Infant LP – Is Sitting or Lateral Recumbent Position Better?
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There was no statistically significant difference in adequate cerebrospinal fluid collection or rate of traumatic taps for lumbar punctures performed on infants <92 days of age when comparing sitting versus lateral recumbent positioning for the procedure.
Source
Retrospective study comparing success rates of lumbar puncture positions in infants. Am J Emerg Med. 2022 Jun;56:228-231. doi: 10.1016/j.ajem.2022.04.013. Epub 2022 Apr 12.
Should We Use Ultrasound-Guided IV in Kids?
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Ultrasound guided peripheral intravenous cannulation (PIVC) has been shown to be effective in some pediatric populations.
Source
Ultrasound for Pediatric Peripheral Intravenous Catheter Insertion: A Systematic Review. Pediatrics. 2022 May 1;149(5):e2021055523. doi: 10.1542/peds.2021-055523.
Does Vapocoolant Spray Work When Used Before Digital Block?
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Vapocoolant spray improved pain from digital blocks for repair of finger injuries.
Source
Evaluation of vapocoolant spray effect on pain reduction during digital nerve block: A randomized clinical trial. Am J Emerg Med. 2021 Dec;50:260-263. doi: 10.1016/j.ajem.2021.08.001. Epub 2021 Aug 6.
Does IV Acetaminophen Reduce Morphine Use?
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A 1g dose of IV acetaminophen had no additional effect on pain control or reduction in overall morphine dosage.
Source
Intravenous acetaminophen does not reduce morphine use for pain relief in emergency department patients: A multicenter, randomized, double-blind, placebo-controlled trial. Acad Emerg Med. 2022 May 2. doi: 10.1111/acem.14517. Epub ahead of print.
POCUS for Predicting Difficult Airways
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Upper airway ultrasound (UA-US) may eventually help us predict if a patient will have a difficult laryngoscopy. However, this is not ready for ED use, and more studies are needed.
Source
Airway Ultrasound as Predictor of Difficult Direct Laryngoscopy: A Systematic Review and Meta-analysis. Anesth Analg. 2022 Apr 1;134(4):740-750. doi: 10.1213/ANE.0000000000005839.
How to Use Nerve Blocks for Acute Headache
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Peripheral nerve blocks may help achieve symptomatic improvement in our primary headache patients, but we are still far off with research supporting it as a first line intervention.
Source
Effectiveness of Peripheral Nerve Blocks for the Treatment of Primary Headache Disorders: A Systematic Review and Meta-Analysis. Ann Emerg Med. 2022 Mar;79(3):251-261. doi: 10.1016/j.annemergmed.2021.08.007. Epub 2021 Oct 28.
Can Parents Remove Scalp Staples at Home?
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Home scalp staple removal by a parent is largely successful. Parent education and loss to follow up are some challenges to this approach.
Source
Scalp Staples Placed in a Pediatric Emergency Department: Feasibility and Benefits of Home Removal. Pediatr Emerg Care. 2022 Mar 1;38(3):e1143-e1146. doi: 10.1097/PEC.0000000000002213.
They Catch on Fire – Electrocautery Trephination with Acrylic Nails
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Electrocautery trephination of acrylic nail products attached to simulated digits was associated with a high likelihood of ignition (83/200; 41.5%). Based on this limited data, electrocautery trephination of acrylic nails should be avoided to reduce risk of further patient harm.
Source
Up in Flames: The Safety of Electrocautery Trephination of Subungual Hematomas with Acrylic Nails. West J Emerg Med. 2022 Feb 23;23(2):183-185. doi: 10.5811/westjem.2021.10.53567.
Is High-dose Intranasal Fentanyl Safe in Children?
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Higher doses of intranasal fentanyl for pain ranging from 2-5 μg/kg (with a maximum of 200 μg) were given in a pediatric emergency department, with no documented episodes of apnea, hypotension, or respiratory failure.
Source
The Safety of High-Dose Intranasal Fentanyl in the Pediatric Emergency Department. Pediatr Emerg Care. 2022 Feb 1;38(2):e447-e450. doi: 10.1097/PEC.0000000000002627.