 1, 2023

A retrospective evaluation of phenobarbital versus benzodiazepines for the treatment of alcohol withdrawal in a regional Canadian emergency department Link: [link] Bottom Line: This study in a small regional ED showed a QI project rolling out a Phenobarbital or Diazepam for Alchohol withdrawal syndrome. and NPV(50%).

Poisoning 52

Poisoning Hyperthermia / Hypothermia Seizures Emergency Department 52

Don't Forget the Bubbles

JUNE 30, 2023

Traditionally thought to result from the dilutional effects of massive transfusion, acidaemia or hypothermia, trauma-induced coagulopathy is now known to be triggered at the time of injury, long before these factors have developed or any medical intervention has taken place. c) Or, do both?

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

Don't Forget the Bubbles

AUGUST 12, 2024

What neuroprotective measures can we undertake in the emergency department? Neuroprotective measures are undertaken in the emergency department and PICU to optimise intracerebral conditions, minimise secondary brain injury, and create optimal tissue healing conditions.

Seizures 75

Seizures Pediatrics Emergency Department Ambulance Services 75

The Skeptics' Guide to EM

MARCH 2, 2019

JAMA 2018 Guest Skeptic: Missy Carter, former City of Bremerton Firefighter/Paramedic, currently a physician assistant practicing in emergency medicine in the Seattle area and an adjunct faculty member with the Tacoma Community College paramedic program. They had a difficult time getting a definitive airway pre-hospital.

Airway Management 52

Airway Management CPR Hyperthermia / Hypothermia Outcomes 52

The Skeptics' Guide to EM

JANUARY 9, 2021

JAMA 2020 Guest Skeptic: Mike Carter is a former paramedic and current PA practicing in pulmonary and critical care as well as an adjunct professor of emergency medical services at Tacoma Community College. Case: During a busy emergency department (ED) shift the paramedic phone rings.

EMS 52

EMS Resuscitation CPR Hyperthermia / Hypothermia 52

The Skeptics' Guide to EM

AUGUST 14, 2021

Circulation 2020 Guest Skeptic: Missy Carter is a PA practicing in emergency medicine in the Seattle area and an adjunct faculty member with the Tacoma Community College paramedic program. They performed high-quality CPR and shocked the patient twice before giving amiodarone via intraosseous (IO).

Shock 52

Shock CPR Hyperthermia / Hypothermia EMS 52

Don't Forget the Bubbles

MAY 17, 2023

Invasive bacterial infection in children with fever and petechial rash in the emergency department: a national prospective observational study. To feed or not to feed during therapeutic hypothermia in asphyxiated neonates: a systematic review and meta-analysis. Raffaele JL, et al. 2023 Apr 4:113407. Storch-De-Gracia P, et al.

Pediatrics 72

Pediatrics X-Ray Interpretation Sepsis Fractures 72

EMDocs

FEBRUARY 9, 2024

Authors: Adam Roussas, MD, MBA, MSE // Reviewed by: Jamie Santistevan, MD ( @jamie_rae_EMdoc, EM Physician, Presbyterian Hospital, Albuquerque, NM); Manpreet Singh, MD ( @MPrizzleER ); and Brit Long, MD ( @long_brit ) Case A 40-year-old female presents to the emergency department for palpitations and lightheadedness.

EKG/ECG 91

EKG/ECG Hyperthermia / Hypothermia EMS Documentation/Coding 91

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives Early identification of patients at higher risk of death and hospital admission is an important problem in emergency departments. Drowsy (11.97%), Hypothermia (13.04%) and Cyanosis (10%) were also high risk categories. 0[0 , 12] HYPOTHERMIA 23 3 11 47.8 NEEDLESTICK/BODY FLUIDS) 113 0 12 10.6

Documentation/Coding 40

Documentation/Coding Sexual Assault Hyperthermia / Hypothermia Head Injuries 40

Don't Forget the Bubbles

JANUARY 10, 2024

Let’s take the humble blood transfusion – used in emergency departments across the globe and playing a key role in critical care. Transfusion Decisions in Severe Anaemia Reducing child mortality remains high on the global health agenda. 8% die in hospital, with a further 12% dying in the six months following discharge.

Blood Transfusions 78

Blood Transfusions Research Outcomes Hospitals 78

Northwestern EM Blog

JANUARY 24, 2022

While the diagnosis of hypothyroidism can be delayed by lab results, clues to the diagnosis include thyroidectomy scar, non-pitting edema of the extremities, macroglossia, altered mental status, hypoglycemia and hypothermia. Revised National Estimates of Emergency Department Visits for Sepsis in the United States.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

EMDocs

DECEMBER 16, 2023

An 18-month-old boy presents to the emergency department with loss of consciousness. Evaporative cooling is the preferred method to actively reduce body temperature in the emergency department , as it can be performed with ongoing resuscitation efforts. 1 Fever is usually < 40C. 1 Fever is usually < 40C.

Hyperthermia / Hypothermia 87

Hyperthermia / Hypothermia EMS Stroke Seizures 87

Don't Forget the Bubbles

OCTOBER 28, 2024

doi: 10.1136/archdischild-2024-327224 Six-year-old Rhaenyra is brought into the emergency department after being hit by a car. How do we prevent hypothermia? Hypothermia is another part of the ‘ diamond of death ’. Care must be taken to avoid the ‘diamond of death’ (coagulopathy, acidosis, hypothermia, and hypocalcemia).

Blood Transfusions 72

Blood Transfusions Hyperthermia / Hypothermia Shock Pediatrics 72

Taming the SRU

APRIL 26, 2023

First aid cooling techniques for heat stroke and exertional hyperthermia: A systematic review and meta-analysis. Evidence-Based Heatstroke Management in the Emergency Department. West J Emerg Med 2021. April 26, 2023) Acute Hyperthermia in the Emergency Department. Thyroid storm: an updated review.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Emergency Department Stroke Sepsis 52

Intensive Blog

FEBRUARY 9, 2023

Labs and Lytes 040 Author: Dr Nasreen Bahemia Peer reviewers: Dr Craig Johnston, A/Prof Chris Nickson A 56-year-old female presented to the Emergency Department (ED) with 2 days of severe nausea, vomiting and diarrhoea. It refers to hypernatraemia, hyperventilation, haemodialysis, and induced hypothermia.

Poisoning 52

Poisoning Hyperthermia / Hypothermia Fluid Resuscitation Resuscitation 52

RebelEM

DECEMBER 19, 2022

The fragility index of these findings found to be 1 for VC and 9 for DED Obtaining a second defibrillator in the emergency department or intensive care unit can be very easy to do. It’s difficult to definitively say which of the two is statistically better, however there is a trend pointing toward DED.

EMS 52

EMS CPR Shock Resuscitation 52

Don't Forget the Bubbles

AUGUST 4, 2024

Morris and colleagues investigated the efficacy of refrigerated gel packs for therapeutic hypothermia in neonatal retrieval. They used servo-controlled therapeutic hypothermia (versus passive hypothermia) and found no major difference in outcome. More studies on this topic will surely follow. Gallo Ruelas M, et al. 2024 Jul 8.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Pediatrics Burns Sepsis 52

EMDocs

JUNE 27, 2024

Intranasal fentanyl and discharge from the emergency department among children with sickle cell disease and vaso-occlusive pain: A multicenter pediatric emergency medicine perspective. -smoke, high ozone levels, smog) Asthma/reactive airway disease (RAD) Diagnostic criteria 7,8 Respiratory symptoms +/- fever (at least 38.0

Pediatrics 94

Pediatrics Dehydration EMS Hospitals 94

Don't Forget the Bubbles

OCTOBER 2, 2024

Children often spend many hours in the emergency department (ED) before being sent home or admitted. In this issue of Pediatrics , Leyenaar and colleagues reported on a trial to compare the effectiveness of direct admission to bypass their emergency departments. Pecenka C, et al. 2024 Sep 21;404(10458):1157-1170.

Pediatrics 52

Pediatrics Hyperthermia / Hypothermia Emergency Department Urgent Care 52

PulmCCM

JUNE 19, 2023

No drug or combination improved the primary outcome (a composite outcome of hypoxemia, visit to the emergency department, hospitalization, or death). Sepsis was a main trigger, and hypothermia and shock were as common (>50%) as coma. That was in NEJM Aug 18 2022. Very high TSH levels (17-100 mIU/L) and very low FT3 (0-2.2)

Infectious Diseases 52

Infectious Diseases Hyperthermia / Hypothermia Outcomes Sepsis 52