Pediatric Emergency Playbook

JUNE 1, 2016

Do we recognize shock early enough? World wide, shock is a leading cause of morbidity and mortality in children, mostly for failure to recognize or to treat adequately. So, what is shock? Simply put, shock is the inadequate delivery of oxygen to your tissues. How do we prioritize our interventions? Pericardial Effusion?

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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.,

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Sepsis Pediatrics Outcomes Documentation/Coding 75

Pediatric Emergency Playbook

AUGUST 1, 2017

Pediatr Rev. Intestinal Malrotation – Not Just the Pediatric Surgeon’s Problem. Pediatr Surg Int. Eur J Pediatr Surg 2016; 26:192. Pediatrics 1977; 60:457. J Pediatr Gastroenterol Nutr 2008; 46:13. J Pediatr 2005; 146:787. Pediatr Surg Int 2003; 19:439. 1988; 9(7):219-226. Radiographics.

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Pediatrics Ultrasounds Resuscitation Sepsis 52

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.

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Sepsis Fluid Resuscitation Shock Resuscitation 52

Don't Forget the Bubbles

MARCH 4, 2024

Reviewed by: John Coveney Article 2: How do we define sepsis in children? International Consensus Criteria for Pediatric Sepsis and Septic Shock. The aim of this paper was to update and evaluate the criteria for sepsis and septic shock in children. It doesn’t help to diagnose or exclude sepsis.

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Hospitals Sepsis Fractures Emergency Department 78

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!

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Fluid Resuscitation Pediatrics Sepsis Shock 59

PEMBlog

OCTOBER 18, 2023

PEMPix is the American Academy of Pediatrics Section on Emergency Medicine’s annual visual diagnosis competition. rectally, prompting a sepsis workup given his age. Neonatal Toxic Shock Syndrome C. Neonatal Toxic Shock Syndrome-Like Exanthematous Disease E. Neonatal toxic shock syndrome-like exanthematous disease (NTED).

Infectious Diseases 59

Infectious Diseases Shock Pediatrics Wellness 59

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.

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Sepsis Emergency Department Seizures Pediatrics 52

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.

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Pediatrics Sepsis Shock Outcomes 52

EMDocs

JULY 1, 2023

BMC Pediatrics. Upon further research in the 1970’s, retrospective data from autopsies of those patients showed coronary aneurysms 5 Pathophysiology: Kawasaki Disease is a vasculitis of medium sized arteries. Rosh Review Website Link FOAMed: [link] [link] [link] References: Noorani, M., Lakhani, N. 2018;18(334). link] McCrindle, B.,

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EMS Infectious Diseases Pediatrics Research 91

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.

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EKG/ECG Shock Wellness EMS 97

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 (..)

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EKG/ECG Sepsis Documentation/Coding Stroke 52

Taming the SRU

AUGUST 30, 2023

Sepsis PCT may have some utility in guiding posttest probability for sepsis when the diagnosis is unclear. A 2013 meta-analysis of 30 studies including 3,244 patients published in The Lancet found PCT to have a pooled sensitivity of 77% and specificity of 79% for sepsis in critically ill patients [52]. Cleland DA, Eranki AP.

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

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.

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Seizures Sepsis Pediatrics Shock 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.

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Emergency Department Pediatrics Sepsis Hospitals 40

Pediatric Emergency Playbook

MAY 1, 2017

Pediatrics. Pediatrics. He will be dehydrated – possibly in shock. Check the bilirubin in any neonate you are working up for sepsis. Pediatrics. Pediatrics. Pediatrics. Pediatrics. This will tell you: home or admission. Use the Bilitool or Bhutani Nomogram (below). Can I go Home Now?

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Dehydration Pediatrics Wellness Seizures 52

Don't Forget the Bubbles

NOVEMBER 15, 2023

Jasmine, a hypothetical case Jasmine is a 5-year-old girl weighing 18kg admitted to PICU with suspected sepsis. She had septic shock on presentation and was resuscitated with 60ml/kg of balanced crystalloid solution and escalating vasoactive medications. Pediatrics. Crit Care Med. 2020;48:1034-1041. doi:10.1097/CCM.0000000000004376

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Resuscitation Dehydration Administration Shock 80

Mind The Bleep

FEBRUARY 27, 2024

saline vs balanced crystalloid solutions for initial fluid management in the treatment of septic shock which may give us more insight into this topic. [5] They concluded that some evidence in the literature shows a shorter length of hospital stay associated with prescribing balanced isotonic fluids (Plasma-lyte) over non-balanced (0.9%

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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

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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.

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The Skeptics' Guide to EM

DECEMBER 14, 2024

Development and Validation of the Phoenix Criteria for Pediatric Sepsis and Septic Shock. Is this pneumonia or could this be sepsis? Background: Pediatric sepsis is a major global health concern, causing an estimated 3.3 Reference: Sanchez-Pinto, L.N., Guest Skeptic: Prof. million deaths annually.

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Sepsis Pediatrics Shock Hospitals 103

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] Pediatric Bacterial Tracheitis—A Variable Entity: Case Series with Literature Review. Hospital Pediatrics. Pediatric Pulmonology. Published 2023. Published 2020.

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EMS Pediatrics Sepsis Airway Management 110

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?

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Shock Emergency Department Pediatrics EKG/ECG 106

The Skeptics' Guide to EM

SEPTEMBER 28, 2019

Case: A 45-year-old female in the emergency department is being admitted to the intensive care unit (ICU) for septic shock secondary to urinary tract infection (UTI). But you remember seeing in the news there was a study claiming vitamin C could cure sepsis. You are ready to call the ICU and get her admitted.

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Sepsis Shock Outcomes Stroke 52

Don't Forget the Bubbles

JUNE 30, 2023

Ranulf went white with the shock. Importantly, there were no differences between the groups regarding complications, including acute respiratory distress syndrome, multiple organ failure, venous thromboembolism, sepsis, and transfusion-related complications. J Pediatr Surg. 2022 Dec;57(12):986-993.

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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.

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Shock Sepsis Airway Management Pediatrics 40

Pediatric Emergency Playbook

JANUARY 1, 2016

Be aware that later stages of malrotation may present as shock – they present in hypovolemic shock due to third-spacing from necrotic bowel and/or septic shock from translocation or perforation. Think meningitis, UTI, or sepsis. Effortless tachypnea may be a sign of acidosis or sepsis. Pediatr Diabetes.

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Head Injuries Pediatrics Shock Sepsis 40

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].

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Sepsis Ultrasounds Radiology Radiology 52

EB Medicine

NOVEMBER 1, 2018

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. Nachi: Each year, in the US, approximately 10,000 patients present with electrical burns or shocks. In total, they pulled references from 1966 until 2018. That’s -- high.

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Emergency Department Burns EKG/ECG Shock 40

EB Medicine

MARCH 4, 2020

Literature Review: There is abundant literature on pediatric AGE but sparse research on AGE in adults. Therefore, many recommendations are extrapolated from the pediatric literature. Higher sugar solutions can be diluted 50% Coconut water Half strength apple juice has been studied in pediatrics and decreased treatment failure.

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Emergency Department Dehydration Poisoning Allergic Reactions 40

Don't Forget the Bubbles

JANUARY 10, 2024

These were presented as hazard ratios and included fever at presentation, previous transfusion ever, haemoglobinuria, malaria, sickle cell disease on enrolment, HIV, evidence of sepsis, malnutrition, shock, hypothermia, and dehydration. Sepsis indicators and malaria positivity did not modify the risk. Pediatr Crit Care Med.

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Blood Transfusions Research Outcomes Hospitals 78

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 (..)

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Poisoning Hyperthermia / Hypothermia Seizures Emergency Department 52

EB Medicine

SEPTEMBER 1, 2018

In severe cases this can lead to systemic bleeding and even hemorrhagic shock. Jeff: And to round out this section – just be aware that rare effects such as osteonecrosis, ischemic stroke, massive PE, and septic shock have all been reported. Jeff: Continuing right along, the next special population to discuss are pediatric patients.

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Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

Taming the SRU

OCTOBER 31, 2024

Development of a New Screening Tool for Pediatric Septic Shock. Ann Emerg Med 2024; Big Picture Current screening tools for pediatric septic shock and sepsis are highly specific but lack sensitivity. A Brief Sepsis Overview Sepsis is a topic that is ever changing in the literature.

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Sepsis Shock Pediatrics Administration 72

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. Volume resuscitation has historically been the first-line therapy for patients in septic shock. As the PICU Registrar, you are called to review him. Is more fluid the answer?

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Pediatrics Ultrasounds Shock Resuscitation 78

EM Literature of Note

FEBRUARY 3, 2025

Piperacillin/Tazobactam, Cefepime, and the Risk of Harm: December 2024 Annals of Emergency Medicine Journal Club ACEPNow Settling the Cefepime versus Piperacillin-Tazobactam Debate 2024 Emergency Medicine Research Highlights: Forced Air, Sepsis, and More Tweet

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Sepsis Shock Pediatrics Research 62

Pediatric EM Morsels

FEBRUARY 2, 2024

Pediatric patients with recent travel and fever of unknown origin should be considered for admission if malaria is a possible diagnosis. Fever in the Returned Pediatric Traveler. Glob Pediatr Health. Curr Probl Pediatr Adolesc Health Care. Malaria requires 3 negative thick and thin smears over 12 hours to fully exclude.

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Infectious Diseases Pediatrics Sepsis Documentation/Coding 164