That’s Twisted – A Review of Pediatric Volvulus
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Pediatric volvulus is associated with a high morbidity and mortality rate but remains a challenging diagnosis. This review highlights pearls and pitfalls of diagnosis and management.
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High risk and low incidence diseases: Pediatric digestive volvulus. Am J Emerg Med. 2024 Aug;82:153-160. doi: 10.1016/j.ajem.2024.06.012. Epub 2024 Jun 14. PMID: 38908340.
Putting Patients in Their Place…at the Center of Emergency Care
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In the complex world of modern medicine, it often requires purposeful thought and action to place our patients at the center of the care process. This study serves to remind us how to employ evidence-based patient-centered care during the course of emergency medicine (EM) practice.
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Recommendations for patient-centered emergency care. CJEM. 2024 Aug;26(8):513-519. doi: 10.1007/s43678-024-00706-3. Epub 2024 Jun 21. PMID: 38904747.
PGY, Laryngoscopic View, and ETT Placement Success
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This retrospective study found increased first pass success (FPS) when EM post-graduate year (PGY) PGY2s, 3s, or 4s intubated patients with Cormack-Lehane grade 3 or 4 airways compared to EM PGY1s. There was no difference in obtained views by PGY after PGY1.
Source
Emergency Medicine Postgraduate Year, Laryngoscopic View, and Endotracheal Tube Placement Success. Ann Emerg Med. 2024 Jul;84(1):11-19. doi: 10.1016/j.annemergmed.2024.03.004. Epub 2024 Apr 19. PMID: 38639674.
Does Piperacillin-Tazobactam Increase Mortality?
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In adult patients with sepsis, empiric use of vancomycin and piperacillin/tazobactam compared to vancomycin and cefepime, when anti-anaerobic coverage was not clinically indicated, was associated with a 5% increase in mortality.
Source
Mortality of Patients With Sepsis Administered Piperacillin-Tazobactam vs Cefepime. JAMA Intern Med. 2024 Jul 1;184(7):769-777. doi: 10.1001/jamainternmed.2024.0581. PMID: 38739397.
Bubble Time – A New, Simple Way to Detect RV Dysfunction
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By agitating and injecting a saline flush into an IV catheter, right ventricular (RV) dysfunction was identified when bubbles were cleared from the RV at a time of ≥ 40 seconds with high sensitivity. It was ruled out as well with good specificity, with a bubble time < 40 seconds.
Source
Right Ventricular "Bubble Time" to Identify Patients With Right Ventricular Dysfunction. Ann Emerg Med. 2024 Aug;84(2):182-194. doi: 10.1016/j.annemergmed.2024.02.005. Epub 2024 Apr 10. PMID: 38597847.
Radiate Positivity – ACEP Policy on Advanced Imaging in Pediatrics
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Advanced imaging, including ultrasound, MRI, and CT, is an important tool for diagnosing children in the emergency department. This policy statement provides guidance to help clinicians optimize the use of these diagnostic tools.
Source
Optimizing Advanced Imaging of the Pediatric Patient in the Emergency Department: Policy Statement. Ann Emerg Med. 2024 Aug;84(2):e13-e23. doi: 10.1016/j.annemergmed.2024.03.023. PMID: 39032991.
Even a Blind Squirrel…Estimating Gestational Age with AI
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AI-enabled ultrasound devices are able to accurately estimate gestational age (GA) between 14 and 27 weeks when employed by novice users. This is particularly of importance in resource poor settings.
Ultrasound + Pediatric Appendicitis Risk Calculator = Rule Out?
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This was a single center retrospective study at a tertiary pediatric ED of patients with suspected pediatric appendicitis. The authors found that combining a low pediatric Appendicitis Risk Calculator (pARC) result with a nondiagnostic ultrasound results in a high negative predictive value for appendicitis.
Source
Identification of children with a nondiagnostic ultrasound at a low appendicitis risk using a pediatric Appendicitis Risk Calculator. Acad Emerg Med. Published online July 21, 2024.
Lipliner Sign and False Positive FAST – Is Ultrasound Too Smart?
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Post-processing techniques completed by ultrasound machines to improve spatial resolution has gotten so advanced that it now can fool us into thinking a FAST exam is positive.
Source
The Lipliner Sign: Potential Cause of a False Positive FAST Examination. Journal of Emergency Medicine, June 28, 2024; https://doi.org/10.1016/j.jemermed.2024.06.013
Honey, Don’t Forget About Botulism
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Maintaining a high suspicion for botulism is crucial in making a prompt diagnosis and in reducing morbidity and mortality. This review highlights pearls and pitfalls of diagnosis and management.
Source
High risk and low prevalence diseases: Botulism. Am J Emerg Med. 2024 Aug;82:174-182. doi: 10.1016/j.ajem.2024.06.018. Epub 2024 Jun 20. PMID: 38925095.