Current screening tools for pediatric septic shock and sepsis are highly specific but lack sensitivity. This study substituted age adjusted vital sign measures and a pediatric shock index into currently existing pediatric sepsis scoring systems to create the qPS4.When utilizing a cut off of ≧ 2 points, the qPS4 was highly sensitive and specific, and identified pediatric septic shock far sooner into a patient's course. 

Pediatric Septic Score

The sports medicine team visits the studio as we consider common knee injuries in student athletes. We explore the cause, diagnosis, management, and prevention of patellofemoral pain syndrome, Osgood-Schlatter disease, Sinding-Larsen-Johansson syndrome, meniscal tears, patellar dislocation, and your everyday sprains and strains. We hope you can join us!

Common Knee Injuries in Student Athletes - PediaCast CME 102

Drs Roopali Bapat and Berkeley Bennett visit the studio as we consider clinical pathways in pediatric medicine. How are pathways developed, implemented, evaluated, and updated? Where are they useful? What are their benefits… and pitfalls? Tune in to find out!

Clinical Pathways in Pediatric Medicine - PediaCast CME 103

Can a nitro slurry help with food bolus impaction? Glucagon and effervescent beverages have limited evidence for benefit.  Can an old drug used in a new way help these patients?

Oral Nitro for Food Bolus Impaction

We know that the d-dimer can be a helpful test for patients who have a low pre-test probability of pulmonary embolism. But can the test be pushed into use for higher risk patients? Will it still have useful negative predictive value or will we risk missing too many PEs?

Can D-dimer be Used and Useful in High Pre-Test Probability PE Patients?

Severe trauma is the leading cause of death worldwide for adults younger than 50 years of age. Acute traumatic life support (ATLS) guidelines endorse early and aggressive usage of supplemental oxygen in patients with severe trauma, at least until abnormalities of airway or breathing can be safely ruled out. However, unclear target concentration, duration or saturation goals often leads to hyperoxemia. Emerging studies in the intensive care unit (ICU) setting suggest that liberal supplemental oxygen therapy and hyperoxemia is associated with increased mortality. Limited evidence in the trauma population suggests similar outcomes.

Is Hyperoxemia in Trauma Bad?

More than 1.5 million critically ill adults undergo tracheal intubation each year in the United States. Hypoxemia is a common and serious complication during tracheal intubation in critically ill adults, occurring up to 10-20% of intubations in the emergency department (ED) or intensive care unit (ICU). Hypoxemia increases the risk of cardiac arrest and death. The effect of preoxygenation with noninvasive ventilation, as compared with preoxygenation with an oxygen mask, on the incidence of hypoxemia during tracheal intubation is uncertain. In this breakdown of a Journal Club article, Dr de Castro will cover a recent paper comparing NIPPV to oxygen mask only during preoxygenation for intubation.

NIPPV vs OM for preox

It is well known that ultrasound has exploded in its application in both diagnostics and procedures and has ultimately revolutionized the way we practice medicine. With its growing use, more and more providers are comfortable using ultrasound for both identification of anatomy/pathology and to guide procedures that were previously only done with landmarks. While having the skills to perform landmark guided procedures is incredibly important, there is much value in being able to visually confirm anatomy to avoid procedure complications, especially when landmarks are difficult to palpate / identify in certain individuals. This recap of a recent journal club article covers a paper looking into the use of POCUS to help perform cricothyrotomy.

Using Sound Waves to Help a Cric

Many clinical decision rules exclude elderly patients from the derivation cohorts.  So the question remains unanswered do all elderly patients need cervical spine CTs in the setting of trauma? What if they have no symptoms? This recap of a journal club article explores the incidence of significant cervical spine fractures in elderly patients.

Is Old Age a Reason to Scan a Cervical Spine?

Lung-protective ventilation (LPV), characterized by low tidal volumes and appropriate PEEP, is a cornerstone in managing patients with acute respiratory distress syndrome (ARDS). However, its application in patients with severe acute brain injury raises concerns. The potential for lung protective ventilation to increase intracranial pressure due to hypercapnia and elevated PEEP levels necessitates a closer examination of its safety and efficacy in this unique patient population.

When Lung-Protective Ventilation Isn’t Brain-Protective? A Look at the PROLABI Trial

Pediatrician and podcast pioneer. Answering questions, interviewing experts and explaining evidence since 2006. Join us wherever podcasts are found!

www.tamingthesru.com - Free. Open-Access. Focused on Emergency Medicine, critical care and prehospital medicine, as well as practice algorithms and decreasing knowledge translation in Med Ed.

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