Don't Forget the Bubbles

NOVEMBER 27, 2023

Four-year-old Ed is being resuscitated for presumed Invasive Group A Streptococcal Sepsis from tonsilitis. In middle-to-high-income countries, after 40-60ml/kg of fluid resuscitation, the Surviving Sepsis Campaign International Guidelines recommend using vasoactive drugs. After 40ml/kg of IV 0.9% The CRT is unchanged.

Shock 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

Don't Forget the Bubbles

JUNE 19, 2023

It is useful to know that there are two kinds of weight curves: Descriptive , in which nearly all mothers and their children are included with few exclusion criteria, and Prescriptive , in which groups of women with pathologies that affect neonatal morbidity and mortality outcomes have been excluded. J Pediatr 2018;196:71-6.

Pediatrics 143

Pediatrics Ultrasounds Hyperthermia / Hypothermia Sepsis 143

Don't Forget the Bubbles

MAY 6, 2024

Acad Pediatr. Outcomes included clinical status when urine culture was available, subsequent antibiotic treatment within seven days and subsequent UTI within 30 days. The primary outcome was the successful intubation on the second attempt. Pediatric Critical Care Medicine , 25 (3), pp.e117-e128. 2024;24(1):111-118.

Sepsis 75

Sepsis Pediatrics Outcomes Documentation/Coding 75

EMDocs

OCTOBER 19, 2024

Blood cultures: Blood cultures are rarely positive; however, should be obtained if suspicion for sepsis is present or if the patient is immunocompromised. [2][3] 2][3][9] Glucocorticoid were not shown to alter clinical course or patient outcomes. [2][3] Hospital Pediatrics. Pediatric Pulmonology. Pediatric Pulmonology.

EMS 106

EMS Pediatrics Sepsis Airway Management 106

Pediatric Emergency Playbook

AUGUST 1, 2017

Pediatr Rev. Intestinal Malrotation – Not Just the Pediatric Surgeon’s Problem. Pediatr Surg Int. Does Functional Outcome Improve with Time Postsurgery for Hirschsprung Disease? Eur J Pediatr Surg 2016; 26:192. Pediatrics 1977; 60:457. J Pediatr Gastroenterol Nutr 2008; 46:13. J Pediatr 2005; 146:787.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

Don't Forget the Bubbles

JUNE 30, 2023

The primary outcome measure was chest drain failure, i.e., retained haemothorax requiring a secondary interventional procedure. They stratified patients according to the ratio of FFP: PRBC received (1:1, 1:2, 1:3 and 1:3+) and performed logistic regression analyses for various outcomes.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

Don't Forget the Bubbles

MAY 17, 2023

Eur J Pediatr. Original clinical studies The impact of the early onset neonatal sepsis calculator on antibiotic initiation: a single center study in Israel. Eur J Pediatr. J Pediatr Gastroenterol Nutr. Eur J Pediatr. J Pediatr Gastroenterol Nutr. J Pediatr Gastroenterol Nutr. Eur J Pediatr.

Pediatrics 72

Pediatrics X-Ray Interpretation Sepsis Fractures 72

Don't Forget the Bubbles

MAY 31, 2023

What outcomes did they look at? Was the outcome accurately measured to minimise bias? The inability to test for SARS-CoV-2 antibodies may have led to an underestimation of the impact of the virus on the reported outcomes. All ED visits that met the criteria for ‘new onset diabetes’ or DKA (‘decompensation’) were included.

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

Pediatric Emergency Playbook

SEPTEMBER 1, 2015

Get up-to-date in the understanding and management of pediatric status epilepticus. Pediatric status epilepticus is analogous to the multi-organ dysfunction syndrome in severe sepsis. Pediatric Seizures and Strokes: Beyond Benzos and Brain Scans. Pediatr Emerg Care. In other words – time is brain. Boston, MA.

Pediatrics 40

Pediatrics Seizures Stroke Radiology 40

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

The Skeptics' Guide to EM

SEPTEMBER 28, 2019

The Effect of Vitamin C on Clinical Outcome in Critically Ill Patients: A Systematic Review with Meta-Analysis of Randomized Controlled Trials. The Effect of Vitamin C on Clinical Outcome in Critically Ill Patients: A Systematic Review with Meta-Analysis of Randomized Controlled Trials. Critical Care Medicine. Critical Care Medicine.

Sepsis 52

Sepsis Shock Outcomes Stroke 52

Don't Forget the Bubbles

JANUARY 10, 2024

Some wonder if giving blood to children with a haemoglobin <6g/dl will improve outcomes. Outcomes Primary outcome Mortality at 28 days after randomisation. The authors chose a patient-centred, primary outcome in keeping with their pragmatic design. What were the research questions? The study asked TWO questions: 1.

Blood Transfusions 78

Blood Transfusions Research Outcomes Hospitals 78

Taming the SRU

MARCH 10, 2024

For example breath holding spells in pediatrics, loss of autonomic sensitivity in the elderly, loss of vasculature compliance in the elderly, and compression of the IVC by a gravid uterus. Keep in mind special populations such as the elderly, children and pregnant women who may have slightly different physiology leading to syncope.

EKG/ECG 97

EKG/ECG Shock Wellness EMS 97

PEMBlog

AUGUST 20, 2024

ECPR involves using ECMO (Extracorporeal Membrane Oxygenation) to take over heart and lung functions, offering a last-resort option that is becoming more common in large pediatric hospitals. ELSO guidelines for adult and pediatric extracorporeal membrane oxygenation circuits. Pediatric Emergency Care , 40(8), 618-622.

CPR 52

CPR Resuscitation Pediatrics Hospitals 52

Taming the SRU

AUGUST 30, 2023

Significantly elevated CRP (>122mg/L) and PCT (>0.5ng/mL) levels are predictors of bad outcomes, and are useful for tracking therapy progress, but are not specific enough to rule-in infectious endocarditis [38-39]. Sepsis PCT may have some utility in guiding posttest probability for sepsis when the diagnosis is unclear.

Infectious Diseases 89

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 89

Pediatric Education

FEBRUARY 4, 2024

This close monitoring does not appear to have poorer outcomes if the patient has neuroblastoma. What are the most common pediatric cancers? Clinical features and surgical outcome of a suprarenal mass detected before birth. Pediatr Surg Int. Pediatr Radiol. Questions for Further Discussion 1. 2010;26(3):241-246.

Ultrasounds 52

Ultrasounds Radiology Radiology Pediatrics 52

Northwestern EM Blog

MAY 16, 2022

Do outcomes for patients with suspected nephrolithiasis differ based on the initial imaging? However, with ultrasonography becoming more prevalent in EDs, it may be possible that initial imaging may avoid this radiation risk and still have similar outcomes for patients. Would you be satisfied with only US and no follow-up CT?

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

Broome Docs

APRIL 6, 2023

Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. Renal outcomes following intravenous contrast administration in patients with acute kidney injury: a multi-site retrospective propensity-adjusted analysis. Epinephrine metered-dose inhaler for pediatric croup. N Engl J Med. 2023 Jan 21. Am J Emerg Med.

Sepsis 52

Sepsis Ultrasounds Hospitals Fractures 52

Mind The Bleep

AUGUST 5, 2023

Common signs and symptoms include: Abdominal distention with prominent veins and discolouration Umbilical flaring Poor feeding Bilious vomiting Abdominal tenderness Bowel changes, including diarrhoea, blood and mucus Lethargy, apnoea, bradycardia Sepsis Risk factors of low birth rate, prematurity and formula feeding. (1, Updated 2022 Aug 8].

Sepsis 52

Sepsis Ultrasounds Radiology Radiology 52

Pediatric Emergency Playbook

JANUARY 1, 2016

Think meningitis, UTI, or sepsis. The International Society for Pediatric and Adolescent Diabetes (ISPAD) criteria for DKA : Hyperglycemia, with a blood glucose of >200 mg/dL (11 mmol/L) AND Evidence of metabolic acidosis, with a venous pH of less than 7.3 Effortless tachypnea may be a sign of acidosis or sepsis. Radiographics.

Head Injuries 40

Head Injuries Pediatrics Shock Sepsis 40

The Skeptics' Guide to EM

FEBRUARY 10, 2018

Lancet January 2018 Guest Skeptic: Dr. Tessa Davis is a Pediatrician specialising in Pediatric Emergency Medicine and currently practicing in a central London hospital. Lancet January 2018 Guest Skeptic: Dr. Tessa Davis is a Pediatrician specialising in Pediatric Emergency Medicine and currently practicing in a central London hospital.

Emergency Department 40

Emergency Department Pediatrics Sepsis Hospitals 40

Pediatric Education

AUGUST 20, 2023

in the pediatric populations as noted above. In the US study, the most common underlying PLA risk factor was liver transplant with biliary disease, malignancy and intrabdominal pathology and severe sepsis being other common factors in this population. J Pediatr Gastroenterol Nutr. Pediatr Infect Dis J. 2020;71(1):106-111.

Pediatrics 40

Pediatrics Infectious Diseases Wellness Sepsis 40

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. 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

Don't Forget the Bubbles

JUNE 10, 2024

Despite advancements in neonatal care, NEC remains a significant concern due to its association with adverse outcomes, including prolonged hospitalisation, the need for surgical intervention, and increased mortality rates. Differential diagnoses include septic ileus, and infection causes such as sepsis, meningitis and pneumonia.

Pediatrics 40

Pediatrics Sepsis Fluid Resuscitation Outcomes 40

ACEP Now

MARCH 6, 2024

The PATCH-Trauma trial took a critical look at TXA in major trauma in the advanced trauma systems of Australia and found a mixed result: a slightly greater number of patients were still alive six months following TXA administration, but there was no difference in survival with a good functional outcome. percent to 38.3

Research 52

Research Airway Management Stroke Outcomes 52

ACEP Now

JULY 7, 2024

Although they may not appear as physically injurious as convulsive seizures, nonconvulsive seizures can significantly impact the neurological outcomes and overall prognosis of patients in critical care settings. Utility of electroencephalogram in the pediatric emergency department. Ann Emerg Med. 2014;63(4):437-447. Am J Emerg Med.

Seizures 52

Seizures Emergency Department Outcomes EMS 52

Don't Forget the Bubbles

NOVEMBER 15, 2023

One-liner… Understanding how to manage maintenance fluids in critically unwell children best is a basic but important way to improve outcomes. Jasmine, a hypothetical case Jasmine is a 5-year-old girl weighing 18kg admitted to PICU with suspected sepsis. Pediatrics. Crit Care Med. 2020;48:1034-1041. doi:10.1097/CCM.0000000000004376

Resuscitation 80

Resuscitation Dehydration Administration Shock 80

Taming the SRU

MAY 1, 2023

Midline Ludwig’s angina Dermoid cyst Thyroglossal duct cyst Thyroid mass Thyroid goiter Lateral Sialadenitis Branchial cleft cyst Kawasaki’s Lymphoma Diagnosis: Thyroglossal Duct cyst with a superimposed strep throat infection without typical symptoms of pharyngitis Test of choice: Ultrasound Thyroglossal Duct cyst Most common pediatric cervical congenital (..)

Poisoning 52

Poisoning Hyperthermia / Hypothermia Seizures Emergency Department 52

Don't Forget the Bubbles

MAY 28, 2024

Hence, PPHN can be idiopathic or secondary to a variety of conditions such as meconium aspiration syndrome , respiratory distress syndrome, sepsis, asphyxia and congenital diaphragmatic hernia. Pediatric Critical Care Medicine , 11(2 Suppl), S79-S84. Imagine being a few hours old and dealing with this). StatPearls Publishing.

Sepsis 52

Sepsis Ultrasounds Pediatrics Research 52

EB Medicine

JULY 8, 2019

Leakage from the staple line typically presents within the first week, but can present up to 35 days, usually with fevers, tachycardia, abdominal pain, nausea, vomiting sepsis, or peritonitis. Some may present with isolated tachycardia while others may present with profound sepsis – tachycardia, hypotension, and fever. At 6 to 8 mL/kg.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

EB Medicine

SEPTEMBER 1, 2018

Nachi: Not only are they out, they actually worsen outcomes, so definitely don’t pursue any of them. Instead, since no treatment has been shown to improve outcome, you should prioritize prompt transport. Fasciotomies have not been shown to improve outcomes and are reserved only for those failing anti-venom treatment.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

Don't Forget the Bubbles

MARCH 4, 2024

This was a secondary outcome embedded in the Travel Fever study – a multi-centre, retrospective diagnostic accuracy study for imported malaria. Reviewed by: John Coveney Article 2: How do we define sepsis in children? International Consensus Criteria for Pediatric Sepsis and Septic Shock. doi:10.1001/jama.2024.0179

Hospitals 78

Hospitals Sepsis Fractures Emergency Department 78

Don't Forget the Bubbles

AUGUST 21, 2023

Infection/sepsis? What are the long-term outcomes for children with dilated cardiomyopathy? Outcomes at 1 year seem to be influenced by the severity of illness at presentation. Outcomes at 5 years, though, are better amongst those patients admitted to intensive care. Female sex and younger age favour better outcomes.

Pediatrics 98

Pediatrics Outcomes Research Sepsis 98

Don't Forget the Bubbles

JULY 22, 2024

Randomised controlled trials addressing the benefit of steroids in preschool wheeze have compared different cohorts, used different trial designs and measured different outcomes. This is a way to overcome different trial outcomes. This paper’s primary outcome was a change in wheeze severity score (WSS). What does this mean?

Outcomes 105

Outcomes Research Pediatrics Hospitals 105

Don't Forget the Bubbles

MAY 8, 2024

An interesting study (JAMA Pediatrics) shows the benefits of newborn screening for spinal muscular atrophy (SMA), as initiating disease-modifying therapy earlier improves clinical outcomes. These findings advocate for expanding newborn screening programs to enhance outcomes for children with SMA. Pediatr Nephrol.

Pediatrics 69

Pediatrics Emergency Department Outcomes Research 69

EMDocs

NOVEMBER 25, 2023

Source Intranasal fentanyl and discharge from the emergency department among children with sickle cell disease and vaso-occlusive pain: A multicenter pediatric emergency medicine perspective. 3: High or Low Fluid Volume in Sepsis? Clay Smith at @spoonfedEM , and sign up for email updates here. #1: Am J Hematol. 2023 Apr;98(4):620-627.

Sepsis 63

Sepsis Emergency Department Pediatrics Academics 63

Mind The Bleep

FEBRUARY 27, 2024

The children who received no bolus had significantly better outcomes and reduced mortality compared to the two bolus group. [2] Boluses were given in 20-40ml/kg aliquots.

Fluid Resuscitation 96

Fluid Resuscitation Dehydration Hospitals Research 96