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James Broselow, a family medicine-turned-emergency medicine physician from Hickory, North Carolina , recognized that his team spent a lot of time trying to calculate doses of medications rather than spending their mental energy on the actual medical decisions for the resuscitation. This system has now become the “ industry standard.”
Early resuscitation, particularly with blood products in patients with hemorrhage, is literally a lifesaver. To facilitate this, massive transfusion protocols (MTP) have been designed to rapidly deliver sizable quantities of blood products to the trauma resuscitation bay. J Pediatr Surg. But what about children? 2019.10.008.
To celebrate the end of trauma season ( is it ever really over? ), we here at the Ped EM Morsels Bakery have cooked up a morsel to remind you that pediatric trauma can be even more difficult than you think. Unfortunately, there are numerous other pitfalls that can be encountered during the management of pediatric trauma patients.
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.
The goal of this update is to provide a practical update in pediatric emergency medicine to the average Canadian adult or community emergency clinician. We will review the following three […] The post Little People, Big Updates: Updates in Pediatric Emergency Medicine appeared first on EMOttawa Blog.
3 A three-pronged management approach provides a framework for addressing post-tonsillectomy bleeds: resuscitation, early ENT consultation with transport arrangements, and temporizing measures applied to control bleeding. Int J Pediatr Otorhinolaryngol. Anesthetic management of the pediatric bleeding tonsil. 2012;344:e3054.
On this month's EM Quick Hits podcast: Anand Swaminathan on update to ED management of postpartum hemorrhage, Nour Khatib on serotonin syndrome and its mimics, Katie Lin on an approach to recognition and management of severe TBI and brain herniation syndromes, Hans Rosenberg on the ED management of ulcerative colitis, Heather Cary on pediatric c-spine (..)
In most pediatricresuscitations, I feel very comfortable standing with the Broselow tape in my hand for dosing. The […] The post Pediatric transfusion dosing appeared first on First10EM. This isn’t a full blog post, but just an opportunity to share a resource that I think many people will find valuable.
This can obviously be helpful if you are updating or building new resuscitation rooms. Pediatric cart. Have your contractor mock up a space exactly the size of your new resuscitation room. In the last two posts, I discussed the size of your trauma bay and how to measure it. But what about all the stuff that goes into it?
Pediatric trauma is a high acuity but low frequency event (2). There is a well-documented correlation amongst EMS and adult ED physicians who provide less pediatric care to […] The post Pediatric Traumatic Cardiac Arrest appeared first on EMOttawa Blog.
University of Maryland Department of Emergency Med
OCTOBER 13, 2023
This excellent review article discussing damage control resuscitation in traumatically injured children highlights several points including: Click to view the rest
They include toxicology, trauma, ophthalmology, orthopaedics, resuscitation, human factors, addiction and pediatric emergencies. The post EM Quick Hits 1 Massive PE, Gabapentin for Alcohol Withdrawal, Dental Avulsions, Pediatric Eye Exam, Best Resuscitation Fluid appeared first on Emergency Medicine Cases.
Resuscitation. Antibiotic prophylaxis in pediatric dog bite injuries: Infection rates and prescribing practices. Resuscitation. Palatinus HN, Johnson MA, Wang HE, Hoareau GL, Youngquist ST. Early intramuscular adrenaline administration is associated with improved survival from out-of-hospital cardiac arrest. 2024.110266.
Of course, we all have a healthy respect for post-tonsillectomy hemorrhage and we like to talk about Damage Control Resuscitation. Acute Esophageal Variceal Bleeding: Basics Pediatric liver disease may be due to numerous causes. Pediatric patients with cirrhosis and acute Upper GI Bleeds are at risk of developing bacterial infections.
It appears the agency did so in 2020 for the PCORI-funded CLOVERS randomized trial comparing fluid strategies in septic shock, in which patients were routinely exempted from receiving crystalloid resuscitation if they were improving. The Infectious Diseases Society of America (IDSA) has consistently opposed SEP-1 since at least 2016.
We cover new evidence on chest trauma management, intraosseous access safety, pediatric imaging updates, AI in medicine, toxic alcohol poisoning, and airway management. St.Emlyn's - Emergency Medicine #FOAMed This months St Emlyns podcast wraps up Season 11 with a review of key emergency medicine topics.
Please support EM Cases to continue to be free open access by making a donation: [link] The post EM Quick Hits 64 Whole Blood Transfusions, Calcium Before Diltiazem in Afib, Thoracotomy Pearls, Uterine Casts, OMI Scale & Proportionality appeared first on Emergency Medicine Cases.
There is also a tremendous cognitive load during pediatricresuscitations determining the appropriate sized equipment and medication dosing, increasing the pressure. There are numerous critical differences in managing the pediatric airway. Use a pediatric bronchoscope. There are physiologic differences.
In this episode, Sam Ashoo, MD interviews Rawad Rayes, MD and Eva Tovar Hirashima, MD, MPH – two of the authors of the August 2022 PEMP article on Pediatric Firearm Injuries to the Extremity: Management in the Emergency Department. Episode Outline: How common are pediatric firearm injuries? Can they stay in? Can they stay in?
Things like inaccurate estimation of burn size, unnecessary endotracheal intubation, over- and under-estimation of fluid resuscitation volumes, inadequate analgesia and inappropriate wound dressings are just some of the issues where a small change to ED practice patterns could have a huge impact on patient care.
Sodium bicarbonate use during pediatric cardiopulmonary resuscitation: a secondary analysis of the icu-resuscitation project trial. Pediatric Crit Care Med. 2022 Date: February 15, 2023 Guest Skeptic: Dr. Carlie Myers is Pediatric Critical Care Attending at Cincinnati Children’s Hospital Medical Center.
When it comes to pediatric drowning, prevention is the best medicine. The team should begin CPR and follow the PALS pediatric bradycardia algorithm. Pediatric Drowning Download Hon, K. , Pediatric Emergency Care,32 (9), 623-626. Unfortunately, the child becomes bradycardic. PICU should be called if not already involved.
The post Neonatal Resuscitation NRP Rapid Reviews Video appeared first on Emergency Medicine Cases. Nick Clarridge runs through the NRP algorithm and delivers the nuggets of wisdom on how best to prepare for the sick neonate, best monitoring practices and ventilation strategies of the neonate.
Management of the pediatric trauma patient is challenging regardless of where you work. How do you clear the pediatric c-spine? Are atropine and fentanyl recommended as pre-induction agents in the pediatric trauma patient? Is tranexamic acid recommended in early pediatric trauma like it is in adults? and many more.
Kari Sampsel, Emergency Physician at Ottawa Hospital and Assistant Professor at University of Ottawa, Medical Director of Sexual Assault and Partner Abuse Care Program guides us through an example of a perimortem C-section - a resuscitative hysterotomy at Janus General.
Spoon Feed Don’t hang your hat on lactate clearance to assess therapeutic response to resuscitation in sepsis; there are too many confounders, and initial clearance does not necessarily project clinical course. Clay Smith at @spoonfedEM , and sign up for email updates here. #1: 1: How Useful Is Lactate Clearance Anyway? Circulation.
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:
Eric Russell, Assistant Professor of Pediatrics at the Baylor College of Medicine, Pediatric Emergency Medicine attending physician at the Texas Children's Hospital, and editor at the Human Diagnosis Project. They discuss a challenging case of a pediatric patient who presents with what at first appears to be bronchiolitis.
. #3: STOP RCT – Duration of Antibiotics for Pediatric Febrile UTI Spoon Feed The Short-Course Oral Antibiotic Therapy of Acute Pyelonephritis (STOP trial) demonstrated that a 5-day course of amoxicillin-clavulanate was noninferior to the standard 10-day course with regard to recurrence of infection. Pediatrics. doi: 10.1542/peds.2023-062598.
Hilary Whyte, Dr. Jabeen Fayyaz, Dr. Emily MacNeill discuss a neonatal resuscitation algorithm, airway management, fluid resuscitation, central access tips, glucose and temperature control and transport tips.
Four-year-old Ed is being resuscitated for presumed Invasive Group A Streptococcal Sepsis from tonsilitis. Obviously, one also needs to address the cause of the shock, or any efforts in resuscitation will only bring a temporary improvement. Pediatr Crit Care Med. Pediatr Crit Care Med. After 40ml/kg of IV 0.9%
Direct Oral Anticoagulants in Pediatrics Spoon Feed Treatment with direct oral anticoagulants (DOACs) in pediatric patients appears to reduce venous thromboembolism (VTE) recurrence compared to standard of care, with no difference in major bleeding or serious adverse events. Resuscitation. Ann Emerg Med. 2023 Aug;82(2):219-221.
sodium chloride) reduced acute kidney injury and improved other outcomes in these pediatric patients with septic shock. Source Multiple Electrolytes Solution Versus Saline as Bolus Fluid for Resuscitation in Pediatric Septic Shock: A Multicenter Randomized Clinical Trial. Crit Care Med. 2023 Nov 1;51(11):1449-1460.
General resuscitation with broad spectrum antibiotics and volume resuscitation if the patient appears to be septic. Predictive value of visible lesions (cheeks, lips, oropharynx) in suspected caustic ingestion: may endoscopy reasonably be omitted in completely negative pediatric patients? Pediatr Emerg Care. N Engl J Med.
Just as pediatric patients are not small adults, geriatric patients are not just old adults. The post Ep 159 Geriatric Trauma Part 1: The Under-Triaging Problem, Resuscitation, Airway, Head and C-spine Imaging, Clearing the C-spine appeared first on Emergency Medicine Cases. What is the utility of the Shock Index in older patients?
The Importance of Civility in Critical Care Resuscitation A 3-year-old patient with diabetic ketoacidosis arrives at your ED. While you are leading the resuscitation, one of your senior colleagues belittles a junior staff member for struggling to site an IV line. Conclusion Critical care resuscitation is stressful.
Pediatrics. Resuscitation. . #3: Don’t Make A Rash Decision About Infant Vesicles or Pustules Spoon Feed In a cohort of afebrile infants with pustular or vesicular rashes, none were diagnosed with serious bacterial infection attributable to a skin source, though some were ultimately diagnosed with herpes simplex virus (HSV).
The post Neonatal Resuscitation Rapid Review Video Part 2 – Chest Compressions, Epinephrine, Algorithm Pearls and Pitfalls appeared first on Emergency Medicine Cases.
cm is normal Hazard ratio in patients with abnormal TAPSE in normotensive patients is high even though the patient is currently hemodynamically stable Acute vs chronic right heart strain Acute McConnell’s sign: apical hypokinesis with RV free wall hypokinesis Will be present in all causes of increased RV pressure including PE, pulmonary HTN, etc.
A bayesian interpretation of a pediatric cardiac arrest trial (THAPCA-OH). She is part of the Don’t Forget the Bubbles team and faculty at Queen Mary […] The post SGEM #404: Sitting on the Dock of the Bay-esian Interpretation of Therapeutic Hypothermia for Pediatric Cardiac Arrest first appeared on The Skeptics Guide to Emergency Medicine.
For decades, only one major organization—the American Heart Association (AHA)—provided standardized training and certifications in Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS). Major resuscitation organizations worldwide meet in this forum to share knowledge and best practices.
The post EM Quick Hits 38 ACS in Older Patients, Rural Neonatal Resuscitation, Hemophilia, Hiccups, ECG Computer Interpretation appeared first on Emergency Medicine Cases.
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