![]() The Role of the ECG in Acute Nontraumatic BLE Weakness Acute bilateral lower extremity paralysis
Hypokalemic periodic paralysis I. Familial hypokalemic periodic paralysis
Hyperkalemic paralysis
ECG signs of severe hyperkalemia
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![]() Pediatric pericardial effusion/pericarditis 1) Kids with chest pain also hide gremlins 2) Consider bedside echo for all pediatric chest pain visits! 3) Effusions of 500cc, circumferential, or 2 cm on CT scan are by definition LARGE and likely mandate admission and stat echo looking for tamponade 4) Ultrasound guidance for bedside pericardiocentesis is the new standard 5) Be vigilant in sign outs, always add an update note Abdominal pigtail placement 1) Small bore seldinger technique makes abdominal placement more likely, you can't finger sweep 2) Consider clamping the introducer needle at the skin once air is aspirated to avoid unintentional advancement 3) Remember the triangle of safety, go as high as possible with pigtails 4) In the event of an abdominal mishap, scan the region and discuss with surgery Headache with ICH/IVH 1) Be wary of the "different" migraine 2) Deep brain structure bleeding is associated with intraventricular extension 3) IVH carries a 20-50% in hospital mortality 4) ABCs, potential emergent EVD placement 5) Even though a CT head is negative within the window, the LP may give you additional information that makes the diagnosis (opening pressure, cell counts, etc) ![]()
![]() 1: Case reports and case series are foundational to clinical research. 2: Case reports and case series provide the opportunity for clinicians to describe novel clinical management and treatment of patient case(s). 3: Case reports and case series provide clinicians to offer “clinical pearls” to trainees and junior clinicians. 4: Despite inability to perform hypothesis tests, case reports offer the opportunity clinician investigators to develop a command of a clinical condition/disease state and treatment/management protocol. ![]() Define status epilepticus:
Consider etiologies:
Remember ABCs and supportive care in addition to treating seizures Learn dosing for hypoglycemic seizure with dextrose
Learn dosing for hyponatremia seizure with 3% NaCl Medications First line:
Second line:
Refractory/Third line:
![]() Differential Diagnosis
When the intrinsic rhythm is sinus: I. What was the first beat of the tachycardia?
When the intrinsic rhythm is atrial fibrillation:
Artifact Always consider artifact if:
![]() 1. Osteomyelitis can be difficult to detect in the ED so always maintain a high suspicion for it in children with refusal to bear weight or persistent pain in a long bone. 2. Bloodwork rarely helps diagnose osteomyelitis, but can be reassuring if normal and you have low suspicion. 3. X-rays help rule-out other causes of pain such as fracture but more definitive imaging (i.e. MRI vs bone scan) are usually needed to diagnose. ![]() Steven-Johnsons Syndrome: - Diffuse, PAINFUL rash after viral prodrome, mucocutaneous lesions - Severity described by percentage of bulous lesions: SJS at < 10% coverage (10% mortality) vs. TEN at > 30% coverage (30% mortality) - Treatment: stop offending agent, IVF, supportive care, consider steroids DVT Negative PE: - Consider follow-up US in clinically appropriate population of negative lower extremity US. - In PEA of unknown origin remember Goal Directed Echo to evaluate for PE: RV enlargement, poor RV function, flat or leftward bowing septum. CODE COOL Update: - Improvement needed with early vasopressor therapy. Early, aggressive Norepi use for MAP < 70. - When cooling remember 15 ice packs, cold fluids at 30ml/kg and paralytics. ![]() 1. A systematic approach to describing rashes should include the following: - Identification of primary lesion type with or without secondary changes; - Lesion color; - Lesion shape/pattern; - Lesion distribution 2. Red flag history/exam features, suggestive of life threatening rash, include: - Fever/hypotension, - Immunocompromised status, - Extremes of age, - Petechiae/purpura, - Mucosal involvement, - Diffuse erythroderma ![]() Family Presence During a Code
Cardiac syncope
ii. Normal EKG and Physical exam iii. Unlike ALCAPA where the EKG and PE will be abnormal from chronic ischemia iv. Diagnosed in older children and teens v. Usually presents with exertional syncope vi. Needs PEDIATRIC cardiology referral Exertional syncope is cardiac until proven otherwise!
Pediatric CPR
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