Don't Forget the Bubbles

JUNE 19, 2023

Fetal Growth Restriction (FGR) and dysmaturity are common in neonatology and are a leading cause of morbidity during the neonatal period, as well as later in life. J Pediatr 2018;196:71-6. Pediatrics 2022;149:e2021053413. Curr Pediatr Rev 2018;14:212–8. Eur J Pediatr 2016;175:1047-57. J Pediatr 2015;167:238-45.

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Pediatrics Ultrasounds Hyperthermia / Hypothermia Sepsis 143

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

EMDocs

OCTOBER 19, 2024

Leukocytosis, as well as mild leukopenia, are common. 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.

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EMS Pediatrics Sepsis Airway Management 106

Pediatric EM Morsels

APRIL 7, 2023

There are many conditions that we would like to think belong only to the “ adult patient problem DDx; ” however, as we have discussed several times previously, pediatric patients can experience many “adult conditions” (see, Aortic Dissection , Kidney Stones , and Cholecystitis ). Expert Rev Hematol. doi: 10.1586/ehm.13.25.

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Stroke Pediatrics Seizures Sepsis 130

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 Outcomes Pediatrics Documentation/Coding 75

The Skeptics' Guide to EM

SEPTEMBER 30, 2017

Natalie May trained as an emergency physician with subspecialty paediatric emergency medicine in the UK and worked in Manchester and Oxford before moving to Australia in 2015 to work for Sydney […] The post SGEM#190: Wee are the Champions of Pediatric Urine Samples first appeared on The Skeptics Guide to Emergency Medicine.

Pediatrics 52

Pediatrics Emergency Department Sepsis Wellness 52

Pediatric Emergency Playbook

SEPTEMBER 1, 2015

Get up-to-date in the understanding and management of pediatric status epilepticus. This definition includes clinically apparent seizures as well as those seen only on EEG.) Or… is it something else as well? Pediatric status epilepticus is analogous to the multi-organ dysfunction syndrome in severe sepsis.

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Pediatrics Seizures Stroke Radiology 40

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. Tachycardia may be present both from many medications or drugs, as well as withdrawal. What is this patient’s disposition? In short: yes, but it depends.

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Shock Emergency Department Pediatrics EKG/ECG 105

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.

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Fluid Resuscitation Pediatrics Sepsis Shock 59

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

Don't Forget the Bubbles

JUNE 30, 2023

You will be running the show today, and you want to use your preparation time well. 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.

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Resuscitation Operations Sepsis Pediatrics 139

Don't Forget the Bubbles

MAY 31, 2023

The DIMPLES study by PERUKI sought to investigate the incidence of new-onset diabetes in the paediatric population across the UK and Ireland, as well as the characteristics of these ED presentations, and to determine if SARS-CoV2 infection was involved. Which patients were involved? How good was this paper? Do you believe the results?

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Emergency Department Research Documentation/Coding Outcomes 135

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

PEMBlog

OCTOBER 18, 2023

PEMPix is the American Academy of Pediatrics Section on Emergency Medicine’s annual visual diagnosis competition. The night prior to presentation, mom noticed he was not feeding as well and seemed fussy. Initially in the emergency department he was generally well-appearing with normal vital signs. Labs were notable for: WBC 9.1

Infectious Diseases 59

Infectious Diseases Shock Pediatrics Wellness 59

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 84

EMDocs

NOVEMBER 27, 2023

ESR & CRP – nonspecific and typically elevated Blood culture – if presenting with sepsis Imaging: Consider a chest radiograph in patients with pulmonary symptoms to evaluate for associated pneumonitis, pleural effusions, cardiomegaly. Case Rep Pediatr. Rule out confounding viral or autoimmune hepatitis. Am J Emerg Med. 2022;56:1-6.

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EMS Sepsis Burns EKG/ECG 91

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.

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CPR Resuscitation Pediatrics Hospitals 52

The Skeptics' Guide to EM

SEPTEMBER 28, 2019

But you remember seeing in the news there was a study claiming vitamin C could cure sepsis. Background: There was a huge buzz in the media a few years ago about a vitamin C cocktail (vitamin C, hydrocortisone and thiamine) as a possible cure for sepsis. This was because of a well-known critical care physician Dr. Paul Marik.

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Sepsis Shock Outcomes Stroke 52

EMDocs

OCTOBER 25, 2024

ESR & CRP – nonspecific and typically elevated Blood culture – if presenting with sepsis Imaging: Consider a chest radiograph in patients with pulmonary symptoms to evaluate for associated pneumonitis, pleural effusions, cardiomegaly. Provide clear instructions for use and have patient throw it out after 24 hours.

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Sepsis Burns EKG/ECG EMS 91

PEMBlog

MARCH 27, 2024

My special guest podcaster, Emily Groopman, is an actual Pediatric Geneticist in training and we hope that you will find this episode useful. Pediatr Rev. Pediatrics. Transcript Note: This transcript was partially completed with the use of the Descript AI Welcome to PEM Currents, the Pediatric Emergency Medicine Podcast.

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Pediatrics Seizures Emergency Department Sepsis 59

Taming the SRU

AUGUST 30, 2023

As the name would suggest, inflammatory markers are biological markers of, well, inflammation. Sepsis PCT may have some utility in guiding posttest probability for sepsis when the diagnosis is unclear. High serum procalcitonin concentrations in patients with sepsis and infection. days (secondary endpoint) [51].

Infectious Diseases 89

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

Pediatric Emergency Playbook

MAY 1, 2017

Pediatrics. Pediatrics. Home care The neonate who is safe to go home is well appearing, and not dehydrated. Make sure to enlist the family's help and support to keep Mom hydrated, eating well, and resting whenever she can. Check the bilirubin in any neonate you are working up for sepsis. Can I go Home Now?

Dehydration 52

Dehydration Pediatrics Wellness Seizures 52

Pediatric Education

AUGUST 20, 2023

Patient Presentation An 8-year-old male came to clinic for his well-child care after moving to the area. Patients needed prolonged treatment and followup (up to 88 days) but did well without recurrences. in the pediatric populations as noted above. J Pediatr Gastroenterol Nutr. Pediatr Infect Dis J.

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Pediatrics Infectious Diseases Wellness Sepsis 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. Groups were well matched at baseline. Pediatr Crit Care Med. Pediatr Blood Cancer.

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Blood Transfusions Research Outcomes Hospitals 78

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

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

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

Broome Docs

APRIL 6, 2023

Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. Epinephrine metered-dose inhaler for pediatric croup. Casey The CLOVERS trial: National Heart, Lung, and Blood Institute Prevention and Early Treatment of Acute Lung Injury Clinical Trials Network; Shapiro NI, Douglas IS, Brower RG, et al. N Engl J Med.

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Sepsis Ultrasounds Hospitals Fractures 52

Pediatric Education

SEPTEMBER 10, 2023

The patient had a sepsis evaluation and was started on empiric antibiotics. Surgical treatment may include ligation as well as vascular re-implantation. These patients may have tracheal stenosis as well as ~75% may have complete cartilaginous tracheal rings. Surgical correction may also include tracheal correction as well.

Pediatrics 40

Pediatrics Radiology Radiology Sepsis 40

Pediatric Emergency Playbook

JULY 1, 2016

Lab work can be helpful, as well as US of the hip to look for an effusion, but sometimes, regardless of the results, the joint just has to be tapped to know for sure. Children with limb-length discrepancy only need a non-urgent referral to pediatric orthopedics to look for congenital dysplasia of the hip, or other growth abnormalities.

Fractures 52

Fractures Poisoning Wellness Sepsis 52

Don't Forget the Bubbles

JUNE 10, 2024

Baby A, a preterm infant, appears to be faring well for the moment—requiring minimal respiratory support, on full feeds, without IV access, and generally in an okay condition. Systemic Infections : Sepsis and other systemic infections can predispose infants to NEC by compromising the gut barrier and promoting inflammation. Longford, N.,

Pediatrics 40

Pediatrics Sepsis Fluid Resuscitation Outcomes 40

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. As well as considering volume, hyponatraemia is a harmful consequence of incorrect administration of fluids. Pediatrics. Remember, we can add more if needed, but taking it away is much harder. Crit Care Med.

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Resuscitation Dehydration Administration Shock 80

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

Northwestern EM Blog

MAY 16, 2022

The above study was well summarized and bears repeating that, in this multicenter randomized study assessing CT vs POCUS vs radiology performed US in patients with suspected renal colic in the ED setting, initial US reduced radiation exposure without adversely affecting patient-centered outcomes. were hospitalizations during f/u period; 26.4%

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Ultrasounds Radiology Radiology Outcomes 52

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