LR vs NS for Pediatric DKA

LR vs NS for Pediatric DKA

Use of any LR in pediatric patients with DKA, as opposed to only NS, was associated with lower overall costs, similar length of stay, and markedly reduced incidence of cerebral edema in this retrospective study.

Who's Giving Inappropriate Antibiotics - Urgent Care, Retail, Emergency, or Medical Office?

Who's Giving Inappropriate Antibiotics - Urgent Care, Retail, Emergency, or Medical Office?

Urgent care centers wrote the most inappropriate antibiotic prescriptions for viral respiratory illnesses.  They were followed by the ED, medical offices, and finally by retail health clinics.

Acetaminophen 3rd Trimester and Ductal Closure

Acetaminophen 3rd Trimester and Ductal Closure

Acetaminophen use during late pregnancy was associated with premature ductus arteriosus closure in these two cases.

NPO Status - No Correlation With Sedation Outcomes

NPO Status - No Correlation With Sedation Outcomes

In this cohort of thousands of pediatric ED sedation patients who didn't meet the American Society of Anesthesiologists (ASA) fasting guideline, none had aspiration nor was there any correlation of fasting time with any adverse events or vomiting.  It is time to change hospital NPO policies for the ED.

Start Strong, Finish Weak - Attending Shift Productivity

Start Strong, Finish Weak - Attending Shift Productivity

Attending physician productivity peaks at the beginning of the shift, starting with about 3 new patients in the first hour and decreases as the shift progresses.  This has important implications for staffing models.  Assuming a simple, uniform average over the shift won't work.

Time to Epi for Non-Shockable Rhythm Matters

Time to Epi for Non-Shockable Rhythm Matters

Earlier epinephrine administration for non-shockable rhythm was associated with better overall survival to discharge and neurologically-intact survival.  Reducing EMS time to the scene, time to IV (or IO) access, and time to drug may improve survival in this group of patients.

GlideScope Not Easy to Use in Kids

GlideScope Not Easy to Use in Kids

The GlideScope in pediatric patients was not easy to use.  Experienced intubators had technical difficulty 58% of the time, most often just as the tube passed the cords.  Clockwise rotation helped passage.  You must practice with it before you use it on live patients.

Influenza Kills - A Sobering Reminder

Influenza Kills - A Sobering Reminder

Influenza killed 675 children from the 2010-11 flu season to the 2015-16 season.  Infants under 6 months had the highest incidence of mortality.  Encourage everyone to get vaccinated.  Antiviral treatment is encouraged in all children under 2, all patients with severe illness, and all hospitalized patients regardless of whether or not the duration of illness exceeds 48 hours.

Does Pan-Scan Benefit Pediatric Trauma Patients?

Does Pan-Scan Benefit Pediatric Trauma Patients?

Whole body CT vs selective CT in children with trauma did not result in mortality benefit.  This large, retrospective study with propensity matching suggested that any additional injuries found on pan-CT may have been either not life-threatening or did not change management to produce mortality benefit.

Atraumatic Needles Drastically Reduce Post-LP Headache

Atraumatic Needles Drastically Reduce Post-LP Headache

In this large meta-analysis of 110 RCTs, the incidence of post-dural puncture headache (PDPH) was only 4.2% compared to conventional LP needles at 11%; NNT = 14.  This is a game-changer.

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