Pediatric Emergency Playbook

APRIL 1, 2016

Read on to go from bread-and-butter pediatric blood work to answer the question – what’s up with troponin, lactate, d-dimer, and BNP in kids? This is especially true in children – the majority of pediatric ambulatory visits do not require blood work to make a decision about acute care. The punchline is, use a pediatric reference.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Taming the SRU

APRIL 13, 2023

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. EtOH, amphetamines, or cocaine) Prescription drugs (i.e. cuffed ETT) preloaded and intubate through the stoma if PPV needed Infection (i.e.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Poisoning EKG/ECG Seizures 52

Advanced Emergency Nursing from AENJ

NOVEMBER 24, 2016

These indices would have reinforced the clinical decision progress and avoided bad outcomes from unsuccessful estimates. So much more than just a BP cuff and a rhythm monitor. Disposable BVMs (one at every bedside). Yes, there's a crash cart —at the end of the ward's hallway from me. Readers must verify validity to their own practice.

Emergency Nursing 40

Emergency Nursing Seizures CPR Wellness 40

Don't Forget the Bubbles

NOVEMBER 11, 2024

One-liner… Traumatic brain injury (TBI) is a leading cause of mortality and morbidity in paediatric populations, and fever is associated with worse outcomes. The aim of TTM is to control the body and brain’s temperature, thus reducing secondary brain injury and improving the neurological outcome. What do the guidelines recommend?

Hyperthermia / Hypothermia 117

Hyperthermia / Hypothermia Pediatrics Outcomes Resuscitation 117

EMDocs

DECEMBER 6, 2024

Characterized by hypovolemia, vasodilation, reduced cardiac output, hyperventilation, elevated temperature, seizure, coma, and cardiovascular collapse. Ferrous sulfate tablets are radiopaque and can be visualized on radiographs, however not all preparations are radiopaque (pediatric chewable and liquid preparations). 2 L/hr in adults.

Poisoning 97

Poisoning Fluid Resuscitation Seizures Resuscitation 97

Don't Forget the Bubbles

JANUARY 24, 2024

Four-year-old Fern is a previously healthy girl who presents with a febrile illness and seizures. Seizure activity did not respond to either first or second-line treatments, so she needed rapid sequence induction and transfer to PICU for ongoing anaesthesia and management. What causes Super Refractory Status Epilepticus?

Seizures 111

Seizures Pediatrics Outcomes Hyperthermia / Hypothermia 111

Don't Forget the Bubbles

APRIL 7, 2025

Early recognition of these signs is crucial, as timely hormone replacement can significantly improve outcomes. It can present with jitteriness, poor feeding, prolonged jaundice, seizures, bluish skin discolouration (cyanosis), lethargy, or even acute collapse. Pediatr Rev March 2015; 36 (3): 92103. link] Bornstein SR et al.

Dehydration 72

Dehydration Pediatrics Administration Seizures 72

Don't Forget the Bubbles

JUNE 30, 2023

The primary outcome was 28-day mortality – TXA improved survival with no increased risk of cerebral clots. Survival was better, both at 24 hours and six months, in the TXA group, although the primary outcome, a quality of life score at six months, called the Glasgow Outcome Scale Extended (GOS-E), was the same in both groups ( 53.7%

Head Injuries 145

Head Injuries Seizures Pediatrics Outcomes 145

ACEP Now

MAY 10, 2024

A 9-month-old male presents to emergency department (ED) with his mother for seizure. The child was diagnosed with seizure disorder at 2 months of age and has had multiple visits to the emergency department (ED) for seizures. The child was started on Levetiracetam and levels always have been normal despite breakthrough seizures.

Forensics 98

Forensics Psychiatric Seizures Pediatrics 98

EMDocs

JANUARY 4, 2024

Bupropion lowers the seizure threshold and even at therapeutic doses patients can have seizures. 6 Severe toxicity: Seizures: It is unclear if seizures are caused by bupropion or the active metabolite, hydroxybupropion. 3 Seizures are dose-dependent. 3 Seizures are dose-dependent.

Seizures 91

Seizures EKG/ECG Poisoning Shock 91

ACEP Now

OCTOBER 3, 2023

These guidelines present the best available evidence to support clinical decision making in the prehospital setting when TBI care may have the most significant impact on outcomes; they also establish a research agenda for future investigations. This document is an update of guidelines first published in 2000, and then updated in 2007.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation EMS 98

Pediatric EM Morsels

AUGUST 9, 2024

If not treated early, then increased risk of poor outcomes and death. The post Congenital Syphilis appeared first on Pediatric EM Morsels. Maternal screening early in pregnancy is the best means to prevent congenital syphilis. Penicillin is 98% effective at preventing congenital syphilis. A case of congenital syphilis. Emerg Radiol.

Hyperthermia / Hypothermia 154

Hyperthermia / Hypothermia Emergency Department Seizures Pediatrics 154

Don't Forget the Bubbles

FEBRUARY 5, 2025

There is significant evidence in adults and developing in the paediatric population that TXA results in better outcomes if given early in patients with mild to moderate traumatic brain injury (TBI) and does not cause harm. Disability – Altered mentation, seizure, stroke symptoms, severe headache, neurological deficit, visual symptoms.

Domestic Violence 59

Domestic Violence Fluid Resuscitation Head Injuries Sexual Assault 59

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. Causes and outcomes of the acute chest syndrome in sickle cell disease. Infectious: bacterial or viral pneumonia ( M. pneumoniae, C. Am J Emerg Med. 2022 Aug;58:235-244.

Blood Transfusions 103

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 103

EMDocs

MAY 28, 2024

There are a variety of triggers, including infection (most common in pediatric patients), fat embolism, vaso-occlusive pain crisis, pulmonary embolism, and others. Causes and outcomes of the acute chest syndrome in sickle cell disease. Infectious: bacterial or viral pneumonia ( M. pneumoniae, C. Am J Emerg Med. 2022 Aug;58:235-244.

Blood Transfusions 97

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 97

Don't Forget the Bubbles

MARCH 18, 2024

A similar process can also occur in the CNS (causing seizures ), the liver and the pancreas. Depending on the progression of the illness, children may present with pallor, oedema, lethargy, seizures, hypertension or abnormal liver function tests. Early Volume Expansion and Outcomes of Hemolytic Uremic Syndrome. F1000Research.

Dehydration 59

Dehydration Infectious Diseases Seizures Pediatrics 59

Taming the SRU

MARCH 14, 2023

Case 2 19 year old seizure A 19-year-old male is brought into your emergency department via EMS for witnessed seizure-like activity. The seizure abated with rectal diazepam given by the squad. You notice a med-alert bracelet with the patient’s name and the word “SEIZURES.” His abdomen is soft. Lancet Neurol.

Seizures 52

Seizures Emergency Department Pediatrics Critical Access 52

Taming the SRU

MAY 1, 2023

Exertional Hyperthermia Patients with heat stroke will present with Temp > 104, AMS, or seizures.

Poisoning 52

Poisoning Hyperthermia / Hypothermia Seizures Emergency Department 52

Don't Forget the Bubbles

JULY 26, 2023

Some families have unexplained deaths during sporting events, an unusual number of car accidents, seizures in someone without a formal diagnosis of epilepsy. Claudius et al, Pediatrics 2007 here a US-based study showed that of all admitted patients only 14% had a subsequent clinical course requiring admission.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

Pediatric Education

MARCH 3, 2024

Eclampsia is a severe complication of pre-eclampsia that has new onset seizures. Preeclampsia and neonatal outcomes in adolescent and adult patients. D’Alessandro, MD Professor of Pediatrics, University of Iowa .” Estimate are between 1 – 5.6% of pregnancies have pre-eclampsia. Pregnancy Hypertens. J Med Life.

Pediatrics 40

Pediatrics Seizures Wellness Stroke 40

EB Medicine

AUGUST 1, 2018

Jeff: Medicinally, cannabinoids are currently used in the treatment of chronic pain syndromes, complications of multiple sclerosis and paraplegia, weight loss due to appetite suppression in HIV/aids, chemotherapy-induced nausea and vomiting, seizures, and many other neuropsychiatric disorders.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

ACEP Now

MARCH 11, 2025

A survey that looked at 637 residency programs including pediatric, family, and internal medicine in 2014 found that only 42 programs offered formal training in eating disorders. Comorbidity and outcome in eating disorders. There is a lack of education on eating disorders in residency programs in the United States. Int J Eat Disord.

Emergency Department 83

Emergency Department Psychiatric Dehydration Pediatrics 83

EMDocs

NOVEMBER 4, 2024

Headache red-flag characteristics include neurological symptoms, thunderclap nature, syncope, trauma, immunocompromised, coagulopathy, fever, rash, seizure, nuchal rigidity, altered mental status, pregnancy, temporal tenderness, jaw claudication, and cancer history. Cause and outcome of atypical chest pain in patients admitted to hospital.

Emergency Department 106

Emergency Department Fractures Burns EMS 106

Pediatric Education

JUNE 25, 2023

Borate toxicity can cause abdominal pain, diarrhea, emesis, fever, irritability, seizures, and death. Related Cases Disease: Ear Infections Symptom/Presentation: Ear Pain Specialty: Otolaryngology | Infectious Diseases Age: Teenager To Learn More To view pediatric review articles on this topic from the past year check PubMed.

Infectious Diseases 40

Infectious Diseases Pediatrics Seizures Outcomes 40

Pediatric EM Morsels

NOVEMBER 15, 2024

Seizures are super scary for a parent to witness, but not all seizures mean danger. There is actually a diagnosis of seizures that has “ BENIGN” in the name! We have even talked about using a ketogenic diet to control seizures , and seizure mimics.

Seizures 154

Seizures Stroke Pediatrics Wellness 154

Taming the SRU

SEPTEMBER 1, 2023

for detecting major injuries Abnormal CXR Rapid deceleration mechanism Presence of a distracting injury Chest wall tenderness Sternal/thoracic spine/scapular tenderness There are limited decision-making rules for thoracic spine imaging Yet a study (Inaba et al., 2015) reported a sensitivity of 98.9%

Sepsis 96

Sepsis Fractures Documentation/Coding Administration 96

EMDocs

JUNE 7, 2023

mg/kg pediatrics) Double dose every 5 min Titrate up to end point of therapy and may require very large doses Target End Point of Therapy = clear chest sounds, HR > 80/min, pupil size greater than pinpoint, and dry axillae. Used for treatment of acutely symptomatic anxiety, muscle fasciculations, and seizures. See figure below.

Poisoning 98

Poisoning Airway Management Seizures PPE 98

Don't Forget the Bubbles

DECEMBER 9, 2024

Clinical recommendations for pain, sedation, withdrawal, and delirium assessment in critically ill infants and children Pediatric Acute Lung Injury and Sepsis Investigators ( PALISI ). Implementation of a Risk-Stratified Opioid and Benzodiazepine Weaning Protocol in a Pediatric Cardiac ICU. Pediatr Crit Care Med. Transl Pediatr.

Pediatrics 59

Pediatrics Sepsis Hospitals Administration 59

Taming the SRU

FEBRUARY 3, 2025

These can lead to a wide spectrum of emergent complications including but not limited to cardiac dysrhythmias, seizures, and acute renal failure. It is also worth noting that these aggressive hematologic cancers occur more commonly in children and thus the risk of TLS can be higher in the pediatric population6. in females and 2.5-7.0

Fluid Resuscitation 56

Fluid Resuscitation Seizures Dehydration Emergency Department 56

Taming the SRU

JUNE 6, 2023

then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9, HAJDU Mild TBI’s & Concussions in the Emergency Department TBI’s are relatively common >3 million TBI’s in the US annually 2.5

Documentation/Coding 65

Documentation/Coding Seizures Psychiatric Wellness 65

Taming the SRU

NOVEMBER 13, 2024

opiates or anticholinergics): Use initial nomogram and treat if initial level is above the treatment line. haffner and wright The number of psychiatric emergencies across the U.S., haffner and wright The number of psychiatric emergencies across the U.S., haffner and wright The number of psychiatric emergencies across the U.S.,

Psychiatric 90

Psychiatric Seizures Emergency Department Pediatrics 90

Taming the SRU

AUGUST 25, 2023

wrist in extension clavicle tibial pediatric forearm Most likely injuries to need an x-ray? bicarb <18mEq/L) ketosis (preferably serum beta-hydroxybutyrate >3mmol/L) Risk factors SGLT2 inhibitor use fasting state ketogenic diet intra-abdominal pathology (AGE, pancreatitis, etc.) to 1 mcg/kg/hour procedural sedation loading dose: 0.5-1

Seizures 76

Seizures Fractures EKG/ECG Resuscitation 76

Don't Forget the Bubbles

FEBRUARY 24, 2025

Infants usually present in a non-specific manner, following an apnoea, cough, cyanosis, or seizure so a high index of suspicion is required in this age group. However, our true success is measured by how effectively we share knowledge, foster understanding, and improve patient outcomes. Pediatr Crit Care Med J.

Pediatrics 59

Pediatrics Outcomes Blood Transfusions Sepsis 59

Don't Forget the Bubbles

JULY 5, 2023

Furthermore, educating both patients and their families is important in order to achieve good treatment compliance and better clinical outcomes. Do not use pethidine since it can cause seizures and CNS hyperexcitability. Pediatr Allergy, Immunol Pulmonol 2017; 30: 191–201. Alternatives to morphine are hydromorphone or fentanyl.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

Don't Forget the Bubbles

DECEMBER 3, 2024

In this issue of Pediatrics, Morales and colleagues investigated the effect of exercise on the brain. In this issue of Pediatric Nephrology, Bahat et al. In this issue of Pediatrics , Gkiourtzis and colleagues performed a systematic review and meta-analysis on prophylaxis in children with recurrent urinary tract infections.

Pediatrics 59

Pediatrics Telemedicine Research Hospitals 59