PV card: Pediatric Assessment Triangle

Have you heard of the Pediatric Assessment Triangle? Taught in the Pediatric Education for Prehospital Professionals (PEPP) certification course, it provides a clear and simple approach to the emergency assessment of pediatric patients. The following PV card summarizes the PAT:

PV Card: Pediatric Assessment Triangle

Adapted from [1]
Go to ALiEM (PV) Cards for more resources.

Reference

Dieckmann R, Brownstein D, Gausche-Hill M. The pediatric assessment triangle: a novel approach for the rapid evaluation of children. Pediatr Emerg Care. 2010;26(4):312-315. [PubMed]

By Michelle Reina, MD|2021-10-06T19:54:37-07:00May 30, 2013|ALiEM Cards, Pediatrics|

Out-of-Hospital Cardiac Arrest and Prehospital Intubation

Worldwide, death from cardiac arrest in the out-of-hospital setting remains the leading cause of mortality. Focuses have aimed at improving bystander CPR, public access to AEDs, minimizing chest compression interruptions, and decreasing the emphasis on advanced airway management. This latter concept has become so important that the AHA/ASA have now changed their “ABC” philosophy to “CAB.” Below is the review of the literature that has changed this philosophy.

(more…)

By Salim Rezaie, MD|2019-09-10T13:38:46-07:00May 29, 2013|Cardiovascular|

Patwari Academy video: Child abuse injury patterns

What are common injury patterns seen in children who are abused? Non-accidental trauma should always be considered in pediatric patients who present with traumatic injuries. Watch this great 8 minute video on child abuse injury patterns by Dr. Rahul Patwari.

(more…)

By Rahul Patwari, MD|2016-11-10T11:38:56-08:00May 26, 2013|Orthopedic, Patwari Videos, Pediatrics|

On the Horizon: Propofol for Migraines

Propofol for the treatment of migraines in the ED might be on the horizon. This will possibly be a new practice in emergency medicine, although it has been known for some time. Propofol, when given at procedural sedation doses, seems to miraculously terminate migraines refractory to usual treatment. Patients awake with minimal to no headache and may be discharged from the ED much quicker than traditional treatment with possibly less side effects. The proposed mechanism of action is described in below papers, but in short, propofol seems to “reboot” the brain and terminate the migraine.

(more…)

By Zlatan Coralic, PharmD|2016-11-11T18:37:24-08:00May 25, 2013|Neurology, Tox & Medications|

PV Card: Contraindications to Thrombolytics in Stroke

This Paucis Verbis (PV) card is an updated version of the PV card on Contraindications to Thrombolytics for CVA from September 10, 2010, based on the Stroke 2013 AHA/ASA new guidelines that were just published.¹ Some changes include…

There is new mention of new anticoagulants in the market with additional absolute exclusion criteria.
A blood glucose < 50 mg/dL has been upgraded from a relative exclusion to an absolute exclusion criteria. There is no more mention of glucose > 400 mg/dL as an exclusion criteria.
Seizure at onset of presentation has moved from an absolute to a relative risk.
Post-AMI pericarditis is no longer a relative exclusion criteria.

PV Card: Contraindications for Thrombolytics in Stroke

Adapted from [1]
Go to ALiEM (PV) Cards for more resources.

Reference

Jauch E, Saver J, Adams H, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(3):870-947. [PubMed]

By Michelle Lin, MD|2021-10-06T19:58:38-07:00May 23, 2013|ALiEM Cards, Neurology, Tox & Medications|

Calcium before Diltiazem may reduce hypotension in rapid atrial dysrhythmias

The Case

A 56 y/o man presents to the ED via ambulance. He was sent from clinic for ‘new onset afib.’ His pulse ranges between 130 and 175 bpm, while his blood pressure is holding steady at 106/58 mm Hg. He has a past medical history significant for hypertension and hypercholesterolemia. His only medications are hydrochlorothiazide and atorvastatin. The decision is made to administer an IV medication to ‘rate control’ the patient with a goal heart rate < 100 bpm.

Calcium channel blockers, such as diltiazem and verapamil, can both cause hypotension. In the case above, the patient has borderline hypotension.

The Clinical Question

What is the evidence behind giving IV calcium as a pre-treatment to prevent hypotension from calcium channel blockers?

(more…)

By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2016-11-11T19:47:24-08:00May 22, 2013|Cardiovascular, Tox & Medications|

Patwari Academy video: Discharge instructions

Read more about the writing of appropriate ED discharge instructions. Clear communication of your thoughts and recommendations are a crucial part of patient care despite their no longer being in the ED. Learn about the pearls and pitfalls in writing instructions in this short 7.5 minute video. ¹

(more…)

By Rahul Patwari, MD|2016-11-11T18:37:29-08:00May 19, 2013|Medical Education, Patwari Videos|