Fenton O'Leary

New @JAMANetwork publication the PECARN febrile infant rule identified all infants with bacterial meningitis. 📊 1,537 infants 🦠 4.5% with invasive bacterial infections 🧠 0.7% with bacterial meningitis 🔍 NPV: 99.4% 🤔 Somewhere between 400 and infinity LPs needed to find 1 infant with bacterial meningitis! This is the level of evidence EM clinicians need to seriously consider whether a febrile infant in the first month of life needs a LP or not. jamanetwork.com/journals/jama/… #HOMERUN

@EM_VATA @DrSimonCraig @AmerAcadPeds @CanPaedSociety @PICSociety Well done for considering that approach. Sounds like a CPVT type situation

After 45 min CPR and 11 X single defib. shocks, got ROSC after 3 x Double sequential defibrillation in an 8 yr old sudden collapse with immediate CPR. @DrSimonCraig 🤷🏽 @PEMDocSyd @AmerAcadPeds @CanPaedSociety @PICSociety #paediatrics

Any one know what the test is?

Avoiding unrecognised oesophageal intubation The @RCoA & @dasairway have agreed to drop ‘no trace wrong place’ The message now is that we need to exclude oesophageal intubation by identifying SUSTAINED EXHALED CO2 This requires 4 elements -CO2 rises & falls with respiration -sustained (non-fading, >7 cycles) -amplitude >1 KPa -clinically appropriate It replaces ‘no trace wrong place’ which is insufficient & therefore inadequate See these two updated webpages Sustained exhaled CO2 rcoa.ac.uk/safety-standar… Prevention of future deaths rcoa.ac.uk/safety-standar… @AAGBI @AndyHiggsGAA @NicholasChrimes

@DrSimonCraig Paywalled unfortunately

An excellent article! Is shaken baby syndrome landing innocent people in jail? theage.com.au/interactive/20…

@DrSimonCraig @EM_VATA @jminardi21 I think it localises the pathology. DD still bacterial, inflamm, oncology, blood etc. so is helpful in my practice. I use it and with clinical exam may not do further imaging or bloods if family happy with wait and see approach

@EM_VATA @jminardi21 I suppose if that’s the case, is there much value in POCUS for a child with a limp?

We have been lucky enough to get some funding to look at children presenting to the ED with an acute limp. For those with #POCUS expertise, we are also hoping to incorporate some research on its role in these children.

@adamsonjon @DrSimonCraig @EM_VATA @cianmcdermott We see loads of kids with limp. Some are hips, some arent. So being able localise is useful. Classic exam findings of septic hip is rare. If no effusion then we look harder for other causes. If is effusion then we consider that aetiology

@PEMDocSyd @DrSimonCraig @EM_VATA @cianmcdermott Accepting that I sound like a Luddite then but what is it adding that a good history and examination can’t tell you?

@DrSimonCraig @EM_VATA @cianmcdermott It confirms fluid in joint. So site of pathology which is useful. Doesnt really differentiate cause though which is trap for young players……

I’m keen to look at presence / absence of joint effusion However, interested in the opinions of those with more expertise… What else is reasonable to expect to be “routinely” documented by ED clinicians? Size / depth? Simple vs complex effusion? @EM_VATA @cianmcdermott

@DrSimonCraig @salmannaeem217 @cianmcdermott @EMAJournal @nzpetejones @AnselmWong1 @prof_cameron @WileyHealth @acemonline @cliffreid Maybe those extra few moments you used to teach the reg very basic echo allowed them to diagnose cardiomyopathy in the next patient they see with persistent tachycardia 😀😀. Massively useful skill and changes management

@salmannaeem217 @cianmcdermott @EMAJournal @nzpetejones @AnselmWong1 @prof_cameron @WileyHealth @acemonline @cliffreid If there's very few waiting and the place is under control, absolutely knock yourself out with "practicing" scanning, as long the patient isn't under the impression it's actually going to help them. Otherwise, see the next patient.

Tests performed in EDs that clinicians believe are at high risk of unwarranted variation or low-value care doi.org/10.1111/1742-6… #OpenAccess @DrSimonCraig @nzpetejones @AnselmWong1 @prof_cameron @WileyHealth @acemonline

Please share this episode of 'Asthma with Experts'. Professor Francine Ducharme shares her practical approach to this challenging task of diagnosing asthma in children under 5.   See: Spotify: bit.ly/3IPfaXT Apple: apple.co/4o9ACHh ginasthma.org/gina-podcasts/

If you think AI is the answer to healthcare, you probably don’t work in healthcare. Well ok, maybe you work in healthcare but not the part where our patients are. ‘Diagnosis is easy. Disposition is war.’ Well said @Rick_Pescatore.

BMJ finds inaccuracies in key studies for AstraZeneca’s blockbuster heart drug ticagrelor. Investigation finds evidence of serious misreporting, raising fresh doubts over the approval and decade long use of ticagrelor bmj.com/content/389/bm…

Short infographic on the potential impact of the FIDO study What are your preconceptions on managing febrile infants? youtu.be/IxLFHYtZaGA?fe… Paper: sciencedirect.com/science/articl…

This is a beautiful piece of writing about a tragic event and a powerful testimony of learning and courage in the face of uncertainty. Knowing the right thing to say to parents and caregivers in these situations can be an impossible challenge. I suspect I still get it wrong.

@DrSimonCraig I cant see time from randomisation to drug ingestion. Outcome from time of randomisation interesting choice. Was there an analysis using time of ingestion of study drug as starting point?

A brief summary: 9-hospital RCT of children/adolescents (9-17 years) with acute severe behavioural disturbance where oral medications were deemed suitable. 176 randomised to diazepam 172 randomised to olanzapine 5 mg if <40 kg 10 mg if >40 kg

Time to replace ‘No trace, wrong place’ with ‘Sustained exhaled carbon dioxide. authors.elsevier.com/a/1kUpV1dCDurIJ

The NSW mental health system is in crisis under the Minns Labor Government. But for Queensland, “never let a crisis go to waste” as they now start to poach our state’s staff psychiatrists - with ads in today’s @smh and @dailytelegraph

Perhaps a ‘thank you’ would have made a difference, from the life guards too I saved a stranger’s life at the beach. I’m not sure I’d do it again smh.com.au/national/i-sav…

I make no apologies for repeating myself: No-one gives a damn until it's your loved one on a trolley. Shock. Shame. Demoralised. Broken. Undignified. 300+ excess deaths a week. And we shrug. Until it's *your* loved one on a trolley. #NHSCollapse bbc.co.uk/news/articles/…

In response to an article about consent for anaesthesia in children we have undertaken an analysis of PAEDIATRIC PERIOPERATIVE MORTALITY in NAP7 This gives up to date data for (all cause) perioperative mortality Really low for older children Low for infants High for neonates Almost 80-fold higher (Small numbers & wide confidence intervals) bjanaesthesia.org/article/S0007-… @jas_soar @drrichstrong @emirakur @FiOglesby @adk300 @NAPs_RCoA