Department of Emergency Medicine

UMEM Educational Pearls

Category: Pediatrics

Title: Apnea and bronchiolitis

Keywords: hospitalization, RSV, bronchiolitis (PubMed Search)

Posted: 12/17/2021 by Jenny Guyther, MD (Emailed: 8/14/2024) (Updated: 8/14/2024)
Click here to contact Jenny Guyther, MD

Typical admission considerations for patients with bronchiolitis are work of breathing, hypoxia, and dehydration.  The patients risk of apnea should also be considered.  Younger infants with bronchiolitis are at a risk for apnea.  Studies have cited anywhere from a 16-25% risk in younger infants.  The problem lies in identifying those patients who are at risk and those who are not.  This older study looked at 691 infants and developed criteria which identified all of the 2.7% of patients who developed apnea.
The high risk criteria used in this study were: 1) Full term and younger than 1 month; 2) Born < 37 weeks gestation and younger than 48 weeks post conception or 3) Parents already noted an episode of apnea with this illness.
Bottom line: Incorporate the infants risk of apnea into your disposition decision for patients with bronchiolitis.

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Category: Visual Diagnosis

Title: POCUS: Pulmonary Embolism (Submitted by Alexis Salerno)

Posted: 5/11/2022 by Michael Bond, MD (Emailed: 8/14/2024) (Updated: 8/14/2024)
Click here to contact Michael Bond, MD

Pulmonary Embolism 

  • In patients with high pretest probability and abnormal vital signs think about cardiac evaluation for pulmonary embolism. McConnell’s sign is most specific but can also be found in acute RCA infarct. TAPSE < 1.8 cm is also a good identifier of RV strain. Remember that patients with COPD or Pulm Htn may have RV dilation at baseline. You may also want to risk stratify patients with PE with labs as well as lower extremity dvt studies. 
  • Let’s give a shout out to Ashley Pickering who recently took some awesome echo images of a patient with a known saddle embolism. 

 

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Category: Trauma

Title: Injury score comparable geriatric vs non-geriatric patients: Over 65 years do much worse

Keywords: geriatric, trauma, orthopedic injury, injury severity score (PubMed Search)

Posted: 11/5/2022 by Robert Flint, MD (Emailed: 8/14/2024) (Updated: 12/9/2022)
Click here to contact Robert Flint, MD

Trauma patients over age 65 should be cared for by a multidisciplinary trauma team. Here is another study affirming that patients over age 65 do worse when having similar injuries to those under 65. Interestingly, those under 65 had more operative repairs of their orthopedic injuries as well.  

The authors conclude: “Although the ISS and NISS were similar, mortality was significantly higher among patients aged ≥ 65 years compared to patients < 65 years of age”.

 Also it bears further investigation of why those under 65 received more operative repairs

 

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