yths about EMS
Dr. Bledsoe
1. Merit Badges (ACLS,BCLS,ATLS,etc): Good for initial education and updates, but they do not represent the standard of care, they are not always current, and are not at a higher level of education than your training as an EP.
2. Epinephrine and Cardiac Arrest: Will increase ROSC, but no demonstrable increase in survival to hospital discharge compared to patients who did not receive epinephrine.
3. AEDs: save very few lives in residential units and private homes.
4. Response times: Survival advantage if 4minutes or less. Best response time in LV is in the casinos. Trauma patients saw no increase in survival with shorter response time
5. Prehospital IVs in trauma patients: Increase mortality.
Pediatric Adrenal Emergencies
Dr. Fox
Dr. Bledsoe
1. Merit Badges (ACLS,BCLS,ATLS,etc): Good for initial education and updates, but they do not represent the standard of care, they are not always current, and are not at a higher level of education than your training as an EP.
2. Epinephrine and Cardiac Arrest: Will increase ROSC, but no demonstrable increase in survival to hospital discharge compared to patients who did not receive epinephrine.
3. AEDs: save very few lives in residential units and private homes.
4. Response times: Survival advantage if 4minutes or less. Best response time in LV is in the casinos. Trauma patients saw no increase in survival with shorter response time
5. Prehospital IVs in trauma patients: Increase mortality.
Pediatric Adrenal Emergencies
Dr. Fox
1. Pheochromocytoma: Treatment is first alpha blockade (phenoxybenzamine, prazosin, doxazosin, nifedipine, nicardipine) followed by BB for dysrhythmias and then surgery once stable.
2. Congenital Adrenal Hypertrophy: Usually presents within first 2-3 weeks of life- hyponatremia, hyperkalemia, acidotic, hypotension. Management with hydrocortisone 60-80mg/m^2 (until hemodynamically stable) potassium-free saline fluids with dextrose, ICU admission, endocrine consult, serial labs.
3. Causes of adrenal insufficiency: Addison’s disease, Waterhouse-Friderichsen syndrome, chronic exogenous steroid use, etomidate (one time bolus is safe), Sheehan syndrome, pituitary tumor, sepsis, trauma, apoplexy, empty sella.
Pediatric Head Trauma
Dr. John Turner
1. Life time risk of cancer after CT scan in pediatric patients: CT abdà 1:550, CT headà 1:1500
2. Role of ultrasound in localizable head trauma in pediatric patient population: high specificity and moderate sensitivity for identifying skull fracture. But absence of skull fracture does not exclude clinically significant TBI
3. Pediatric concussions: Recommend a graduated return to activity over the course of 7 days. Strict rest has no added benefit.
2. Congenital Adrenal Hypertrophy: Usually presents within first 2-3 weeks of life- hyponatremia, hyperkalemia, acidotic, hypotension. Management with hydrocortisone 60-80mg/m^2 (until hemodynamically stable) potassium-free saline fluids with dextrose, ICU admission, endocrine consult, serial labs.
3. Causes of adrenal insufficiency: Addison’s disease, Waterhouse-Friderichsen syndrome, chronic exogenous steroid use, etomidate (one time bolus is safe), Sheehan syndrome, pituitary tumor, sepsis, trauma, apoplexy, empty sella.
Pediatric Head Trauma
Dr. John Turner
1. Life time risk of cancer after CT scan in pediatric patients: CT abdà 1:550, CT headà 1:1500
2. Role of ultrasound in localizable head trauma in pediatric patient population: high specificity and moderate sensitivity for identifying skull fracture. But absence of skull fracture does not exclude clinically significant TBI
3. Pediatric concussions: Recommend a graduated return to activity over the course of 7 days. Strict rest has no added benefit.
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