PEM GEMS

Contrary to what F. Scott Fitzgerald may have written, i think there are second acts in American life.  While PEM education has been my passion for the last 7 years, I have made the hard decision to transition away from Academic Emergency medicine.  So enjoy this short and sweet goodbye as I express my gratitude for all the people who made this podcast go over the last 3 years.

Stealing a bit from Bill Shakespeare, this is a daily and possibly the most important question we grapple with on a daily basis. But unlike, the Melancholy Dane the question we struggle with is the incredible diagnostic power or a CT vs. the possible downsides.  This podcast aims to look at the CT question through the old standard- the lens of risks and benefits and hopefully will give you a framework for how to think about this famous question.

Y'all asked, I answered! Thanks to an email from across the boarder in Quebec.- I've tried to put together my thoughts on those pesky dots- i.e. what to do the next time you see a kid with petechia. 

The dog days of summer are winding down, but there is still plenty of time to soak up some sun and spend some time in the water.  But even a day at the beach can quickly turn tragic, as drowning (aka submersions injuries) can happen suddenly.  Hopefully this review will give you some pointers about how to monitor, resuscitate and prognosticate the next time you get a pediatric submersion injury. 

If you like the PEM content and lame dad jokes then here is your chance to see it in person!  I have entered ACEPs drop the mic new speaker competition.  Voting is open to all ACEP members and can be accessed here: https://ecme.acep.org/diweb/gateway/init/1/f/catalog*2Fitem*2Feid*2F900028So if you like what you hear and see (in this case) take some time and vote Joe.  Hope to see y'all in Philly in October.

There have been several reports over the last few years of increasing pediatric Group A Strep (Strep Pyogenes) infections. While most these are localized infections the mortality of invasive Strep will keep even the most seasoned doctor up at night. Hope you enjoy this quick primer on Strep its presentations and treatment. 

How many times in pediatrics do we say "it's just a virus" and "testing wont change our management".    For the most part this is true, but how do we navigate this in a post covid world and are there scenarios where knowing what virus it is may actually help?

We have all had the anxious feeling of a lump in the throat. But what if our anxious lump comes from seeing a pediatric patient with an actual lump. Hopefully this podcast will help demystify those pesky three letter neck infections and give you a framework to get to the right diagnosis and treatment. 

PECARN head trauma guidelines are as close as it comes to dogma in pediatric emergency medicine.  We all know and love them, but what about certain populations where the rules don't apply.  Tune in, and we review some of the latest and greatest literature for those situations that PECARN doesn't cover.

At first, Lyme disease can seem daunting- there are myriad clinical syndromes and patients can even be minimally symptomatic or asymptomatic.  In areas with high prevalence of the causative agent, Borrelia Burgdorferi, which is found in deer ticks, providers are typically accustomed to recognizing the symptoms particularly in the warmer months. However, with climate change, a more interconnected world, and long incubation periods- Lyme may be coming to an area near you! As such, providers in all areas should be familiar with some of the more common syndromes, which diagnostic tests are available, and how to appropriately treat and disposition patients from the emergency department. The aim of this podcast is not to make you Lyme expert but give you key points for diagnostic dilemmas.

Thanks to people who get concussions for a living, like boxers or NFL players, we know a lot more about the long-term effects of hits to the head than we did 30 years ago.  Given this explosion of research and tons of good, bad, and ugly information available to patients and families, what are the best evidence-based recommendations for the next time you see a pediatric patient who has a concussion.

We have all had the experience of something going “down the wrong pipe” or having the wrong thing down the right pipe.  Any way you slice it, things end up in the GI tract or bronchial tree that shouldn't be there.  Try not to get choked up as we cover how to figure out what went where and, more importantly, what to do about it.

Taking care of three kids in cardiac arrest in the span of one month has been rough, to say the least. The very nature of the disease makes a good outcome unlikely, which can be emotionally devastating and can cause us to question our careers. So what do we do when a pediatric cardiac case comes through the door? How can we stay organized and do our very best, which, at the end of the day, is all we are capable of?

 Needles in haystacks can poke and zebras can bite. Pediatric stroke is one of those occurrences so rare that diagnosis can be delayed simply because we don't think of it. Tune in as we put our minds to the pediatric brain, cogitate about how this disease can present, and how we can be ready to recognize and manage it. 

Nothing underscores the adage “Don't just do something- stand there” like a simple febrile seizure. The terror level in parents is often mega high and the temptation may be to go quickly to IVs and CTs.  But if the kid is well and back to baseline, one approach is a chair, 5 minutes and the FAQs- it might just save you an invasive work up.

There is no getting around it: rashes are rough. Different pathologies can have the same sympotoms; the same pathologies can look completely different on different skin tones. I realized that if I'm to have any street cred as a PEM physician, I need to either memorize the Atlas of Dermatology or come up with another approach for the ED. After making it through a few pages of the Atlas, I gave up and created Joe's Three Step Approach to Rashes. 

For the most part young and healthy kids have young and healthy kidneys. However, for a small subset there is either acute or chronic renal disease. In this episode I spill the beans on some common presentations and not so obvious complications. 

The management of BRUE is based partly on historic etymology and partly on medicine. This episode will walk through the history of the events now known as BRUEs, which are as old as time, and focus on how the name change encapsulates the management. What is and what is not a BRUE? If it is a BRUE what do we do?  All this and a quick sample from George Carlin!   

 Kudos to AAP for trying to tackle one of the toughest questions in PEM: what do we do with the febrile neonate? The PEM community is fired up to get its hot little hands on consensus guidelines about which neonates are low risk for an invasive bacterial infection. Tune in to this special, mid-hiatus episode of PEM GEMS as we explore the recommendations or, for a medium-length dive, check out the accompanying review on EMdocs.net.  

Full disclosure: I am not a toxicologist, but I do know a thing or two about pediatric ingestions. Witnessed ingestions are easy: call poison control and spend as much time as you want reviewing pharmacology and biochemistry.  But what about the unwitnessed ingestion, or the altered and sick kid? Its important to keep Tox on the differential- also remember the medications where one pill can kill or make very ill.

The pediatric oncology population is an emotionally challenging, high-risk group and a classic example of one Joe's laws of PEM: kids with chronic medical conditions must be treated with kid gloves. Let’s think about some incident presentations (including a few with unusual symptoms) and then consider complications of both the underlying malignancy and its treatment.

If last time was wires, this time it's all about the pump. The totality of congential heart disease could be a Tolstoy novel-length podcast; the aim of this recap is to give you the CliffsNotes to help troubleshoot common presentations and complications. Listen in to learn Joe's three questions for kids with congenital heart disease.

As Gloria Estefan would say, "The rhythm is gonna get ya!" Children presenting in an abnormal rhythm can cause palpitations for everyone involved. In a crisis, you can always fall back on PALS/ACLS since algorithms are for doing and not thinking. But if you have time to think, a better understanding of the dysrhythmia will help you stay calm and speak intelligently with your cardiology and critical care colleagues.

Asthma is a spectrum disease: from viral wheezing (which may or may not be asthma), to the well appearing patient with a mild exacerbation, all the way to the crashing kid.  A lot of asthma care is algorithmic -- steroids and nebs, then discharge -- but let's get subtle with some nuance plus some tips for the terrifying sceniro of an intubated asthmatic.

All cultures have myths. Many myths have the dual effects of explaining why something is the way it is while at the same time warning us against danger. These two tennants are certainly the corner stones of most medical myths. Let's dive into three myths in pediatric EM, examine their roots, and think critically about changing our practice - in this episode of pediatric myth busters.

...And now the exciting conclusion! If the last podcast took the anxiety out of pediatric airway, here's a scareway story to ramp it back up! Plus we troubleshoot common airway problems and cover some survival techniques (for both you and the patient) for when you have one of those nightmare cases.

This podcast is brought to you by the letter "U". Pediatric intubations are Uncommon, use Unusual equipment sizes, and can be Upsetting cases. It's no surprise that these cases can cause a great deal of anxiety. So let's talk about the steps we can take to set ourselves and our patients up for success the next time we have to manage a pediatric airway.

Non-Accidental Trauma (NAT) is a tough thing to talk about. While almost all parents just want what is best for their kids, we cannot ignore the statistics that NAT (aka child abuse or child mal-treatment) is one of the leading causes of morbidity and mortality - particularly in young children. Even more concerning: the vast majority of children with bad outcomes have some form of prior medical contact. So let's acknowledge the difficulty, then talk about some subtle signs of abuse that you need to look out for that may just save a kids life.

Whether it's doom in the diaper, a three-nager with a UTI, a bashful preteen or a rare disease in a 14-year-old, the GU area can harbor serious pathology. While it's easy enough if the complaint is, "You need to take a look down there," we must consider how different symptoms or body bashfulness can hinder our ability to make a diagnosis. Luckily, for many of these diagnoses, you don't need labs or a CT; all you need is a pair of eyes and 30 seconds to take a look.

Well-appearing, otherwise healthy, immunized children, who are over 3 months old and have short duration of fever is the bread and butter of PEM. How many times can we say, "it's just a virus?" While the vast majority of infections are viral, lets talk about an approach that will help you not miss anything and leave the patient and family happy when they leave the ED.

Trauma to the chest or abdomen can put you and your patient in a tough spot. This region contains three places where the patient can bleed to death and also lots of prime real estate that doesn't want to be radiated. So how do we know who needs imaging and what imaging do they need? All that and a whole lot more!

From a bump on the head to a high speed accident, head trauma, like kids, comes in all shapes and sizes. Minor head trauma is a Shakespearian dilemma: To CT or not to CT? Major head trauma is all hands on deck to protect the injured brain. All that plus the pediatric cervical spine!

Traumas, just like kids, come in all shapes and sizes. No matter what, a severely injured child always raises the tension in the ED, regardless of the practice setting. So how do we stay cool when that next kid rolls in? Keep calm and remember our ABCs

Bronchiolitis both keeps the Pediatric ED in business and makes us crazy. We have been studying it for almost a century and the only thing that makes it better is time (or maybe nasal suction). So, if we can't cure it, the only thing left to do, is do what we do best, and figure out who needs to be admitted. Can you name the 5 reasons for admission in a patient with bronchiolitis?

The limiping child is a cunundrum. Did they just come off a trampoline? Have they had a fever? It's a mixed bag of truamtic and non traumatic conditions. Come strecth your legs and take a stroll down the peidatric lower extremity as we cover both common and 'can't miss' conditions. Hopefully, I don't put my foot in my mouth.

What should we do with the 2 year old that fell and wont move their arm? Before we just do an "armogram" x-ray, lets stop and think about the weak points in the pediatric arm. Once we find one of the common fractures, what next? Splint and refer, sedate and reduce, transfer?

Age ain't nothin' but a number? You are only as young as you feel? When it comes to pediatric surgical disease timing really is everything. Hopefully, you enjoy the rule of six (credit to Dr. Dave Nelson for this) as a framework for the common presentation of abdominal surgical disease in the pediatric patient.

Making the diagnosis of DKA takes about 30 seconds. But before we open up the order set, check some boxes, and send the kid upstairs, let's think about how we can fine-tune our care. What complications do we need to look out for and how can we manage them?

Pediatric patients presenting with prolonged fever and laboratory signs of inflammation have a broad differential. In addition to the standards, such as viral illness and bacterial infection, we need to consider the inflammatory states of KD, TSS, and the emerging MIS-C. Join us on this journey through the fire and we review these three conditions in a podcast that accompanies a blog post for EMdocs.net

To people who know me, it will come as no surprise that I love statistics and bad puns. So have fun streaming this e-piss-ode as we learn about whom to test, how to test, and what to do with the result. We also reveal a PEM GEMS exclusive: Ravera's Spectrum, the Joe Ravera approach to the diagnosis of pediatric UTI. Hopefully you find this to be liquid gold!

The radio call comes in: a 3 year old who is actively seizing. Time to get the board set up and play. In this episode we strive to be more than just algorithm readers; we want to be a status epilepticus grandmaster. Let's learn to think moves ahead and make calculated sacrifices as we try to checkmate a child's seizure.

What do a 7-week-old with a fever and breaking up with someone have in common? There is no right way to approach either situation - because if there were, everyone would just do it. Come take a journey into the fire as we talk about neonatal fever: what we know, what we don't know, and the 40 year search for low risk.

PEM GEMS a Pediatric Emergency Medicine podcast with Tips and tricks to help you take care of kids on your next shift.