Podcasts about cleveland clinic children

Whether it's the taste of broccoli, texture of mom's meatloaf, or not wanting to drink milk, kids can be pretty picky about their food and drinks.  But, why is that?  “It typically starts early in toddlerhood, and at that age, it really kind of comes because kids are finding their independence; a lot of times it's behavioral. It's not always 100% because of the food,” explained Jennifer Hyland, RD, registered dietitian for Cleveland Clinic Children's. “They're also experiencing different textures, different flavors. Things don't taste the same every single time they eat them. So, it can be common for kids to become picky.”   Hyland said other factors could be playing a role too, like maybe they had a bad day at school and don't have much of an appetite, they're having issues swallowing, or get an upset stomach after they eat.  She said it's important to notice any patterns and try to get to the root of the issue, which may include talking to their pediatrician.  So, what can parents do to help their picky eaters?  She recommends being consistent with mealtimes and expectations, serving at least one food you know they like, and trying to make fruits and vegetables fun.  It can also help to include them in the cooking process.  If you are going to serve them something new, Hyland suggests giving them a smaller portion so it's less intimidating.   “Some other things that you can work towards is repetition. So oftentimes I hear parents say, ‘My kid doesn't like X food,' so they never serve it again. It takes a lot of exposures for kids to learn to like something. And if they're not given the opportunity, they never have a chance to even learn to like something. So even if you feel like your kid does not like green beans, please continue to offer green beans,” she said. Hyland cautions parents against force feeding.  If your child doesn't like a certain food, don't try to make them eat it or sit at the table until they finish their plate.  This can cause unnecessary stress and could lead to an argument.

Join pediatric otolaryngologist Swathi Appachi, MD as she discusses the latest innovations in pediatric voice and sleep care, including Cleveland Clinic Children's Pediatric Voice Center and hypoglossal nerve stimulation for sleep apnea in children with Trisomy 21. Dr. Appachi also shares on update on our Otolaryngology-Head and Neck Surgery Residency Program, where she serves as Associate Program Director.

Nowadays, it's common for most women to be in the workforce before they embark on motherhood. Once they have decided to expand their families, maternity leave is something that enters their minds. How much time will she have off? How much will be paid or unpaid? What should she prepare for to have a smooth maternity leave? There are a lot of questions, so we had to "chick chat" with Dr. Jessica Madden, a mom of four, a board-certified pediatrician and neonatologist, and an International Board-Certified Lactation Consultant (IBCLC), her recommendations on how to prepare for maternity leave and what to mothers should add to their maternity leave checklist. Who is Dr. Jessica Madden? Dr. Jessica Madden has been a board-certified pediatrician and neonatologist for over 15 years. She's currently on staff in the neonatal intensive care unit (NICU) at Rainbow Babies and Children's Hospital in Cleveland, OH. She previously worked in the Boston and Cleveland Clinic Children's Hospitals. In 2018 she started Primrose Newborn Care to provide in-home newborn medicine and lactation support. Dr. Madden is currently the Medical Director at Aeroflow Breastpumps. She also enjoys traveling, yoga, reading, and spending time with her four children. What Did We Discuss? In this episode, we chat with Dr. Madden about the ideal maternity leave checklist for expectant mothers, such as what to discuss with employers and insurance companies, what resources are available during and post-delivery, including lactation support, and more. Here are several of the questions that we covered in our conversation: What is the current landscape of maternity leave in the U.S.?  How important is it for mothers to plan for maternity leave? When should they start? What are the most important things to take into consideration when preparing for maternity leave? And what needs to be on every maternity leave checklist? Can you please explain to us the consequences of limited access to paid or partially paid maternity leave for expecting mothers? Can you provide an overview of resources available for expecting mothers, such as lactation support services, community and online support groups, and educational classes on childbirth, breastfeeding, and newborn care? How can women involve partners, family members, and even employers in the maternity leave planning process? What are your top recommendations to expectant mothers as they start to plan for their maternity leave and beyond?  Dr. Jessica Madden gave us some incredible insights in this episode, and we are including all of them in our maternity leave checklist, which you can find and download in our SHOW NOTES. Be sure to download it to prepare for your maternity leave successfully! Dr. Madden's Resources Website: aeroflowbreastpumps.com Facebook: @AeroflowBreastpumps Instagram: @aeroflow_breastpumps Pinterest: @aeroflowbp YouTube: @AeroflowBreastpumps Mentioned in the Episode: Nesting Parties Postpartum Plan Thank you for listening to this episode! Be sure to subscribe to our podcast, leave us a review, and follow us on our podcast Instagram page @thebabychickchat for more content. Cheers to preparing for an amazing maternity leave! Learn more about your ad choices. Visit megaphone.fm/adchoices

6 year old John-Henry couldn't contain himself when he found out he was getting a new heart.  The Cleveland Clinic Children's Hospital shared the video on TikTok this week and Rocky & Lissa tried to keep it together listening to this little dude's exciting news.

IntroductionWelcome to PICU Doc On Call, a podcast dedicated to current and aspiring pediatric intensivists. I'm Dr. Pradip Kamat from Children's Healthcare of Atlanta/Emory University School of Medicine, and I'm Dr. Rahul Damania from Cleveland Clinic Children's Hospital. We are two Pediatric ICU physicians passionate about medical education in the PICU. This podcast focuses on interesting PICU cases and their management in the acute care pediatric setting.Episode OverviewIn today's episode, we are excited to welcome Dr. Karen Zimowski, Assistant Professor of Pediatrics at Emory University School of Medicine and a practicing pediatric hematologist at Children's Healthcare of Atlanta at the Aflac Blood & Cancer Center. Dr. Zimowski specializes in pediatric bleeding and clotting disorders.Case PresentationA 16-year-old female with a complex medical history, including autoimmune thyroiditis and prior cerebral infarcts, was admitted to the PICU with acute chest pain and difficulty breathing. Despite being on low-dose aspirin, her oxygen saturation was 86% on room air. A CT angiography revealed a pulmonary embolism (PE) in the left lower lobe and signs of right heart strain. The patient was hemodynamically stable, and thrombolytic therapy was deferred in favor of anticoagulation. She was placed on BiPAP to improve her respiratory status. Her social history was negative for smoking, illicit drug use, or oral contraceptive use.Key Case PointsDiagnosis: Pulmonary embolism (PE)Hemodynamics: Stable with no right ventricular (RV) strain on echocardiogramManagement Focus: Anticoagulation and consultation with the hematology/thrombosis teamExpert Discussion with Dr. Karen ZimowskiRisk Factors and Epidemiology of VTE in PediatricsPathophysiology: Venous thromboembolism (VTE) in children involves components of Virchow's triad: stasis of blood flow, endothelial injury, and hypercoagulability.Incidence: VTE is rare in the general pediatric population but increases significantly in hospitalized children.Age Distribution: Bimodal peaks in infants and adolescents aged 15-17 years.Risk Factors: Central venous lines, infections, congenital heart disease, cancer, and autoimmune disorders.Clinical Manifestations of DVTSymptoms: Swelling, pain, warmth, and skin discoloration in the affected extremity.Specific Presentations:SVC syndrome from superior vena cava thrombosisAbdominal pain from portal vein thrombosisHematuria from renal vein thrombosisNeurological symptoms...

Matteo Trucco, MD joins us on OsteoBites to provide a preview of the FACTOR 2024 scientific panels in layperson terms with a brief overview of vocabulary and terms as a helpful resource for patients and families attending our FACTOR 2024 conference.Dr. Matteo Trucco is a pediatric oncologist caring for children, teens and young adults with sarcomas at Cleveland Clinic Children's. He also serves as Clinical Director, directs the Children's Cancer Innovative Therapy Program and co-chairs the National Pediatric Cancer Foundation's Sunshine Project consortium where he and colleagues develop and conduct clinical trials seeking more effective and less toxic treatments for childhood cancers. He received his undergraduate degree from the University of Pennsylvania, Medical Degree from Temple University School of Medicine, and completed his Pediatrics Residency at Rainbow Babies and Children's Hospital and his Pediatric Hematology/Oncology Fellowship at Johns Hopkins and the National Cancer Institute. He is honored to be on the MIB Agents Board of Directors, chairs the MIB Agents Scientific Advisory Board, and co-chairs the organizing committee for the annual FACTOR Conference. He also has the privilege of moderating the MIB Agents Tumor Review Board for Osteosarcoma

Welcome to PICU Doc On Call, where Dr. Pradip Kamat from Children's Healthcare of Atlanta/Emory University School of Medicine and Dr. Rahul Damania from Cleveland Clinic Children's Hospital delve into the intricacies of Pediatric Intensive Care Medicine. In this special episode of PICU Doc on Call shorts, we dissect the Alveolar Gas Equation—a fundamental concept in respiratory physiology with significant clinical relevance.Key Concepts Covered:Alveolar Gas Equation Demystified: Dr. Rahul explains the Alveolar Gas Equation, which calculates the partial pressure of oxygen in the alveoli (PAO2). This equation, PAO2 = FiO2 (Patm - PH2O) - (PaCO2/R), is essential in understanding hypoxemia and the dynamics of gas exchange in the lungs.Calculating PAO2: Using the Alveolar Gas Equation, the hosts demonstrate how to calculate PAO2 at sea level, emphasizing the influence of atmospheric pressure, fraction of inspired oxygen (FiO2), water vapor pressure, arterial carbon dioxide pressure (PaCO2), and respiratory quotient (R) on oxygenation.A-a Gradient and Hypoxemia: The A-a gradient, derived from the Alveolar Gas Equation, is discussed in the context of hypoxemia evaluation. Understanding the causes of hypoxemia, including ventilation/perfusion (V/Q) mismatch, anatomical shunt, diffusion defects, and hypoventilation, is crucial for clinical diagnosis and management.Clinical Scenarios and A-a Gradient Interpretation: Through a clinical scenario, the hosts elucidate how different conditions affect the A-a gradient and oxygenation, providing insights into respiratory pathophysiology and differential diagnosis.Clinical Implications and Management Strategies: The hosts highlight the clinical significance of the Alveolar Gas Equation in assessing oxygenation status, diagnosing gas exchange abnormalities, and tailoring respiratory management strategies in the pediatric intensive care setting.Key Takeaways:Utility of the Alveolar Gas Equation: Understanding and applying the Alveolar Gas Equation is essential for evaluating oxygenation and diagnosing respiratory abnormalities.Interpreting A-a Gradient: A normal A-a gradient suggests alveolar hypoventilation as the likely cause of hypoxemia, whereas elevated gradients indicate other underlying pathologies.Clinical Relevance: Recognizing the clinical implications of the Alveolar Gas Equation aids in accurate diagnosis and optimal management of respiratory conditions in pediatric intensive care patients.Conclusion:Join Dr. Kamat and Dr. Damania as they unravel the complexities of the Alveolar Gas Equation, providing valuable insights into respiratory physiology and its clinical applications. Don't forget to subscribe, share your feedback, and visit picudoconcall.org for more educational content and resources.References:Fuhrman & Zimmerman - Textbook of Pediatric Critical Care Chapter: Physiology of the respiratory system. Chapter 42. Khemani et al. Pages 470-481Rogers textbook of Pediatric intensive care: Chapter 44....

Andrea Adler, RD, CSPCC, LD, is a board certified specialist in pediatric critical care nutrition and has worked as a Pediatric Dietitian at the Cleveland Clinic Children's Hospital for over 19 years.  She's worked with the neonatal population since 2004 and, about 10 years ago, expanded her practice to include pediatric patients with intestinal failure, liver failure and organ transplantation.  She currently volunteers as RD Co-Chair of the Pediatric Intestinal Failure Work Group Subcommittee of the American Society for Parenteral and Enteral Nutrition, and was Andrea recently received the Recognized Neonatal Dietitian award from Pediatric Nutrition Practice Group from the Academy of Nutrition and Dietetics.  When she is not working, she enjoys spending her time at her daughter's swim meets or her son's wrestling matches and enjoys riding with her virtual friends on her “bike that goes nowhere”.  This episode was hosted by Christina M. Rollins MBA, MS, RDN, LDN, CNSC, FAND and was recorded on 1/10/24.

Hosts:Pradip Kamat, Children's Healthcare of Atlanta/Emory University School of MedicineRahul Damania, Cleveland Clinic Children's HospitalIntroductionToday, we discuss the case of an 8-month-old infant with severe bronchospasm and abnormal blood gas. We'll delve into the epidemiology, pathophysiology, and evidence-based management of acute bronchiolitis.Case SummaryAn 8-month-old infant presented to the ER with decreased alertness following worsening work of breathing, preceded by URI symptoms. The infant was intubated and transferred to the PICU, testing positive for RSV. Initial blood gas showed 6.8/125/-4, and CXR revealed massive hyperinflation. Vitals: HR 180, BP 75/45, SPO2 92% on 100% FIO2, RR 12 (prior to intubation), now around 16 on the ventilator, afebrile.Discussion PointsEtiology & Pathogenesis: Bronchiolitis is primarily caused by RSV, with other viruses and bacteria playing a role. RSV bronchiolitis is the most common cause of hospitalization in infants, particularly in winter months. Immuno-pathology involves an unbalanced immune response and can lead to various extra-pulmonary manifestations.Diagnosis: Diagnosis is clinical, based on history and examination. Key signs include upper respiratory symptoms followed by lower respiratory distress. Blood gas, chest radiography, and viral testing are generally not recommended unless warranted by severe symptoms or clinical deterioration.Management Framework: For patients requiring PICU admission, focus on oxygenation and hydration. High-flow therapy and nasal continuous positive airway pressure (CPAP) can be used. Hydration and feeding support are crucial. Antibiotics, steroids, and bronchodilators are generally not recommended. Mechanical ventilation and ECMO may be necessary in severe cases.Immunoprophylaxis & Nosocomial Infection Prevention: Palivizumab and nirsevimab are used for RSV prevention in high-risk infants. Strict infection control measures, including hand hygiene and isolation, are essential to prevent nosocomial infections.ConclusionRSV bronchiolitis is a common and potentially severe respiratory illness in infants. Management focuses on supportive care, with a careful balance between oxygenation and hydration. Immunoprophylaxis and infection control are crucial in preventing the spread of the virus.Thank you for listening to our episode on acute bronchiolitis. Please subscribe, share your feedback, and visit our website at picudoconcall.org for more resources. Stay tuned for our next episode!ReferencesRogers - Textbook of Pediatric Critical Care Chapter 49: Pneumonia and Bronchiolitis. De Carvalho et al. page 797-823Reference 1: Dalziel, Stuart R; Haskell, Libby; O'Brien, Sharon; Borland, Meredith L; Plint, Amy C; Babl, Franz E; Oakley, Ed. Bronchiolitis. The Lancet. , 2022, Vol.400(10349), p.392-406. DOI: 10.1016/S0140-6736(22)01016-9; PMID:...

Hosts:Pradip Kamat, Children's Healthcare of Atlanta/Emory University School of MedicineRahul Damania, Cleveland Clinic Children's HospitalCase Introduction:6-year-old patient admitted to PICU with severe pneumonia complicated by pediatric Acute Respiratory Distress Syndrome (pARDS).Presented with respiratory distress, hypoxemia, and significant respiratory acidosis.Required intubation and mechanical ventilation.Despite initial interventions, condition remained precarious with persistent hypercapnia.Physiology Concept: Dead SpaceDefined as the volume of air that does not participate in gas exchange.Consists of anatomic dead space (large airways) and physiologic dead space (alveoli).Physiologic dead space reflects ventilation-perfusion mismatch.Pathological Dead Space:Occurs due to conditions disrupting pulmonary blood flow or ventilation.Common in conditions like pulmonary embolism, severe pneumonia, or ARDS.Clinical Implications:Increased dead space fraction (DSF) in PARDS is a prognostic factor linked to severity and mortality.Elevated DSF indicates worse lung injury and inefficient gas exchange.DSF can be calculated using the formula: DSF = (PaCO2 – PetCO2) / PaCO2.Practical Management:Optimize Mechanical VentilationEnhance PerfusionConsider Positioning (e.g., prone positioning)Summary of Physiology Concepts:Bohr equation for physiologic dead space.Importance of lung-protective ventilation strategies.Monitoring and trending dead space fraction.Strategies to improve airway patency and mucociliary clearance.Connect with us!PICU Doc on Call provides concise explanations of critical concepts in pediatric intensive care.Feedback, subscriptions, and reviews are encouraged.Visit picudoconcall.org for episodes and Doc on Call infographics.

TJ Gliha, Co-Founder of Journey Wealth.Established in 2021, Journey Wealth is a full-service wealth planning firm that helps entrepreneurs explore the world of opportunities availed by their success, by addressing their needs and enabling them and their families to lead the lives they aspire to. From its humble beginnings with just 4 employees, Journey Wealth has grown as a self-governing Registered Investment Advisory firm to nearly 20 professionals, with the strategic acquisition of a significant equity stake in FSM Wealth, offering multi-family office services primarily to professional golfers.With a robust background as a portfolio manager and trader at the Chicago Mercantile Exchange, and as a former shareholder at Sequoia Financial Group, TJ brings a wealth of experience to the table. Not only is he dedicated to helping entrepreneurs make the most of their time…their most valuable asset… but he also plays an active role in the community as a board member of the Make-A-Wish Foundation and Cleveland Clinic Children's Council in addition to his role as Treasurer of the Avon Lake Football Club, stemming from his passion for football!This was a really fun conversation for me, as a long-time student of public market investing, TJ and I got to really unpack the wealth management business and industry overall, the intersection of investing and entrepreneurship, the psychology and cognitive biases of investors, his formative past as trader on the exchange floor, the evolution of Journey Wealth over time in service of entrepreneurs, leadership, and so much more.-----Lay of The Land is brought to you by Ninety. As a Lay of The Land listener, you can leverage a free trial with Ninety, the platform that helps teams build great companies and the only officially licensed software for EOS® — used by over 7,000 companies and 100,000 users!This episode is brought to you by Impact Architects. As we share the stories of entrepreneurs building incredible organizations throughout NEO, Impact Architects helps those leaders — many of whom we've heard from as guests on Lay of The Land — realize their visions and build great organizations. I believe in Impact Architects and the people behind it so much, that I have actually joined them personally in their mission to help leaders gain focus, align together, and thrive by doing what they love! As a listener, you can sit down for a free consultation with Impact Architects by visiting ia.layoftheland.fm!-----Connect with TJ on LinkedIn — https://www.linkedin.com/in/t-j-gliha-aif%C2%AE-cepa-a4ba801/Learn more about Journey Wealth — https://www.journey-wealth.com/-----For more episodes of Lay of The Land, visit https://www.layoftheland.fm/Past guests include Cleveland Mayor Justin Bibb, Steve Potash (OverDrive), Ed Largest (Westfield), Ray Leach (JumpStart), Lila Mills (Signal Cleveland), Pat Conway (Great Lakes Brewing), Lindsay Watson (Augment Therapy), and many more.Stay up to date on all our podcasts by signing up for Lay of The Land's weekly newsletter — sign up here.Connect with Jeffrey Stern on LinkedIn — https://www.linkedin.com/in/jeffreypstern/Follow Jeffrey Stern on Twitter @sternJefe — https://twitter.com/sternjefeFollow Lay of The Land on Twitter @podlayofthelandhttps://www.jeffreys.page/

Welcome to PICU Doc on Call, a podcast dedicated to current and aspiring intensivists. I'm Pradeep Kumar coming to you from Children's Healthcare of Atlanta, Emory University School of Medicine, and I'm Rahul Damania from Cleveland Clinic Children's Hospital. We are two pediatric ICU physicians passionate about all things medical education in the PICU.Episode Overview: PICU.com call focuses on interesting PICU cases and management in the acute care Pediatric setting. In this episode, we discuss the case of an eight-year-old boy with chest pain, fatigue, and shortness of breath. This case presentation by Rahul highlights the complexity of pediatric care in the PICU.Case Presentation: An eight-year-old boy with up-to-date immunizations and no recent travel or pet exposure presented to the PICU with chief complaints of chest pain, fatigue, and decreased oral intake. His history over the preceding two weeks included a diminishing appetite, episodes of vomiting, and shortness of breath.On examination, he exhibited various cardiac findings, including a hyperdynamic left ventricle, murmurs, and a noted gallop. Abdominal and neurological findings were also concerning. Diagnostic studies revealed an enlarged heart, and sinus tachycardia with left ventricular hypertrophy, and echocardiography confirmed severe valvular and ventricular abnormalities.Laboratory Findings:Laboratory findings included elevated BNP, slightly elevated troponin, and elevated inflammatory markers (ESR and CRP). Strep throat culture was negative, but ASO and anti-DNAse B titers were markedly elevated. MRI confirmed multiple punctate infarctions, likely due to valvular heart disease.Diagnosis: Given the complex multisystem presentation, the child was admitted to the PICU for intensive monitoring and comprehensive management of this multisystem pathology. The working diagnosis is rheumatic fever.The episode is organized into three parts:Pathophysiology of Acute Rheumatic FeverApproach to Diagnosis and InvestigationsManagement and PreventionPathophysiology of Acute Rheumatic Fever: Acute rheumatic fever is an autoimmune disease initiated by a response to group A strep infection, primarily due to molecular mimicry. The streptococcal M protein has structural similarities with host proteins, leading to organ damage, especially in the heart.Epidemiology: Acute rheumatic fever is most prevalent in low to middle-income areas, affecting over 80% of cases. It mainly affects children between 5 to 14 years of age, and overcrowded households and limited healthcare access increase the risk. Globally, rheumatic heart disease affects millions of people annually and claims many lives.Jones Criteria for Diagnosis: The Jones criteria help diagnose acute rheumatic fever. For

Matteo Trucco, MD and Kurt Weiss, MD joins us on OsteoBites to describe the collaboration that led to the current Phase 1 clinical trial repurposing the alcoholism drug disulfiram to see if it can overcome the chemotherapy resistance seen in relapsed sarcomas, including osteosarcoma. Matteo Trucco is a Pediatric Oncologist and the Clinical Director of Pediatric Hematology/Oncology at Cleveland Clinic Children's, specializing in the care of children, teenagers and young adults battling bone and soft tissue cancers. He also directs the Children's Cancer Innovative Therapy Program where he and colleagues design, develop and conduct clinical trials seeking more effective and less toxic treatments for childhood cancers. Dr. Trucco earned his undergraduate degree from the University of Pennsylvania and Medical Degree from Temple University School of Medicine. He completed his Pediatrics Residency at Rainbow Babies and Children's Hospital and his Pediatric Hematology/Oncology Fellowship from Johns Hopkins and the National Cancer Institute. In addition to his roles at the Cleveland Clinic, he is a Co-chair of the National Pediatric Cancer Foundation's Sunshine Project consortium, partnering with other top pediatric cancer centers to develop clinical trials. He is honored to be on the Board of MIB Agents, chairs its Scientific Advisory Board and co-chairs the organizing committee for the FACTOR Conference. He also has the privilege of moderating the MIB Agents TURBO Tumor Review Board for Osteosarcoma. Dr. Weiss directs the Department's Musculoskeletal Oncology Laboratory, a basic science laboratory dedicated to the study of sarcomas. His mission is to help develop a world-class translational sarcoma research program at the University of Pittsburgh. As a bone cancer survivor himself, Dr. Weiss brings passion and enthusiasm to the laboratory, clinic, and operating room. Through the UPMC Hillman Cancer Center, he is also a proud collaborator with scientists who are trying to understand how other forms of cancer spread to and destroy the bone. Dr. Weiss is a Founding Member of the Musculoskeletal Oncology Research Initiative (MORI), Pittsburgh Cure Sarcoma (PCS), the Pittsburgh Sarcoma Research Collaborative (PSaRC), and the Pittsburgh Center for Bone and Mineral Research (PCBMR). He is a peer reviewer for multiple journals including the Journal of the American Academy of Orthopaedic Surgeons, BioMed Central Cancer, Sarcoma, Cancer Research, International Journal of Cancer, and others. He is a former member of the NIH's Center for Scientific Review Early Career Reviewer program. He has served on multiple National Cancer Institute Study Sections. He is a member of the Musculoskeletal Tumor Society (MSTS) for which he serves as Chair of the Research Committee and the Connective Tissue Oncology Society (CTOS), for which he has served on the Board of Directors. ----- What We Do at MIB Agents: PROGRAMS: End-of-Life MISSIONS Gamer Agents Agent Writers Prayer Agents Healing Hearts - Bereaved Parent and Sibling Support Ambassador Agents - Peer Support Warrior Mail Young Adult Survivorship Support Group EDUCATION for physicians, researchers and families: OsteoBites, weekly webinar & podcast with thought leaders and innovators in Osteosarcoma MIB Book: Osteosarcoma: From our Families to Yours RESEARCH: Annual MIB FACTOR Research Conference Funding multiple $100,000 and $50,000 grants annually for OS research MIB Testing & Research Directory The Osteosarcoma Project partner with Broad Institute of MIT and Harvard ... Kids are still dying with 40+ year old treatments. Help us MakeItBetter. https://www.mibagents.org​ Help support MIB Agents, Donate here https://give-usa.keela.co/embed/YAipuSaWxHPJP7RCJ SUBSCRIBE for all the Osteosarcoma Intel

Introduction: Welcome to "PQ Doc On Call," a podcast dedicated to current and aspiring intensivists. Hosted by Dr. Pradeep Kamar from Children's Healthcare of Atlanta, Emory University School of Medicine, and Dr. Rahul Damia from Cleveland Clinic Children's Hospital, both passionate PICU physicians.You will hear:This episode dives into the management of pediatric drowning cases in the PICU, providing valuable insights into assessment, pathophysiology, and practical management strategies.Case Presentation: An 18-month-old girl was admitted to the PICU following a submersion incident in a residential pool. The child's initial unresponsiveness and subsequent clinical deterioration presented challenges for the PICU team, including respiratory distress, electrolyte imbalances, and potential neurological complications.Key Elements from the Case:Severe acute respiratory failure following submersionAbnormal electrolytes (hyponatremia)Neurological insult requiring ongoing monitoringDefinitions and Terminology:Clarification of drowning terminology, emphasizing uniform definitions and avoiding outdated terms like "near drowning." Key terms include primary vs. secondary drowning, saltwater vs. freshwater, intentional vs. non-intentional, and fatal vs. non-fatal drowning incidents.Pathophysiology:Airway Reflexes: Initial reflex laryngospasm triggered by liquid penetration, followed by relaxation due to hypoxia, hypercarbia, and acidosis.Gas Exchange Compromise: Decreased functional residual capacity leading to impaired oxygen uptake and CO2 elimination.Pulmonary Complications: Pulmonary edema, surfactant washout, increased pulmonary vascular resistance, and shunting, impacting oxygen delivery.Management Strategies:Out-of-Hospital: Aggressive on-site CPR and advanced life support are crucial for favorable outcomes. Swift control of hypoxia and acidosis is vital.In-PICU: Ventilation strategies resembling ARDS management (low tidal volume, low plateau pressures, high PEEP). Consider neurological exam, continuous EEG, and neuromuscular blockade if needed.Prognostic Factors: Duration of submersion, time to effective CPR, initial GCS, apnea persistence, pH levels, and neurologic status.Prevention:Empowering prevention through measures like fencing around pools, teaching children to swim, and vigilant adult supervision can significantly reduce the risk of pediatric drowning incidents.Conclusion:"PQ Doc On Call" underscores the importance of timely, effective CPR, swift management...

The Be Well Kids Clinic brings together a comprehensive team of physicians, researchers and healthcare professionals at Cleveland Clinic Children's with expert knowledge in childhood obesity. Joining this episode of the Butts and Guts podcast from the team is Dr. Jennifer Brubaker. She is a Certified Nurse Practitioner and has been on the staff of the Be Well Kids Clinic for the past eight years. Listen to learn more about this program and how the team can assist children and their families in the prevention and treatment of childhood obesity.

Dr. Sandra Kim, the new Chair of Gastroenterology, Hepatology, and Nutrition at Cleveland Clinic Children's, joins this episode of the Butts and Guts podcast to discuss inflammatory bowel disease (IBD) in children. Listen to learn about what symptoms to be on the lookout for in a child who potentially may have IBD, what treatment looks like for this disease at Cleveland Clinic Children's, and more.

Welcome to PICU Doc On Call, A Podcast Dedicated to Current and Aspiring Intensivists.I'm Pradip Kamat coming to you from Children's Healthcare of Atlanta/Emory University School of Medicine and I'm Rahul Damania from Cleveland Clinic Children's Hospital. We are two Pediatric ICU physicians passionate about all things MED-ED in the PICU. PICU Doc on Call focuses on interesting PICU cases & management in the acute care pediatric setting so let's get into our episode.In today's episode, we're bringing together some of the best content from our previous podcasts to present a comprehensive clinical case. We're also excited to share with you some of the most highly cited articles from the past year, presented in a practical, case-based format. This episode will offer you valuable insights into the latest research findings while also highlighting the real-world application of this knowledge in a clinical setting.We'll start by presenting an interesting case of a toddler who was transferred to the PICU due to increasing respiratory distress:A 2-year-old male was brought to the emergency department with a chief complaint of increased work of breathing and URI symptoms, including a cough and runny nose. The child had no significant past medical history, was not taking any medications, and had no known allergies. The child was up-to-date on immunizations, and there were no significant sick contacts.The family brought the child to the emergency department after noticing a significant increase in work of breathing, including the use of accessory muscles, nasal flaring, and chest retractions. The initial physical exam revealed tachypnea and decreased breath sounds on the right side. The child's vital signs were concerning for respiratory distress, with a heart rate of 170 beats per minute, respiratory rate of 50 breaths per minute, and oxygen saturation of 85% on room air. Chest X-ray revealed right lower lobe pneumonia.The child was started on supplemental oxygen, and broad-spectrum antibiotics, and trialed with albuterol. Despite initial treatment, the child's respiratory distress worsened, and the decision was made to transfer the child to the PICU and place the patient on HFNC 1.5 L/kg. Upon admission to the PICU, the child's vital signs were still concerning, he was afebrile, with a heart rate of 180 beats per minute, respiratory rate of 60 breaths per minute, and oxygen saturation of 85% on 1.5L/kg HFNC at 75% FiO2. Given the persistent respiratory distress, the decision was made to intubate the child in the PICU for acute hypoxemic respiratory failure. Shortly after intubation, a central line is placed in the R internal jugular vein.To summarize key elements from this case:2-year-old with a prodrome of URI symptomsIs otherwise previously healthy with no significant medical history or allergiesDeveloped respiratory distress and diagnosed with pneumoniaTransferred to PICU, intubated for respiratory failureLet's fast forward in the case and talk about a scenario that frequently arises in the PICU. It's hospital day 2, and the patient's RSV swab is positive, and we're seeing some improvement on the X-ray....

Welcome to PICU Doc On Call, A Podcast Dedicated to Current and Aspiring Intensivists.I'm Pradip Kamat coming to you from Children's Healthcare of Atlanta/Emory University School of Medicine. I'm Rahul Damania from Cleveland Clinic Children's Hospital and we are two Pediatric ICU physicians passionate about all things MED-ED in the PICU. PICU Doc on Call focuses on interesting PICU cases & management in the acute care pediatric setting so let's get into our episode.Today, we are going to discuss the management of the postoperative patient admitted to the PICU. Our discussion will focus on the non-cardiac and non-transplant admission. Our objective in this episode is to create a framework on what areas of care to focus on when you have a patient admitted to the PICU post-operatively. Each surgery and patient is unique; however, we hope that you will garner a few pearls in this discussion so you can be proactive.in your management. Without any further delay, let's get started with today's case:We begin with a 13-year-old child, Alexa, with h/o of a genetic syndrome, who presents today with a history of thoracolumbar kyphoscoliosis. Over the years, Alexa's curvature has progressively worsened, resulting in difficulty breathing and chronic back pain. The decision was made to proceed with a complex spinal surgery, including posterior spinal fusion and instrumentation.In the weeks leading up to the surgery, Alexa underwent a thorough preoperative evaluation, including consultations with specialists and relevant imaging studies. Pulmonary function tests revealed a restrictive lung pattern, while the echocardiogram showed no significant cardiac abnormalities. Preoperative labs, including CBC, electrolytes, and coagulation profile, were within normal limits.During the surgery, Alexa was closely monitored by the anesthesia team, who administered general anesthesia with endotracheal intubation. The surgery was performed by the pediatric neurosurgery and orthopedics, with intra-operative neuromonitoring to assess spinal cord function. The surgical team encountered an unexpected dural tear, which was repaired using sutures and a dural graft. Due to the prolonged surgical time, a temporary intra-operative loss of somatosensory evoked potentials was noted. However, signals were restored after adjusting the patient's position and optimizing blood pressure. The posterior spinal fusion and instrumentation were completed successfully, but the surgery lasted 8 hours. Total intra-operative blood loss was 800 mL, and Alex received 2 units of packed red blood cells and was on NE for a little over half the case before weaning off.Alexa was admitted to the PICU intubated and sedated for postoperative care. The initial assessment showed stable vital signs, with a systolic blood pressure of 100 mmHg, heart rate of 90 bpm, and oxygen saturation of 99% on mechanical ventilation. Postoperative pain was managed with a continuous morphine infusion. The surgical team placed a closed suction drain near the surgical site and a Foley catheter for urinary output monitoring. You are now at the bedside for OR to PICU handoff…To summarize key components from this case:This is a patient with thoracolumbar kyphoscoliosis, underwent complex spinal surgery (posterior spinal fusion and instrumentation) due to progressive curvature, breathing difficulties, and chronic pain.

Arun D. Singh, MD, Director of Ophthalmic Oncology at Cleveland Clinic Cole Eye Institute, and Stacey Zahler, DO, a pediatric hematologist-oncologist at Cleveland Clinic Children's join the Cancer Advances podcast to discuss retinoblastoma. Listen as they discuss this unique children's eye cancer, the treatment options available, and the genetic counseling we have at Cleveland Clinic.

Welcome to PICU Doc On Call, A Podcast Dedicated to Current and Aspiring Intensivists.I'm Pradip Kamat coming to you from Children's Healthcare of Atlanta/Emory University School of Medicine and I'm Rahul Damania from Cleveland Clinic Children's Hospital. We are two Pediatric ICU physicians passionate about all things MED-ED in the PICU. PICU Doc on Call focuses on interesting PICU cases & management in the acute care pediatric setting so let's get into our episode.Here's the case of a 12-week-old girl old who is limp and seizing presented by Rahul.Chief Complaint: A 12-week-old previously healthy female infant was found limp in her crib and developed generalized tonic-clonic seizures on the way to the hospital.History of Present Illness: The mother returned from work on a Saturday to find her daughter unresponsive in her crib. The infant had been left in the care of her mother's boyfriend, who stated that the daughter had been sleeping all day and had a small spit up. As the patient continued to have low appetite throughout the day and continued to be unresponsive in her crib, mother called EMS to bring her to the emergency department. En route, the patient had tonic movement that did not resolve with intranasal benzodiazepines.ED Course: The infant presents to the ED being masked. Upon arrival at the ED, the infant was in respiratory distress, with a heart rate of 190 beats per minute, respiratory rate of 50 breaths per minute, and oxygen saturation of 85% with bagging. She was intubated for seizure control upon arrival at the ED. Physical examination in the ED revealed bruising on the right neck region but was otherwise unremarkable. A non-contrast head CT showed no acute intracranial abnormalities. The initial diagnostic workup revealed normal CBC, mildly elevated hepatic enzymes, and pancreatic enzymes which were within normal limits. The blood gas showed metabolic acidemia with PCO2 in the 60s.Admission to PICU: Upon admission to the PICU, neurosurgery and trauma teams were consulted. A skeletal survey and ophthalmology consult for a fundoscopic examination were ordered, as there were concerns of non-accidental trauma. Further investigation is underway to determine the cause of the infant's condition.To summarize key elements from this case, this patient has:Patient left with mother's boyfriendInfant found limp and had seizures requiring intubationNeck bruiseAll of these bring up a concern for Non-Accidental Trauma (NAT) the topic of our discussion.Let's start with a short multiple-choice question:Which imaging modality is the most appropriate for establishing a diagnosis of abusive head trauma (AHT) in a 12-week-old infant with an open fontanelle on the exam?A. CT scan of the brain without contrast B. MRI of the brain without contrast C. Skull X-ray D. Doppler ultrasound of the headRahul, the correct answer is A. Though

The Cancer Advances podcast is joined by Kate Eshleman, PsyD, a pediatric psychologist in the Center for Pediatric Behavioral Health at Cleveland Clinic Children's to talk about the mental health of children and teenagers with cancer. Listen as Dr. Eshleman discusses the Cleveland Clinic Children's survivorship program, what medical professionals should watch out for, and how to assist patient families.

Welcome to PICU Doc On Call, A Podcast Dedicated to Current and Aspiring Intensivists.I'm Pradip Kamat coming to you from Children's Healthcare of Atlanta/Emory University School of Medicine and I'm Rahul Damania, from Cleveland Clinic Children's Hospital. We are two Pediatric ICU physicians passionate about all things MED-ED in the PICU. PICU Doc on Call focuses on interesting PICU cases & management in the acute care pediatric setting so let's get into our episode:Welcome to our Episode about a 14-year-old male who collapsed on the baseball field.Here's the case presented by Rahul:A 14-year-old male athlete was playing in a high school baseball tournament when he was hit in the chest with a pitched ball. The impact caused him to collapse on the field. Bystander CPR was begun given his unresponsiveness and emergency medical services were immediately called. The patient was transported to the hospital. Upon arrival, he was unresponsive and had no pulse. An electrocardiogram (ECG) showed ventricular fibrillation, and advanced cardiac life support was initiated. After several shocks and cardiac compressions, the patient regained a pulse and was transferred to the pediatric intensive care unit for further evaluation and management.To summarize key elements from this case, this patient has:Been struck by a high-velocity object in the chestSuffered a cardiac arrest, likely due to an arrhythmia from the blunt chest traumaThe presentation brings up a concern for Commotio Cordis, our topic of discussion today!We wanted to create this educational episode in light of the recent medical event experienced by the Buffalo Bill's safety Damar Hamlin. His blunt chest trauma, which led to cardiac arrest, has been postulated to be due to commotio cordis. At the date of this record, we are glad that Damar Hamlin is on the road to recovery.Absolutely, let's dive in more into this topic, Let's start with a short multiple-choice question:The 14-year-old described in our case suffered cardiac arrest after blunt chest trauma. Based on the working diagnosis of comottio cordis, what is the most likely EKG finding which may be seen in this patient?A. Ventricular fibrillationB. Ventricular tachycardiaC. Complete heart blockD. AsystoleThe correct answer is A. In a study published in JAMA (2002; 287(9):1142-1146) which used data from the US Commotio Cordis registry maintained by the Minneapolis Heart Institute Foundation, reported that the most common arrhythmia out of the 128 confirmed cases, 82 of which had EKGs which could be analyzed was ventricular fibrillation. Three patients had Vtach, 3 had Bradyarrhythmia and 1 had complete heart block. Although 40 patients had asystole, this was unlikely to be the initial rhythm after impact. Interestingly, the majority of these rhythms were recorded at the scene.Rahul, What is the definition of Commotio...

Approach to Pediatric Trauma Welcome to PICU Doc On Call, A Podcast Dedicated to Current and Aspiring Intensivists.I'm Pradip Kamat coming to you from Children's Healthcare of Atlanta/Emory University School of Medicine and I'm Rahul Damania, from Cleveland Clinic Children's Hospital. We are two Pediatric ICU physicians passionate about all things MED-ED in the PICU. PICU Doc on Call focuses on interesting PICU cases & management in the acute care pediatric setting so let's get into our episode.Welcome to our Episode today of a 7 yo M who presents to the PICU after a severe Motor Vehicle Accident.Here is the case presented by RahulA 7-year-old male child is admitted to the PICU after sustaining severe trauma. The patient was brought to the emergency department after a motor vehicle accident that involved an 18-wheeler truck & the family's car; in this severe accident the 7 yo was noted to be restrained however upon impact was ejected from the vehicle. He was unconscious and had multiple injuries, including a laceration on the head and bruising on the chest. The EMS was activated and the patient presented to the ED for acute stabilization. Upon examination, the patient was found to have a Glasgow Coma Scale score of 8, indicating a serious head injury. He had multiple bruises and abrasions on the chest and arms, and his pulse was rapid and weak. The patient was resuscitated with colloid and blood products, intubated, and transferred to the pediatric intensive care unit for further management.Notably, a CT scan of the head showed a skull fracture and a subdural hematoma. A chest X-ray showed multiple rib fractures and bilateral pulmonary opacities with no evidence of pneumothorax. The patient was also found to have a grade 2 liver laceration and a splenic injury. Pelvic x-ray and cardiac FAST exam were unrevealing.To summarize key elements from this case, this patient has:A traumatic brain injuryPulmonary contusions and is at risk for PARDSLiver and spleen injuryAnemiaPertinent negative includes: No pelvic injuries or injuries to great vessels in the chestRahul, let's approach the PICU medical management of this case based on a culmination of various guidelines published in the Pediatric Critical Care literature. Namely, let's use this case to dive deep into guidelines for:Traumatic brain injury (TBI)****Transfusion and Anemia Expertise Initiative (****TAXI)pediatric blunt liver and spleen injury management, are also known as the ATOMAC protocol, as well as general PICU management of acute trauma.As we take the management of this pediatric trauma patient in a systems-based fashion let's first go into the Management of Pediatric Traumatic Brain Injuries, can you start us off with some key management considerations?Based on the March 2019 TBI guidelines published in Pediatric Critical Care Medicine in 2019 (PCCM20(3S):p S1-S82, March 2019)This patient should have an ICP monitor or even an EVD placed for CSF diversion in consultation with the NS and trauma team. A CPP of at least >50 in our 7 yo patient and ICP < 20 mm Hg has been shown to improve outcomes and reduce mortality.Just as a quick review, CPP stands for cerebral perfusion pressure, which is the pressure that maintains blood flow to the brain. The formula for CPP is:CPP = MAP (mean arterial pressure) - ICP (intracranial pressure)Monitoring does not affect outcomes directly; rather the information from monitoring can be used to direct treatment decisions. Treatment informed by data from monitoring may result in better outcomes than treatment informed solely by data from clinical assessment. In short, it is important to have qualitative and quantitative data to optimize your decision-making.As we talked about ICP control is so crucial for

Dear Listeners & Peds ICU community, WE are back on air!Welcome to PICU Doc On Call, A Podcast Dedicated to Current and Aspiring Intensivists.I'm Pradip Kamat coming BACK to you from Children's Healthcare of Atlanta/Emory University School of Medicineand I'm Rahul Damania from Cleveland Clinic Children's Hospital and we are two Pediatric ICU physicians passionate about all things MED-ED in the PICU.PICU Doc on Call focuses on interesting PICU cases & management in the acute care pediatric setting.As we turn into a new year, we would like to introduce Season 2 of PICU Doc on Call. Yes Pradip, I am super excited for this year & I want to take this moment to thank YOU all, our listener community for making PICU Doc on Call such a success as we share our passion for medical education thru this forum!This episode will give you a quick layout of how we will be organizing each episode of PICU doc on call this year. We will also highlight some tips and tricks on how to best learn from a medical podcast. Our goal in this episode is to provide you a framework on some best practices in medical podcasting and how to retain information from a podcast. Especially for our past & future episodes, we hope you can use this audio learning platform to assist you in applying the knowledge at the bedside when you are working in the acute care setting.Let's get into our first learning objective,Rahul, did you know that learning via podcasts can actually benefit your brain & change the neural chemistry.In fact, a 2016 med ed study published out of UC Berkeley concluded that listening to narrative stories from podcasts can stimulate multiple parts of your brain such as the limbic system and can enhance mood as it modulates dopamine and serotonin driven neural pathways. Think about listening to your favorite true-crime podcast — the suspense actually allows for you to stimulate centers in your medulla that increase the amount of endorphines, dopamine and serotonin that keep you on the edge of your seat.That is so unique, so based on this, I do want to highlight some of the key elements which will make our podcast or any medical podcast you listen to beneficial. These pearls will also help you if you are developing a medical podcast of your own!The first concept here is that many podcasts provide narratives.When it comes to medical podcasts, narratives are in the form of medical cases which allow for you to retain content knowledge as a patient case invokes emotion and this can help you remember information more robustly.When listening to a podcast, you have to use your imagination to picture what's going on. For example, if I painted a 2 yo M with a history of rhinorrhea at home for about a week who now presents to the ED with subcostal & intercostal retractions that then progresses to intubation in the PICU, you not only are envisioning a patient in front of you, but also are shifting your mind across settings. Our brain has to work at the pace of the audio, so hopefully your mind doesn't wander off like it does when reading a textbook page. And because you have to...

Stacey Zahler, DO, a pediatric hematologist-oncologist at Cleveland Clinic Children's, joins the Cancer Advances podcast to talk about the advances in neuroblastoma care for pediatric patients. Listen as Dr. Zahler talks about current treatment options, creating a metaiodobenzylguanidine (MIBG) therapy center at Cleveland Clinic, and studying difluoromethylornithine (DFMO) against cancer cells.

Acute liver failure (ALF), though rare in both kids and adults, is when your liver suddenly begins to not function properly. Dr. Mike Leonis of Cleveland Clinic Children's joins this episode of Butts and Guts to discuss everything you need to know about ALF in children, including the symptoms, diagnosis and treatment of this life-threatening condition.

Rates of thyroid cancer in adults and children have seen a steep increase over the past decade, making it the fastest-rising cancer in the U.S. Rachel Georgopoulos, MD, pediatric otolaryngologist and Director of the Thyroid Head and Neck Oncology and Pediatric Endocrine Center (Thyroid HOPE), joins to discuss the innovative research and treatment happening at Cleveland Clinic Children's.

Dr. Sophia Patel is a pediatric gastroenterologist at Cleveland Clinic Children's. She joins the Butts & Guts podcast for the first time to discuss a procedure called transnasal endoscopy. Listen to learn more about this approach and how it can help patients (such as those with eosinophilic esophagitis) be evaluated without sedation.

Welcome to PICU Doc On Call, A Podcast Dedicated to Current and Aspiring Intensivists. I'm Pradip Kamat coming to you from Children's Healthcare of Atlanta/Emory University School of Medicine and I'm Rahul Damania from Cleveland Clinic Children's Hospital. We are two Pediatric ICU physicians passionate about all things MED-ED in the PICU. PICU Doc on Call focuses on interesting PICU cases & management in the acute care pediatric setting so let's get into our episode: Welcome to our Episode a three-year-old girl with altered mental status and acute respiratory failure Here's the case presented by Rahul— A three-year-old presents to the PICU with altered mental status and difficulty breathing. Per the mother, the patient was in the usual state of health on the day prior to admission when the mother left her in the care of her maternal grandmother. When mom arrived home later in the afternoon, mom was unable to wake her and reported that she seemed "stiff". She did not have any abnormal movements or shaking episodes. Mom called 911 and the patient was brought to our ED. No known head trauma, though the patient is in the care of MGM throughout the day. No emesis. Nhttp://emesis.no/ (o) recent sick symptoms. No witnessed ingestion, however, the patient's mother reports that MGM is on multiple medications (Xarelto, zolpidem, Buspar, gabapentin, and acetaminophen) and uses THC-containing products specifically THC gummies. In the ED: The patient had waxing and waning mentation with decreased respiratory effort. GCS was recorded at 7. Arterial blood gas was performed showing an initial pH of 7.26/61/31/0. The patient was intubated for airway protection in the setting of likely ingestion. The patient has no allergies, immunizations are UTD. BP 112/52 (67) | Pulse 106 | Temp 36.2 °C (Tympanic) | Resp (!) 14 | Ht 68.5 cm | Wt 14.2 kg | SpO2 100% | BMI 30.26 kg/m² Physical exam was unremarkable-pupils were 4-5mm and sluggish. There was no rash, no e/o of trauma Initial CMP was normal with AG of 12, CBC was unremarkable, and Respiratory viral panel was negative. Serum toxicology was negative for acetaminophen, salicylates, and alcohol. Basic Urine drug screen was positive for THC To summarize key elements from this case, this patient has: Altered mental status: - waxing and waning with GCS less than 8 suggestive of decreased ventilatory effort pre-intubation impending acute respiratory failure Dilated but reactive pupils All of which brings up a concern for possible ingestion such as THC (but cannot rule out other ingestion) This episode will be organized… Pharmacology of Cannabis Clinical presentation of Cannabis toxicity Workup & management of Cannabis toxicity The Cannabis sativa plant contains over 500 chemical components called cannabinoids, which exert their psychoactive effect on specific receptors in the central nervous system and immune system. The 2 best-described cannabinoids are THC and cannabidiol (CBD)—and are the most commonly used for medical purposes. Patients with intractable epilepsy or chronic cancer pain may be using these drugs. THC is the active ingredient of the cannabis plant that is responsible for most symptoms of central nervous system intoxication. The term cannabis and the common name, marijuana, are often used interchangeably). Rahul, can you shed some light on the pharmacokinetics/pharmacodynamics of cannabis? Cannabis exists in various forms: marijuana (dried, crushed flower heads, and leaves), hashish (resin), and hash oil (concentrated resin extract), which can be smoked, inhaled, or ingested. THC is the active ingredient of the cannabis plant that is responsible for most symptoms of central nervous system intoxication, in contrast to CBD, the main non-psychoactive component of cannabis. The potency of cannabis is usually based on the THC content of the preparation. The THC is lipid soluble and highly protein bound and has a volume of distribution of 2.5 to 3.5...

1: Dana Tischler, PT, DPT, MS, PCS, Doctor of Physical Therapy Program, Rocky Mountain University of Health Professions, Provo, UT, USA “Quality of Life, Participation, and Individualized Support in a Community-Based Yoga Class: A Case Series” Physical therapy researchers in Utah have been trialling a ten-week yoga training class as therapy for children with impairments. In it, they assessed quality of life and participation with the help of doctor of physical therapy students who gave the children individualized support. 2: Noelle Moreau, PT PhD, Louisiana State University Health Sciences Center, New Orleans, LA, USA Safety and Feasibility of 1-Repetition Maximum (1-RM) Testing in Children and Adolescents With Bilateral Spastic Cerebral Palsy New insights about optimal use of the 1-Repetition Maximum (1-RM) test have emerged from a study among children with bilateral spastic cerebral palsy. 3: Pamela Tucker PT DPT, Upstate Medical University Hospital, Syracuse, New York, USA Effectiveness of Robotic-Assisted Gait Training and Aquatic Physical Therapy in a Child With Long-Chain 3-Hydroxyacyl-CoA Dehydrogenase Deficiency: A Case Report A case study of a child with the rare, variable condition Long-Chain 3-Hydroxyacyl-CoA Dehydrogenase Deficiency (L-CHAD) brings encouragement that practical management strategies can bring big benefits. 4: Kari S. Kretch PT, DPT, PhD, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA Developmental Surveillance Milestone Checklist Updates: “Learn the Signs. Act Early”—Implications for Physical Therapists Physical therapist’s perspective on the Centers for Disease Control updated developmental assessment milestones. 5: Ramona ClarkeBExSci/BPhty, Griffith University, Gold Coast, Queensland, Australia International Delphi Recommendations for Pediatric Lower Limb Neurological Test Protocols for Muscle Strength, Reflexes, and Tactile Sensitivity An assessment of lower limb neurological testing in children, with recommendations on muscle strength, reflexes and tactile sensitivity. 6: Andrina Sabet PT ATP, Cleveland Clinic Children’s Hospital for Rehabilitation, Cleveland, Ohio, USA ON Time Mobility: Advocating for Mobility Equity And: Darrien Fann, Patient Self-Advocate, Cleveland OH, USA Equality in mobility—irrespective of physical impairment—is the focus of a new program of information and communication aimed at establishing mobility equity as a human right 7: Hércules Ribeiro Leite, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil Research on Children With Cerebral Palsy in Low- and Middle-Income Countries World Health Organisation data on cerebral palsy services in low- and middle-income countries (discussed at the recent 75th Annual Meeting of the American Academy for Cerebral Palsy and Developmental Medicine) identified big geographical disparities and key areas for improvement in access to good therapy and research. 8: Sudha Srinivasan PT PhD, Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, CT, USA Feasibility of Using Joystick-Operated Ride-on-Toys to Promote Upper Extremity Function in Children With Cerebral Palsy: A Pilot Study While children who can’t walk can benefit from using a powered ride-on toy, those who have impairments not severe enough to prevent walking altogether can also benefit. This is according to a new study of powered mobility assistance among children with hemiplegic cerebral palsy using a mobility toy controlled by a single joystick. 9: Sofie Meijer MSc HU University of Applied Sciences, Master of Pediatric Physical Therapy program, Utrecht, the Netherlands Reliability of Using a Smartphone Application to Objectify Skull Deformation Research using a smartphone app called: the Skully Care App shows that smartphones can be used to quantify infant skull deformation. 10: Carole A Tucker, PT, PhD, Associate Dean of Research, Chair of Physical Therapy, University of Texas Medical Branch, Galveston, TX, USA Enhancing the Content Validity of Self-Reported Physical Activity Self-Efficacy in Adolescents: A Qualitative Study A study of self-efficacy in adolescents reports that measures to increase self-confidence among youngsters can help them achieve physical therapy goals.

 Does your child struggle to make friends or engage in social activities? Do lunch, gym and recess create more anxiety than fun in your child's school day? If so, join Amy L. Lee, PhD, and Rebekah Bryson, LISW, of Cleveland Clinic Children's, as they provide tips for caregivers to help ease a child's anxiety and boost social skills. You will learn tools to support your child such as body calming, coping thoughts and facing challenges in smaller steps. 

Welcome to PICU Doc On Call, A Podcast Dedicated to Current and Aspiring Intensivists. I'm Pradip Kamat coming to you from Children's Healthcare of Atlanta/Emory University School of Medicine and I'm Rahul Damania from Cleveland Clinic Children's Hospital. We are two Pediatric ICU physicians passionate about all things MED-ED in the PICU. PICU Doc on Call focuses on interesting PICU cases & management in the acute care pediatric setting so let's get into our episode: Welcome to our Episode: A Somnolent Toddler. Here's the case: A 2 yo M presents to the PICU after being found increasingly sleepy throughout the day. The toddler is otherwise previously healthy and was noted to be in his normal state of health prior to today. The mother dropped the toddler off at his Grandmother's home early this morning. Grandmother states that he was playing throughout the day, and she noticed around lunchtime the toddler stumbles around and acts more sleepy. She states that this was around his nap time so she did not feel it was too out of the ordinary. The toddler 1 hr later was still very sleepy, and the grandmother noticed that the toddler had some shallow breathing. She called mother very concerned as she also found her purse open where she typically keeps her pills. The grandmother has a history of MI and afib as well as hypertension. She is prescribed a multitude of medications. Given the child's increased lethargy, the grandmother presents the patient to the ED. In the ED, the child is noted to be afebrile with HR 55 & RR of 18. His blood pressure is 78/40. On exam he has minimal reactivity to his pupils, he has shallow breathing and laying still on the bed. A POC glucose is 68 mg/dL. Acute resuscitation is begun and the patient presents to the PICU. To summarize key elements from this case, this patient has: Drowsiness Bradycardia Normotension This is in the setting of being at grandma's home and having access to many medications Given the hemodynamic findings and CNS obtundation, this patient's presentation brings up concern for a clonidine or beta-blocker ingestion. This episode will be organized: Beta-Blocker poisoning We will also examine other medications that potentially can be toxic to a toddler (one pill can kill) present in Grandma's purse which include: TCA, CCB, Opioids, oral anti-diabetic agents, digoxin, etc. The presence of a grandparent is a risk factor for unintentional pediatric exposure to pharmaceuticals commonly referred to as the Granny Syndrome. Grandparents' medications account for 10% to 20% of unintentional pediatric intoxications in the United States. To kids, all pills look like candy. Let's start with a multiple choice. An overdose of which of the following medications may mimic the presentation of Metoprolol overdose? A. Verapamil toxicity B. Ketamine toxicity C. Valium toxicity D. Lithium toxicity The correct answer is A, verapamil toxicity. Verapamil is a non DHP CCB. It acts at the level of the SA and AV node similar to Metoprolol, a beta-1-specific antagonist. Both cause bradycardia and AV node block. Valium though a CNS depressant, can cause CV depression as well, however, would have fewer changes on the conduction system compared to a non-DHP CCB.  What is the mechanism of toxicity with beta-blockers? Beta-blockers are competitive inhibitors at beta-adrenergic binding sites, which results in decreased production of intracellular cyclic adenosine monophosphate (cAMP) with a resultant blunting of multiple metabolic and cardiovascular effects of circulating catecholamines. They attenuate the effect of adrenergic catecholamines on the heart Decrease inotropic and chronotropic response. Some drugs like Propranolol can act as Na channel blockers (myocyte membrane stabilizing activity) at high doses resulting in arrhythmias and seizures. Toxic doses of drugs like Sotalol can result in K channel blockade giving rise to prolonged QT and risk for...

Seth Rotz, MD, pediatric hematologist-oncologist and Director of the Childhood Cancer Survivorship Program at Cleveland Clinic Children's, joins the Cancer Advances podcast to talk about CAR T-cell therapies and immunotherapy in pediatric patients. Listen as Dr. Rotz explains the long-term survivorship factors to consider when using these therapies and the exciting studies that are being developed for this type of treatment.

Brandon Hopkins, MD, Surgical Director of the Pediatric Center for Airway, Voice and Swallowing at Cleveland Clinic Children's, joins to discuss the spectrum of disorders that are treated in this center and the importance of coordination to achieve optimal outcomes. Dr. Hopkins also shares his thoughts on this year's American Academy of Otolaryngology – Head and Neck Surgery Annual Meeting that's taking place this week.

Welcome to PICU Doc On Call, A Podcast Dedicated to Current and Aspiring Intensivists. I'm Pradip Kamat coming to you from Children's Healthcare of Atlanta/Emory University School of Medicine and I'm Rahul Damania from Cleveland Clinic Children's Hospital and we are two Pediatric ICU physicians passionate about all things MED-ED in the PICU. PICU Doc on Call focuses on interesting PICU cases & management in the acute care pediatric setting so let's get into our episode: Welcome to our Episode of a 4-day-old with jaundice and vomiting. Here's the case presented by Rahul: A full-term 4-day-old boy presents to the ED after recently being discharged from the newborn nursery. Per mom, the patient "look yellow" and was having difficulty with feeding. The mother states that the patient would be increasingly sleepy, and will only latch to the breast for five minutes. The patient has been having decreased wet diapers, and the stool is loose and non-bloody. Mother was concerned today as the child continue to look yellow, especially in the eyes, had four episodes of vomiting, and overall was acting lethargic. The patient presented to the emergency room afebrile, tachypneic, and tachycardic. The patient was noted to have initial serum glucose of 70. As the patient was increasingly dehydrated, laboratory testing was difficult to obtain. The infant was fussy for the caregivers. The patient was resuscitated with 2 x 10 per kilo boluses and responded well. Point of care ultrasound noted normal four-chamber cardiac anatomy and squeeze. Given the instability of the patient, a RAM cannula was initiated, and the patient presented to the PICU. To summarize key elements from this case, this 4-day-old infant has: an acute presentation of jaundice and poor feeding Prominent GI symptoms and dehydration A sepsis-like presentation with hemodynamic instability responsive to fluids All of which brings up a concern for inborn error of metabolism, likely galactosemia. This episode will be organized… Clinical Presentation Laboratory Findings & Biochemistry Management of Galactosemia Rahul, let's start with a short multiple choice question: Of the following biochemical enzymes, which of the following is deficient in classic galactosemia? A. UDP Glucoronyl Transferase B. Aldolase B C. Galactose 1 Uridyl Transferase D. Galactokinase The correct answer is C. Galactose 1 Uridyl Transferase aka GALT. Classic galactosemia is caused by a complete deficiency of galactose-1-phosphate uridyl transferase (GALT). We should contrast this with galactokinase deficiency. These two present quite differently — GALT deficiency presents like our patient with jaundice, vomiting, hepatomegaly, renal dysfunction, and sepsis. Galactokinase deficiency has less of systemic symptoms and these patients similar to GALT deficiency have cataracts that are usually bilateral and resolved with dietary therapy. To go through our other answer choices, remember that Aldolase B is the rate-limiting enzyme in fructose metabolism, thus a deficiency in this enzyme would cause hereditary fructose intolerance. With this lead in question, let's pivot into the biochemistry of galactose and review key lab findings in our patient with galactosemia. Rahul, can you give us a quick summary of how galactose is metabolized in our body? Galactose is a sugar found primarily in human milk and milk products as part of the disaccharide lactose. Lactose is hydrolyzed to glucose and galactose by the intestinal enzyme lactase. The galactose then is converted to glucose for use as an energy source, however it needs a series of reactions: Galactokinase → which catalyzes the rxn galactose to galactose 1 PO4 Our rate limiting enzyme Galactose-1-phosphate uridyl transferase (GALT). GALT helps place a sugar moiety on galactose 1 PO4 to turn it into glucose 1 Phos which can then be utilized in glycolysis or glycogenesis. A complete deficiency in GALT is known as classic...

Maureen Pisanick is the Chief Executive Officer and founder of Pisanick Partners, LLC a nutrition consulting firm servicing early childhood and K-12 foodservice programs.  She currently supports over 40 school districts in Northeast Ohio in creating and implementing a strategic improvement plan for their meal service programs. Mrs. Pisanick led one of the first schools in Ohio to win the HealthierUS Schools Challenge award in 2011.  Through her involvement in farm to school efforts, culinary training course development, and recipe and menu software analysis, she has created turn-key solutions for a niche market geared towards wellness and public health in Ohio.  She is often called upon to provide professional development training as a respected leader in the local and national school nutrition industry. Mrs. Pisanick is a graduate of Case Western Reserve University and the Cleveland Clinic Foundation Dietetic Internship.  She has worked in multiple sectors of nutrition to clinical in and outpatient dietetics at the Cleveland Clinic Children's Hospital, and the latter half of her career in school nutrition programs as both a food service director and consultant.  Maureen has served as the Team Nutrition USDA HealthierUS Schools Consultant for the Ohio Department of Education, as well as worked on the Smarter Lunchroom Team Nutrition Grant movement throughout the state.  She currently is a qualified regional trainer for the Institute of Child Nutrition in the area of allergy management and farm to school procurement in schools.  Maureen has held office positions for the local and state School Nutrition Association, and is an active member of SNA, and the Academy of Nutrition and Dietetics.   Throughout the pandemic, Maureen utilized networking and coaching to ensure a resilient pivot and continued provision of school meals during unprecedented school closures.  She also expanded her client reach by supporting Feeding San Diego, a Feeding America division providing services to some of the most at risk communities in southern California.   Maureen is the mother of two wonderful girls and maintains an active role in local and state school nutrition advocacy through her work and consulting.    Show Notes: When it comes to learning nutrition is one of the most important factors Hungry minds can't learn! School lunches can provide healthy options such as a produce bar and encourage the children to taste and “eat the rainbow!”  Maureen and I discuss the importance of a healthy school lunch to get families and children across the country start the school year off right! 

Dr. Deborah Goldman is a pediatric gastroenterologist at Cleveland Clinic Children's and joins this episode of Butts & Guts to discuss everything you need to know about hereditary pancreatitis. Listen and learn about what symptoms to look for, how and when to seek treatment, and other facts to be aware of related to this condition.

Welcome to PICU Doc On Call, A Podcast Dedicated to Current and Aspiring Intensivists. I'm Pradip Kamat coming to you from Children's Healthcare of Atlanta/Emory University School of Medicine. I'm Rahul Damania from Cleveland Clinic Children's Hospital and we are two Pediatric ICU physicians passionate about all things MED-ED in the PICU. PICU Doc on Call focuses on interesting PICU cases & management in the acute care pediatric setting so let's get into our episode: Here's the case presented by Rahul: A 21-month-old girl was brought to an OSH ED for somnolence and difficulty breathing, which developed after she accidentally ingested an unknown amount of liquid medicine that was used by her grandfather. Per the mother, the patient's grandfather was given the liquid medication for the treatment of his opioid addiction. The patient took some unknown amount from the open bottle that was left on the counter by the grandfather. Immediately after ingestion of the medicine, the patient initially became irritable and had some generalized pruritus. The patient subsequently became sleepy followed by difficulty breathing and her lips turned grey. The patient was rushed to an outside hospital ED for evaluation. OSH ED: The patient arrived unresponsive and blue, she was noted to be sleepy and difficult to arouse on arrival, with pinpoint pupils and hypoxic to 88%. , but After receiving Naloxone, however, she became awake and interactive. Her glucose on presentation was 58 mg/dL and Her initial VBG resulted 7.3/49.6/+2. She continued to have intermittent episodes of somnolence without apnea. Poison control called and recommend starting a naloxone infusion; she was also given dextrose bolus. The patient was admitted to the PICU. To summarize key elements from this case, this patient has: Accidental ingestion of an unknown medication Altered mental status Difficulty breathing—with grey lips suggestive of hypoventilation/hypoxia All of which brings up a concern for a toxidrome which is our topic of discussion for today The typical symptoms seen in our patient of pinpoint pupils, respiratory depression, and a decreased level of consciousness is known as the “opioid overdose triad” Given the history of opioid addiction in the grandfather, the liquid medicine given to him is most likely methadone.In fact, in this case, the mother brought the bottle of medicine, which was subsequently confirmed to be prescription methadone given to prevent opioid withdrawal in the grandfather.   To dive deeper into this episode, let's start with a multiple choice question: Which of the following opioids carries the greatest risk of QTc prolongation? A. Methadone B. Morphine C. Fentanyl D. Dilaudid The correct answer is methadone. Methadone prolongs QT interval due to its interactions with the cardiac potassium channel (KCNH2) and increases the risk for Torsades in a dose-dependent manner. Besides the effect on cardiac repolarization, methadone is also associated with the development of bradycardia mediated via its anticholinesterase properties and through its action as a calcium channel antagonist. Hypokalemia, hypocalcemia, hypomagnesemia, and concomitant use of other drugs belonging to the family of CYP3A4 system inhibitors such as erythromycin can prolong Qtc. Even in absence of these risk factors, methadone alone can prolong QTc.   Thanks for that, I think it is very important to involve your Pediatric Pharmacy team to also help with management as children may be concurrent qt prolonging meds. Rahul, what are some of the pharmacological and clinical features of methadone poisoning? Methadone is a synthetic opioid analgesic made of a racemic mixture of two enantiomers d-methadone and l-methadone. besides its action on mu and kappa receptors, it is also an NMDA receptor antagonist. Due to its long action, methadone is useful as an analgesic and to suppress opioid withdrawal symptoms (hence used for opioid...

Welcome to PICU Doc On Call, A Podcast Dedicated to Current and Aspiring Intensivists. I'm Pradip Kamat coming to you from Children's Healthcare of Atlanta/Emory University School of Medicine. Today we are joined by two wonderful clinical pharmacists — Whitney Moore & Stephanie Yasechko. Whitney is a Clinical Pharmacy Specialist at Children's Healthcare of Atlanta. She is on Twitter at @MoorephinRx. Stephanie is a Pediatric Lung Transplant Clinical Pharmacy Specialist at Cincinnati Children's Hospital Medical Center. We are so excited to have you both on today. My name is Rahul Damania and I am a Pediatric Intensivist at Cleveland Clinic Children's Hospital; Welcome to PICU Doc On Call where we focus on all things MED-ED in the PICU. Our podcast focuses on interesting PICU cases & management in the acute care pediatric setting so let's get into our episode: Welcome to our Episode an 18 yo immunocompromised patient with headache & sore throat Here's the case presented by Rahul: An 18-year-old female (40 kg) with PMH significant for fibrolamellar carcinoma of the liver, presents to the ED with headache and sore throat. She is febrile to 38.3, tachycardic, tachypneic, and has a WBC of 27K on her CBC. She is markedly hypotensive with BP on the arrival of 99/65. Cultures were drawn, the patient was given x1 doses of vancomycin and meropenem, and she was transported to the PICU for further workup and management. Due to her progressive hemodynamic instability, increased inflammatory markers, and marked immunocompromised state, the team is considering broadening her anti-microbial coverage. To summarize key elements from this case, this patient has: Fibrolamellar carcinoma of the liver A presentation of headache, sore throat, and hemodynamic instability with concern for sepsis A current regimen of just antibacterials, which brings up the consideration of adding anti-fungal coverage in her clinically ill state. Our episode today will be covering anti-fungal agents in the PICU. We will review general mycology, understand different classes of antifungals, and highlight practical clinical pearls in the acute care setting. As mentioned, this patient has risk factors for an immunocompromised state due to her underlying liver condition. As we dive deeper into antifungals, Whitney, can you please give us an overview of common fungal pathogens in the PICU? Before we discuss the major drugs, it's important that we take some time to briefly review the most common fungi we encounter clinically since it's hard to choose the right agent when you don't know exactly what you are treating. Clinically, Candida is probably the most common fungal pathogen encountered, especially in warm, moist environments. It is important to determine what type of species is growing. The three major species known to cause infection are C. albicans, C. glabrata, and C. krusei, but it is important to differentiate these species when identified since they have different resistance patterns. Cryptococcus is another type of fungus that is known to cause meningitis or fungemia, especially in immunocompromised or cirrhotic patients. Both Candida and Cryptococcus are classified as yeast on Gram stain. Treating cryptococcus will require the use of an agent that has good penetration to the CNS. Endemic fungi known as Coccidia, Histoplasma, and Blastomyces are known to cause disseminated infections in immunocompromised hosts; however, each fungus is associated with a different geographic region in the United States. With any type of infection, it is always very important to consider your patients' exposures and recent travel history. And finally, there are two major molds that have the potential to be pathogenic. The first is Aspergillus which is identified via hyphae (tall filaments) on Gram stain well known to cause invasive pulmonary infections in the immunocompromised, specifically those who are neutropenic and/or received a lung transplant.

Welcome to PICU Doc On Call, A Podcast Dedicated to Current and Aspiring Intensivists. I'm Pradip Kamat coming to you from Children's Healthcare of Atlanta/Emory University School of Medicine and I'm Rahul Damania from Cleveland Clinic Children's Hospital. We are two Pediatric ICU physicians passionate about all things MED-ED in the PICU. PICU Doc on Call focuses on interesting PICU cases & management in the acute care pediatric setting so let's get into our episode: Welcome to our Episode about a 4-year-old girl with a chief complaint of headache and vomiting Here's the case: A 4-year-old presents to the PICU with headaches + vomiting and abnormal CT scan findings. The patient presented to the ED with h/o abdominal pain X 5 days with nonbilious, non-bloody emesis. Initial CBC, UA was normal. The patient was given some pain meds and IV fluids. Further history revealed that the patient has been having severe headaches for the last 5 days and had emesis secondary to the headaches resulting in generalized, non-specific abdominal pain. No h/o of trauma or seizures, no h/o of fever or diarrhea, no h/o toxic ingestions h/o recent travel, exposure to sick contacts, COVID test negative. No family h/o migraines, her immunizations are UTD. Besides the normal UA and CBC, her CMP was also normal. A CT scan of the head revealed right frontoparietal mass with moderate surrounding edema, 6 mm leftward midline shift, diffuse sulcal narrowing, and right cisternal narrowing. Imaging of the abdomen (US and CT w/ contrast) was unremarkable. An MRI done revealed: Right parietal diffusion restricting lesion, most compatible with abscess. Moderate surrounding vasogenic edema. Given her abdominal pain- Abdominal KUB as well as contrast CT scan of abdomen and pelvis were performed and revealed no abdominopelvic pathology. In the ED her vitals were normal and the patient was afebrile. On her PE: the patient appeared sleepy but woke up and answered questions appropriately. No focal deficits, PERRL, normal tone and strength. The rest of her physical exam was completely normal. She now is transferred to the PICU for serial neurological exams. To summarize key elements from this case, this patient has: Headache with altered mental status No focal deficits Vomiting surprisingly no fever Imaging showing right frontoparietal mass. All of which brings up a concern for brain abscess This episode will be organized… Epidemiology and pathogenesis Diagnosis Management Rahul, can you inform our listeners about the epidemiology of brain abscesses? Only about 25% of brain abscesses occur in children. Incidence in developed countries is about 1-2% while in developing countries it's about 8%. Peak incidence in children is seen between the ages of 4-7 years and is more common in males. Brain abscess in the neonatal age group is rare but are associated with a higher risk of complications and mortality. Risk factors for brain abscess include Otologic infections (ear, sinus, and dental infections), Congenital heart disease (30% of patients with BA have an underlying heart defect) with intra-cardiac or intrapulmonary shunting (pulmonary AV malformations in hemorrhagic telangiectasis), immunodeficiencies (solid organ transplantation, HIV, etc), prolonged steroid use, diabetes, alcoholism neurosurgical procedures, trauma. Other rare causes can be airway foreign bodies, congenital dermal sinuses, and esophageal procedures (such as dilatations). Brain abscess typically begins with a localized area of cerebritis which evolves through various stages (typically 10-14 days) to develop into an encapsulated collection of purulent material with peripheral gliosis or fibrosis. 40-50% of the spread of infection is via a contiguous site of infection such as otitis, sinusitis or mastoiditis or from head trauma or neurosurgical procedure. 30-40% is spread through the hematogenous route from endocarditis, pulmonary infections, or dental abscess. 90% of brain...

Two special guests from the Cleveland Clinic are featured on this episode of Butts & Guts: Dr. Jacob Kurowski and Dr. Jessica Philpott. Dr. Kurowski is a pediatric gastroenterologist at Cleveland Clinic Children's, and Dr. Philpott is an adult care gastroenterologist. Learn how the two work together to ease young patients who experience Inflammatory Bowel Disease (IBD) from pediatric to adult-centered care in what is know as Cleveland Clinic's Pediatric Inflammatory Bowel Disease Program.

Welcome to PICU Doc On Call, A Podcast Dedicated to Current and Aspiring Intensivists. I'm Pradip Kamat coming to you from Children's Healthcare of Atlanta/Emory University School of Medicine and I'm Rahul Damania from Cleveland Clinic Children's Hospital and we are two Pediatric ICU physicians passionate about all things MED-ED in the PICU. PICU Doc on Call focuses on interesting PICU cases & management in the acute care pediatric setting so let's get into our episode: Welcome to our Episode an 18 -year old with sore throat, and unilateral L-sided neck pain for ~2 weeks. Here's the case presented by Rahul: An 18-year-old female presents to the ED with cough, fever, fatigue, sore throat, and unilateral L-sided neck pain for ~2 weeks. The patient also has been having non-specific chest pain, weight loss, and decreased appetite for ~ 1 month. Patient has no recent travel h/o, no h/o of vaping or illicit drug use, and there were no sick contacts at home. Vitals revealed an HR 105, BP 116/66, Temp 38.3, and respiratory rate 35, She was 65 Kg and SPO2 on 2L NC was 100%. Physical exam was negative except (L) neck tender to palpation. There was no goiter, lymphadenopathy or hepatosplenomegaly. An initial chest x-ray was significant for possible multi-lobar pneumonia versus metastases. A Chest CT revealed multifocal septic emboli in the lungs. Echo did not show any gross vegetation. She has no rash or any trauma to the neck or difficulty swallowing, no oral ulcers, joint pain, or diarrhea. She had no recent dental work or drinking of unpasteurized milk or eating raw fish or meat. She was admitted to the PICU as she had hypotension requiring fluid boluses, and lab works significant for hyponatremia, rhabdomyolysis, worsening AKI, elevated ferritin, and elevated D-dimer. Her serum uric acid was 9.9, LDH = 230 (normal) ,ESR 78 (normal = 20 or less). Her serum lactate and serum troponin and BNP were all normal. Pertinently, US neck revealed an occlusive thrombus in the (L) IJ vein (done so as to avoid contrast in face of AKI), and blood cultures sent. To summarize key elements from this case, this 18-year-old female presents with fever +cough+sore throat Fatigue + Weight loss (L) neck pain Hypotension with abnormal labs including a concerning WBC with (L) shift, anemia, AKI, elevated uric acid, and ESR Chest CT with possible pulmonary emboli US showing occlusion. All of which brings up a concern for possible malignancy or pulmonary emboli from a septic focus in the neck and a possible diagnosis of Lemierre syndrome This episode will be organized… Definition Diagnosis (physical, laboratory) Management Rahul: What is the definition of Lemierre's syndrome? Lemierre's syndrome, also known as post-anginal septicemia or necrobacillosis, is characterized by bacteremia, internal jugular vein thrombophlebitis, and metastatic septic emboli secondary to acute pharyngeal infections. All of which are seen in our above case presentation. Previously called as the forgotten disease as its incidence was decreasing due to the increasing use of antibiotics especially penicillin for URI. However, recently there is an increase in Lemierre's disease cases with decreased use of antibiotics due to antibiotic stewardship. The recent increase in Lemierre disease due to decreased antibiotic use has not been proven and remain controversial. Rahul what are some of the causative organisms of Lemierre syndrome? The most common causative agent of Lemierre's syndrome is Fusobacterium necrophorum, followed by Fusobacterium nucleatum and anaerobic bacteria such as streptococci, staphylococci, and Klebsiella pneumoniae. Rahul: Can you tell our listeners about the pathophysiology of Lemierre's syndrome? Lemierre syndrome can occur in health adults (more common in males in the age group of 14-24 years). Risk factors include immunocompromised patients, organisms, and environmental conditions. Lipopolysaccharides in F. necrophorum have endotoxic...

This week we review a recent large scale administrative database study assessing racial and socioeconomic disparities in congenital heart disease outcomes in the US. How does patient neighborhood income affect outcomes? How does the presence of Down Syndrome mitigate risk? How does race or socioeconomic status affect length of stay? How can these data inform change to improve outcomes for all children with CHD? Professor Tara Karamlou of Cleveland Clinic Children's shares her deep insights into this critically important factor that may be every bit as important as the congenital heart anatomy. We also speak briefly in tribute to Dr. James Tweddell of Cincinnati Children's Hospital, who tragically passed last week. DOI: 10.1016/j.athoracsur.2021.04.008

Leslie Jurecko, MD, MBA, is Chief Safety and Quality Officer of Cleveland Clinic Health System, and a pediatric hospitalist with Cleveland Clinic Children's. As Chief Safety and Quality Officer, Dr. Jurecko is responsible for the development and implementation of Cleveland Clinic's Enterprise Quality and Safety strategy and driving high reliability across the enterprise. Link to claim CME credit: https://www.surveymonkey.com/r/3DXCFW3 (https://www.surveymonkey.com/r/3DXCFW3) CME credit is available for up to 3 years after the stated release date Contact CEOD@bmhcc.org if you have any questions about claiming credit.

Harry (Adrian) Lesmana, MD, pediatric hematologist/oncologist and medical geneticist at Cleveland Clinic Children's joins the Cancer Advances podcast to talk about pediatric cancer predispositions. Listen as Dr. Lesmana describes gene predispositions for solid tumors vs hematologic cancers as well as the study he is working on to increase the ability to identify these genes through genomic sequencing.

Welcome to PICU Doc On Call, A Podcast Dedicated to Current and Aspiring Intensivists. I'm Pradip Kamat coming to you from Children's Healthcare of Atlanta/Emory University School of Medicine and I'm Rahul Damania from Cleveland Clinic Children's Hospital. We are two Pediatric ICU physicians passionate about all things MED-ED in the PICU. PICU Doc on Call focuses on interesting PICU cases & management in the acute care pediatric setting so let's get into our episode: In today's episode, we discuss about a 12-year-old male with lethargy after ingestion. Here's the case presented by Rahul: A 12-year-old male is found unresponsive at home. He was previously well and has no relevant past medical history. The mother states that he was recently in an argument with his sister and thought he was going into his room to “have some space.” The mother noticed the patient was in his room for about 1 hour. After coming into the room she noticed him drooling, minimally responsive, and cold to the touch. The patient was noted to be moaning in pain pointing to his abdomen and breathing fast. Dark red vomitus was surrounding the patient. The mother called 911 as she was concerned about his neurological state. With 911 on the way, the mother noticed a set of empty vitamins next to the patient. She noted that these were the iron pills the patient's sister was on for anemia. EMS arrives for acute stabilization, and the patient is brought to the ED. En route, serum glucose was normal. The patient presents to the ED with hypothermia, tachycardia, tachypnea, and hypertension. His GCS is 8, he has poor peripheral perfusion and a diffusely tender abdomen. He continues to have hematemesis and is intubated for airway protection along with declining neurological status. After resuscitation, he presents to the Pediatric ICU. Upon intubation, an arterial blood gas is drawn. His pH is 7.22/34/110/-6 — serum HCO3 is 16, and his AG is elevated. To summarize key elements from this case, this patient has: Lethargy and unresponsiveness after acute ingestion. His hematemesis is most likely related to his acute ingestion. And finally, he has an anion gap metabolic acidosis, as evidenced by his low pH and low HCO3. All of these salient factors bring up the concern for acute iron ingestion! In today's episode, we will not only go through acute management pearls for iron poisoning, but also go back to the fundamentals, and cover ACID BASE disorders. We will break this episode down into giving a broad overview of acid base, build a stepwise approach, and apply our knowledge with integrated cases. We will use a physiologic approach to cover this topic! Pradip, can you give us a quick overview of some general principles when it comes to tackling this high-yield critical care topic? Absolutely, internal acid base homeostasis is paramount for maintaining life. Moreover, we know that accurate and timely interpretation of an acid–base disorder can be lifesaving. When we conceptualize acid base today, we will focus on pH, HCO3, and CO2. As we go into each disorder keep in mind to always correlate your interpretation of blood gasses to the clinical status of the patient. Going back to basic chemistry, can you comment on the relationship between CO2 and HCO3? Yes, now this is a throwback. However, we have to review the Henderson–Hasselbalch equation. The equation has constants & logs involved, however in general this equation shows that the pH is determined by the ratio of the serum bicarbonate (HCO3) concentration and the PCO2, not by the value of either one alone. In general, an acid–base disorder is called “respiratory” when it is caused by a primary abnormality in respiratory function (i.e., a change in the PaCO2) and “metabolic” when the primary change is attributed to a variation in the bicarbonate concentration. Now that we have some fundamentals down, let's move into definitions. Can you define acidemia and alkalemia and comment on how...

Rachel Georgopoulos, MD, pediatric otolaryngologist and Director of the Thyroid Head and Neck Oncology and Pediatric Endocrine (Thyroid HOPE) Center, and Stefanie Thomas, MD, hematologist/oncologist at Cleveland Clinic Children's join the Cancer Advances podcast to discuss the rise in pediatric thyroid cancer cases. Listen as they discuss the possible factors causing the increase in cases and the multidisciplinary care given at the Thyroid HOPE Center.

The body's cells need a steady supply of fuel (known as glucose) in order to properly function. Kadakkal Radhakrishnan, MD, Director of Nutrition and Intestinal Rehabilitation at Cleveland Clinic Children's, discuss what happens when the body isn't able to use glucose the right way, also known as glycogen storage disease.

Rabi Hanna, MD, Chair of the Department of Pediatric Hematology, Oncology and Blood and Marrow Transplantation at Cleveland Clinic Children's joins the Cancer Advances podcast to discuss the use of gene therapy in sickle cell disease. Listen as Dr. Hanna describes how the last several years have brought significant advancements in the field, expanding our understanding and treatment of sickle cell disease, including the possibility of curative gene therapy.

Rabi Hanna, MD, Chair of the Department of Pediatric Hematology, Oncology and Blood and Marrow Transplantation at Cleveland Clinic Children's and Angelika Erwin, MD, PhD, Medical Geneticist at the Center for Personalized Genetic Healthcare at the Cleveland Clinic join the Cancer Advances podcast to discuss the lysosomal storage disease program (LSD). Listen as Dr. Hanna and Dr. Erwin discuss how the interdisciplinary team for children and adults with LSDs is dedicated to improving diagnosis, management and treatment of these disorders.

Today, more children are surviving cancer than ever before. But now, increasing efforts are needed to detect and treat late effects as early as possible. Seth Rotz, MD, Director of the Childhood Cancer Survivorship Program at Cleveland Clinic Children's joins the Cancer Advances podcast to discuss survivorship. Listen as Dr. Rotz highlights how Cleveland Clinic is helping ensure survivor success by identifying and managing late effects in survivors.

Angelika Erwin, MD, PhD and Rabi Hanna, MD join Butts & Guts to discuss the unique topic of lysosomal storage diseases. While rare, these diseases can affect organs throughout the body and even lead to death if untreated. Listen as Dr. Erwin and Dr. Hanna share common symptoms, how these are diagnosed, and how Cleveland Clinic Children's treats young patients with these diseases.

Karen F. Murray, MD is Chair of Pediatrics, Physician in Chief at Cleveland Clinic Children's and President of Cleveland Clinic Children's Hospital for Rehabilitation and Professor of Pediatrics at Cleveland Clinic Lerner College of Medicine. In this episode, Dr. Murray talks about transitioning to life in the Midwest, and, as a leader, why she appreciates and values Cleveland Clinic's annual professional review process and structure.

Pediatric heart failure and transplant cardiologist at Cleveland Clinic Children's, Shahnawaz Amdani, MD, joins the Cancer Advances podcast to discuss cardio-oncology for both pediatric and adult cancer patients who are undergoing chemotherapy or have completed their chemotherapy and are now long-term survivors. Listen as Dr. Amdani highlights when and how cardiac toxicity develops, preventative therapies and how the field has evolved.

Physicians treating patients with Ewing sarcoma get a chance to discuss challenging cases with experts from Cleveland Clinic, Cleveland Clinic Children's and other leading cancer centers throughout the country in a new National Ewing Sarcoma Tumor Board, led by Matteo Trucco, MD, a pediatric hematologist oncologist at Cleveland Clinic Children's. Dr. Trucco joins the Cancer Advances podcast to talk about how the tumor board started, what to expect and how you can get involved.

Developing a healthy body image and sense of self in our children is so important. And as we round out the end of summer, you might be heading to the mall or other store to pick up some new clothes for your kids for this school year.Developing a healthy body image and sense of self in our children is so important. And as we round out the end of summer, you might be heading to the mall or other store to pick up some new clothes for your kids for this school year. So how can you keep that experience positive and constructive?Ellen Rome, MD, MPH, currently serves as Head of the Center for Adolescent Medicine at Cleveland Clinic Children's Hospital. She is a board-certified pediatrician who was also among the first in the United States to be board-certified in Adolescent Medicine.We talk today about eating disorders, social media, social standards and trends in fashion, as well as how parents can steer clear or talking weight in front of their kids.

Developing a healthy body image and sense of self in our children is so important. And as we round out the end of summer, you might be heading to the mall or other store to pick up some new clothes for your kids for this school year.Developing a healthy body image and sense of self in our children is so important. And as we round out the end of summer, you might be heading to the mall or other store to pick up some new clothes for your kids for this school year. So how can you keep that experience positive and constructive?Ellen Rome, MD, MPH, currently serves as Head of the Center for Adolescent Medicine at Cleveland Clinic Children's Hospital. She is a board-certified pediatrician who was also among the first in the United States to be board-certified in Adolescent Medicine.We talk today about eating disorders, social media, social standards and trends in fashion, as well as how parents can steer clear or talking weight in front of their kids.

Answering parent questions in a 12 minute talk. Katie, Certified Child Life Specialist talks with Christine Bomberger, Music Therapist at Cleveland Clinic Children's. We talk about: +Why music therapy should be a staple in every children's hospital +An example of how “Baby Shark” helped a child through a painful dressing change +How you can seek out music therapists in your community Have you heard? The Child Life On Call mobile app for parents, kids and their care team will be available in 2022. Sign up to stay informed here. Child Life On Call is a community of parents and professionals that share ideas, stories and resources to help YOU navigate your child's unique experiences. We give you strategies to support yourself and your family through life's challenges. We are so glad you are here. Child Life On Call | Instagram | Facebook | Twitter

Pediatric Hematologist-Oncologist at Cleveland Clinic Children's, Peter Anderson, MD, joins the Cancer Advances podcast to talk about the challenges and areas of opportunity in pediatric sarcoma care. Listen as Dr. Anderson covers the importance of multidisciplinary care when managing pediatric sarcoma patients and how virtual visits have become more important than ever.

As campuses reopen, how can college leaders help students who have struggled with alcohol and drug use and mental health issues during the pandemic? In ACTA's webinar, The Pandemic and Campus Substance Use: What Colleges Need to Know Now, four distinguished health experts explored this topic in all of its dimensions, from research to practical solutions on the ground. Panelists included Robert L. DuPont, M.D. of the Institute for Behavior and Health; Amelia M. Arria, Ph.D. of the University of Maryland School of Public Health; Ellen Rome, M.D., M.P.H. of the Center for Adolescent Medicine at Cleveland Clinic Children’s; and Caleb S. Boswell, L.L.P.C., N.C.C. of the Office of Counseling & Career Planning at Washtenaw Community College.

In order to bring novel, more effective therapies to the youngest patients, Cleveland Clinic launched a new, early phase clinical trial program called Cleveland Clinic Children’s Cancer Innovative Therapy Program, led by Matteo Trucco, MD, a pediatric hematologist oncologist at Cleveland Clinic Children’s. Dr. Trucco joins the Cancer Advances podcast to talk about the program and how it's bringing novel therapies to patients with pediatric cancers.

Compared to younger children, cancer rates are higher in adolescents and young adults (AYA). However, AYA's are less likely to receive a prompt diagnosis or be enrolled in clinical trials for innovative treatment. Cleveland Clinic Children's pediatric hematologist oncologist, Stefanie Thomas, MD, joins the Cancer Advances podcast to discuss Cleveland Clinic Children's Adolescent and Young Adult cancer program. Listen as Dr. Thomas covers why the program was developed and how it is impacting our patients.

Rabi Hanna, MD, Chair of Pediatric Hematology, Oncology and Blood and Marrow Transplantation at Cleveland Clinic Children's joins the Cancer Advances podcast to discuss best practices for treating pediatric and young adult cancer patients with autism spectrum disorder (ASD). Listen as Dr. Hanna discusses how we treat the patient, not the disease. By making simple adjustments and individualizing therapy can make a significant difference in a patients treatment.

February 23, 2021: Francisco Lindor talks about going easy in the weight room at the end of last season for the Tribe, Gov. Mike DeWine and Fran DeWine get their second dose of the COVID vaccine, which Northeast Ohio bars are facing suspensions, and how Cleveland native screenwriter Danny Kravitz hit it out of the park with ‘The Marksman’ starring Liam Neeson and filmed in Ohio, on 3News Now with Stephanie Haney. Like this show? Check out the 3 Things to Know with Stephanie Haney podcast, with this week’s topic on kids returning to classrooms with Cleveland Clinic Children’s pediactric psychologist Dr. Emily Mudd. http://wkyc.com/3thingstoknow Connect with Stephanie here: http://twitter.com/_StephanieHaney http://instagram.com/_StephanieHaney http://facebook.com/thestephaniehaney Read more here: (0:10) Gov. Mike DeWine and First Lady Fran receive second dose of COVID-19 vaccine. https://www.wkyc.com/article/news/health/coronavirus/mike-dewine-fran-dewine-covid-19-vaccine-second-dose/95-18c4f00d-cb18-46e6-8dc0-ea45298e4b79 (1:05) Pair of Northeast Ohio bars receive suspension of liquor licenses for violating state's COVID-19 protocols. https://www.wkyc.com/article/news/health/coronavirus/northeast-ohio-restaurants-receive-suspension-liquor-licenses-violating-coronavirus-protocols/95-81d531eb-5e35-4861-85dd-9efba0b7d7c0 (1:05) Barley House in Cleveland to have liquor license revoked due to repeated violations of state health orders; owners plan to appeal. https://www.wkyc.com/article/entertainment/dining/barley-house-cleveland-liquor-license-revoked/95-1940cd25-5f25-488b-8bb4-1e8e0e407e72 (3:14) The latest on the number of COVID-19 cases in Ohio. https://www.wkyc.com/article/news/health/coronavirus/coronavirus-ohio-updates/95-e2faeb56-d02a-443a-bcdb-141f2c7fafe8 https://www.wkyc.com/article/news/health/coronavirus/timeline-of-coronavirus-cases-ohio/95-c97c228d-c6c7-4949-b12b-4324d7ed8bb5 (6:15) Meijer donates $2 million to the Cleveland Clinic Children's healthcare program providing care to Northeast Ohio students. https://www.wkyc.com/article/news/local/meijer-2-million-dollar-donation-cleveland-clinic-childrens/95-0f568933-30e0-41f3-9ed0-6fd21cff1e9b (7:49) Francisco Lindor says not giving his best in the weight room led to late-season struggles. https://www.wkyc.com/article/sports/mlb/indians/francisco-lindor-discusses-2020-struggles-indians-mets/95-680a3478-5feb-470e-8931-6779e6b7a775 (9:41) Watch | Filming 'The Marksman' starring Liam Neeson in Ohio was like 'living in a dream' for Cleveland native screenwriter. https://www.wkyc.com/article/entertainment/movies/cleveland-native-screenwriter-says-filming-the-marksman-in-ohio-starring-liam-neeson-was-like-living-in-a-dream-danny-kravits-rob-lorenz-jacob-perez/95-cc17b57a-99c5-4a1b-857c-c39bd8addbb5

February 22, 2021: George Clooney to produce docuseries on OSU sexual abuse scandal, what to do if you’re a victim of unemployment fraud, how to watch President Biden’s speech as US expected to hit 500,000 COVID deaths today, US Coast Guard rescues 10 people off of ice on Lake Erie, how the tribe might replace Carlos Santana, and the Russo brothers share never-seen photos from Cleveland productions ahead of “Cherry” premiere, on 3News Now with Stephanie Haney. Like this show? Check out the 3 Things to Know with Stephanie Haney podcast, with this week’s topic on kids returning to classrooms with Cleveland Clinic Children’s pediactric psychologist Dr. Emily Mudd. http://wkyc.com/3thingstoknow Connect with Stephanie here: http://twitter.com/_StephanieHaney http://instagram.com/_StephanieHaney http://facebook.com/thestephaniehaney Read more here: (0:12) George Clooney to produce docuseries on Ohio State sexual abuse scandal. https://www.wkyc.com/article/sports/college/osu/george-clooney-producing-osu-series/95-f5ce7b67-1aa6-4835-9a11-735b85b6bef9 (1:40) Unemployment fraud in Ohio: 3 things you need to do if somebody has stolen your information. https://www.wkyc.com/article/money/ohio-unemployment-fraud-what-you-need-to-do/95-b54c5e6e-4a43-4b9e-a6c2-8d4d41a13ace (1:40) Fraud wreaks havoc on Ohio unemployment system https://www.wkyc.com/article/news/investigations/scam-squad/fraud-ohio-unemployment-system/95-f4a9aa1b-1728-4584-854f-25176b37247e (4:31) Biden to mark US crossing 500,000 COVID-19 deaths with candle lighting, moment of silence. https://www.wkyc.com/article/news/health/coronavirus/biden-to-mark-nation-crossing-500000-covid-19-deaths/507-ebe40c76-1476-40f9-991e-5172c6dbc792 (5:30) The latest on the number of COVID-19 cases in Ohio. https://www.wkyc.com/article/news/health/coronavirus/coronavirus-ohio-updates/95-e2faeb56-d02a-443a-bcdb-141f2c7fafe8 https://www.wkyc.com/article/news/health/coronavirus/timeline-of-coronavirus-cases-ohio/95-c97c228d-c6c7-4949-b12b-4324d7ed8bb5 (7:15) Ohio Gov. Mike DeWine announces which ages will be next for COVID-19 vaccine; will remain at 65-years-plus for weeks. https://www.wkyc.com/article/news/health/coronavirus/dewine-age-ranges-covid-19-distribution/95-b49b6f13-2cf1-4e5b-af7e-69aaaac7ce29 (7:30)Gov. Mike DeWine urges Ohio nursing homes to allow compassionate visits https://www.wkyc.com/article/news/health/coronavirus/dewine-nursing-homes-visit-exceptions/95-7287ec50-1bf4-42b2-8d85-2ddaa1b197ab (8:35) U.S. Coast Guard rescues 10 people stuck on Lake Erie at Edgewater Park. https://www.wkyc.com/article/news/local/coast-guard-ice-rescue-edgewater-park-cleveland/95-95649b86-0b9a-4e96-8b3b-0e4c8a19b04e (10:00) How will the Cleveland Indians replace Carlos Santana? https://www.wkyc.com/article/sports/mlb/indians/how-will-the-indians-replace-santana/95-e48b11b6-3c3b-431f-adfc-add5f6299b69 (11:45) Cleveland Indians pitcher Zach Plesac goes one-on-one with 3News' Nick Camino. https://www.wkyc.com/article/sports/mlb/indians/cleveland-indians-zach-plesac-spring-training-interview/95-f63e4f19-51f3-4481-a464-d0e2e4657b36 (12:35) Joe and Anthony Russo share never-before-seen pictures and videos from Cleveland-filmed projects ahead of "Cherry" premiere https://www.wkyc.com/article/entertainment/joe-and-anthony-russo-instagram-pictures-cleveland-projects-cherry-tom-holland/95-3f069263-f940-4111-b7a5-df87e49f5b4e

On this week's 3 Things to Know with Stephanie Haney podcast, Cleveland Clinic Children's pediatric psychologist Dr. Emily Mudd, PhD, explains why returning to in-person learning is so important for students, what parents should watch out for as everyone adjusts, and what long-lasting impacts might await children after nearly a year of isolation due to the COVID-19 pandemic. Plus, 3News reporter Lindsay Buckingham shares why Alpine Valley Resort and the Cleveland Metroparks are the winter fun family destinations you Need to Know in NEO, and to go along with that, Stephanie breaks down by the metroparks accounts are such A Good Follow on Twitter and Instagram. Watch this podcast on YouTube: http://youtu.be/lP2E_WKJoiQ Connect with Dr. Emily Mudd, PhD: https://my.clevelandclinic.org/staff/23833-emily-mudd Need to Know in NEO: Alpine Valley Resorts http: //alpinevalleyohio.com/ Need to Know in NEO: Cleveland Metroparks https://clevelandmetroparks.com/ A Good Follow: Cleveland Metroparks https://twitter.com/hashtag/TenToExplore http://Twitter.com/clevemetroparks http://Instagram.com/clevemetroparks Connect with Lindsay Buckingham: http://twitter.com/LindsayBuckWKYC http://instagram.com/LindsayBuckinghamWKYC https://facebook.com/LindsayBuckWKYC Connect with Stephanie Haney: http://twitter.com/_StephanieHaney http://instagram.com/_StephanieHaney http://facebook.com/thestephaniehaney

Jordana Green was in for Chad. She talked to Dr. Frank Esper from the Cleveland Clinic Children's hospital about the CDC reporting a racial disparity in the deaths of kids from Covid.  See omnystudio.com/policies/listener for privacy information.

After being diagnosed with epilepsy as a baby, 7-year-old Alex Winter has spent many days and nights in the hospital--so she knows what it's like to need a friend to help you feel better. And that's why she created "Alex's Fluffy Buddies" to provide stuffed animals for kids being treated at Cleveland Clinic Children's Hospital.

We encourage you to listen to this 8-minute podcast with Dr. Amrit Gill, the Patient Safety Officer for Cleveland Clinic Children’s. On this podcast, Dr. Gill highlighted the important role of physicians in keeping the safety momentum moving forward. One way that she recommends doing this is by celebrating successes. Additionally, she encouraged physician leaders to see challenges and setbacks as a learning opportunity by sharing lessons learned. She shared the role of physician leaders in closing the loop with staff by talking about how they are working to resolve issues from past safety rounds as well as assigning owners to new problems.  Additionally, she remarked that there is immense power in storytelling—these stories motivate and re-energize the listeners to continue to work towards making things safer. She encouraged physicians to set goals and make plans so that we can “together keep our patients safe.”

Life can be so challenging prior to someone getting an Autism diagnosis. On this episode we will talk about getting an Autism diagnosis with Katie Hatmaker. Katie is a clinical assistant and part of the Autism evaluation team of the Cleveland Clinic Children’s Center for Autism. Autism Stories connects you with amazing people who are helping teens and adults with Autism become more independent and successful. Music for this podcast was written and recorded by Megan Metzelaar. Megan is a 26 yr old part time student at UC Clermont where she is just about to earn her Associate's Degree in Biological Sciences. She has two cats that live at her mom and grandmothers house (BW and Sunshine). Megan likes to write music, sing, dance, and watch movies with her husband. She has Autism and ADHD and enjoys performing on stage as it makes her feel she is just like everyone else. Megan just created her first album "24" (however, she is waiting for songs to be copyrighted).

Gail Cresci, PhD, RD, LD, CNSC works in the Department of Pediatric Gastroenterology at Cleveland Clinic Children’s Hospital and Inflammation & Immunity, Lerner Research Institute, as well as Director for Nutrition Research within the Center for Human Nutrition, Digestive Disease and Surgery Institute at Cleveland Clinic. In this episode, we discuss Gail's research in nutrition, gut microbiome, digestive diseases, surgery and critical care, enteral feeding, liver and intestine diseases. She has received numerous awards and published numerous peer-reviewed manuscripts and book chapters as well as editing a textbook in critical care nutrition.

Dr. Brian Schroer of Cleveland Clinic Children’s Hospital, Center for Pediatric Allergy, will answer parent questions on a variety of food allergy topics including causes of food allergies, how to discuss allergies with your child's teacher and when to use an epi pen vs an Antihistamine. With food allergies affecting 1 in 13 children, or two in every classroom, Dr. Schroer will also talk about advocating for your child at school.

Does your child struggle to keep emotions in check? Can he or she be flexible when changes occur? Does your child procrastinate in starting a project or have trouble keeping on task? Jennifer Negrey, MOT, OTR/L, BCP, CLT, pediatric occupational therapist at Cleveland Clinic Children’s Hospital for Rehabilitation; and Danielle R. Petrozelle, MS OTR/L, pediatric occupational therapist at Cleveland Clinic Children’s Hospital for Rehabilitation and Cleveland Clinic Center for Autism; will help families gain an understanding of typical executive function skills at the preschool through preteen levels. Families will learn strategies to help their child gain better emotional control and flexibility. They will also discuss ways to help a child with task initiation, planning, organization and time management as well as strategies to increase working memory and sustained attention to tasks.

Featuring: Michael "Boston" Hannon, John "Knobs" Knoblach, and Ryan Pratt Running Time: 2:07:36 Music: Bulletstorm In an episode that goes off the rails in the best way possible very quickly, we chat about Rage, Battlefield 3, Gears of War 3, DC Universe Online, Words With Friends, Call of Duty: Black Ops, Battlefield 3, X-Men Destiny, Torchlight, Uncharted 3, and the Metal Gear Solid HD Collection. Yet another Assassin’s Creed game coming next year Mass Effect 3’s three different single player modes have leaked RUMOR: Simpsons Arcade Game to see a release on XBLA/PSN/iOS Donate to the Cleveland Clinic Children’s Hospital or your local hospital via Child’s Play