Podcasts about j pain symptom manage

In this Complex Care Journal Club podcast episode, Dr. Kate Nelson discusses a qualitative study exploring decision-making skills developed by family caregivers of children with medical complexity. She describes the impact of contextual factors and relationships within care teams on decision-making, family partnership in research, and the next steps from this work. SPEAKER Kate Nelson, MD, PhD Staff Pediatrician, Paediatric Advanced Care Team The Hospital for Sick Children Scientist SickKids Research Institute Assistant Professor University of Toronto HOST Kathleen Huth, MD, MMSc Pediatrician, Complex Care Service, Division of General Pediatrics Boston Children's Hospital Assistant Professor of Pediatrics Harvard Medical School DATE Initial publication date: August 5, 2024. Journal Club Article Finlay M, Chakravarti V, Buchanan F, Dewan T, Adams S, Mahant S, Nicholas D, Widger K, McGuire KM, Nelson KE. Learning to Trust Yourself: Decision-Making Skills Among Parents of Children With Medical Complexity. J Pain Symptom Manage. 2024 May 28:S0885-3924(24)00792-9. doi: 10.1016/j.jpainsymman.2024.05.023. Epub ahead of print. PMID: 38810951. TRANSCRIPT https://op-docebo-images.s3.amazonaws.com/Transcripts/Choice+and+Voice+Family+Perspectives+on+Decision-making+for+Children+_nelson_080524.pdf Clinicians across healthcare professions, advocates, researchers, and patients/families are all encouraged to engage and provide feedback! You can recommend an article for discussion using this form: https://forms.gle/Bdxb86Sw5qq1uFhW6 Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user.For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu CITATION Nelson K, Huth K. Choice and Voice: Family Perspectives on Decision-making for Children with Medical Complexity. 8/2024. OPENPediatrics. Online Podcast. https://soundcloud.com/openpediatrics/choice-and-voice-family-perspectives-on-decision-making-for-children-with-medical-complexity

About Our GuestAllison Kestenbaum, BCC, ACPE, is the Supervisor of Spiritual Care and Clinical Pastoral Education at UC San Diego Health.  She is a Board Certified Chaplain (NAJC and APC) with Advanced Certification in Hospice and Palliative Care. She is also a Certified Pastoral Educator (ACPE).   Allison conducts research about spiritual palliative care and education and is founding faculty at SpiritualAIM.org.  She has worked at UC San Francisco Health,  Jewish Theological Seminary and UJA-Federation of New York.   She was the first chaplain to receive a Sojourns Scholar Award for palliative care leaders. Her two kids bring her daily joy, challenge and keep her on her toes. Here are links to websites and articles referenced in interview: PubMedSpiritual AIMLife's DoorBased in Israel and the U.S., Life's Door engages health care professionals, patients, elderly, family members, caregivers, clergy, community members, lay leaders, and policy makers to promote hopefulness, wellbeing, dignity, and compassion within healthcare, social service and community settings.NAJC articles and resourcesKestenbaum A, McEniry KA, Friedman S, Kent J, Ma JD, Roeland EJ. Spiritual AIM: assessment and documentation of spiritual needs in patients with cancer. J Health Care Chaplain. 2022 Oct-Dec;28(4):566-577. doi: 10.1080/08854726.2021.2008170. Epub 2021 Dec 5. PMID: 34866556.Kestenbaum A, Shields M, James J, Hocker W, Morgan S, Karve S, Rabow MW, Dunn LB. What Impact Do Chaplains Have? A Pilot Study of Spiritual AIM for Advanced Cancer Patients in Outpatient Palliative Care. J Pain Symptom Manage. 2017 Nov;54(5):707-714. doi: 10.1016/j.jpainsymman.2017.07.027. Epub 2017 Jul 21. PMID: 28736103; PMCID: PMC5650916.Kestenbaum A, Fleischman CA, Dabis M, Birnbaum B, Dunn LB. Examination of Spiritual Needs in Hurricane Sandy Disaster Recovery Through Clinical Pastoral Education Verbatims. J Pastoral Care Counsel. 2018 Mar;72(1):8-21. doi: 10.1177/1542305017748663. PMID: 29623794.NeshamaCast is starting to produce transcripts of our episodes. Here is a transcript of Episode 1 with Rabbi Joe Ozarowski, BCC.Here is a transcript to our Bonus Episode with Rabbi Valerie Stessin, BCC, of Israel. Here is a transcript of Episode 2 with Rabbi Shira Stern.Check NeshamaCast Home Page for more transcripts as they become available.  About our host:Rabbi Edward Bernstein, PBCC, is the producer and host of NeshamaCast. He serves as Chaplain at Boca Raton Regional Hospital of Baptist Health South Florida. He is a member of the Board of Neshama: Association of Jewish Chaplains. Prior to his chaplain career, he served as a pulpit rabbi in congregations in New Rochelle, NY; Beachwood, OH; and Boynton Beach, FL. He is also the host and producer of My Teacher Podcast: A Celebration of the People Who Shape Our Lives.

Contributor: Travis Barlock MD Educational Pearls: Common sedatives used in the Emergency Department and a few pearls for each. Propofol Type: Non-barbiturate sedative hypnotic agonizing GABA receptors. Benefit: Quick on and quick off (duration of action is approximately 2-7 minutes), helpful for suspected neurologic injury so the patient can wake up and be re-evaluated. Also has the benefit of reducing intracranial pressure (ICP). Downsides: Hypotension, bradycardia, respiratory depression. What should you do if a patient is getting hypotensive on propofol? Do not stop the propofol. Start pressors. May have to reduce the propofol dose if delay in pressors. Dexmedetomidine (Precedex) Type: Alpha 2 agonist - causes central sedation Uses: Patients are more alert and responsive and therefore can be on BiPAP instead of being intubated. Does not cause respiratory depression. Downsides: Hypotension and Bradycardia. Caution in using this for head injuries, its side effects can mask the Cushing reflex and make it more difficult to spot acute elevations in ICP and uncal herniation. Ketamine Type: NMDA antagonist and dissociative anesthetic, among other mechanisms. Benefits: Quick Onset (but slower than propofol). Does not cause hypotension, but can even increase HR and BP (Thought to potentially cause hypotension if patient is catecholamine-depleted (ie. sepsis, delayed trauma)). Dosing ketamine can be challenging. Typically low doses (0.1-0.3mg/kg (max ~30mg)) can give good pain relief. Higher doses (for intubation/procedural sedation) are generally thought to have a higher risk of dissociation. Downsides: Emergence reactions which include hallucinations, vivid dreams, and agitation. Increased secretions. Benzos Type: GABA agonists. Benefits: Seizure, alcohol withdrawal, agitation due to toxic overdoses.  Push doses are useful because doses can stack. Longer half-life than propofol.   Downsides: Respiratory depression. Longer half-life can make neuro assessments difficult to complete. Etomidate MOA: Displaces endogenous GABA inhibitors. Useful as a one-time dose for quick procedures (cardioversion, intubation). Often drug of choice for intubation since it is thought to have no hemodynamic effects.  Downsides; If used without paralytic - myoclonus. Though to have some adrenal suppression. Fentanyl Type: Opioid analgesic. Not traditional sedative. Benefits: There are many instances in emergency medicine in which sedation can be avoided by prioritizing proper analgesia. Fentanyl can even be used to maintain intubated patients without needing to keep them constantly sedated. Downsides: Respiratory depression. Patients may have tolerance. References Chawla N, Boateng A, Deshpande R. Procedural sedation in the ICU and emergency department. Curr Opin Anaesthesiol. 2017 Aug;30(4):507-512. doi: 10.1097/ACO.0000000000000487. PMID: 28562388. Keating GM. Dexmedetomidine: A Review of Its Use for Sedation in the Intensive Care Setting. Drugs. 2015 Jul;75(10):1119-30. doi: 10.1007/s40265-015-0419-5. PMID: 26063213. Lundström S, Twycross R, Mihalyo M, Wilcock A. Propofol. J Pain Symptom Manage. 2010 Sep;40(3):466-70. doi: 10.1016/j.jpainsymman.2010.07.001. PMID: 20816571. Matchett G, Gasanova I, Riccio CA, Nasir D, Sunna MC, Bravenec BJ, Azizad O, Farrell B, Minhajuddin A, Stewart JW, Liang LW, Moon TS, Fox PE, Ebeling CG, Smith MN, Trousdale D, Ogunnaike BO; EvK Clinical Trial Collaborators. Etomidate versus ketamine for emergency endotracheal intubation: a randomized clinical trial. Intensive Care Med. 2022 Jan;48(1):78-91. doi: 10.1007/s00134-021-06577-x. Epub 2021 Dec 14. PMID: 34904190. Mihaljević S, Pavlović M, Reiner K, Ćaćić M. Therapeutic Mechanisms of Ketamine. Psychiatr Danub. 2020 Autumn-Winter;32(3-4):325-333. doi: 10.24869/psyd.2020.325. PMID: 33370729. Nakauchi C, Miyata M, Kamino S, Funato Y, Manabe M, Kojima A, Kawai Y, Uchida H, Fujino M, Boda H. Dexmedetomidine versus fentanyl for sedation in extremely preterm infants. Pediatr Int. 2023 Jan-Dec;65(1):e15581. doi: 10.1111/ped.15581. PMID: 37428855. Summarized by Jeffrey Olson MS2 | Edited by Jorge Chalit, OMSII  

Em algumas situações, por uma variedade de motivos, pacientes submetidos a suporte ventilatório artificial não conseguem se recuperar. O respirador, pensado como uma “ponte” para melhora, vira uma “ponte” para nada. E agora? Vamos falar sobre extubação paliativa?   Leitura complementar: Ortega-Chen C, Van Buren N, Kwack J, Mariano JD, Wang SE, Raman C, Cipta A. Palliative Extubation: A Discussion of Practices and Considerations. J Pain Symptom Manage. 2023 Aug;66(2):e219-e231. doi: 10.1016/j.jpainsymman.2023.03.011. Epub 2023 Apr 4. PMID: 37023832.

In this Complex Care Journal Club podcast episode, Dr. P. Galen DiDomizio and Dr. Dominic Moore discuss the findings of an online survey of complex care clinicians about challenges related to discussing goals of care, advance care planning and care coordination. They describe opportunities for embedding palliative care principles in the care of children with medical complexity, implications for clinical practice, and next steps from this work. If you'd like to join the complex care listserv mentioned in the episode, please visit complexcarehome.com and scroll down to the bottom of the webpage for the link to join. SPEAKERS P. Galen DiDomizio, MD Assistant Professor of Pediatrics, Division of Complex Care Medical College of Wisconsin Dominic Moore, MD Associate Professor and Division Chief, Pediatric Palliative Care Department of Pediatrics, University of Utah School of Medicine HOST Kilby Mann, MD Assistant Professor Pediatric Rehabilitation Medicine Children's Hospital Colorado DATES Initial publication: July 11, 2023 CITATION DiDomizio PG, Moore D, Mann K. Exploring Roles and Goals of Palliative Care and Complex Care. 07/2023. OPENPediatrics. Online Podcast. Links: https://youtu.be/RffkiH9pw80, https://soundcloud.com/openpediatrics/exploring-roles-and-goals-of-palliative-care-and-complex-care. ARTICLES REFERENCED DiDomizio PG, Millar MM, Olson L, Murphy N, Moore D. Palliative Care Needs Assessment for Pediatric Complex Care Providers. J Pain Symptom Manage. 2023;65(2):73-80. doi:10.1016/j.jpainsymman.2022.11.005 TRANSCRIPT https://op-docebo-images.s3.amazonaws.com/Transcripts/Exploring+Roles+and+Goals+of+Palliative+Care+and+Complex+Care_Moore+%26+DiDomizio_071123.pdf Clinicians across healthcare professions, advocates, researchers, and patients/families are all encouraged to engage and provide feedback! You can recommend an article for discussion using this form: forms.gle/Bdxb86Sw5qq1uFhW6 Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu

Dr. Chochinov returns to the show to dive into the patient dignity question, the platinum rule, and how biases in the healthcare system can impact both patients and providers. Hosts: Eyrn, Toshia Guests: Harvey Max Chochinov, MD, PhD, FRCPC, Yasmine Dakhama, MS4 References: Chochinov HM. The platinum rule: a new standard for person-centered care. J Palliat Med. 2022;25(6):854-856. doi:10.1089/jpm.2022.0075 Chochinov HM. The Platinum Rule: A New Standard for Person-Centered Care. J Palliat Med. 2022 Jun;25(6):854-856. doi: 10.1089/jpm.2022.0075. Epub 2022 Feb 25. PMID: 35230173; PMCID: PMC9145569. Chochinov HM, McClement S, Hack T, Thompson G, Dufault B, Harlos M. Eliciting Personhood Within Clinical Practice: Effects on Patients, Families, and Health Care Providers. J Pain Symptom Manage. 2015 Jun;49(6):974-80.e2. doi: 10.1016/j.jpainsymman.2014.11.291. Epub 2014 Dec 17. PMID: 25527441. Chochinov HM. Dignity and the essence of medicine: the A, B, C, and D of dignity conserving care. BMJ. 2007 Jul 28;335(7612):184-7. doi: 10.1136/bmj.39244.650926.47. PMID: 17656543; PMCID: PMC1934489.

We explore Dr. Harvey Max Chochinov's work on dignity therapy, its application in practice, and ways we can enhance humanism in medicine. Dr. Chochinov is a psychiatrist and researcher in palliative and end-of-life care. Our discussion also touches on burnout and systemic challenges the field of medicine faces. Hosts: Eyrn, Toshia Guests: Harvey Max Chochinov, MD, PhD, FRCPC, Yasmine Dakhama, MS4 References: Website to learn more about online dignity therapy training workshops: https://dignityincare.ca/en/ Chochinov HM, Hack T, Hassard T, Kristjanson LJ, McClement S, Harlos M. Dignity therapy: a novel psychotherapeutic intervention for patients near the end of life. J Clin Oncol. 2005 Aug 20;23(24):5520-5. doi: 10.1200/JCO.2005.08.391. PMID: 16110012. Chochinov HM. The platinum rule: a new standard for person-centered care. J Palliat Med. 2022;25(6):854-856. doi:10.1089/jpm.2022.0075 Chochinov HM. The Platinum Rule: A New Standard for Person-Centered Care. J Palliat Med. 2022 Jun;25(6):854-856. doi: 10.1089/jpm.2022.0075. Epub 2022 Feb 25. PMID: 35230173; PMCID: PMC9145569. Chochinov HM, McClement S, Hack T, Thompson G, Dufault B, Harlos M. Eliciting Personhood Within Clinical Practice: Effects on Patients, Families, and Health Care Providers. J Pain Symptom Manage. 2015 Jun;49(6):974-80.e2. doi: 10.1016/j.jpainsymman.2014.11.291. Epub 2014 Dec 17. PMID: 25527441. Chochinov HM. Dignity and the essence of medicine: the A, B, C, and D of dignity conserving care. BMJ. 2007 Jul 28;335(7612):184-7. doi: 10.1136/bmj.39244.650926.47. PMID: 17656543; PMCID: PMC1934489.

SummaryWhat is your plan for medical care as you get older? Most people don't know. While 87% of people say they want to die at home, just under half of people do. In this episode we discuss goals of care, comfort care, palliative care, hospice, code status and more. Morbidity and MortalityMedical errors are the 3rd leading cause of death in the United States (sorry healthcare team…its true). As people get older, sicker, and frailer, their chances of being hurt by healthcare increase dramatically. At some point for everyone, the benefits of aggressive medical care are outweighed by the risks. StoryIn 1900 the average life expectancy in the United States was 47.3 years. By 2019, life expectancy had increased to 78.8 years. This was largely due to public health measures like clean water, lifesaving antibiotics, and vaccines. However, life expectancy is now trending down-ward.  Key Points1. Comfort care is when the main goal of care is person's quality of life2. Palliative care is a medical discipline that helps people cope mentally, physically, and spiritually with severe illness. People on aggressive medical and comfort care can utilize palliative care.3. Code Status concerns a patient's wishes when they are dead. It has nothing to do with their medical care while alive.4. Hospice is a program centered around comfort care for those persons expected to live < 6 months. It is under-utilized and our current medical incentives push people away from it.  References-       Connor SR, Pyenson B, Fitch K, Spence C, Iwasaki K. Comparing hospice and nonhospice patient survival among patients who die within a three-year window. J Pain Symptom Manage. 2007 Mar;33(3):238-46. -       https://hospicefoundation.org/Hospice-Care/Hospice-Services-       Hughes MT, Smith TJ. The growth of palliative care in the United States. Annu Rev Public Health. 2014;35:459-75. doi: 10.1146/annurev-publhealth-032013-182406. PMID: 24641562.-       Gomes, B., Calanzani, N., Gysels, M. et al. Heterogeneity and changes in preferences for dying at home: a systematic review. BMC Palliat Care 12, 7 (2013)-       Adair T-       Who dies where? Estimating the percentage of deaths that occur at home-       BMJ Global Health 2021-       QuickStats: Percentage of Deaths, by Place of Death — National Vital Statistics System, United States, 2000–2018. MMWR Morb Mortal Wkly Rep 2020-       Makary MA, Daniel M. Medical error-the third leading cause of death in the US. BMJ. 2016-       Google searches and numerous sites describing “comfort care”, “palliative care”, “End of life care”

Apresentação: Cláudia Inhaia Instagram @cinhaia Twitter cinhaia Sabrina Corrêa da Costa Ribeiro Instagram @papopaliativo Twitter Uti.Correa Convidadas: Glauce C Corrêa da Silva Instagram @glaucecorreadasilva CHAMADA O setor de emergência dos hospitais costuma ser cenário de atendimentos variados, alguns para atendimentos de intercorrências agudas e inesperadas, outros para atendimento de complicações recorrentes de doentes crônicos, para controle de sintomas desconfortáveis e mesmo para acompanhamento de fim de vida. Neste episódio a psicóloga e coordenadora do comitê de Cuidados Paliativos na Emergência da ANCP, Glauce Corrêa, em bate-papo com apresentação das médica Cláudia Inhaia e Sabrina Corrêa da Costa Ribeiro, conversam sobre o trabalho em equipe, burnout, comunicação com famílias e pacientes e como tornar a rotina mais amena para todos. Informamos que as opiniões dos entrevistados não necessariamente reflete a opinião da ANCP. REFERÊNCIAS CITADAS NO EPISÓDIO 1. Hunt LJ, Ritchie CS, Cataldo JK, Patel K, Stephens CE, Smith AK. Pain and Emergency Department Use in the Last Month of Life Among Older Adults With Dementia. J Pain Symptom Manage. 2018 Dec;56(6):871-877.e7. doi: 10.1016/j.jpainsymman.2018.09.005. Epub 2018 Sep 15. PMID: 30223013; PMCID: PMC6289599 2. Recomendações para Atenção Psicológica aos Pacientes Suspeitos ou Portadores da COVID-19, Familiares e Equipe de Assistência ABRAMED e AMB http://abramede.com.br/wp-content/uploads/2020/06/RECOMENDACAO-PSICOLOGIA-01-040620.pdf 3. Silva GCC, Koch HA, Sousa EG. O PERFIL DO MÉDICO EM FORMAÇÃO EM RADIOLOGIA E DIAGNÓSTICO POR IMAGEM. Radiol Bras 2007;40(2):99–103 4. Silva GCC, Sousa EG, Martins LAN et al A importância do apoio psicológico ao médico residente e especializando em radiologia e diagnóstico por imagem. Radiol Bras 2011;44(2):81-84 5. Silva GCC, Koch HA, Sousa EG et al. Ansiedade e depressão em residentes em Radiologia e Diagnóstico por Imagem. Revista Brasileira de Educação Médica 2010 34(2): 199-206 6. https://www.youtube.com/watch?v=CqsA_68X61c DIRECIONAMENTO METADADOS #ANCPaliativos #CuidadosPaliativos #PalliativeCare #Saude #ProfissionaisDeSaude #EquipeMultidisciplinar #CongressoPaliativo22 #Paliativo22 #Omelhorcuidadoparatodosavidatoda #conforto #autonomia #objetivodecuidado #bioetica #bioethics #decisaocompartilhada #controledesintomas #emergencia #cuidadopaliativonaemergencia #emergenciahumanizada #gequipemultidisciplinarnaemergencia #psicologianaemergencia

Description: An immersive reading of the poem ‘On Pain' by Kahlil Gibran reflecting on total pain and spirituality in healthcare. PoemOn Pain by Kahlil Gibran And a woman spoke, saying, Tell us of Pain.     And he said:     Your pain is the breaking of the shell that encloses your understanding.     Even as the stone of the fruit must break, that its heart may stand in the sun, so must you know pain.     And could you keep your heart in wonder at the daily miracles of your life your pain would not seem less wondrous than your joy;     And you would accept the seasons of your heart, even as you have always accepted the seasons that pass over your fields.     And you would watch with serenity through the winters of your grief.      Much of your pain is self-chosen.     It is the bitter potion by which the physician within you heals your sick self.     Therefore trust the physician, and drink his remedy in silence and tranquility:     For his hand, though heavy and hard, is guided by the tender hand of the Unseen,     And the cup he brings, though it burn your lips, has been fashioned of the clay which the Potter has moistened with His own sacred tears.  ReferencesThe Prophet: https://www.gutenberg.org/ebooks/58585  Zuskin E, Lipozencić J, Pucarin-Cvetković J, Mustajbegović J, Schachter N, Mucić-Pucić B, Neralić-Meniga I. Ancient medicine--a review. Acta Dermatovenerol Croat. 2008;16(3):149-57.Shinall MC Jr, Stahl D, Bibler TM. Addressing a Patient's Hope for a Miracle. J Pain Symptom Manage. 2018 Feb;55(2):535-539.Puchalski CM. The role of spirituality in health care. Proc (Bayl Univ Med Cent). 2001;14(4):352-357. https://www.mypcnow.org/fast-fact/total-pain/ Accessed 12.24.21https://poets.org/poet/kahlil-gibran Accessed 12.25.21https://www.health.harvard.edu/healthbeat/giving-thanks-can-make-you-happier Accessed 12.31.21

Welcome to Episode 9 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 9 of “The 2 View” – STI Treatment Guidelines, Muscle Relaxers, Patient Satisfaction Scores, Lidocaine, and More… 2021 Updated CDC STI Treatment Guidelines Pocket Guide: Sexually Transmitted Infections. Summary of CDC Treatment Guidelines – 2021. Cdc.gov. Accessed September 7, 2021. https://www.cdc.gov/std/treatment-guidelines/pocket-guide.pdf Sexually Transmitted Infections Treatment Guidelines, 2021. CDC. Provider Resources. Cdc.gov. Published August 5, 2021. Accessed September 7, 2021. https://www.cdc.gov/std/treatment-guidelines/provider-resources.htm SGEM#335: Sisters Are Doin' It for Themselves…Self-Obtained Vaginal Swabs for STIs. The Skeptics' Guide to EM. Thesgem.com. Published June 26, 2021. Accessed September 7, 2021. https://www.thesgem.com/2021/06/sgem335-sisters-are-doin-it-for-themselves/ The Center for Medical Education. The 2 View: Episode 1. Fireside.fm. Published January 11, 2021. Accessed September 7, 2021. https://2view.fireside.fm/1 Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. CDC. Published July 23, 2021. Accessed September 7, 2021. https://www.cdc.gov/mmwr/volumes/70/rr/rr7004a1.htm Muscle Relaxers Cashin AG, Folly T, Bagg MK, et al. Efficacy, acceptability, and safety of muscle relaxants for adults with non-specific low back pain: systematic review and meta-analysis. BMJ. PubMed.gov. Published July 7, 2021. Accessed September 7, 2021. https://pubmed.ncbi.nlm.nih.gov/34233900/ Chou R, Peterson K, Helfand M. Comparative efficacy and safety of skeletal muscle relaxants for spasticity and musculoskeletal conditions: a systematic review. J Pain Symptom Manage. PubMed.gov. Published August 2004. Accessed September 7, 2021. https://pubmed.ncbi.nlm.nih.gov/15276195/ Gerardo Sison P. Robaxin vs. Flexeril: Differences, similarities, and which is better for you. Singlecare.com. Published April 28, 2020. Accessed September 7, 2021. https://www.singlecare.com/blog/robaxin-vs-flexeril/ Gordon, S. Muscle Relaxants for Back Pain Are Soaring: Are They Safe? Webmd.com. Published July 1, 2020. Accessed September 7, 2021. https://www.webmd.com/back-pain/news/20200701/muscle-relaxants-for-back-pain-are-soaring-are-they-safe Motov, S. Faculty Forum: A Practical Approach to Pain Management. YouTube. https://www.youtube.com/watch?v=lJSioPsGw3A. The Center for Medical Education. Published December 2, 2020. Accessed September 7, 2021. van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low back pain. Cochrane Database Syst Rev. PubMed.gov. Published 2003. Accessed September 7, 2021. https://pubmed.ncbi.nlm.nih.gov/12804507/ Patient Satisfaction Scores Belanger T, Axene E, Martens K. numbERs: How to Improve Patient Satisfaction Scores (Without Really Trying). Emergency Medicine News: The Most Trusted News Source in Emergency Medicine. Lww.com. Published July 2021. Accessed September 7, 2021. https://journals.lww.com/em-news/Fulltext/2021/07000/numbERs_HowtoImprovePatient_Satisfaction.22.aspx Lidocaine El-Boghdadly K, Pawa A, Chin KJ. Local anesthetic systemic toxicity: current perspectives. Local Reg Anesth. PMC: US National Library of Medicine National Institutes of Health. Published August 8, 2018. Accessed September 7, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6087022/ Van Meter M. How is a 1% lidocaine concentration for oral nerve block calculated? Medscape.com. Updated January 17, 2019. Accessed September 7, 2021. https://www.medscape.com/answers/82850-105919/how-is-a-1-lidocaine-concentration-for-oral-nerve-block-calculated Mike & Martha's Something Sweet Emanuel G. Does Your Kid's Classroom Need An Air Purifier? Here's How You Can Make One Yourself. NPR. Published August 26, 2021. Accessed September 7, 2021. https://www.npr.org/sections/back-to-school-live-updates/2021/08/26/1031018250/does-your-kids-classroom-need-an-air-purifier-heres-how-you-can-make-one-yoursel. Mahoney S. Summerville woman receives national “Magic Maker” award from Disney. WCIV. Published August 26, 2021. Accessed September 7, 2021. https://abcnews4.com/news/local/summerville-woman-receives-national-magic-maker-award-from-disney Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Last month we asked you a trivia question in conjunction with our pediatric-themed episode. It was another 2-part question and we asked: What year did the TV show Sesame Street first air in the United States and what color was Oscar the Grouch's fur? The answer was: 1969 and orange. Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to.

027 - Don't Miss this Diagnosis #2 Dr Baumrucker discusses Hypertrophic Pulmonary Osteopathy a rare but important syndrome palliative medicine caregivers are likely to encounter in their careers, References: Pourmorteza M, Baumrucker SJ, Al-Sheyyab A, Da Silva MA. Hypertrophic Pulmonary Osteoarthropathy: A Rare But Treatable Condition in Palliative Medicine. J Pain Symptom Manage. 2015 Aug;50(2):263-7. Albrecht S, Keller A. Postchemotherapeutic reversibility of hypertrophic osteoarthropathy in a patient with bronchogenic adenocarcinoma. Clin Nucl Med. 2003;28(6):463-466. Johnson SA, Spiller PA, Faull CM. Treatment of resistant pain in hypertrophic pulmonary osteoarthropathy with subcutaneous octreotide. Thorax. 1997;52(3):298-299. Ooi A, Saad RA, Moorjani N, Amer KM. Effective symptomatic relief of hypertrophic pulmonary osteoarthropathy by video-assisted thoracic surgery truncal vagotomy. Ann Thorac Surg. 2007;83(2):684-685.

Michael A. Norko, MD, professor of psychiatry at Yale University in New Haven, Conn., spoke with Lorenzo Norris, MD, MDedge Psychiatry editor in chief, about incorporating patients’ spiritual and religious histories into psychiatric evaluations. Dr. Norko, lead author of a paper exploring whether religion is protective against suicide, sat down with Dr. Norris at the 2019 fall meeting of the Group for the Advancement of Psychiatry, or GAP.   Evidence, questions to consider about religion and spirituality Various spiritual and religious factors are linked to decreased rates of suicide behaviors and attempts, including weekly attendance to worship services, personal beliefs about the preciousness of life, and commitment to a faith practice. Which specific parts of religious and spirituality are protective? Are the protective factors the social connection or the spiritual connection alone? Those who attend worship services weekly are at lower risk of suicide. It’s unclear whether weekly attendance is a proxy for the social connectedness or for the level of internalization of the religious beliefs. Commitment to a faith is measured by a consistent and strong belief in the faith tradition. Just because someone says they belong to a faith tradition does not automatically mean a person is at lower risk of suicide. Strong alignment with the faith also is protective. Alignment is different from commitment, because if patients are doubting or their personal beliefs conflict with long-held religious traditions, this can increase patients’ suicide risk.  Questions to ask about spirituality and religion in clinical practice A spiritual and religious history is essential to a psychiatric evaluation, because asking about religion lets the patient know that this is a welcome topic. Examples of questions a clinician can ask include: “Is there any faith tradition that you belong to? How important is your faith or beliefs? Is there anything about your religious beliefs you think are important to your mental health treatment?”  Difficult areas to navigate with religion and spirituality Lack of expertise or personal experience with religion can be a barrier. It is important to remember that patients usually welcome curiosity about their religious beliefs and emotional lives. Clinicians need not be experts in religion, but they can be alert to the salient values and notice whether the person is struggling with certain beliefs. Clinicians also can encourage patients to talk to their clergy. When someone asks a clinician, “What is your faith practice?” this can be approached as an informed consent question. The clinician can ask how talking about their own beliefs or faith practices will deepen and help the therapeutic work of the patient. If a person is feeling let down by a certain failing of their religious community, therapy is a good place to explore what strengths and succor they had received from their religion. Therapy also can be used to guide patients toward additional places, or even substitutes, to meet their needs. Understanding patients’ faith background and beliefs can help clinicians reframe certain crises, especially if the psychiatrist and therapist have talked discussed those crises with patients over time. It’s more useful to understand patients’ faith before the crisis, because grasping for a spiritual or religious answer at the last moment can feel inauthentic.  References  Norko et al. Can religion protect against suicide? J Nerv Ment Dis. 2017. Jan;205(1):9-14. Kruizinga R et al. Toward a fully-fledged integration of spiritual care and medical care. J Pain Symptom Manage. 2018 Mar;55(3):1035-40.   Thomas LP et al. Meaning-centered psychotherapy: A form of psychotherapy for patients with cancer. Curr Psychiatry Rep. 2014 Oct;16(10):488. Lawrence RE et al. Religion and suicide risk: A systematic review. Arch Suicide Res. 2016;20(1):1-21. D’Souza R, George K. Spirituality, religion and psychiatry: its application to clinical practice. Australas Psychiatry. 2006 Dec;14(4):408-12. FICA Spiritual History Tool: https://smhs.gwu.edu/gwish/clinical/fica/spiritual-history-tool, which is based on Puchalski C and Romer AL. Taking a spiritual history allows clinicians to understand patients more fully. J Palliat Med. 2000 Spring;3(1):129-37. George Washington University Institute for Spirituality and Health (GWISH): https://smhs.gwu.edu/gwish/

Et oui, c’est la fin de l’année et qui dit fin de l’année dit Gala des grands crus et des piquettes du Pharmascope! Ne ratez donc pas ce 43ème épisode dans lequel Nicolas, Sébastien et Isabelle dévoilent les grands gagnants de célèbres catégories comme Les affaires simples et pas chères mais combien intéressantes ou encore L’étude musicale de l’année ! Les objectifs pour cet épisode sont: Comprendre le rôle de la cigarette électronique en cessation tabagiqueExpliquer les risques et les bénéfices associés à la flibansérineConnaître l’impact de la thérapie par ventilateur en dyspnée en soins palliatifsConnaître l’impact du port d’un masque et de bouchons pour les oreilles sur le sommeil chez les patients hospitalisésIdentifier des mesures pour diminuer la douleur et la peur associées aux injections intrasmusculaires en pédiatrie Ressources pertinentes en lien avec l’épisode Essai randomisé contrôlé comparant la cigarette électronique à la thérapie de remplacement de nicotine en cessation tabagiqueHajek P, Phillips-Waller A, Przulj D, et coll. A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy. N Engl J Med. 2019 Feb 14;380(7):629-637. Article portant sur l’approbation de la flibansérineWoloshin S, Schwartz LM. US Food and Drug Administration Approval of Flibanserin: Even the Score Does Not Add Up. JAMA Intern Med. 2016 Apr;176(4):439-42. Revue systématique évaluant l’efficacité et l’innocuité de la flibansérineJaspers L, Feys F, Bramer WM, et coll. Efficacy and Safety of Flibanserin for the Treatment of Hypoactive Sexual Desire Disorder in Women: A Systematic Review and Meta-analysis. JAMA Intern Med. 2016 Apr;176(4):453-62. Revue systématique évaluant l’efficacité du vinaigre en diabèteCheng LJ, Jiang Y, Wu XV, et coll. A systematic review and meta-analysis: Vinegar consumption on glycaemic control in adults with type 2 diabetes mellitus. J Adv Nurs. 2019 Oct 31. Étude observationnelle évaluant l’association entre la capacité à faire des push-up et le risque cardiovasculaireYang J, Christophi CA, Farioli A, et coll. Association Between Push-up Exercise Capacity and Future Cardiovascular Events Among Active Adult Men. JAMA Netw Open. 2019 Feb 1;2(2):e188341. Étude randomisée contrôlée évaluant l’efficacité d’un ventilateur pour la soulager la dyspnée en soins palliatifsKako J, Morita T, Yamaguchi T, et coll. Fan Therapy Is Effective in Relieving Dyspnea in Patients With Terminally Ill Cancer: A Parallel-Arm, Randomized Controlled Trial. J Pain Symptom Manage. 2018 Oct;56(4):493-500. Étude randomisée contrôlée évaluant l’efficacité du port d’un masque et de bouchons sur le sommeil durant une hospitalisationSweity S, Finlay A, Lees C, et coll. SleepSure: a pilot randomized-controlled trial to assess the effects of eye masks and earplugs on the quality of sleep for patients in hospital. Clin Rehabil. 2019 Feb;33(2):253-261. Étude randomisée contrôlée évaluant l’efficacité de la gomme à mâcher après une césarienneYenigul NN, Aydogan Mathyk B, Aslan Cetin B, et coll. Efficacy of chewing gum for improving bowel function after cesarean sections: a randomized controlled trial. J Matern Fetal Neonatal Med. 2019 Jan 4:1-6. Revue systématique évaluant l’efficacité de la gomme à mâcher après une césarienneCiardulli A, Saccone G, Di Mascio D, et coll. Chewing gum improves postoperative recovery of gastrointestinal function after cesarean delivery: a systematic review and meta-analysis of randomized trials. J Matern Fetal Neonatal Med. 2018 Jul;31(14):1924-1932. Étude randomisée contrôlée évaluant l’efficacité de la musicothérapie en pruritDemirtas S, Houssais C, Tanniou J, et coll. Effectiveness of a music intervention on pruritus: an open randomized prospective study. J Eur Acad Dermatol Venereol. 2019 Dec 15. Étude randomisée contrôlée évaluant l’efficacité d’un supplément de vitamine D aux soins intensifsGinde AA, Brower GD, Caterino JM, et coll.

Dr. Tasha Stanton’s background in physiotherapy and pain science means her research is very clinically relevant. BJSM’s Liam West discusses with Dr. Stanton the pain experienced by patients with osteoarthritis, how fear and emotions can alter this pain and where the future of osteoarthritis pain management might lie. Related Articles: Evidence of central sensitisation, impaired pain inhibition, enhanced pain facilitation in OA: Edwards et al. BMC Musculoskeletal Disorders 2016; 17:284 Perception of harm influences pain: Wiech et al J Neurosci 2010; 30:16324-31 What people with OA think about exercise/harm: Holden MA, et al. Role of exercise for knee pain: what do older adults in the community think? Arthritis Care Res. 2012;64:1554-64. Somers et al. J Pain Symptom Manage. 2009;37:863-72. Pouli N, et al. The experience of living with knee OA. Disabil Rehabil. 2014;36:600-7 Modulation of pain by vision: Longo et al. J Neurosci 2009; 29: 12125-30; Longo et al. J Neurosci 2012; 32: 2601-7 Alterations in body perception in people with OA: Nishigami et al. PLoS ONE 2017; 12:e0179225 Gilpin et al. Rheumatology 2015; 54:678-82 Body illusions in people with pain: Bosch et al. PAIN 2016; 157:519-29. Altering sounds alters feelings of back stiffness: Stanton et al. Scientific reports 2017; 7: 9861. Associated Podcasts: Prof Hunter on OA and exercise - http://bit.ly/2DQAd9z OA in the spotlight - http://bit.ly/1Frwnxt Prof Moseley on the brain and mind in chronic pain - http://bit.ly/1u33pPY Pain coach and first patient contact for pain management - http://bit.ly/2DHCaGa Am I safe to move? Prof Moseley on understanding pain and focusing on the patient - http://bit.ly/2nmCAqu Podcast Quotes: “Give your patient the locus of control” “Knowledge helps you frame what is happening in your world” “People with osteoarthritis often hold beliefs that movement is harmful”

Sarina Isenberg, interviewed by Ross Upshur, discusses palliative care from the lens of a scientist and health researcher committed to making a difference for those who receive such care in the course of their disease. Sarina’s first experience with palliative care was at a relatively young age when two loved ones were in palliative care in the course of their terminal illnesses. Later, her studies in health-related subjects landed Sarina in palliative care study and research, which is a subject area with great challenges in any health system in the world in terms of complexity, cost and degree of needed care. As mentioned in the podcast, palliative care is no longer limited to end-of-life care. The shifting face of palliative care, in light of the aging population in Canada, is a great opportunity for Sarina and others to research palliative care with the intent of improving access to, and the quality of palliative care. Sarina Isenberg is a Scientist at the Temmy Latner Centre for Palliative Care and the Lunenfeld-Tanenbaum Research Institute (both at Sinai Health System), as well as an Assistant Professor in the Department of Family and Community Medicine – Division of Palliative Care at the University of Toronto. Her research has leveraged  varied health services approaches—both quantitative and qualitative—to assess access to and quality of palliative care,(1, 2) evaluate the cost effectiveness of palliative care inpatient services,(3, 4) and test interventions for improving advance care planning discussions.(5-7) Sarina’s ongoing work also relates to evaluating the cost effectiveness of home-based palliative care, assessing the patient and caregiver experience of receiving palliative care, transitioning across palliative care settings, and designing and implementing quality improvement initiatives in palliative care. Sarina’s central research goal is to apply a public health approach to palliative care research that is translatable to decision-makers, practitioners, patients, and their companions. Sarina has worked with knowledge users translating research into practice and policy through collaborations with Ontario Palliative Care Network, Veterans Affairs Canada,(8) the American Society of Clinical Oncology,(9) and the Agency for Health Research and Quality. (10) Sarina received her PhD in Social and Behavioral Sciences at the Johns Hopkins Bloomberg School of Public Health. She has previously worked as a management consultant on Deloitte’s National Health Services Team (Canada). Prior to consulting, Sarina received her MA in English Literature from Queen’s University and her BA in English Literature from McGill University. Find out how she puts those humanities degrees to work in her role as a scientist in this podcast. Link to some of Sarina’s articles on PubMed, so far.  References in this article: 1. Aslakson R, Dy SM, Wilson RF, et al. Patient and caregiver-reported assessment tools for palliative care: summary of the 2017 AHRQ Technical Brief. J Pain Symptom Manage. 2017 Aug 14. PubMed PMID: 28818633. Epub 2017/08/19. eng. 2. Dy SM, Al Hamayel NA, Hannum SM, et al. A survey to evaluate facilitators and barriers to quality measurement and improvement: Adapting tools for implementation research in palliative care programs. J Pain Symptom Manage. 2017 Aug 08. PubMed PMID: 28801007. Epub 2017/08/13. eng. 3. Isenberg SR, Lu C, McQuade J, et al. Impact of a New Palliative Care Program on Health System Finances: An Analysis of the Palliative Care Program Inpatient Unit and Consultations at Johns Hopkins Medical Institutions. Journal of Oncology Practice. 2017;epub ahead of print. 4. Isenberg SR, Lu C, McQuade J, et al. Economic Evaluation of a Hospital-Based Palliative Care Program. Journal of Oncology Practice. 2017;epub ahead of print. 5. Aslakson RA, Isenberg SR, Crossnohere NL, et al. Utilizing Advance Care Planning Videos to Empower Perioperative Patients and Families: The Protocol...

Abdominal pain is common; so are strongly held myths and legends about what is concerning, and what is not.   One of our largest responsibilities in the Emergency Department is sorting out benign from surgical or medical causes of abdominal pain.  Morbidity and mortality varies by age and condition.   Abdominal Surgical Emergencies in Children: A Relative Timeline General Advice Neonate (birth to one month) Necrotizing Enterocolitis Pneumatosis Intestinalis. Essentials: Typically presents in 1st week of life (case reports to 6 months in chronically ill children) Extend suspicion longer in NICU graduates Up to 10% of all cases of necrotizing enterocolitis are in full-term children Pathophysiology is unknown, but likely a translocation of bacteria Diagnosis: Feeding intolerance, abdominal distention Abdominal XR: pneumatosis intestinalis Management: IV access, NG tube, broad-spectrum antibiotics, surgery consult, ICU admission Intestinal Malrotation with Volvulus Essentials: Corkscrew Sign in Malrotation with Volvulus Bilious vomiting (80-100%) in the 1st month; especially in the 1st week May look well initially, then rapidly present in shock Ladd’s bands: abnormally high tethering of cecum to abdominal wall; peristalsis, volvulus, ischemia Diagnosis: History of bilious emesis is sufficient to involve surgeons Upper GI series: corkscrew appearance US (if ordered) may show abnormal orientation of and/or flow to superior mesenteric artery and vein Management: Stat surgical consult IV access, resuscitation, NG tube to decompress (bowel wall perfusion at risk, distention worsens) Hirschprung Disease Essentials: Problem in migration of neural crest cells Aganglionic colon (80% rectosigmoid; 15-20% proximal to sigmoid; 5% total colonic aganglionosis) colon (known as short-segment disease) Poor to no peristalsis: constipation, perforation, and/or sepsis Diagnosis: May be diagnosed early as “failure to pass meconium in 1st 48 hours” In ED, presents as either bowel obstruction or enterocolitis Contrast enema Beware of the toxic megacolon (vomiting, distention, sepsis) Management: Resuscitation, antibiotics, NG tube decompression, surgical consultation; stable patients may need rectal biopsy for confirmation Staged surgery (abdominoperineal pull-through with diverting colostomy, subsequent anastomosis) versus one-stage repair. Infant and Toddler (1 month to 2 years) Pyloric Stenosis Essentials: Hypertrophy of pyloric sphincter; genetic, environmental, exposure factorsString Sign in Pyloric Stenosis. Diagnosis: Hungry, hungry, not-so-hippos; they want to eat all of the time, but cannot keep things down Poor weight gain (less than 20-30 g/day) US: “π–loric stenosis” (3.14); pylorus dimensions > 3 mm x 14 mm UGI: “string sign” Management: Trial of medical treatment with oral atropine via NGT (muscarinic effects decrease pyloric tone) Ramstedt pyloromyotomy (definitive) Intussusception Essentials: Majority (90%) ileocolic; no pathological lead point Small minority (4%) ileoileocolic due to lead point: Meckel’s diverticulum, polyp, Peyer’s patches, Henoch-Schönlein purpura (intestinal hematoma) Diagnosis: Target Sign (Donut Sign). Ultrasound sensitivity and specificity near 100% in experienced hands Abdominal XR may show non-specific signs; used mainly to screen for perforation before reduction Management: Hydrostatic enema: contrast (barium or water-soluble contrast with fluoroscopy) or saline (with ultrasound) Air-contrast enema: air or carbon dioxide (with either fluoroscopy or ultrasound); higher risk for perforation than hydrostatic (1% risk), but generally safer than perforation from contrast Consider involving surgical service early (precaution before reduction) Traditional disposition is admission; controversial: home discharge from ED Young Child and Older (2 years and up) Appendicitis Essentials: Appendicitis occurs in all ages, but rarer in infants. Infants do not have fecalith; rather they have some other anatomic or congenital condition.  More common in school-aged children (5-12 years) and adolescents Younger children present atypically, more likely to have perforated when diagnosed. Diagnosis: Non-specific signs and symptoms Often have abdominal pain first; vomiting comes later Location/orientation of appendix varies Appendicitis scores vary in their performance Respect fever and abdominal pain   Management: Traditional: surgical On the horizon: identification of low-risk children who may benefit from trial of antibiotics If perforated, interval appendectomy (IV antibiotics via PICC for 4-6 weeks, then surgery) Obstruction SBO. Incarcerated Inguinal Hernia. Essentials: Same pathophysiology and epidemiology as adults: “ABC” – adhesions, “bulges” (hernias), and cancer. Diagnosis: Obstruction is a sign of another condition. Look for cause of obstruction: surgical versus medical Abdominal XR in low pre-test probability CT abdomen/pelvis for moderate-to-high risk; confirmation and/or surgical planning Management: Treat underlying cause NG tube to low intermittent wall suction Admission, fluid management, serial examinations   Take these pearls home: Consider surgical pathology early in encounter Resuscitate while you investigate Have a low threshold for imaging and/or consultation, especially in preverbal children   Selected References Necrotizing Enterocolitis Neu J, Walker A. Necrotizing Enterocolitis. N Eng J Med. 2011; 364(3):255-264. Niño DF et al. Necrotizing enterocolitis: new insights into pathogenesis and mechanisms. Nature. 2016; 13:590-600. Walsh MC et al. Necrotizing Enterocolitis: A Practitioner’s Perspective. Pediatr Rev. 1988; 9(7):219-226. Malrotation with Midgut Volvulus Applegate KE. Intestinal Malrotation in Children: A Problem-Solving Approach to the Upper Gastrointestinal Series. Radiographics. 2006; 26:1485-1500. Kapfer SA, Rappold JF. Intestinal Malrotation – Not Just the Pediatric Surgeon’s Problem. J Am Coll Surg. 2004; 199(4):628-635. Lee HC et al. Intestinal Malrotation and Catastrophic Volvulus in Infancy. J Emerg Med. 2012; 43(1):49-51. Martin V, Shaw-Smith C. Review of genetic factors in intestinal malrotation. Pediatr Surg Int. 2010; 26:769-781. Nehra D, Goldstein AM. Intestinal malrotation: Varied clinical presentation from infancy through adulthood. Surgery. 2010; 149(3):386-391. Hirschprung Disease Amiel J, Sproat-Emison E, Garcia-Barcelo M, et al. Hirschsprung disease, associated syndromes and genetics: a review. J Med Genet 2008; 45:1. Arshad A, Powell C, Tighe MP. Hirschsprung's disease. BMJ 2012; 345:e5521. Aworanti OM, McDowell DT, Martin IM, Quinn F. Does Functional Outcome Improve with Time Postsurgery for Hirschsprung Disease? Eur J Pediatr Surg 2016; 26:192. Clark DA. Times of first void and first stool in 500 newborns. Pediatrics 1977; 60:457. Dasgupta R, Langer JC. Evaluation and management of persistent problems after surgery for Hirschsprung disease in a child. J Pediatr Gastroenterol Nutr 2008; 46:13. De Lorijn F, Reitsma JB, Voskuijl WP, et al. Diagnosis of Hirschsprung's disease: a prospective, comparative accuracy study of common tests. J Pediatr 2005; 146:787. Doig CM. Hirschsprung's disease and mimicking conditions. Dig Dis 1994; 12:106. Khan AR, Vujanic GM, Huddart S. The constipated child: how likely is Hirschsprung's disease? Pediatr Surg Int 2003; 19:439. Singh SJ, Croaker GD, Manglick P, et al. Hirschsprung's disease: the Australian Paediatric Surveillance Unit's experience. Pediatr Surg Int 2003; 19:247. Suita S, Taguchi T, Ieiri S, Nakatsuji T. Hirschsprung's disease in Japan: analysis of 3852 patients based on a nationwide survey in 30 years. J Pediatr Surg 2005; 40:197. Sulkowski JP, Cooper JN, Congeni A, et al. Single-stage versus multi-stage pull-through for Hirschsprung's disease: practice trends and outcomes in infants. J Pediatr Surg 2014; 49:1619. Pyloric Stenosis Aspelund G, Langer JC. Current management of hypertrophic pyloric stenosis. Semin Pedaitr Surg. 2007; 16:27-33. Dias SC et al. Hypertrophic pyloric stenosis: tips and tricks for ultrasound diagnosis. Insights Imaging. 2012; 3:247-250. Kawahara H et al. Medical treatment of infantile hypertrophic pyloric stenosis: should we always slice the olive? J Pediatr Surg. 2005; 40:1848-1851. Mack HC. Adult Hypertrophic Pyloric Stenosis. Arch Inter Med. 1959; 104:78-83. Meissner PE et al. Conservative treatment of infantile hypertrophic pyloric stenosis with intravenous atropine sulfate does not replace pyloromyotomy. Pediatr Surg Int. 2006; 22:1021-1024. Mercer AE, Phillips R. Can a conservative approach to the treatment of hypertrophic pyloric stenosis with atropine be considered a real alternative to pyloromyotomy? Arch Dis Child. 2013; 95(6): 474-477. Pandya S, Heiss K, Pyloric Stenosis in Pediatric Surgery.Surg Clin N Am. 2012; 92:527-39. Peters B et al. Advances in infantile hypertrophic pyloric stenosis. Expert Rev Gastroenterol Hepatol. 2014; 8(5):533-541. Intussusception Apelt N et al. Laparoscopic treatment of intussusception in children: A systematic review. J Pediatr Surg. 2013; 48:1789-1793. Applegate KE. Intussusception in Children: Imaging Choices. Semin Roentgenol. 2008; 15-21. Bartocci M et al. Intussusception in childhood: role of sonography on diagnosis and treatment. J Ultrasound. 2015; 18 Gilmore AW et al. Management of childhood intussusception after reductiion by enema. Am J Emerg Med. 2011; 29:1136-1140.:205-211. Chien M et al. Management of the child after enema-reduced intussusception: hospital or home? J Emerg Med. 2013; 44(1):53-57. Cochran AA et al. Intussusception in traditional pediatric, nontraditional pediatric, and adult patients. Am J Emerg Med. 2011; 523-527. Loukas M et al. Intussusception: An Anatomical Perspective With Review of the Literature. Clin Anatomy. 2011; 24: 552-561. Mendez D et al. The diagnostic accuracy of an abdominal radiograph with signs and symptoms of intussusception. Am J Emerg Med. 2012; 30:426-431. Whitehouse et al. Is it safe to discharge intussusception patients after successful hydrostatic reduction? J Pediatr Surg. 2010; 45:1182-1186. Appendicitis Amin P, Chang D. Management of Complicated Appendicitis in the Pediatrc Population: When Surgery Doesn’t Cut it. Semin Intervent Radiol. 2012; 29:231-236 Blakely ML et al. Early vs Interval Appendectomy for Children With Perforated Appendicitis. Arch Surg. 2011; 146(6):660-665. Bundy DG et al. Does This Child Have Appendicitis? JAMA. 2007; 298(4):438-451. Cohen B et al. The non-diagnostic ultrasound in appendicitis: is a non-visualized appendix the same as a negative study? J Pediatr Surg. 2015 Jun;50(6):923-7 Herliczek TW et al. Utility of MRI After Inconclusive Ultrasound in Pediatric Patients with Suspected Appendicitis. AJT. 2013; 200:969-973. Janitz et al. Ultrasound Evaluation for Appendicitis. J Am Osteopath Coll Radiol. 2016; 5(1):5-12. Kanona H et al. Stump Appendicitis: A Review. Int J Surg. 2012; 10:4255-428. Kao LS et al. Antibiotics vs Appendectomy for Uncomplicated Acute Appendicitis. Evid Based Rev Surg. 2013;216(3):501-505. Petroianu A. Diagnosis of acute appendicitis. Int J Surg. 2012; 10:115-119. Mazeh H et al. Tip appendicitis: clinical implications and management. Amer J Surg. 2009; 197:211-215. Puig S et al. Imaging of Appendicitis in Children and Adolescents. Semin Roentgenol. 2008; 22-28. Schizas AMP, Williams AB. Management of complex appendicitis. Surgery. 2010; 28(11):544-548. Shogilev DJ et al. Diagnosing Appendicitis: Evidence-Based Review. West J Emerg Med. 2014; 15(4):859-871. Wray CJ et al. Acute Appendicitis: Controversies in Diagnosis and Management. Current Problems in Surgery. 2013; 50:54-86 Intestinal Obstruction Babl FE et al. Does nebulized lidocaine reduce the pain and distress of nasogastric tube insertion in young children? A randomized, double-blind, placebo-controlled trial. Pediatrics. 2009 Jun;123(6):1548-55 Chinn WM, Zavala DC, Ambre J. Plasma levels of lidocaine following nebulized aerosol administration. Chest 1977;71(3):346-8. Cullen L et al. Nebulized lidocaine decreases the discomfort of nasogastric tube insertion: a randomized, double-blind trial. Ann Emerg Med. 2004 Aug;44(2):131-7. Gangopadhyay AN, Wardhan H. Intestinal obstruction in children in India. Pediatr Surg Int. 1989; 4:84-87. Hajivassiliou CA. Intestinal Obstruction in Neonatal/Pediatric Surgery. Semin Pediatr Surg. 2003; 12(4):241-253. Hazra NK et al. Acute Intestinal Obstruction in children: Experience in a Tertiary Care Hospital. Am J Pub Health Res. 2015; 3(5):53-56. Kuo YW et al. Reducing the pain of nasogastric tube intubation with nebulized and atomized lidocaine: a systematic review and meta-analysis. J Pain Symptom Manage. 2010 Oct;40(4):613-20.  . Pediatric Surgery Irish MS et al. The Approach to Common Abdominal Diagnoses in Infants and Children. Pedaitr Clin N Am. 1998; 45(4):729-770. Louie JP. Essential Diagnosis of Abdominal Emergencies in the First Year of Life. Emerg Med Clin N Am. 2007; 25:1009-1040. McCullough M, Sharieff GQ. Abdominal surgical emergencies in infants and young children. Emerg Med Clin N Am. 2003; 21:909-935. Pepper VK et al. Diagnosis and Management of Pediatric Appendicitis, Intussusception, and Meckel Diverticulum. Surg Clin N Am. 2012   This post and podcast are dedicated to Mr Ross Fisher for his passion and spirit of collaboration in all things #FOAMed.  Thank you, sir!

Tim Platts-Mills shares his pearls about pain management for older adults in the ED. See here to leave a comment: https://gempodcast.com/2016/05/02/pearls-and-pitfalls-of-pain-management-in-older-adults/ Pain is the number one reason why people seek care in the Emergency Department (ED). One major goal of acute care is diagnosing the cause of the pain, but another is helping relieve the suffering associated with pain. In older adults, some of the risks of pain management with opioids are amplified, such as the risk of sedation and falls. With NSAIDs, there is a higher risk of acute renal insufficiency and electrolyte abnormalities, as well as cardiovascular risks with longer treatment. How should we approach acute pain management in the ED, and on discharge in older patients? In this podcast episode, Tim Platts-Mills, an expert and researcher on pain in older adults talks us through some ideas for non-opiates, opiates, and other adjuncts. We discuss some of the risks of over-treatment and under-treatment, and introduce the idea of the allostatic load created by chronic pain. Selected References 1. Hwang U, Platts-Mills TF. Acute pain management in older adults in the emergency department. Clin Geriatr Med. 2013;29(1):151-164. http://www.ncbi.nlm.nih.gov/pubmed/23177605 2. Platts-Mills TF, Esserman DA, Brown DL, Bortsov AV, Sloane PD, McLean SA. Older US emergency department patients are less likely to receive pain medication than younger patients: Results from a national survey. Ann Emerg Med. 2012;60(2):199-206. http://www.ncbi.nlm.nih.gov/pubmed/22032803 3. Hwang U, Richardson LD, Harris B, Morrison RS. The quality of emergency department pain care for older adult patients. J Am Geriatr Soc. 2010;58(11):2122-2128. http://www.ncbi.nlm.nih.gov/pubmed/21054293 4. Terrell KM, Hui SL, Castelluccio P, Kroenke K, McGrath RB, Miller DK. Analgesic prescribing for patients who are discharged from an emergency department. Pain Med. 2010;11(7):1072-1077. http://www.ncbi.nlm.nih.gov/pubmed/20642733 5. Gilron I, Bailey JM, Tu D, Holden RR, Weaver DF, Houlden RL. Morphine, gabapentin, or their combination for neuropathic pain. N Engl J Med. 2005;352(13):1324-1334. http://www.ncbi.nlm.nih.gov/pubmed/15800228 6. Siddall PJ, Cousins MJ. Persistent pain as a disease entity: Implications for clinical management. Anesth Analg. 2004;99(2):510-20, table of contents. http://www.ncbi.nlm.nih.gov/pubmed/15271732 7. Jakobsson U, Klevsgard R, Westergren A, Hallberg IR. Old people in pain: A comparative study. J Pain Symptom Manage. 2003;26(1):625-636. http://www.ncbi.nlm.nih.gov/pubmed/12850645 8. Elliott AM, Smith BH, Penny KI, Smith WC, Chambers WA. The epidemiology of chronic pain in the community. Lancet. 1999;354(9186):1248-1252. http://www.ncbi.nlm.nih.gov/pubmed/10520633 9. Bernabei R, Gambassi G, Lapane K, et al. Management of pain in elderly patients with cancer. SAGE study group. systematic assessment of geriatric drug use via epidemiology. JAMA. 1998;279(23):1877-1882. http://www.ncbi.nlm.nih.gov/pubmed/9634258 This podcast uses sounds from freesound.org by Jobro and HerbertBoland Image credit: https://pixabay.com/en/heart-3d-stone-white-pain-old-1463424/

Judith Tintinalli discusses her thoughts about caring for an older patient with a severe ICH as part of a multidisciplinary team. For the show notes and blog site, see: http://gempodcast.com/2015/11/11/15/ What does Dr. Tintinalli do when she has a dying patient and a family who needs help to make decisions and understand the options? – She gets involved. She calls the PCP. She gets palliative care on the line. She advocates for the patient to help make sure their wishes are understood and honored. There comes a time when you go from prolonging life to prolonging death. Knowing when that point is can be hard. Listen to hear her thoughts in this post from 10/2015. There are many models for how palliative care can work in an ED. We can provide it ourselves to a certain extent, and in some cases, can consult palliative care services to help with end-of-life decisions. But we should do something to make sure we consider the patient’s wishes before performing aggressive measures that could leave the patient with a quality of life that would not be meaningful for them. References: 1. Rosenberg M, Rosenberg L. Integrated model of palliative care in the emergency department. West J Emerg Med. 2013;14(6):633-636. PMID: 24381685 2. Rosenberg M, Lamba S, Misra S. Palliative medicine and geriatric emergency care: Challenges, opportunities, and basic principles. Clin Geriatr Med. 2013;29(1):1-29 PMID: 23177598 3. Grudzen CR, Richardson LD, Hopper SS, Ortiz JM, Whang C, Morrison RS. Does palliative care have a future in the emergency department? discussions with attending emergency physicians. J Pain Symptom Manage. 2012;43(1):1-9. PMID: 21802899 4. Grudzen CR, Richardson LD, Morrison M, Cho E, Morrison RS. Palliative care needs of seriously ill, older adults presenting to the emergency department. Acad Emerg Med. 2010;17(11):1253-1257. PMID: 21175525 5. Quest TE, Marco CA, Derse AR. Hospice and palliative medicine: New subspecialty, new opportunities. Ann Emerg Med. 2009;54(1):94-102. PMID: 19185393 6. Penrod JD, Deb P, Dellenbaugh C, et al. Hospital-based palliative care consultation: Effects on hospital cost. J Palliat Med. 2010;13(8):973-979. PMID: 20642361 7. Penrod JD, Deb P, Luhrs C, et al. Cost and utilization outcomes of patients receiving hospital-based palliative care consultation. J Palliat Med. 2006;9(4):855-860. PMID: 16910799 8. Beemath A, Zalenski RJ. Palliative emergency medicine: Resuscitating comfort care? Ann Emerg Med. 2009;54(1):103-105. PMID: 19346031 9. Ciemins EL, Blum L, Nunley M, Lasher A, Newman JM. The economic and clinical impact of an inpatient palliative care consultation service: A multifaceted approach. J Palliat Med. 2007;10(6):1347-1355. PMID: 18095814 10. Barbera L, Taylor C, Dudgeon D. Why do patients with cancer visit the emergency department near the end of life? CMAJ. 2010;182(6):563-568. PMID: 20231340 This podcast uses sounds from freesound.org by Jobro and HerbertBoland. Image from: http://news.unchealthcare.org/som-vital-signs/2013/nov-7/2013-berryhill-lecture-video-available