Pediatric EM Morsels

SEPTEMBER 20, 2024

Diarrhea is one of the most common complaints in the pediatric emergency department, especially in the summer and early fall. Though most children recover well after STEC is cultured from their stool, some will go on to display the findings that make up HUS. E.coli 0157:H7 may lead to HUS in young children ( ~15% ). 2020.12.077.

Pediatrics 164

Pediatrics Ultrasounds Dehydration Emergency Department 164

ALiEM

MAY 13, 2024

Take the ALiEMU PEM POCUS: Soft Tissue Quiz Case Goals List the indications of performing a pediatric soft tissue point-of-care ultrasound (POCUS). Case Introduction: Child with abdominal pain Wendy is a 7-year-old girl who comes into the emergency department with redness, swelling, and pain on her left calf.

Ultrasounds 64

Ultrasounds Pediatrics Emergency Department Wellness 64

Ultrasound Gel

JUNE 18, 2018

Ultrasound can see many causes of chest pain. Sooooo lets use ultrasound in patients with chest pain to help with decision making. Well, wipe the smile from your face validity because it is not that simple. Ultrasound can see many causes of chest pain. Chest pain is common. Chest pain is common.

Emergency Department 52

Emergency Department Ultrasounds Wellness 52

Taming the SRU

JULY 24, 2023

THE CASE A male in his 60s presented to the emergency department for right upper quadrant abdominal pain. A bedside right upper quadrant ultrasound was performed, and the images are below. The most well-accepted classification of acute perforated cholecystitis is the Niemeier classification which is outlined as below (3,6).

Ultrasounds 79

Ultrasounds Sepsis Radiology Radiology 79

ALiEM

MARCH 7, 2024

Given her pain with a history of intermittent hematuria and dysuria, you perform a renal and bladder point of care ultrasound (POCUS) examination. Pre-warmed ultrasound gel is helpful when available. Then test your skills on the ALiEMU course page to receive your PEM POCUS badge worth 2 hours of ALiEMU course credit.

Ultrasounds 70

Ultrasounds Pediatrics Radiology Radiology 70

RebelEM

FEBRUARY 24, 2025

RESUS SCENARIO Picture this: you just arrived at your shift at the local emergency department. Well, the established cutoff for the distensibility index is 18%. Regarding caval indexes, the advent of artificial intelligence and advanced learning has become integrated into many ultrasound machines. Ultrasound Med Biol.

Ultrasounds 74

Ultrasounds Shock Fluid Resuscitation Resuscitation 74

RebelEM

JANUARY 25, 2024

Background: Point-of-care ultrasound (PoCUS) is a valuable clinical tool in the assessment of acute dyspnea. In many emergency departments (ED), US machines are readily available and can be used to rapidly assess and monitor patients with acute dyspnea at the bedside. Emerg Med J. 2023;40(10):700-707.

Ultrasounds 129

Ultrasounds Outcomes COPD Hospitals 129

EMDocs

SEPTEMBER 28, 2024

It was ruled out as well with good specificity, with a bubble time < 40 seconds. Ann Emerg Med. 2: Ultrasound + Pediatric Appendicitis Risk Calculator = Rule Out? Source Identification of children with a nondiagnostic ultrasound at a low appendicitis risk using a pediatric Appendicitis Risk Calculator. Acad Emerg Med.

Ultrasounds 98

Ultrasounds Pediatrics Emergency Department Wellness 98

The Skeptics' Guide to EM

APRIL 20, 2024

Efficacy and safety of ultrasound-guided erector spinae plane block compared to sham procedure in adult patients with rib fractures presenting to the emergency department: A randomized controlled trial. Background: We have covered rib fractures once before on the Skeptics’ Guide to Emergency Medicine.

Fractures 87

Fractures Ultrasounds Emergency Department CDC 87

Taming the SRU

OCTOBER 14, 2024

THE CASE A female in her 60’s with a remote history of bilateral cataract surgery presented to the emergency department (ED) with a two-week history of right eye swelling. Ocular point-of-care-ultrasound (POCUS) was performed as seen below. Performing an ocular ultrasound requires preparation and caution. Brzycki et al.

Ultrasounds 52

Ultrasounds Urgent Care Emergency Department Documentation/Coding 52

Taming the SRU

MAY 13, 2024

The patient is a well-appearing male who is awake, alert, and oriented. There is also a well-appearing, healed surgical scar. There is also a well-appearing, healed surgical scar. The skin is warm and well perfused with brisk capillary refill. Respiratory and cardiovascular exams are normal. BMP : Na 136, K 4.3,

Ultrasounds 98

Ultrasounds Emergency Department Wellness Operations 98

Taming the SRU

APRIL 14, 2024

You may place cold packs or ice packs to the hernia site to help reduce inflammation and swelling, as well as to assist in local analgesia. Symptoms include persistent tenderness in the area, as well as symptoms of obstruction including nausea, vomiting, and pain, despite reduction. (2) 1) In a study performed by Chen et al.

Ultrasounds 93

Ultrasounds Emergency Department Pediatrics Radiology 93

PEMBlog

SEPTEMBER 20, 2023

The Choosing Wisely Pediatric Emergency Medicine Recommendations The Choosing Wisely Campaign Toolkit Expert Contributors Kelly Levasseur, DO Children’s Hospital of Michigan Detroit, MI, USA docklevasseur@gmail.com Jennifer Thull-Freedman, MD Alberta Children’s Hospital Calgary, Alberta, Canada Jennifer.Thull-Freedman@albertahealthservices.ca

Pediatrics 123

Pediatrics Emergency Department Hospitals Ultrasounds 123

EMDocs

DECEMBER 4, 2023

Johnson, MD ( Community EM, Salina Regional Health Center) // Reviewed by: Joshua Lowe, MD (EM Attending Physician, USAF); Marina Boushra, MD (Cleveland Clinic Foundation, EM-CCM); Brit Long, MD (@long_brit) Case A 40-year-old woman presents to a rural emergency department (ED) with left leg pain and swelling for the past 5 days.

Ultrasounds 97

Ultrasounds Documentation/Coding Wellness EMS 97

Greater Sydney Area HEMS

FEBRUARY 20, 2024

The evidence for improved safety and quality with the use of ultrasound for CVC implementation is well established [i]. In fact, it’s use is so ubiquitous that the newer generation of emergency physicians are largely inexperienced in the insertion of central lines as a blind technique. i] Leibowitz A, Oren-Grinberg A, Matyal R.

Ultrasounds 98

Ultrasounds Shock Research Operations 98

ACEP Now

FEBRUARY 11, 2024

1,2 In the emergency department (ED), the focus of treatment is pain control and immobilization unless there is a clear indication for surgery, such as open fractures, skin tenting, or neurovascular compromise. The ultrasound-guided clavipectoral plane block (CPB) is a newly described technique in the emergency medicine literature.

Ultrasounds 52

Ultrasounds Fractures Emergency Department Hospitals 52

Dr. Smith's ECG Blog

JUNE 17, 2024

Written by Bobby Nicholson, MD 67 year old male with history of hypertension and hyperlipidemia presented to the Emergency Department via ambulance with midsternal nonradiating chest pain and dyspnea on exertion. There are well preserved R-waves in Wellens waves. Now another, with ultrasound. What do you think?

EKG/ECG 139

EKG/ECG Emergency Department Shock Ultrasounds 139

EMDocs

JUNE 1, 2024

Source Ultrasound-guided central venous catheterization around the neck: Systematic review and network meta-analysis. Am J Emerg Med. Source PECARN prediction rules for CT imaging of children presenting to the emergency department with blunt abdominal or minor head trauma: a multicentre prospective validation study.

Emergency Department 92

Emergency Department Ultrasounds Pediatrics Wellness 92

Don't Forget the Bubbles

SEPTEMBER 20, 2023

Do not obtain abdominal radiographs for suspected constipation The parents of 4-year-old Matthew bring him into the Emergency Department with abdominal pain. Functional constipation and nonspecific, generalized abdominal pain are common presenting complaints for children in emergency departments. 2017;191:179-183.

Pediatrics 133

Pediatrics Emergency Department Radiology Radiology 133

Don't Forget the Bubbles

NOVEMBER 8, 2023

7-year-old Tilly is brought to your emergency department at 11 p.m. Abdominal pain in children is common, accounting for over 1 in 20 attendances to paediatric emergency departments [1]. Tilly is normally fit and well, with no significant past medical history. by her father. She is obviously uncomfortable.

Emergency Department 105

Emergency Department Ultrasounds Pediatrics Best Practices 105

The Trauma Pro

OCTOBER 4, 2024

Clinical outcomes assessed at 60 days included an unplanned return to the emergency department (ED), re-admission, complications, and development of new bleeding confirmed by surgery, ultrasound, or computed tomography (CT) at 60 days post-injury. ” This means they probably did not. I am still intrigued by this study!

Pediatrics 113

Pediatrics Outcomes Operations Emergency Department 113

ACEP Now

AUGUST 22, 2023

Regardless of the domain, somewhere an expert panel has convened to issue a pronouncement informing all of the ideal care of patients under their specialty umbrella, indirectly extending to their care in the emergency department. 1 To date, there have been three GRACE publications. 1 To date, there have been three GRACE publications.

Emergency Department 98

Emergency Department Academics Critical Access Research 98

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. Journal of general internal medicine. 2017 Jun;32:660-6.

Emergency Department 64

Emergency Department Operations Psychiatric EMS 64

ACEP Now

AUGUST 12, 2024

Well, it happens that my interest in birding seemed to parallel a simultaneous growth in the practice of mindfulness in medicine. Now let me take it one step further and tell you why emergency physicians in particular make excellent birders. It has brought me a wealth of joy. But, you might be asking, why should you care?

Ultrasounds 116

Ultrasounds Emergency Department Wellness 116

ALiEM

OCTOBER 23, 2023

A 32-year-old man with a history of traumatic globe rupture from a stab wound two months ago, status post repair, presented to the emergency department for worsening right eye pain and green malodorous drainage for the past three days. There was a well-healed scar on the bottom eyelid.

Academics 111

Academics Emergency Department Ultrasounds Wellness 111

Taming the SRU

APRIL 5, 2023

THE CASE An elderly female patient presents to the emergency department (ED) with 1 week of generalized weakness leading to numerous falls. IMAGING WITH ULTRASOUND In patients with a horseshoe kidney, there are several differences that make point-of-care ultrasound (POCUS) evaluation difficult. Images are seen below.

Ultrasounds 52

Ultrasounds Pediatrics Radiology Radiology 52

RebelEM

APRIL 29, 2024

CVC vs PIV The critically ill patient is often associated with pathology that makes IV access difficult such as shock state, hypovolemia, obesity, IV drug abuse, end-stage renal disease, cardiac arrest, as well as other conditions. World J Emerg Surg 2023 PMID: 36918947 3. Int J Emerg Med 2009 PMID: 20157465 4. Crit Care Med.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

Ultrasound Gel

APRIL 26, 2021

We have been ultrasounding hips for a while now. First it asks the question - "Does point-of-care ultrasound (POCUS) in the emergency department lead to a faster diagnosis?". First it asks the question - "Does point-of-care ultrasound (POCUS) in the emergency department lead to a faster diagnosis?".

Ultrasounds 52

Ultrasounds Emergency Department Wellness 52

ALiEM

MAY 19, 2023

A heavy alcohol drinker, who is well known to your Emergency Department, presents with altered mental status, except that he looks different this time. Additional trick: If the x-ray is delayed, you can pre-check with ultrasound [7]. PulmCrit Wee: Ultrasound-guided blakemore tube placement. He is hypotensive.

Emergency Department 98

Emergency Department Ultrasounds Wellness EMS 98

EMDocs

OCTOBER 8, 2024

Tachycardia may be present both from many medications or drugs, as well as withdrawal. Let’s use the example of the well appearing patient, without significant comorbidities. Disposition of sinus tachycardia depends on many factors, however the well-appearing asymptomatic patient does not require admission for tachycardia alone.

Shock 105

Shock Emergency Department Pediatrics EKG/ECG 105

EMDocs

AUGUST 12, 2023

He presented to the emergency department because he is having numbness distal to the site of injury, as well as constant bleeding and some difficulty with flexing his finger. The value of ultrasound for detecting hand fractures: A meta-analysis. Examination reveals the following: What is the diagnosis? 2012;16(4):338-349.

EMS 96

EMS Fractures Operations Ultrasounds 96

RebelEM

DECEMBER 10, 2023

Background: The use of ultrasound is well established for trauma patients in the emergency department, with almost every patient receiving a FAST (Focused Assessment with Sonography in Trauma) examination as part of the “ABC’s” of trauma. As always, we should consider new data as it emerges.

Ultrasounds 40

Ultrasounds Emergency Department Wellness EMS 40

Dr. Smith's ECG Blog

OCTOBER 18, 2023

If you were working in a busy emergency department, would you like to be interrupted to interpret these ECGs or can these patients safely wait to be seen because of the normal computer interpretation? Emergent cardiac outcomes in patients with normal electrocardiograms in the emergency department. Am J Emerg Med.

EKG/ECG 119

EKG/ECG Documentation/Coding Emergency Department Outcomes 119

SheMD

APRIL 24, 2023

Well there were two other ones that were in morula phase but needed to progress to blastocyst. I break bad news almost every shift in the emergency department. An email with a sad face to a woman jacked up hormones was not the best approach. I waited until my 6 week ultrasound. It was October. It was certain.

Ultrasounds 83

Ultrasounds Radiology Radiology Emergency Department 83

Dr. Smith's ECG Blog

MAY 20, 2024

Diagnosis of Type I vs. Type II Myocardial Infarction in Emergency Department patients with Ischemic Symptoms (abstract 102). Annals of Emergency Medicine 2011; Suppl 58(4): S211. The T waves in the anterior leads have become a bit “peaked” and symmetrical as well, which is a sign of reperfusion of the posterior wall.

EKG/ECG 126

EKG/ECG Hospitals Wellness Emergency Department 126

Taming the SRU

FEBRUARY 5, 2024

The LP is now a standard procedure and in 2010 well over 135,000 LPs were performed in Emergency Departments throughout the US (3). As may be seen in the table below, there are several themes as well a range of stringency. This resource offers additional information on ultrasound assisted LP’s. WHY - Why Not?

Infectious Diseases 97

Infectious Diseases Seizures Ultrasounds Sepsis 97

Dr. Smith's ECG Blog

MAY 13, 2024

Written by Destiny Folk, MD, Adam Engberg, MD, and Vitaliy Belyshev MD A man in his early 60s with a past medical history of hypertension, type 2 diabetes, obesity, and hyperlipidemia presented to the emergency department for evaluation of chest pain. The ECG shows sinus rhythm and relatively normal QRS morphology.

EKG/ECG 120

EKG/ECG Emergency Department Ultrasounds Documentation/Coding 120