Actively Teaching Active Teaching Techniques.

Audience: The target audience for this small group workshop are interns and residents of any specialty.

Introduction: All residents are expected to become proficient teachers in a variety of settings as they progress in training, and many residency programs offer advanced training or credentialing in medical education.1,2 Recently, some emergency medicine programs have also begun to offer a formal medical education fellowship.

How state firework restrictions affect the incidence of paediatric firework injuries in the USA.

Objectives: State laws dictate firework access in the USA, and the association between state laws and paediatric firework injuries has not been investigated. We hypothesise that states with fewer firework restrictions will have a higher incidence of paediatric firework injuries.

Methods: A retrospective review (2012-2020) of paediatric patients who sustained a fireworks-related injury was conducted using the Pediatric Health Information System.

Ultrasound Investigation of the Fifth Intercostal Space Landmark for Chest Tube Thoracostomy Site Selection in Pediatric Patients.

Objectives: Chest tube thoracostomy site selection is typically chosen through landmark identification of the fifth intercostal space (ICS). Using point-of-care ultrasound (POCUS), studies have shown this site to be potentially unsafe in many adults; however, no study has evaluated this in children. The primary aim of this study was to evaluate the safety of the fifth ICS for pediatric chest tube placement, with the secondary aim to identify patient factors that correlate with an unsafe fifth ICS.

Surpass embolization of intracranial aneurysms: Perspective from a 2-year longitudinal follow-up study across high volume comprehensive stroke centers.

Background: Surpass Streamline (SS; Stryker) is an over-the-wire first-generation flow diverter (FD). There is a scarcity of data on real-world outcomes and complications of this FD.

Methods: A retrospective review of consecutive cases between January 2019 and July 2021 at two high-volume comprehensive stroke centers, involving SS was conducted.

Safety and Effectiveness of Expandable Intravertebral Implant Use for Thoracolumbar Burst Fractures.

Purpose: To determine the safety and effectiveness of an expandable intravertebral implant (Spinejack; Stryker, Kalamazoo, Michigan) as a treatment option for patients with thoracolumbar spine burst fractures without fracture-related neurologic deficit.

Materials And Methods: Imaging studies before and after expandable intravertebral implantation and medical records of 33 patients, 11 (33.3%) men and 22 (66.

Leaving a plastic legacy: Current and future scenarios for mismanaged plastic waste in rivers.

Mismanaged plastic waste (MPW) entering the riverine environment is concerning, given that most plastic pollution never reaches the oceans, and it has a severe negative impact on terrestrial ecosystems. However, significant knowledge gaps on the storage and remobilization of MPW within different rivers over varying timescales remain. Here we analyze the exposure of river systems to MPW to better understand the sedimentary processes that control the legacy of plastic waste.

Pediatric ED Utilization in a Destination City: Demographic, Clinical, and Temporal Trends.

Objectives: Seasonal variation in emergency department (ED) visits has been shown for a variety of pediatric conditions, but previous studies have not considered how geographic location may also influence when and why these patients present to the ED. Our study examined the demographic and clinical characteristics as well as the seasonal variation among 3 patient populations (locals, in-state nonlocals, and out-of-state visitors) presenting to our pediatric ED (PED), which is located in a coastal, destination city.

Methods: This was a retrospective chart review of PED visits from June 2014 to June 2019 at the Medical University of South Carolina Children's Hospital, a tertiary care facility located in Charleston, SC.

Child Abuse Recognition Training for Prehospital Providers Using Deliberate Practice.

Background: In most states, prehospital professionals (PHPs) are mandated reporters of suspected abuse but cite a lack of training as a challenge to recognizing and reporting physical abuse. We developed a learning platform for the visual diagnosis of pediatric abusive versus non-abusive burn and bruise injuries and examined the amount and rate of skill acquisition.

Methods: This was a prospective cross-sectional study of PHPs participating in an online educational intervention containing 114 case vignettes.

Point-of-Care Ultrasound to Assess Gastric Content in Pediatric Emergency Department Procedural Sedation Patients.

Objectives: There is debate regarding the timing of procedural sedation and analgesia (PSA) in relation to fasting status. Point-of-care ultrasound (POCUS) provides the ability to measure gastric content and is being used as a surrogate for aspiration risk in anesthesia. We sought to evaluate the gastric content of pediatric emergency department (PED) patients undergoing PSA using POCUS.

Seafloor microplastic hotspots controlled by deep-sea circulation.

Although microplastics are known to pervade the global seafloor, the processes that control their dispersal and concentration in the deep sea remain largely unknown. Here, we show that thermohaline-driven currents, which build extensive seafloor sediment accumulations, can control the distribution of microplastics and create hotspots with the highest concentrations reported for any seafloor setting (190 pieces per 50 grams). Previous studies propose that microplastics are transported to the seafloor by vertical settling from surface accumulations; here, we demonstrate that the spatial distribution and ultimate fate of microplastics are strongly controlled by near-bed thermohaline currents (bottom currents).

Abdominal Distention and Emesis in a Term Neonate.

Background: Necrotizing enterocolitis (NEC) is a gastrointestinal emergency characterized by ischemic necrosis of the intestinal mucosa, leading to bacterial translocation and pneumatosis of the bowel wall. Although there are numerous studies on clinical presentations of preterm NEC, approximately 10-15% of cases occur in full-term neonates. Nearly 10% of all infants with NEC will develop a rapidly progressive and fatal form of the disease called NEC totalis.

Transport and Burial of Microplastics in Deep-Marine Sediments by Turbidity Currents.

The threat posed by plastic pollution to marine ecosystems and human health is under increasing scrutiny. Much of the macro- and microplastic in the ocean ends up on the seafloor, with some of the highest concentrations reported in submarine canyons that intersect the continental shelf and directly connect to terrestrial plastic sources. Gravity-driven avalanches, known as turbidity currents, are the primary process for delivering terrestrial sediment and organic carbon to the deep sea through submarine canyons.

Late-Onset Vitamin K Deficiency Presenting as Scrotal Bruising and Mediastinal Mass.

Although there are several reports of intracranial hemorrhage associated with vitamin K deficient bleeding, there are few reported cases of extracranial manifestations, specifically involving the thymus. Here, we discuss the unique case of a 4-week-old infant presenting with scrotal discoloration, respiratory distress, and widened mediastinum, found to have thymic hemorrhage related to confirmed coagulopathy secondary to late-onset vitamin K deficiency bleeding of the newborn.

Arteriovenous Fistula Formation After Intra-articular Injection Following Total Joint Arthroplasty.

Intra-articular joint capsule injection is a common method used to control postoperative pain as a result of primary total knee arthroplasty (TKA). It is generally considered a safe practice and is highly effective in reducing the need for postoperative opioid administration as well as decreasing recovery time through early mobilization. However, any injection into the posterior knee space has the potential to injure the vascular structures surrounding the knee.

Epidemiology of Aquatic and Recreational Water Sport Injuries: A Case-Control Analysis.

The purposes of the current investigation are to evaluate the epidemiology of water sport injuries at a coastal tertiary trauma center and to determine the association of these activities with spinal column injury and to determine whether aquatic trauma injuries differ significantly from those that occur terrestrially. A retrospective review of a consecutive series of 105 patients with aquatic-based mechanisms of injury admitted to a Level II trauma center over a 3-year period, as well as a matched control cohort with terrestrial-based mechanisms of injury, was conducted. Patients were treated at a Level II trauma center from January 1, 2008, to December 31, 2010.

Thromboelastography predictive of death in trauma patients.

Objectives: To determine if thromboelastography (TEG) is predictive of patient outcomes following traumatic injury.

Methods: A retrospective review of 131 patients with pelvic trauma admitted to a Level II trauma center was conducted over four years from 1 January 2009 to 31 December 2012. Patients were identified retrospectively from a prospectively collected database of acute pelvic trauma (n = 372).

Cerebral oxygen saturation monitoring in pediatric altered mental status patients.

Objectives: A pilot study assessing the potential utility of cerebral oximetry (local cerebral oxygen saturation [rcSO2]) in children presenting to the emergency department (ED) with altered mental status (AMS) and no history of trauma.

Methods: Patients who presented to a tertiary pediatric ED with AMS were monitored with left and right cerebral near-infrared spectroscopy probes and the first 30 minutes of rcSO2 data was analyzed. Patients with a history of trauma were excluded.