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Video on How to Tell Stroke vs. Mimic on Exam

Video on How to Tell Stroke vs. Mimic on Exam

The "upgoing thumb sign" can be used as part of a comprehensive neurological evaluation to help distinguish stroke mimic from actual stroke.  It won't replace MRI, but it can be part of the neurological exam, just like we use the Babinski sign.  One editorial from 1993 suggested calling it the Hachinski-Babinski, after the discover.  Here's how to do it.

Avoiding Adverse Events in Pediatric Sedation

Avoiding Adverse Events in Pediatric Sedation

This large multi-center prospective study of pediatric sedation found adverse events occurred in 12%, most mild desaturation or vomiting.  Severe adverse events occurred in 1%.  Ketamine given alone was the safest drug.  Propofol alone, ketamine + fentanyl, or ketamine + propofol were associated with greater risk for severe adverse events.

Does This Child Have Pneumonia?

Does This Child Have Pneumonia?

No clinical criteria were powerful diagnostic discriminators of the presence or absence of pneumonia in children, though some were fair.  When in doubt, a CXR is probably warranted, with the exceptions of obvious bronchiolitis or asthma.  Low SpO2 (</= 95 to 96%) or increased work of breathing were the best predictors of radiographic pneumonia in children; auscultatory findings and tachypnea were poor.  You don't need a CXR if no cough, no fever, no tachypnea, and normal SpO2.

Does Peds Damage Control Transfusion Help?

Does Peds Damage Control Transfusion Help?

A high plasma to PRBC transfusion ratio (>/= 1:2) was not beneficial in pediatric massive trauma transfusion. But this study was different than adult studies of damage control resuscitation in that these children did not receive platelets

Increased Mortality With Prehospital Intubation

Increased Mortality With Prehospital Intubation

Numerous observational studies have suggested that prehospital intubation (PHI) (in this case of trauma patients) was associated with greater mortality than when it was done in the ED, and this systematic review indicated the same thing.

How to Diagnose Pertussis at the Bedside

How to Diagnose Pertussis at the Bedside

I couldn't state it better than the author's conclusion: "In adult patients, the presence of whooping or posttussive vomiting should rule in a possible diagnosis of pertussis, whereas the lack of a paroxysmal cough or the presence of fever should rule it out. In children, posttussive vomiting is much less helpful as a clinical diagnostic test."

Low-Dose Perfusion or CTPA for PE in Pregnancy?

Low-Dose Perfusion or CTPA for PE in Pregnancy?

Low dose perfusion-only (LDQ) nuclear scan (the "Q" of the V/Q scan) or CTPA are the imaging studies of choice to diagnose PE in pregnant women.  LDQ (using one-third the normal technetium) had high accuracy and lower radiation dose and may be preferred over CTPA, assuming the CXR is normal.

Another Nail in the Coffin for Apneic Oxygenation?

Another Nail in the Coffin for Apneic Oxygenation?

Patients intubated in the Emergency Department with usual care (no apneic oxygenation) vs apneic oxygenation (≥15L/min via nasal cannula) did not have significant differences in lowest mean oxygen saturation.

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