Don't Forget the Bubbles

MAY 6, 2024

Acad Pediatr. Reviewed by: Tasnim Ransome and Spyridon Karageorgos Article 3: Which Sepsis Scoring Tools Perform Best? Organ Dysfunction in Children With Blood Culture-Proven Sepsis: Comparative Performance of Four Scores in a National Cohort Study. Pediatric Critical Care Medicine , 25 (3), pp.e117-e128. Hagenbuch, N.,

Sepsis 75

Sepsis Pediatrics Outcomes Documentation/Coding 75

Critical Care Now

JUNE 30, 2024

The latest Surviving Sepsis Campaign (SSC 2021) guidelines say the following about albumin in in sepsis: The lack of proven benefit and higher cost of albumin compared to crystalloids contributed to our strong recommendation for the use of crystalloids as first-line fluid for resuscitation in sepsis and septic shock.

Sepsis 52

Sepsis Fluid Resuscitation Shock Resuscitation 52

Taming the SRU

JANUARY 12, 2024

pediatric small groups WITH our cchmc colleagues Dermatologic emergencies Children can present with a wide range of rashes, many of which are benign, however identifying concerning rashes is very important. Use your resources to differentiate scary from benign! Children are not just small adults!

Fluid Resuscitation 59

Fluid Resuscitation Pediatrics Sepsis Shock 59

PEMBlog

AUGUST 20, 2024

This episode of PEM Currents discusses ECPR (Extracorporeal Cardiopulmonary Resuscitation), an advanced procedure used in cases of cardiac arrest when traditional CPR fails. ELSO guidelines for adult and pediatric extracorporeal membrane oxygenation circuits. Extracorporeal Cardiopulmonary Resuscitation. Resuscitation.

CPR 52

CPR Resuscitation Pediatrics Hospitals 52

The Skeptics' Guide to EM

NOVEMBER 18, 2017

Fever in the Emergency Department Predicts Survival of Patients With Severe Sepsis and Septic Shock Admitted to the ICU. Fever in the Emergency Department Predicts Survival of Patients With Severe Sepsis and Septic Shock Admitted to the ICU. Following the triage sepsis pathway, recently amended to use qSOFA.

Sepsis 52

Sepsis Emergency Department Seizures Pediatrics 52

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. Pediatr Nephrol. Eur J Pediatr. Long COVID in pediatrics-epidemiology, diagnosis, and management. Eur J Pediatr. JAMA Pediatr.

Pediatrics 69

Pediatrics Emergency Department Outcomes Research 69

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

Don't Forget the Bubbles

NOVEMBER 15, 2023

In a PICU setting, sodium can come from various sources (resuscitation fluids, IV drugs and infusions, enteral feed), not just the maintenance fluids we prescribe. There is growing interest in giving no maintenance fluid and using the input from drug infusions and resuscitative boluses only. Pediatrics. sodium chloride.

Resuscitation 80

Resuscitation Dehydration Administration Shock 80

Taming the SRU

JULY 31, 2024

morbidity and mortality - faculty case follow-up - R4 Capstone - high-risk, low prevalence diseases in pediatrics morbidity and mortality WITH dr. moulds Syncope Complete heart block is a rare but important cause of syncope P waves outnumbering QRS complexes should clue to you to high grade heart block Triage EKGs are often obtained to screen for cardiac (..)

EKG/ECG 52

EKG/ECG Sepsis Documentation/Coding Stroke 52

Pediatric Emergency Playbook

SEPTEMBER 1, 2015

The Pediatric Assessment Triangle is a rapid, global assessment tool using only visual and auditory clues to make determinations on three key domains: appearance, work of breathing, and circulation to the skin. Before you decide on sepsis, ask yourself, could this be a cardiac problem?* Pediatr Clin N Am. 2006; 53:69-84.

Seizures 40

Seizures Sepsis Pediatrics Shock 40

EM Literature of Note

OCTOBER 20, 2022

How FAST Can You Spot a Pneumothorax? Thin Evidence Supporting Thrombolysis of Those on Blood Thinners Epinephrine Norepinephrine, That Is the Question Ill PREPAREd-II Intubate the Critically Ill Enjoy!

Stroke 40

Stroke Sepsis Pediatrics Resuscitation 40

Pediatric Emergency Playbook

JUNE 1, 2016

Hypovolemic Shock The most common presentation of pediatric shock; look for decreased activity, decreased urine output, absence of tears, dry mucous membranes, sunken fontanelle. Distributive Shock The most common cause of distributive shock is sepsis, followed by anaphylactic, toxicologic, adrenal, and neurogenic causes. Pediatrics.

Shock 40

Shock Sepsis Pediatrics Ultrasounds 40

Mind The Bleep

FEBRUARY 27, 2024

There could be any number of reasons for this but some examples are: they have severe D&V and aren’t keeping fluids down, or because they are pre or post-op, or have presented very unwell and need fluid resuscitation. saline + 5% dextrose or plasma-lyte 148 + 5% dextrose. .

Fluid Resuscitation 96

Fluid Resuscitation Dehydration Hospitals Research 96

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. Vaishnav Hyperthermia: abnormally high body temperature due to thermoregulatory failure Severe hyperthermia: temp greater than 40.5C

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Poisoning EKG/ECG Seizures 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

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] Management/Disposition ABCs and resuscitation if indicated Assessment for need of definitive airway is imperative as rate of intubation is high (38-100%) in various studies. [2][3][9]

EMS 110

EMS Pediatrics Sepsis Airway Management 110

Don't Forget the Bubbles

NOVEMBER 1, 2023

This is not always feasible in an acute resuscitation scenario. Lactate as a screening tool for critical illness in a pediatric emergency department. Pediatric Emergency Care. In children who did not need acute resuscitation, the 95th percentile of lactate was 3.2 They do not replace CXRs as the gold standard.

Emergency Department 140

Emergency Department Hospitals Resuscitation Administration 140

Don't Forget the Bubbles

JUNE 30, 2023

In addition, a flimsy cannula is easily dislodged during ongoing resuscitation and easily clots off. This was a randomised controlled multisite study comparing resuscitation of trauma patients requiring massive transfusion using either 1:1::1 or 1:1:2 ratios of platelets to plasma to red blood cells. to −0.5%]; P  = 0.03.).

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

EMDocs

OCTOBER 8, 2024

The full differential diagnosis of sinus tachycardia in isolation is extensive ranging from benign etiologies such as anxiety to severely life threatening etiologies such as sepsis. Additional resuscitation Have we addressed all potential sources of shock for the patient in front of us? What is this patient’s disposition?

Shock 106

Shock Emergency Department Pediatrics EKG/ECG 106

Pediatric Emergency Playbook

NOVEMBER 1, 2015

Pediatric airway management is a skill that integrates the three types of knowledge as described by the ancient Greeks: episteme , or theoretical knowledge, techne , or technical knowledge, and phronesis , or practical wisdom, also called prudence. She is in respiratory failure from bronchiolitis and likely viral sepsis.

Shock 40

Shock Sepsis Airway Management Pediatrics 40

Don't Forget the Bubbles

JUNE 10, 2024

Systemic Infections : Sepsis and other systemic infections can predispose infants to NEC by compromising the gut barrier and promoting inflammation. Differential diagnoses include septic ileus, and infection causes such as sepsis, meningitis and pneumonia. Pediatric Clinics of North America, 64(1), 1-15. ANZNN Annual Report.

Pediatrics 40

Pediatrics Sepsis Fluid Resuscitation Outcomes 40

EB Medicine

NOVEMBER 1, 2018

Thankfully, that gentleman was successfully resuscitated despite no bystander CPR, and if you listen carefully, we hope to arm you with the tools to do so similarly. Jeff: And unlike past issues covering more common pathologies, like, say, sepsis, this month’s team reviewed much more literature than just the past 10 years.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

ACEP Now

MARCH 6, 2024

A Myriad of Infectious Disease Papers The use of steroids in severe sepsis remains challenging, primarily as proper patient selection is necessary to tease out those with the greatest likelihood of benefit. JAMA Pediatr.2023;177(8):782. Survival to hospital discharge favored the “standard care” group, 47.9 percent to 38.3

Research 52

Research Airway Management Stroke Outcomes 52

EB Medicine

SEPTEMBER 1, 2018

If EMS has placed bandages, leave them in place until antivenom and resuscitative equipment is ready. Jeff: Continuing right along, the next special population to discuss are pediatric patients. Next month we are talking sepsis and the ever frequently changing guidelines so it’s not something you want to miss. 1-800-222-1222.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

Don't Forget the Bubbles

FEBRUARY 17, 2025

He has received 20ml/kg in 5 to 10ml/kg aliquots in the ED, as his blood pressure keeps dropping, and the ED team is concerned about possible sepsis. He has had some additional episodes of hypotension post-intubation, which is treated with further volume resuscitation. As the PICU Registrar, you are called to review him.

Pediatrics 78

Pediatrics Ultrasounds Shock Resuscitation 78

Don't Forget the Bubbles

NOVEMBER 18, 2024

Sepsis: This can induce widespread vasodilation and capillary leak, exacerbating hypotension. Blood Tests: Can help identify underlying causes such as infection (sepsis), anaemia, or electrolyte imbalances. Before considering fluid resuscitation or inotropes, it is essential to correct the infant’s body temperature.

Sepsis 59

Sepsis Shock Hyperthermia / Hypothermia Administration 59

EMDocs

JANUARY 20, 2025

Sepsis There has been much controversy over the last two decades around the various nuances of volume resuscitation in ED patients with suspected sepsis, much of which goes beyond the scope of this limited review. In lower-resource settings, the evidence is stronger against a liberal approach to volume resuscitation.

Dehydration 75

Dehydration Fluid Resuscitation Sepsis Resuscitation 75

EMDocs

JUNE 27, 2024

Pediatr Allergy Immunol Pulmonol. smoke, high ozone levels, smog) Asthma/reactive airway disease (RAD) Diagnostic criteria 7,8 Respiratory symptoms +/- fever (at least 38.0 C or 100.4 2 mcg/kg, max 100 mcg) while obtaining IV access 20 IV/IM ketorolac (1 mg/kg, max 15 mg) Morphine (05-0.1 mg/kg, max 0.4 C or 100.4 mg/kg, max 0.4 C or 100.4

Pediatrics 97

Pediatrics Dehydration EMS Hospitals 97

Don't Forget the Bubbles

FEBRUARY 5, 2024

In the review part of the list, we found an interesting systematic review in JAMA Pediatrics about the relationship between 100% juice consumption and weight gain. Pediatr Nephrol. Pediatr Infect Dis J. Role of diagnostic tests for sepsis in children: a review. Eur J Pediatr. Pediatrics. Pediatrics.

Pediatrics 52

Pediatrics Research Resuscitation Psychiatric 52

Taming the SRU

FEBRUARY 3, 2025

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. mg/dl (pediatrics) calcium < 7 mg/dl Clinical Tumor Lysis Syndrome (2) - laboratory TLS + one of the following: cardiac arrhythmia seizure sudden death creatinine > 1.5x

Fluid Resuscitation 56

Fluid Resuscitation Seizures Dehydration Emergency Department 56

Don't Forget the Bubbles

OCTOBER 2, 2024

In our guideline section, we chose a review in Pediatrics looking at phototherapy to prevent severe neonatal hyperbilirubinemia. In this issue of Pediatrics , Leyenaar and colleagues reported on a trial to compare the effectiveness of direct admission to bypass their emergency departments. Pediatrics. Eur J Pediatr.

Pediatrics 52

Pediatrics Hyperthermia / Hypothermia Emergency Department Urgent Care 52

Taming the SRU

JUNE 6, 2023

then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9, then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9,

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., mg/kg (of 0.1 mg/kg (of 0.1 2x maintenance rate

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

JULY 3, 2024

In this month’s issue of Pediatrics, Brewster and colleagues investigated how well Google Translate and ChatGPT perform in translating discharge instructions. Lastly, in this month’s issue of JAMA Pediatrics, Gemmill et al. Eur J Pediatr. Pediatr Nephrol. Pediatrics. Eur J Pediatr. Pediatrics.

Pediatrics 105

Pediatrics Fluid Resuscitation Research Hospitals 105