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A 6-year-old girl with a history of sickle cell disease presents with leg pain — Brain Teaser. Do you know the answer? March 23, 2019

Posted by Andy Jagoda, MD in : Brain Tease , add a comment

Test your knowledge and see how much you know about treating and managing pediatric hypertension and hypertensive emergencies.


Did you get it right? Click here to find out!

The correct answer: D.

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A 68-year-old man with past medical history of atrial fibrillation on warfarin presents to the ED after motor vehicle crash — Brain Teaser. Do you know the answer? March 23, 2019

Posted by Andy Jagoda, MD in : Brain Tease , add a comment

Test your knowledge and see how much you know about treating and managing blunt cardiac injury in the ED.


Did you get it right? Click here to find out!

The correct answer: C.

Earn CME for this topic by purchasing this issue. 

Clinical Pathway for Management of Emergency Department Patients With Suspected Blunt Cardiac Injury March 16, 2019

Posted by Andy Jagoda, MD in : Feature Update , 1 comment so far

Blunt cardiac injury describes a range of cardiac injury patterns resulting from blunt force trauma to the chest. Due to the multitude of potential anatomical injuries blunt force trauma can cause, the clinical manifestations may range from simple ectopic beats to fulminant cardiac failure and death. Because there is no definitive, gold-standard diagnostic test for cardiac injury, the emergency clinician must utilize an enhanced index of suspicion in the clinical setting combined with an evidence-based diagnostic testing approach in order to arrive at the diagnosis. This review focuses on the clinical cues, diagnostic testing, and clinical manifestations of blunt cardiac injury as well as best-practice management strategies.

This clinical pathway will help you improve care in the management of patients with suspected blunt cardiac injury. Download now 

Clinical Pathway for Management of Emergency Department Patients With Suspected Blunt Cardiac Injury

Dosing Information for Antihypertensive Medications March 16, 2019

Posted by Andy Jagoda, MD in : Feature Update , add a comment

For children with severe acute hypertension without further evidence of end-organ damage, initiation of oral agents may be recommended to lower blood pressure. Based on the available studies, aggressive bolus dosing of antihypertensive agents should be avoided in the younger child; careful initiation of a drip for children who are symptomatic is a safer strategy. The therapeutic window for all medications is wider for adolescent children and, likely, none of the oral agents will cause inadvertent hypotension or side effects. For the school-age child, a careful discussion with a specialist will help guide decisions. See Table 3 for dosing recommendations.

Download the table for yourself and check out more content like this at www.ebmedicine.net/topics.

Dosing Information for Antihypertensive Medications

Quiet morning shift. What do you do? March 8, 2019

Posted by Andy Jagoda, MD in : What's Your Diagnosis , 3comments

You are working a quiet morning shift when a patient is brought in after a motor vehicle crash. The patient is hypotensive, and the FAST exam reveals a pericardial effusion. You know that time is of the essence, so you rapidly assess the options and wonder whether a needle pericardiocentesis is the best option…

Case Conclusion:
The patient was triaged directly to the resuscitation unit and the trauma surgery service was immediately available at bedside. Further review of the FAST exam revealed right ventricular collapse, and the initial blood pressure of 80/40 mm Hg was consistent with pericardial tamponade. Two large-bore peripheral IVs were placed, and an ECG revealed sinus tachycardia. A bedside pericardiocentesis was performed under ultrasound guidance and 25 mL of blood was aspirated. Repeat blood pressure was 100/60 mm Hg. Chest and pelvic x-rays were within normal limits. The patient was then emergently transported to the operating room for further management. A thoracotomy was performed and noted a 2.5-mm rupture of the right anterior ventricular wall. The defect was repaired, and the patient had an uneventful recovery.

Would you have done it different? Tell us how you would have handled this case.

Pediatric Hypertension. How would you intervene? March 8, 2019

Posted by Andy Jagoda, MD in : What's Your Diagnosis , 2comments

Your string of shifts is almost over when you are called into a room for an infant with respiratory distress. You’ve just seen 4 kids with upper respiratory infections, and you feel confident that this is the scenario. The 4-month-old, who was born at 26 weeks’ gestation, shows mild-to-moderate respiratory distress; however, there has been no viral prodrome. A chest x-ray demonstrates moderate pulmonary edema. Back in the room, you note that her blood pressure is 110/80 mm Hg, and you begin to wonder whether that is high for an infant. What additional testing—if any—is necessary? Do you need to intervene? Is there anything specific you should be worried about?

Case Conclusion:
The 4-month-old girl had clear evidence of cardiac failure and hypertension. She was started on an esmolol drip that was slowly titrated, and given a dose of furosemide. Her work of breathing slowly improved, and she was admitted to the intensive care unit, where it was learned that she had had an umbilical arterial line and had a renal artery thrombosis.

Would you have done it different? Tell us how you would have handled this case.

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Last Modified: 09-22-2019
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