Tactical Medicine News Blog

The Case of the Solo Senior outlined a scenario of an emergency attending who questioned the common consultant call-etiquette of not activating back-up call, whether that be another resident or the attending physician, on a busy call shift when the “solo senior” is obviously overwhelmed. This month, the MEdIC team (Tamara McColl, Teresa Chan, Sarah Luckett-Gatopoulos, Eve Purdy, John Eicken, Alkarim Velji, and Brent Thoma), hosted a discussion around this case with insights from the ALiEM community. We are proud to present to you the curated community commentary and our expert opinions. Thank-you to all participants for contributing to the very rich discussions surrounding this case!

Background: Fever without source in infants less than three months old presents a difficult diagnostic dilemma for ED physicians.  Over the past 25 years several algorithms have been developed to help guide clinicians, most notably the Rochester, Philadelphia and Boston Criteria, in determining which infants require admission vs. outpatient management.  These studies were designed published between 1992 and 1994 prior to the wide spread use of HiB and pneumococcal vaccines in children, maternal GBS screening and the development of many new biomarkers.  The Step-by-Step approach to febrile infants was developed by a European group of pediatric emergency physicians with the objective of identifying low risk infants who could be safely managed as outpatients without lumbar puncture or empiric antibiotic treatment. The algorithm was designed using retrospective data and this study attempts to prospectively validate it.

“We do make a difference, but not just in the setting of resuscitating critically ill or injured people, but in putting people on the pathway to health. We often get cheated out of the ending of the movie. We don’t see the romantic side of what we’ve helped facilitate. We certainly don’t get credit for it.” – Dr. Richard Cantor There are lots of reasons why Emergency Medicine (EM) has one of the highest burnout rates compared to other medical specialties.1,2 We have long and erratic hours, difficult patients, and an increasing number of bureaucratic tasks such as clicking boxes in an electronic medical records system or ensuring high patient-satisfaction survey responses.2 These stresses are not unique to EM, but our high-volume and high-acuity patient loads do amplify those stresses compared to other fields.

Management of the pediatric trauma patient is challenging regardless of where you work. In this EM Cases episode, with the help of two leading pediatric trauma experts, Dr. Sue Beno from Hospital for Sick Children in Toronto and Dr. Faud Alnaji from Children's Hospital of Eastern Ontario in Ottawa we answer such questions as: what are the most important physiologic and anatomic differences between children and adults that are key to managing the trauma patient? How much fluid should be given prior to blood products? What is the role of POCUS in abdominal trauma? Which patients require abdominal CT? How do you clear the pediatric c-spine? Are atropine and fentanyl recommended as pre-induction agents in the pediatric trauma patient? How can the BIG score help us prognosticate? Is tranexamic acid recommended in early pediatric trauma like it is in adults? Is the Pediatric Trauma Score helpful in deciding which patients should be transferred to a trauma center? and many more... The post Episode 95 Pediatric Trauma appeared first on Emergency Medicine Cases.

Management of the pediatric trauma patient is challenging regardless of where you work. In this EM Cases episode, with the help of two leading pediatric trauma experts, Dr. Sue Beno from Hospital for Sick Children in Toronto and Dr. Faud Alnaji from Children's Hospital of Eastern Ontario in Ottawa we answer such questions as: what are the most important physiologic and anatomic differences between children and adults that are key to managing the trauma patient? How much fluid should be given prior to blood products? What is the role of POCUS in abdominal trauma? Which patients require abdominal CT? How do you clear the pediatric c-spine? Are atropine and fentanyl recommended as pre-induction agents in the pediatric trauma patient? How can the BIG score help us prognosticate? Is tranexamic acid recommended in early pediatric trauma like it is in adults? Is the Pediatric Trauma Score helpful in deciding which patients should be transferred to a trauma center? and many more... The post Episode 95 Pediatric Trauma appeared first on Emergency Medicine Cases.