EB Medicine

FEBRUARY 18, 2024

In this episode, Sam Ashoo, MD interviews Paul Aronson, MD, MHS, one of the authors of the February 2024 Pediatric Emergency Medicine Practice article, Febrile Infants Aged ≤60 Days: Evaluation and Management in the Emergency Department Guideline Changes Pathophysiology Etiology and Definitions Prehospital Care ED History and Physical Diagnostic (..)

Emergency Department 59

Emergency Department Pediatrics 59

Don't Forget the Bubbles

OCTOBER 25, 2023

A lumbar puncture (LP) with manometry is required to diagnose IIH. under [link] Perform the lumbar puncture with the child in a lateral decubitus position, aiming for the L3-4 or L4-5 interspace. However, this must only be performed once neuroimaging has been carried out. Manometer three-way tap. doi: 10.1212/WNL.0b013e3182a55f17.

Pediatrics 124

Pediatrics 124

Emergency Medicine Cases

AUGUST 30, 2022

In this main episode podcast on ED risk stratification and workup of the febrile infant, recorded at the CAEP 2022 Conference in Quebec City with Dr. Brett Burstein and Dr. Gary Joubert, we answer such questions as: Which febrile infants require lumbar puncture? How accurate is procalcitonin in identifying low risk febrile infants?

Pediatrics 52

Pediatrics EMS 52

ALiEM

MARCH 22, 2024

A lumbar puncture can also help rule out infections. Her lumbar puncture revealed 3 nucleated cells and a protein of 197 but was deemed a traumatic tap. The therapeutic approach focuses on treating the underlying cause and hence determining the etiology is of immense importance. There were no oligoclonal bands.

Stroke 67

Stroke Urgent Care Head Injuries Emergency Department 67

JournalFeed

FEBRUARY 25, 2023

Spoon Feed This randomized controlled trial demonstrated that lateral decubitus position was statistically the same as the upright position for lumbar puncture success. This article does an incredible job summarizing existing guidelines and data about how to utilize hs-cTn clinically. LP Me Which Way?

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ALiEM

APRIL 14, 2023

Justin Morgenstern, MD 28 Nov 2022 HM DFTB Regional nerve blocks module Nicola Mulrooney, MD 7 Dec 2022 HM EM Docs Ultrasound Guided Regional Anesthesia for Hip Fractures Olivia Victoriano, MD and Jacob Avila, MD 5 Dec 2022 HM Core EM Ultrasound Guided Lumbar Punctures Aaron Bola, MD 31 Mar 2022 HM (AIR = Approved Instructional Resource; HM = Honorable (..)

EMS 98

EMS Ultrasounds Academics Fractures 98

Don't Forget the Bubbles

AUGUST 13, 2023

However, if radiological evidence of raised intracranial pressure is seen, do not perform lumbar puncture. Indications for LP in simple febrile seizures are: There are signs or symptoms of meningitis after the seizure If the child is not fully immunized or immunization status is unknown ( H. influenza type b or S.

Seizures 97

Seizures Pediatrics Dehydration Radiology 97

JournalFeed

OCTOBER 15, 2022

These patients do not need a lumbar puncture (LP). Pax in the Vaxed Spoon Feed Nirmatrelvir (Paxlovid) use in a population of largely immune outpatients ≥65 years old, during the omicron variant era, was significantly associated with reduction in hospitalization and death.

Hospitals 40

Hospitals 40

ALiEM

JULY 20, 2023

Highlighted Quality Posts: Infectious Disease Site Article Author Date Label SGEM Lumbar punctures in febrile infants with positive urinalysis – it’s just overkill Dennis Ren, MD December 31, 2022 AIR EMDocs Bacterial Meningitis Mounir Contreras Cejin, MD January 28, 2023 HM ALiEM The Febrile Infant Corey Ziemba, MD, Justin Hacnik, MD and J.D.

Infectious Diseases 75

Infectious Diseases EMS Academics Emergency Department 75

Taming the SRU

FEBRUARY 23, 2024

Clinical pathologic case presentation - r1 diagnostics/therapeutics: Lumbar punctures - AIRWAY GROUND ROUNDS- r4 capstone - r3 taming the sru - ultrasound grand rounds Clinical pathologic case presentation WITH Drs.

Pediatrics 68

Pediatrics Ultrasounds Wellness Fractures 68

RCEM Learning

APRIL 9, 2024

Curriculum Category Syllabus Questions SLO1 Complex stable patient Allergy Cardiology Dermatology Ear, nose and throat Elderly care / frailty Endocrinology Environmental emergencies Gastroenterology and hepatology Haematology Infectious diseases Maxillofacial / dental Mental Health Musculoskeletal (non-traumatic) Nephrology Neurology Obstetrics & (..)

Infectious Diseases 52

Infectious Diseases Airway Management Dislocations Resuscitation 52

The Skeptics' Guide to EM

JUNE 20, 2020

Workup for SBI may include lumbar puncture, antibiotics, and hospitalization. It is important to balance the consequences of missing an SBI with performing unnecessary procedures (lumbar punctures), exposing infants to antibiotics, and prolonging hospital stay. There are serious consequences from missed SBI.

Pediatrics 40

Pediatrics Emergency Department Hospitals Wellness 40

The Skeptics' Guide to EM

MARCH 25, 2023

One use of POCUS we have not covered yet is for diagnosing acute biliary disease. Ultrasound is usually the first line imaging modality for diagnosing acute biliary disease.

Ultrasounds 52

Ultrasounds Emergency Department Dislocations Radiology 52

The Skeptics' Guide to EM

NOVEMBER 9, 2019

This has included performing lumbar punctures, diagnosing acute abdominal aneurysms, acute heart failure, pediatric fractures, retinal detachments and endotracheal tube placement. Background: We have reviewed papers on POCUS many times over the years on the SGEM.

Ultrasounds 52

Ultrasounds Fractures Pediatrics Radiology 52

PEMBlog

MAY 11, 2023

Lumbar punctures are painful! This is due to the needle puncturing the skin and deeper tissues and the pressure changes in the spinal canal. Local anesthesia: Lidocaine injected into the skin and deeper tissues at the site of the puncture can numb the tract and reduce pain. What about topical anesthetics? Acad Emerg Med.

Documentation/Coding 52

Documentation/Coding Pediatrics Emergency Department Outcomes 52

Mind The Bleep

NOVEMBER 29, 2023

Lumbar puncture may also be necessary if there are signs of meningeal involvement. If there is suspicion of an intracranial abscess or cavernous sinus thrombosis in a patient with new neurological signs, consider contrast-enhanced MRI head and orbits.

Best Practices 52

Best Practices Administration Hospitals Wellness 52

Taming the SRU

JANUARY 26, 2024

Physical exam maneuvers have an unreliable and low sensitivity, therefore the only test to rule out meningitis is a lumbar puncture. Only a select group of patients require a CT head prior to LP.

Stroke 59

Stroke EKG/ECG Outcomes Seizures 59

Mind The Bleep

FEBRUARY 11, 2024

Lumbar puncture : only to be done after imaging to ensure no risk of herniation. Neuro-imaging CT / CT venogram and MRI / MRV to rule out CVST, stenosis. Features of IIH include: dilated optic nerve sheath, optic nerve tortuosity, posterior flattening of the globe, empty or partially empty Sella.

Ultrasounds 52

Ultrasounds 52

Mind The Bleep

MAY 16, 2023

Invasive tests & imaging: blood tests (including gas), lumbar punctures, neuroimaging are all generally unnecessary in low risk patients. It is reasonable to recommend follow up with their General Practitioner in the next couple of days. Other tests: At most, guidelines suggest that an ECG and pertussis test may be undertaken.

Basic Life Support 52

Basic Life Support Seizures CPR Wellness 52

ACEP Now

OCTOBER 26, 2023

Then the medical-records department will try to find and fax back those records—but not in enough time to help you decide on the need for CT imaging, repeat lumbar puncture, and intravenous antibiotics. Sound familiar?

Infectious Diseases 52

Infectious Diseases Hospitals Documentation/Coding Administration 52

Don't Forget the Bubbles

OCTOBER 23, 2023

Other tests should be conducted to determine potential underlying causes, such as a metabolic screen, genetic testing, MRI, and lumbar puncture. Diagnosis is made based on the history, evidence of spasms and EEG findings.

Seizures 75

Seizures Outcomes Wellness 75

EMDocs

JULY 3, 2023

10 The most recent SAH guidelines, published in 2012, still recommend NCHCT and lumbar puncture (LP) for the diagnosis of SAH; CTA and MRI may be considered on a case-by-case basis according to local institutional protocols.

Seizures 83

Seizures Stroke Outcomes EMS 83

The Skeptics' Guide to EM

AUGUST 21, 2021

Several risk stratification tools have been published over the years. These clinical decision instruments included subjective clinical criteria along with pre-determined thresholds for lab criteria like white blood cell count (WBC) and immature to total neutrophil ratio.

Wellness 52

Wellness Pediatrics Emergency Department Hospitals 52

The Skeptics' Guide to EM

OCTOBER 31, 2020

lumbar punctures). Tap water is usually fine. Sterile Gloves: You do not need sterile gloves for simple wound treatment. Non-sterile gloves are fine. Save the sterile gloves for sterile procedures (ex. Epinephrine in Local Anesthetics: This will not make the tip of things fall off (nose, fingers, toes, etc).

Burns 52

Burns Emergency Department EMS Wellness 52

Don't Forget the Bubbles

SEPTEMBER 16, 2023

Lumbar puncture position in infants-a systematic review and meta-analysis. Phillips G, et al. Arch Dis Child. 2023 Aug 18:archdischild-2023-325929. Pediatric Decision Making: Consensus Recommendations. Salter EK, et al. Pediatrics. 2023 Aug 9:e2023061832. Kuitunen I, et al. Eur J Pediatr. 2023 Aug 4.

Pediatrics 75

Pediatrics Ultrasounds Outcomes Hospitals 75

Taming the SRU

NOVEMBER 29, 2023

Lumbar puncture with xanthochromia or > 2000 RBCs in tube 4 should increase suspicion for SAH. Subarachnoid hemorrhage Subarachnoid hemorrhage is a can’t miss diagnosis which carries significant morbidity and mortality if misdiagnosed.

Stroke 52

Stroke EKG/ECG Shock Resuscitation 52

The Skeptics' Guide to EM

FEBRUARY 8, 2020

Two of the more provocative are the use of the Ottawa SAH Rule and whether a lumbar puncture (LP) is required following a negative CT if the scan is performed within 6-hours of symptom onset. A number of controversies surround the diagnosis of SAH in the emergency department. The Ottawa SAH Rule (tool) was covered on SGEM#201.

Emergency Department 52

Emergency Department Stroke EMS Academics 52

Taming the SRU

MARCH 14, 2023

Diagnosis is made via CT scan and/or lumbar puncture. Lumbar puncture is an option with limited data for success. The presentation is highly variable, but the classic triad of “wet, wild, and wobbly” (urinary incontinence, altered mental status, and gait instability) is rare. The idea is over half a century old.

Seizures 52

Seizures Emergency Department Pediatrics Critical Access 52

ACEP Now

JANUARY 12, 2024

9 The presence of MRS may be confirmed with lumbar puncture, which will display “lymphocytic pleocytosis, elevated protein levels, and mildly decreased glucose levels.” Only newly reported in the literature, the cause of MRS remains undetermined in most cases. 8 Likewise, patients with MRS display normal peripheral nerve conduction.

Infectious Diseases 52

Infectious Diseases Ultrasounds Wellness Hospitals 52

Pediatric Education

APRIL 30, 2023

These may include echocardiogram, lumbar puncture, and hematological studies for bleeding. Other evaluations are completed to include or exclude alternative and concurrent diagnoses (e.g. perinatal stroke and bacterial meningitis) and to evaluate potential causes.

Stroke 52

Stroke Seizures Pediatrics Hyperthermia / Hypothermia 52

The Skeptics' Guide to EM

JUNE 12, 2021

She replies that she thinks the patient has an acute otitis media (AOM) but given his age, she is also thinking about the possibility of an invasive bacterial infection (IBI) and would like to obtain some blood for labs and even consider a lumbar puncture for cerebral spinal fluid. How do you reply?

Pediatrics 40

Pediatrics Emergency Department Administration Hospitals 40

The Skeptics' Guide to EM

MARCH 13, 2021

The debate has historically been about whether or not you need to also get a lumbar puncture on these patients after a non-contrast CT head. It is unclear how it performs against unstructured clinical judgement or in non-urban tertiary care teaching hospitals ( SGEM#283 ).

Stroke 40

Stroke Emergency Department EMS Outcomes 40

The Skeptics' Guide to EM

OCTOBER 28, 2017

Background: Painful procedures are common in the neonatal period, including bloodwork, lumbar punctures and bladder catheterization. You wonder whether there is a way to mitigate the painful experience for the child.

Pediatrics 52

Pediatrics Documentation/Coding Emergency Department Hospitals 52

Pediatric Emergency Playbook

MAY 1, 2016

Computed tomography of the head before lumbar puncture in adults with suspected meningitis. Fatal Lumbar Puncture: Fact Versus Fiction—An Approach to a Clinical Dilemma. Paediatr Child Health. 2010 May-Jun; 15(5): 263–265. Hasbun R, Abrahams J, Jekel J, Quagliarello VJ. N Engl J Med. 2001; 345(24):1727-33. Pediatrics.

Seizures 40

Seizures Sepsis Stroke Pediatrics 40

EM Curious

JULY 29, 2015

EM/CC LITERATURE OF INTEREST Medical expulsive therapy in adults with ureteric colic: a multicentre, randomised, placebo-controlled trial PMID : 25998582 Risk-benefit analysis of lumbar puncture to evaluate for nontraumatic subarachnoid hemorrhage in adult ED patients PMID : 26189054 Novel vagal maneuver technique for termination of supraventricular (..)

Sepsis 52

Sepsis EMS Emergency Department Ultrasounds 52

Resus Review

APRIL 1, 2015

Intracranial hemorrhage confirmed by autopsy, imaging, or lumbar puncture; intraocular bleed compromising vision Type 4 CABG-related bleeding within 48 hours Type 5 a. Overt bleeding plus hemoglobin drop of 3 to b. Overt bleeding plus hemoglobin drop c. Probable fatal bleeding b.

Research 52

Research Academics Hospitals Wellness 52

EMDocs

JULY 11, 2023

Is lumbar puncture safe in patients with hemophilia? If you’re concerned about bleeding and you don’t know the patient’s baseline factor level assume the level is 0%. Excess factor concentrate will not cause a hypercoagulable state. If LP is absolutely necessary, pretreat with clotting factors and speak with hematology.

Head Injuries 60

Head Injuries Pediatrics Dislocations CDC 60