Pediatric EM Morsels

JULY 19, 2024

Since tonsillectomy is one of the most common pediatric surgeries in the US (~500,000 per year) and the rate of post-tonsillectomy hemorrhage is about 1-5% , it is a good idea that we all are familiar with how to manage this issue! 2020 Sep;38(9):1943. Rohe E, Gresham M, Rohde R, Cass L, Brinkmeier JV, Childers A. 2020.01.042.

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E-9-1-1 Epinephrine Emergency Department OR 293

Pediatric EM Morsels

OCTOBER 27, 2023

Initially tested in Johannesburg, South Africa: 1 month old to 12 years old Broselow predicted within 10% of weight in 63.6% 2007-2902 Wells M, Coovadia A, Kramer E, Goldstein L. 2020;13(1):9. 2016;23(1):21-28. 2019 Jan;22(1):147-156. There are other systems that account for body habitus. Broselow does not.

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E-9-1-1 Emergency Medical Services Life Support ALS 274

ALiEM

NOVEMBER 1, 2023

Iron toxicity treated with deferoxamine Background Deferoxamine is the treatment for severe iron toxicity [1]. Deferoxamine 1] Initial dosing starts at 5 mg/kg/hr intravenously. 1, 3, 4] Hypotension is generally the rate-limiting factor for the infusion rate. McGraw-Hill Education; 2019 Madiwale T, Liebelt E. 2023 May 22.

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E-9-1-1 ALS OR ED 161

ALiEM

APRIL 12, 2024

Traditionally large-bore tube thoracostomy has been the standard of care for treating many acute intrathoracic pathologies [1]. Pigtails provide a less invasive and often better tolerated alternative to traditional chest tubes and allow for adequate treatment of pneumothoraces and uncomplicated pleural effusions [1-5]. 1999;3(1):57-61.

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E-9-1-1 ALS Critical Care Emergency Department 183

ALiEM

MAY 19, 2023

The SB tube was created in 1950 in order to help tamponade variceal bleeds [1]. Apply traction to the tube by tying a roller bandage to the end of it and then the other end to a 1 L bag of IV fluids. Pearl 1: Check the units of pressure being used. The conversion rate is: 1 cmH2O = 0.74 1950 May;131(5):781-9.

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E-9-1-1 Emergency Department ICU OR 245

ACEP Now

DECEMBER 7, 2024

1 The reason is understandablethrombolytics in stroke is a high-risk, higher-reward treatment. Acceptance of thrombolytics in stroke is exemplified in the results from a survey of EDs participating in ACEPs Emergency Quality Network (E-QUAL) Stroke Collaborative. Click to enlarge. Click to enlarge.

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E-9-1-1 ED Emergency Department OR 98

This Podcast Will Kill You

FEBRUARY 11, 2025

Journal of Zoological Systematics and Evolutionary Research, 46(1), pp.19-23. Anais da Academia Brasileira de Cincias, 96(1), p.e20230706. Gompper, Matthew E., Diseases of Aquatic Organisms, 66(1), pp.87-90. Pathogens, 9(3), p.230. Carlson, Colin J., ” Science advances 3.9 2017): e1602422. and Okamura, B.,

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E-9-1-1 ALS OR 97

Pediatric EM Morsels

SEPTEMBER 22, 2023

Negative E-FAST and no signs of long bone injuries should raise concern for neurogenic shock in the hypotensive trauma patient with suspected spinal injury. Alpha 1 agonists are necessary to maintain appropriate blood pressure. 2011;46(9):1771. McGraw Hill Education; 2019:125-138 Ziu E, Mesfin FB. J Pediatr Surg.

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E-9-1-1 Epinephrine ALS ED 307

ALiEM

AUGUST 9, 2023

Technique Positioning and Probe Figure 1: Younger children can sit in their parent’s lap and give a hug for lateral and posterior lung scanning. The patient should be in a position of comfort: supine, sitting, or in parent’s lap (Figure 1). Identify anatomical landmarks on ultrasound (Figure 3, Video 1). Tsou et al.,

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E-9-1-1 Emergency Department ALS OR 246

ACEP Now

JUNE 17, 2025

1 According to the ACEP Code of Ethics: The physician-patient relationship is the moral center of medicine and the defining element in clinical ethics. 2018;13(9):e0204113. 2017;17(1):136. 2020;20(1):52. 2023;23(1):270. Winter R, Issa E, Roberts N, et al. 2020;10(9):e036471. 2020;103(9):1866-1867.

Emergency Department 52

Emergency Department E-9-1-1 ALS ED 52

ALiEM

MARCH 7, 2024

Ultrasound probes from left to right: linear (nenoates), phased array (infants/younger children), and curvilinear (older children/adolescents) Pro tips for performing renal/bladder POCUS on a child [1] Addressing potential anxiety leads to a more efficient and comfortable examination. Estimated volume = 39.2

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E-9-1-1 Emergency Department ALS ED 177

Dr. Smith's ECG Blog

DECEMBER 19, 2023

link] A 62 year old man with a history of hypertension, type 2 diabetes mellitus, and carotid artery stenosis called 911 at 9:30 in the morning with complaint of chest pain. Challenge QUESTION: The relative change in T-QRS-D is not the only thing that changes during period of time that passed between recording of the 2 ECGs shown in Figure-1.

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E-9-1-1 Coronary ACS BLS 130

Dr. Smith's ECG Blog

DECEMBER 29, 2024

The Queen of Hearts also knows which large T-waves are hyperacute and which are not: She knows that it is not OMI (Unfortunately, most providers no longer have access to the Queen of Hearts because 1) it is not yet FDA approved and 2) thus a provider can only use it in the context of research.) Here are 9 cases that involve re-occlusion.

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E-9-1-1 STEMI Critical Care OR 69

Dr. Smith's ECG Blog

NOVEMBER 11, 2024

The ECG shows sinus rhythm with a rate of about 78 and 2:1 AV conduction along with right bundle branch block and left anterior fascicular block. 2:1 block is a special case, because the tracing lacks successive PR intervals. I have labeled the P waves below for ease of reference: P waves 8 and 9 both conduct to the ventricles.

OR 74

OR E-9-1-1 Coronary 74

ALiEM

MAY 13, 2024

Her symptoms started 1 week ago as a scratch which progressively got more red and painful. Pediatric Soft Tissue POCUS Ultrasound Technique Figure 1. Cellulitis with cobblestoning Video 1. Abscess with irregular borders and surrounding cellulitis E. Superficial abscess with well-circumscribed borders Table 1.

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E-9-1-1 ALS Emergency Department OR 161

Dr. Smith's ECG Blog

OCTOBER 3, 2024

I agree, however: 1) I don't think you can get a good enough ech o without bubble contrast. 3) E cho is another step that takes time. I had only 9 false positives but I missed 2 OMI. The rhythm for the ECG in Figure-1 is sinus — with normal intervals and axis ( mean QRS axis about +80 degrees ). Time is myocardium.

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E-9-1-1 Coronary ALS ED 127

Dr. Smith's ECG Blog

AUGUST 14, 2024

R waves 6 through 9 have no preceding P waves and are suspiciously regularly spaced. Impulses E, F, G, H, and I were blocked. Progress in Biophysics and Molecular Biology , 120 (1–3), 164–178. Science Translational Medicine , 9 (400). Figure-1: I've labeled the initial ECG in today's case to illustrate my theory.

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E-9-1-1 OR ALS 113

FOAMfrat

JANUARY 7, 2025

His wife tells us he's a long-term alcoholic who drinks several pints of vodka every day, and 3 days ago tried to start weaning himself off by drinking less than 1 pint. Journal of Clinical Medicine , 9 (6), 1901. 2023, October 1). Ben-Menachem, E., Brodtkorb, E., Acta Neurologica Scandinavica , 135 (1), 416.

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E-9-1-1 ALS EMS OR 59

Dr. Smith's ECG Blog

DECEMBER 27, 2023

Written by Willy Frick A man in his 50s with a history of hypertension, dyslipidemia, type 2 diabetes mellitus, and prior inferior OMI status post DES to his proximal RCA 3 years prior presented to the emergency department at around 3 AM complaining of chest pain onset around 9 PM the evening prior. ECG 1 What do you think? Grines, C.

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E-9-1-1 OR Coronary ACS 134

Pediatric EM Morsels

NOVEMBER 17, 2023

Bibl K, Pracher L, Küng E, Wagner M, Roesner I, Berger A, Hermon M, Werther T. 1994 Jul;125(1):57-62. 2019 Sep;74(9):1186-1190. 2016 Feb;30(1):3-11. Differences in intubation outcomes for pediatric patients between pediatric and general Emergency Departments. Paediatr Anaesth. 2021 Jun;31(6):713-719. doi: 10.1111/pan.14185.

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E-9-1-1 Operating Room Emergency Department ALS 190

ALiEM

AUGUST 16, 2023

Common agents include local anesthetics, dapsone, quinones, sulfonamides, phenazopyridine, and nitrites [1, 2]. Treatment for methemoglobinemia in G6PD deficiency may consist of ascorbic acid, exchange transfusion, and hyperbaric oxygen [7, 9]. PMID 23953868 Mack E. Rosen PJ, Johnson C, McGehee WG, Beutler E. 2013.02.005.

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E-9-1-1 ALS OR 130

Dr. Smith's ECG Blog

SEPTEMBER 23, 2024

Here is lead I from ECGs 1 and 2 shown side-by-side to highlight the change in axis from borderline right to completely normal. Consider the following: We become attuned to looking for acute coronary occlusion in patients who present with acute symptoms to the ED ( E mergency D epartment ).

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E-9-1-1 Coronary STEMI ALS 131

This Podcast Will Kill You

DECEMBER 10, 2024

Nature Reviews Gastroenterology & Hepatology , 20 (9), pp.615-624. 2016): 1-9. Conficconi, E., BioMed research international , 2017 (1), p.9784565. Thieme, E. JAMA network open , 4 (8), pp.e2122248-e2122248. Fitz, Reginald H. Ponsky, T.A., Huang, Z.J., Eichelberger, M.R., Gilbert, J.C., and Newman, K.D.,

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E-9-1-1 ALS Emergency Department OR 52

Broome Docs

SEPTEMBER 3, 2024

In a surprise to no one who reads First10EM, clinical judgment is better than all decision tools for sepsis Knack SKS, Scott N, Driver BE, Prekker ME, Black LP, Hopson C, Maruggi E, Kaus O, Tordsen W, Puskarich MA. Epub 2024 Apr 9. 2024 Mar;27(1):26-29. 2024 Jul 4;391(1):9-20. doi: 10.1016/S0140-6736(24)00700-1.

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E-9-1-1 Emergency Department ICU ALS 94

Don't Forget the Bubbles

AUGUST 30, 2023

The parents of 9-month-old Josie bring her into the Emergency Department with coryzal symptoms and difficulty breathing. Among those who do not always obtain a CXR, one-fifth still routinely obtained them under a certain age (2 weeks to 12 years, median of 1 year). doi: 10.1590/s1516-31802007000300005 Beyyumi, E., AlDhanhani, H.,

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E-9-1-1 Emergency Department ALS OR 130

EMDocs

MARCH 2, 2024

Answer : Pneumocephalus 1-21 Background: Pneumocephalus is defined by the presence of air within the cranial cavity. 1-3] The most common location is the frontal region, followed by the occipital and temporal regions. [4] 1-3] The most common location is the frontal region, followed by the occipital and temporal regions. [4]

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E-9-1-1 EMS OR ED 112

EMDocs

FEBRUARY 20, 2024

Fluids in Pancreatitis #1 : de-Madaria E, Buxbaum JL, Maisonneuve P, et al; ERICA Consortium. 2023 Mar 22;27(1):122. Management: 1) Discontinue meds causing hypertriglyceridemia, 2) Gemfibrozil 600 mg BID, 3) Electrolyte repletion, 4) Gentle dextrose/insulin infusion, 5) Nutritional support. N Engl J Med.

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E-9-1-1 ICU ALS OR 96

REBEL EM

JANUARY 25, 2024

What They Did: Design: Randomized, controlled, blinded-outcome trial Sites: Three emergency departments in Denmark Duration: October 9, 2019 to May 26, 2021. The first evaluation of the patient was to be done within 1 hour of arrival to ED (Including the first POCUS). to −0.66) and −1.66 (95% CI −2.09

ED 127

ED E-9-1-1 Emergency Department ALS 127

This Podcast Will Kill You

JUNE 16, 2025

The Lancet Infectious Diseases, 19(9), pp.e313-e321. The Lancet infectious diseases, 9(5), pp.281-290. ” New England Journal of Medicine Atchade, E., ” New England Journal of Medicine Atchade, E., Antibiotics, 13(1), p.96. Wasmuth, S., and Brügger, J., Morbid Mortal Weekly Rep 29:229-230, May 23, 1980.

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E-9-1-1 ALS OR 52

Broome Docs

DECEMBER 22, 2024

2024 Oct 9. There were no differences in survival (12% with IO vs 10% with IV) or neurologically intact survival (9% vs 8%). 2024 Nov 1. Restrictive vs Liberal Transfusion Strategy in Patients With Acute Brain Injury: The TRAIN Randomized Clinical Trial. doi: 10.1001/jama.2024.20424. 2024.20424. Shorter courses of antibiotics.

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E-9-1-1 ACS Paramedic Emergency Department 52

REBEL EM

MAY 27, 2024

No significant differences in heart rate 1 minute after cardioversion were observed between the three groups. 2010;17(1):44-49. 4 patients were considered as failure to antiarrhythmic for recurrence within 5 min of conversion, 3 of them were converted with verapamil and one with amiodarone. seconds (SD = 7.73) Adenosine group: 24.24

OR 137

OR E-9-1-1 ED ALS 137

This Podcast Will Kill You

JULY 23, 2024

Official journal of the American College of Gastroenterology| ACG , 118 (1), pp.59-76. Annals of internal medicine , 172 (1), pp.ITC1-ITC16. ” BMC medicine 17 (2019): 1-20. . ” BMC medicine 17 (2019): 1-20. Gastroenterology , 160 (1), pp.63-75. ” Internal and emergency medicine 9 (2014): 249-256.

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E-9-1-1 ALS OR 98

Dr. Smith's ECG Blog

NOVEMBER 14, 2023

Learning Point: 1. For examples of such exceptions — See My Comment in the January 9, 2019 — August 22, 2020 — and June 30, 2023 posts in Dr. Smith's ECG Blog ). Figure-1: Comparison between the first 3 ECGs in today's case. How Would YOU Interpret the Serial Tracings in Figure-1? No wall motion abnormality identified.

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E-9-1-1 Coronary ED EMS 119

REBEL EM

AUGUST 30, 2023

Epidemiology 1 to 2.4 cases per 100,000 people ( Zimmerli 2010 ) More common in males with M:F of 3:1 Rate is also increasing due to increased number of spinal procedures Typically affects adults, with most cases occurring in patients over 50 years old. Other pathogens include: E. 2009 Aug; 39(1):10-7. In: Sherman SC eds.

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E-9-1-1 ALS ED OR 97

Don't Forget the Bubbles

SEPTEMBER 20, 2023

2012;161(1):44–50.e502. 2014;164(1):83-88.e2 2020;15(9):557-559. 3387 Kearney R, Edwards T, Braford M, Klein E. 2019;35(9):624-629. Value of abdominal radiography, colonic transit time, and rectal ultrasound scanning in the diagnosis of idiopathic constipation in children: a systematic review. 2017;186:87-94.e16.

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E-9-1-1 Emergency Department ALS ED 133

ACEP Now

NOVEMBER 8, 2024

1 Prehospital endotracheal intubation and EGAs are typically placed without paralytics and are reserved for unconscious, apneic, and out-of-hospital cardiac arrest patients. 9 LMAs use an inflatable mask expanded using a similar technique to the endotracheal tube cuff. 2014;4(1):77-87. 2014;18(1):106-115.

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E-9-1-1 Emergency Medical Services Emergency Medical Technician AEMT 40

REBEL EM

SEPTEMBER 27, 2023

Dosing: 1-2 mEq/kg bolus If there is a response, initiate an infusion: 150 mEq in 1L of D5W at maintenance Severely poisoned patients, may require multiple boluses of sodium-bicarbonate until the QRS narrows. 1985 Aug 22;313(8):474-9. Mohan S, Backus T, Furlano E, Howland MA, Smith SW, Su MK. N Engl J Med. PMID: 4022081.

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E-9-1-1 Overdose EMS 103