Podcasts about pecarn

Neck injuries are pretty common in children and may be scary since a significant injury may result in paralysis or loss of sensation. In this episode, we are joined by Pediatric Emergency Medicine specialist Dr. Julia Magaña to discuss common mechanisms of neck injury, how neck injuries are evaluated, when imaging such as x-rays or CT scans are appropriate, and treatment of minor injuries. Don’t let a pain in the neck stop you from listening to this episode! This episode written by Drs. Magaña and Blumberg. We thank Dr. Julia Magaña, Professor of Emergency Medicine at UC Davis Health for joining us for this episode. Additional Resources: Healthy Children Neck Pain or Stiffness Leonard JC et al Lancet article PECARN prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study Healthy Children Kids & Sports Injuries: What to Do If Your Young Athlete Gets Hurt Photo courtesy of Active Sport & Spine Therapy Neck injuries are pretty common in children and may be scary since a significant injury may result in paralysis or loss of sensation. In this episode, we are joined by Pediatric Emergency Medicine specialist Dr. Julia Magaña to discuss common mechanisms of neck injury, how neck injuries are evaluated, when imaging such as x-rays or CT scans are appropriate, and treatment of minor injuries. Don’t let a pain in the neck stop you from listening to this episode! This episode written by Drs. Magaña and Blumberg. We thank Dr. Julia Magaña, Professor of Emergency Medicine at UC Davis Health for joining us for this episode. Additional Resources: Healthy Children Neck Pain or Stiffness Leonard JC et al Lancet article PECARN prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study Healthy Children Kids & Sports Injuries: What to Do I

Reference: Leonard JC et al. PECARN prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study. Lancet Child Adolesc Health. June 2024. Date: Oct 15, 2024 Guest Skeptic: Dr. Tabitha Cheng is a Southern California native and board-certified emergency medicine physician and completed an […] The post SGEM #467: Send me on my way…without Cervical Spine Imaging first appeared on The Skeptics Guide to Emergency Medicine.

This episode Justin and I explore another epi in OOHCA trial, dog bites, the latest PECARN paediatirc neck trauma study and some bougie pearls... and a whole lot more!

مطالعه‌ی پیکارن برای اندیکاسیون تصویربرداری از ستون فقرات گردنی در ترومای بلانت اطفال https://pecarn.org/pecarn_news/clinical-decision-rule-cervical-spine/

Join this fantastic conversation with Dr. Julie Leonard (Nationwide Children's) and Dr. Dan Corwin (CHOP) about the management of pediatric cervical spine injuries. This duo teaches us about the new PECARN clinical decision rule for cervical spine injuries as well as key pearls on physical exam and imaging in pediatric patients with blunt trauma.

The emDOCs.net team is very happy to collaborate with PECARN STELAR (Seattle, Dallas/Texas, and Los Angeles) Node and the Emergency Medical Services for Children Innovation and Improvement Center (EIIC) in presenting high-yield pediatric topics that highlight evidence based medicine with solid research. Today on we have our two renowned experts, Dr. Ilene Claudius and Dr. Danica Liberman, discussing the case for food insecurity and how it impacts the health of our children. To continue to make this a worthwhile podcast for you to listen to, we appreciate any feedback and comments you may have for us. Please let us know!Subscribe to the podcast on one of the many platforms below:Apple iTunesSpotifyGoogle Play

The JournalFeed podcast for the week of August 26-30, 2024.These are summaries from just 2 of the 5 articles we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member.Monday Spoon Feed:A new PECARN clinical decision rule for cervical spine imaging in children after blunt trauma identifies children at low risk for C-spine injury utilizing nine risk factors.Friday Spoon Feed:The MISSION Act Scribes Trial evaluated the implementation of medical scribes in Veterans Health Administration (VHA) EDs. Contrary to expectations, scribes decreased provider productivity and increased patient throughput times.

Drs Julie and Jeffrey Leonard visit the studio as we consider kids and teens with traumatic neck injuries. Do they all need X-rays? Or could we develop criteria that determine who needs films and who doesn't? This would save some young patients from radiation exposure while ensuring bony neck injuries are not missed. We hope you can join us!

The emDOCs.net team is very happy to collaborate with PECARN STELAR (Seattle, Dallas/Texas, and Los Angeles) Node and the Emergency Medical Services for Children Innovation and Improvement Center (EIIC) in presenting high-yield pediatric topics that highlight evidence based medicine with solid research.  Today on we have our two renowned experts, Dr. Ilene Claudius and Dr. Danica Liberman, discussing the case for food insecurity and how it impacts the health of our children. To continue to make this a worthwhile podcast for you to listen to, we appreciate any feedback and comments you may have for us. Please let us know!Subscribe to the podcast on one of the many platforms below:Apple iTunesSpotifyGoogle Play

In this episode we talk with Dr. Julie Leonard about the PECARN C-spine Rule that was just officially published! Dr. Leonard is the senior author of the study and walks us through the findings, why its important, and how she uses the rule in her own clinical practice. Host: Dr. Julia Magaña, Associate Professor of Emergency Medicine at UC Davis Guest: Dr. Julie Leonard, MD, MPH, Professor of Pediatrics at Nationwide Children's Hospital and the Ohio State University College of Medicine. Resources: prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study. EMSC Innovation and Improvement Center PEAK toolkits *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

The JournalFeed podcast for the week of May 20-24, 2024.These are summaries from just 2 of the 5 articles we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member.Monday Spoon Feed:This review article illustrates the evidence-based “no-zone” approach in managing penetrating neck injuries, with a reliance on clinical symptoms as well as multidetector computed tomographic angiography (MDCTA) to mitigate unnecessary invasive tests and negative explorations. Friday Spoon Feed:This multicenter prospective validation study of the PECARN prediction rules for CT imaging of children with blunt abdominal or minor head trauma performed extremely well (all three having NPVs of 100%).

Welcome to Episode 35 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 35 of “The 2 View” – the spring editorial edition! POCUS in the ED for Cholecystitis March 2024: Annals of Emergency Medicine. SoundCloud. Published January 2022. Accessed May 2, 2024. https://soundcloud.com/annalsofem/march-2024 The Center for Medical Education. Upper Abdominal Disorders | The EM Boot Camp Course. YouTube. Published July 12, 2022. Accessed May 2, 2024. https://www.youtube.com/watch?v=ESxRdeEYeHk Wilson SJ, Thavanathan R, Cheng W, et al. Test Characteristics of Emergency Medicine-Performed Point-of-Care Ultrasound for the Diagnosis of Acute Cholecystitis: A Systematic Review and Meta-analysis. Ann Emerg Med. Published October 18, 2023. Accessed May 2, 2024. https://www.annemergmed.com/article/S0196-0644(23)01214-3/abstract PECARN Validation Holmes JF, Yen K, Ugalde IT, et al. PECARN prediction rules for CT imaging of children presenting to the emergency department with blunt abdominal or minor head trauma: a multicentre prospective validation study. Lancet Child Adolesc Health. PubMed. NIH: National Library of Medicine: National Center for Biotechnology Information. Published May 2024. Accessed May 2, 2024. https://pubmed.ncbi.nlm.nih.gov/38609287/ PECARN Pediatric Head Injury/Trauma Algorithm. MDCalc. Accessed May 2, 2024. https://www.mdcalc.com/calc/589/pecarn-pediatric-head-injury-trauma-algorithm PECARN Pediatric Intra-abdominal injury (IAI) algorithm. MDCalc. Accessed May 2, 2024. https://www.mdcalc.com/calc/3971/pecarn-pediatric-intra-abdominal-injury-iai-algorithm PECARN Spotlight: Tools Validated. EM Pulse PodcastTM. EM Pulse PodcastTM - Bringing research and expert opinion to the bedside. Published April 18, 2024. Accessed May 2, 2024. https://ucdavisem.com/2024/04/18/pecarn-spotlight-tools-validated/ 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 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. Be sure to listen in and see what we have to share!

In this episode, we delve into a pivotal multi-center study validating the Pediatric Emergency Care Applied Research Network (PECARN) prediction rules for using CT imaging in children with blunt abdominal and minor head trauma. We discuss with the authors the study's impact, how these validated rules can optimize pediatric trauma care, minimize radiation risks, and what this means for emergency practices worldwide. This conversation not only sheds light on the study's intricate processes and outcomes, but also emphasizes the vital role of evidence-based guidelines in enhancing patient safety and care quality. Host: Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis Guests: Dr. Nate Kuppermann, Pediatric Emergency Physician, Professor and Chair of the UC Davis Department of Emergency Medicine, Founding Chair of the PECARN Steering Committee Dr. James Holmes, Professor of Emergency Medicine at UC Davis Resources: Holmes JF, Yen K, Ugalde IT, Ishimine P, Chaudhari PP, Atigapramoj N, Badawy M, McCarten-Gibbs KA, Nielsen D, Sage AC, Tatro G, Upperman JS, Adelson PD, Tancredi DJ, Kuppermann N. PECARN prediction rules for CT imaging of children presenting to the emergency department with blunt abdominal or minor head trauma: a multicentre prospective validation study. Lancet Child Adolesc Health. 2024 May;8(5):339-347. doi: 10.1016/S2352-4642(24)00029-4. PMID: 38609287. https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(24)00029-4/abstract ***** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

The emDOCs.net team is very happy to collaborate with PECARN STELAR (Seattle, Dallas/Texas, and Los Angeles) Node and the Emergency Medical Services for Children Innovation and Improvement Center (EIIC) in presenting high-yield pediatric topics that highlight evidence based medicine with solid research. Today on we have our two renowned experts, Dr. Ilene Claudius and Dr. Julie Brown, discussing the ins and outs of anaphylaxis.To continue to make this a worthwhile podcast for you to listen to, we appreciate any feedback and comments you may have for us. Please let us know!Subscribe to the podcast on one of the many platforms below:Apple iTunesSpotifyGoogle Play

People living with sickle cell disease can experience severe “pain crises”, or vaso-occlusive episodes (VOE), and are at increased risk for infections, strokes, heart failure, and other serious disease processes. In this 3 part series, we're talking with experts to learn more about sickle cell disease and its complications and how we can best advocate for and treat these patients in the ED. In part 1, we delved into assessment and management of patients presenting with VOE. In this episode, we focus specifically on kids presenting with VOE. We know these patients have usually exhausted their home pain control options and are still in excruciating pain when they arrive in the ED. We interviewed Dr. Chris Rees about his recent paper on the benefits of treating kids with VOE with an initial dose of intranasal fentanyl.  The results are pretty impressive!  Stay tuned for Part 3 of our series where we'll explore the management of other emergent presentations related to sickle cell disease! Did this episode change your practice? Let us know on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis Guests: Dr. Chris Rees, Assistant Professor of Pediatrics and Emergency Medicine at Emory University Resources: Rees CA, Brousseau DC, Ahmad FA, et al; SCD Arginine Study Group and PECARN. Intranasal fentanyl and discharge from the emergency department among children with sickle cell disease and vaso-occlusive pain: A multicenter pediatric emergency medicine perspective. Am J Hematol. 2023 Apr;98(4):620-627. doi: 10.1002/ajh.26837. Epub 2023 Feb 6. PMID: 36606705; PMCID: PMC10023395.. Pediatric Emergency Care Applied Research Network (PECARN) ACEP Emergency Department Sickle Cell Care Coalition Resources ***** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

Host Jeff Matcha, along with System Medical Director Dr. Weston, Assistant Medical Director Dr. Grawey, EMS Fellow Dr. Dahlstrom, PA Joel Vallier, and special guests Dr. Manish Shah and Dr. Lorin Browne, discuss pediatric EMS research, PECARN, CHaMPS, and the legacy of Dr. E. Brooke Lerner.   More info about EMS-C and Dr. Brooke Lerner https://medicine.buffalo.edu/news_and_events/news/2022/11/lerner-naemsp-research-fund-16102.html   https://emscimprovement.center/news/striving-for-the-best-possible-systems-a-conversation-with-e-brooke-lerner/   Dr. E. Brooke Lerner Research Fund https://naemsp.org/career-development/funding-opportunities/e-brooke-lerner-research-fund/

Dr. Dickson leads the discussion with recent cases involving the PECARN pediatric head injury decision rule and some super sneaky toxicology. There is some high-level detective work happening during this episode. Listen so you don't miss vital clues in your clinical practice. REFERENCES 1. Kuppermann N, Holmes JF, Dayan PS, et al; Pediatric Emergency Care Applied Research Network (PECARN). Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet. 2009 Oct 3;374(9696):1160-70. 2. https://www.mchd-tx.org/wp-content/uploads/2023/09/Sodium-Channel-Blocker-Before-1.pdf 3. https://www.mchd-tx.org/wp-content/uploads/2023/09/Sodium-Channel-Blocker-After-2.pdf

Reference: Easter JS et al. Comparison of PECARN, CATCH, and CHALICE rules for children with minor head injury: a prospective cohort study. Annals of Emergency Medicine 2014. Date: July 10, 2023 Guest Skeptic: Dr. Joe Mullally is a paediatric trainee in the Welsh paediatric training program and interested in Paediatric Emergency Medicine. He is a […] The post SGEM#412: I Can't Choose…from all the Head Injury Prediction Rules first appeared on The Skeptics Guide to Emergency Medicine.

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

Dr. Kim Molik, Wesley's Pediatric Trauma Medical Director, stops by to discuss imaging considerations for the pediatric patient. Dr. Molik also explains how to use the PECARN algorithm for evaluating pediatric imaging needs. We also discuss assessing the pediatric c-spine.

In this podcast we discuss the prevalence of bacteremia and even more interestingly the prevalence of meningitis in febrile infants

Pecarn Head Trauma - an update with Drs. Peter Dayan and Nate Kuppermann

In this main episode podcast on ED risk stratification and workup of the febrile infant, recorded at the CAEP 2022 Conference in Quebec City with Dr. Brett Burstein and Dr. Gary Joubert, we answer such questions as: Which febrile infants require lumbar puncture? How accurate is procalcitonin in identifying low risk febrile infants? What is the difference between serious bacterial infection (SBI) and invasive bacterial infection (IBI) and why is this important in the work up of the febrile infant? How do the PECARN, Step-by-Step and Aronson decision tools for identifying febrile infants at low risk for IBI and SBI? Can EM Cases incorporate all these decision tools and the upcoming Canadian Pediatric Society position statement on febrile infants recommendations into one concise algorithm? and many more... The post Ep 173 Febrile Infant – Risk Stratification and Workup appeared first on Emergency Medicine Cases.

Theme: Paediatrics. Participants: Dr Kerf Tan (emergency physician), Dr Karl Pobre (paediatric emergency physician and paediatrician), Yelise Foon, Mariez Gorgi, Shreyas Iyer, Harry Hong, and Samoda WilegodaDiscussion:Goyal, M., Chamberlain, J., Webb, M., Grundmeier, R., Johnson, T., & Lorch, S. et al. (2020). Racial and ethnic disparities in the delayed diagnosis of appendicitis among children. Academic Emergency Medicine, 28(9), 949-956. https://doi.org/10.1111/acem.14142.Presenter: Yelise Foon.Summary: Delay in the diagnosis of appendicitis is associated with perforation and significant subsequent morbidity.  Currently the pre-operative perforation rate for appendicitis is 30%.  Some known risk factors for a delayed diagnosis for appendicitis include a young age, female gender, African-American race, non-English speaking backgrounds and government insurance factors (predominantly in the US).  This was a multi-centre retrospective cohort study conducted over 3 years utilizing the PECARN registry, which aimed to compare the rate of appendiceal perforation, delayed diagnosis of appendicitis and diagnostic imaging use among different ethnicities. Of the 7298 children diagnosed with appendicitis where race/ethnicity data was collected, 34.9% of non-Hispanic white children had a perforated appendix, compared with 36.5% of non-Hispanic black children.  Non-Hispanic black children also had higher rates of delayed diagnosis (defined as having a relevant emergency visit in the week prior to diagnosis): at 4.7% compared with 2.0% for non-Hispanic white children.  Further non-Hispanic black children with a delayed diagnosis of appendicitis were less likely to undergo definite imaging (including MRI, ultrasound, or CT) compared with their non-Hispanic white counterparts (with 28.2% versus 46.2% undergoing imaging).  However, given that this study came out of the US, the generalisability of this study to Australian emergency departments is unclear.  Health literacy is likely to be a large contributor to delayed presentation of appendicitis and something to be carefully considered when treating any child (and their family).  There are tools such as the Paediatric Appendicitis Score (PAS) and the Alvarado Score which may assist in objectively quantifying the possibility of appendicitis (particularly for junior staff).   Take-Home Points:It is important for us to consider how we can minimise racial and ethnic disparities and make sure we are conscious of them. Credits:This episode is produced with help of HETI's Emergency Medicine Training Network 5.Music/Sound Effects Feel Me by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. In The Eyes by Peyruis | https://soundcloud.com/peyruis, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. It's All Good by Roa Music | https://soundcloud.com/roa_music1031, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Love Trip by Sarah Jansen Music | https://soundcloud.com/sarahjansenmusic, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Mamacita by Mike Leite | https://soundcloud.com/mikeleite, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Slipz (audio logo) by tubebackr | https://soundcloud.com/tubebackr, Music promoted by https://www.free-stock-music.com. Sound effects from https://www.free-stock-music.com.  Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

It's the JournalFeed Podcast for the week of November 15-19, 2021. We cover proactive PE screening for COPD admissions, PECARN in an external cohort, β-lactam or vancomycin first for bacteremia, downstream effects of antibiotic over-prescribing, and hyperbaric timing in CO poisoning.

It's the JournalFeed Podcast for the week of October 25-29, 2021. We cover continuous compressions vs 30:2, PECARN under 3 months, POCUS for appendicitis, immediate vs delayed cardiac catheterization post-OHCA, and adding vasopressin and steroids for IHCA.

This episode features three members of the Pediatric Emergency Care Applied Research Network (PECARN) Adolescent Sexual Health Working Group. PECARN is a network that performs multicenter research related to the emergency care of children. The Adolescent Sexual Health Working Group is focused on researching topics of interest around sexual and reproductive health in the ED. […]

This month Andrew and Graham discuss Projected paediatric cervical spine imaging rates with application of NEXUS, Canadian C-spine and PECARN clinical decision rules in a prospective Australian cohort

Recent literature suggests that pediatric patients take longer to recover from mild traumatic brain injury compared to adults, and persistent post-concussive symptoms (PPCS) after 1 month occur in up to 30% of children after minor head injury. These children can and should be identified in the ED based on the PPCS clinical risk score. In this EM Cases main episode podcast "Pediatric Minor Head Injury and Concussion" Dr. Sarah Reid and Dr. Roger Zemek discuss how best to incorporate the PECARN and CRASH2 decision tools into your practice, the role of Fast MRI, how to identify children who are at risk for long term sequelae after a minor head injury and how to manage persistent concussion symptoms when a child returns to the ED after a minor head injury... The post Ep 153 Pediatric Minor Head Injury and Concussion appeared first on Emergency Medicine Cases.

ALiEM podcast host, Dr. Dina Wallin, chats with author Dr. Jacqueline Grupp-Phelan about her recent PECARN publication "Prospective Development and Validation of the Computerized Adaptive Screen for Suicidal Youth" In JAMA Psychiatry 2021. Read more: https://ALiEM.com/computerized-adaptive-screen-for-suicidal-youth-cassy-study Edited by Podcast Engineer: Kellen Vu

Jump into pediatric mild traumatic brain injury with our guest, Dr. Angela Lumba Brown, a pediatric emergency medicine physician and Associate Professor of Emergency Medicine, Pediatrics, and Neurosurgery at Stanford University. In this episode, we talk about the diagnosis of mild traumatic brain injury, when to get neuroimaging for head trauma, and the five concussion subtypes.  We also discuss how you can support your patients in their recovery to get them back to their daily activities and what disparities exist in head trauma. Join us to have your mind blown with this fascinating topic. 

Vitals & Useful Links: Learn about how to manage pediatric head and neck trauma (see spoilers below if you want to know how) Pediatric Emergency Playbook Podcast - Blunt Head Trauma PEM ED Podcast - Clearing the Pediatric C-Spine EMJC's in-house gymnast graces us with his presence as Kyle (MS4) leads Arman (MS4) and Nathan (MS4) through a case of a child brought to the ED after a trampoline accident. How would you approach this case? As always, we learn a couple of very important points about pediatric trauma and injuries. If you have any questions, concerns, or comments, please email us at emjccast@gmail.com. *****EPISODE SPOILERS BELOW***** Here's the article on PECARN Head Injury Algorithm Kuppermann, N., Holmes, J. F., Dayan, P. S., Hoyle, J. D., Atabaki, S. M., Holubkov, R., … & Pediatric Emergency Care Applied Research Network. (2009). Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. The Lancet, 374(9696), 1160-1170. Here's the PECARN C-Spine Paper Leonard, J. C., Kuppermann, N., Olsen, C., Babcock-Cimpello, L., Brown, K., Mahajan, P., … & Pediatric Emergency Care Applied Research Network. (2011). Factors associated with cervical spine injury in children after blunt trauma. Annals of emergency medicine, 58(2), 145-155. PECARN Algorithm - MD Calc Comparison of PECARN, CATCH, and CHALICE Ped EM Morsels Links: PECARN, Trampoline Injuries, and C-Spine Injuries Nexus Criteria - MD Calc DISCLAIMER: The views/opinions expressed in this podcast are that of the hosts/guests and do not reflect their respective institutions. This is NOT a medical advice podcast, if you are having a medical emergency you should call 911 and get help. This is an educational podcast, and as such, sometimes we get things wrong - if you notice this, please email us at emjccast@gmail.com.

A new PECARN study found just a single episode of moderate-severe DKA impacts cognition! This game changing article challenges what we thought about glucose and the brain and really makes a case for aggressive DKA treatment and glucose control! Let us know what you think @empulsepodcast, or through our website, ucdavisem.com. ***Please rate us and leave us a review on iTunes! It helps us reach more people.*** Host: Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis Guest: Dr. Nicole Glaser, Professor of Pediatric Endocrinology at UC Davis Dr. Simmona can you help meGhetti (@sghetti1) Professor Department of Psychology and Center for Mind and Brain at UC Davis   Resources:  Ghetti S, Kuppermann N, Rewers A, Myers SR, Schunk JE, Stoner MJ, Garro A, Quayle KS, Brown KM, Trainor JL, Tzimenatos L, DePiero AD, McManemy JK, Nigrovic LE, Kwok MY, Perry CS 3rd, Olsen CS, Casper TC, Glaser NS; Pediatric Emergency Care Applied Research Network (PECARN) DKA FLUID Study Group. Cognitive Function Following Diabetic Ketoacidosis in Children With New-Onset or Previously Diagnosed Type 1 Diabetes. Diabetes Care. 2020 Sep 22:dc200187. doi: 10.2337/dc20-0187. Epub ahead of print. PMID: 32962981. https://care.diabetesjournals.org/content/early/2020/09/10/dc20-0187.long *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

This podcast presents, Dr. Patrick Carolan, a pediatric emergency medicine physician with Minneapolis Children's Hospital and Clinics of Minnesota, who discusses the evaluation of fever in the neonate and young infant.  Enjoy the podcast! Objectives:     Upon completion of this podcast, participants should be able to: Recognize the implications of fever in the young infant. Discuss the differential diagnosis of fever and critical illness in the young infant. Implement new concepts in risk stratification for evaluating fever in young infants. CME credit is only offered to Ridgeview Providers & Allied Health Staff for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks.  You may contact the accredited provider with questions regarding this program at  rmccredentialing@ridgeviewmedical.org. Click on the following link for your CME credit: CME Evaluation: "The Approach to Fever in the Young Infant" (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview Medical Center & Clinics.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. SHOW NOTES: CHAPTER 1: Today we are talking about fever in the pediatric population, specifically those in the under 3-months of age. Dr. Pat Carolan of Children's Hospitals of Minnesota  will help us demystify fever in this age group.  Going back to the mid-70s, there was a search for criteria to find high-risk vs low-risk pediatric fevers. In the original study out of Boston, it was identified that 10% of the patients under age 2, with WBC greater than 15, and a temperature greater than 38.9C, had severe bacteremia. This was the first set of criteria focused on identifying high-risk infants. With the intro of HIb vaccine in the the late 80s-early 90s, and the pneumococcal vaccine in the mid-90s, there is a much lower prevalence of these infections. The few cases that occur now are due to those who have not received or are non-responders to the vaccine. The shift in study of pediatrics has now been to better differentiate high-risk vs low-risk febrile infants. What is considered a fever? The traditional definition of fever is a temperature over 100.4F. Pediatric fevers can be broken down into 3 groups. Those in 0-28 days are high-risk and regardless of a positive RSV or influenza test, get a full work up - including blood, urine, csf, cultures, antibiotics, and admission.  What if they are 0-28 days and they have otitis media or RSV? The clinical exam of otitis media in this aged population would be difficult, and even if the clinician had confidence in a focal finding, those at this age group are still at significant risk and would get a full work up. RSV would be unusual in a 2-week old and even if positive , that would be an usual finding, and again these neonates would still get a full work up. The rates of bacteremia in studies have shown that a full work up is warranted. Infants at 3-months are lower-risk, and in general, can usually be managed as outpatients with lab work. Risk for infants in the 2nd month of life is harder to determine and they are the target of risk stratification tools discussed later in this podcast. These are the "tweeners". Initially, assessment of these infants include that across the room pediatric triage triangle. How are they reacting to stimulus? What does their skin color look like? What is their body tone? Have the parents noted whether the infant is engaged in feeding? Are they tachycardiac? Infants can present with fever, but some infants that are septic, can present afebrile or hypothermic. Remember, it is important not to overlook a potential differential diagnosis, including congenital ductal lesions or metabolic abnormalities. CHAPTER 2: Risk stratification tools vary, but utilize biomarkers such as procalcitonin and CRP as key features of the pathways. Each tool mentioned today, PECARN, Stepwise and Rochester, all have high sensitivity and high-negative predictive values. Choosing the appropriate tool depends on the patient population, ability to run specific biomarker tests, and comfort level in the subsequent interpretation. For example, the availability of a facility to run a procalcitonin would determine whether a particular stratification tool could be used. The most recent study, conducted by PECARN or the Pediatric Emergency Care Applied Research Network, is a large, multicenter study that uses procalcitonin, absolute neutrophil count and urine analysis as the base of its pathway. The PECARN is structured as a decision tree, formatted in a way, to quote Dr. Carolan that "helps decision making in the trenches." Differentiating between the terms "serious" vs "invasive" infections. Serious infections include, but are not limited to bacterial, bone and joint infections, and UTIs. Invasive includes pneumococcal meningitis and HIB. In the simplest terms, invasive infections are of greater concern, and is "the stuff we want to treat immediately". Bacterial organisms of concern include: group B strep and gram negative organisms for neonates, pneumococcus and more rarely, HIV at 1-month and older. E.Coli, especially as a uro pathogen and Listeria, though rarer, makes the list of concern as well. An important viral organism of concern is Herpes Simplex Virus, which depending on the facility, is an add on order when running CSF. HSV has 3 main types, the most devistating a CNS infection, which presents with fever and seizures - whether focal or generalized. Pleocytosis, or WBC greater than 16 in CSF, is abnormal in those less than 28-days of age. WBC greater than 10 is abnormal for 2-3 months of age. An absence of pleocytosis does not exclude a central nervous infection by HSV. CHAPTER 3: At 2-months of age, infants that meet low-risk criteria, can be treated as an outpatient - if next day follow-up can be assured. Conservative treatment for those with a UTI that have an abnormal urine and positive biomarker, would get blood cultures, LP and antibiotics. The odds ratio is low, but gram negative CNS infections can be devastating and require extended treatment of antibiotics. The stratification tools, PECARN, Stepwise, and Rochester, help guide practice for these 2-month old infants or "tweeners", but it can still be difficult to decide whether or not to do an LP. There is still a place for practitioner gestalt, and if something feels not quite right, an LP is appropriate. Some infants are brought to the ER with reports of a fever, but upon presentation are afebrile. If a rectal temp performed at home, then it is regarded as a true fever, and the age appropriate work up should be started. Empiric treatment for infants include: Ampicillin and Cefotaxime. Cefotaxime is the go to for 3rd generation cephalosporin, instead of Rocephin, which can cause a rise in bilirubin in young infants. For those under 3-weeks, Acyclovir coverage is added till HSV is ruled out. Vancomycin would be used for those beyond 2-weeks of life with pneumococcus or staph infection with sepsis. Tamiflu is started for infants with positive influenza greater than 2-weeks and under 2-years of age, per CDC recommendations. For those infants who are not vaccinated, the plan of care does not change for those under 3-months or greater that are vaccinated. Intuitively, it would be suggested that they are at higher risk, but there is little data bout this specific group. Thanks for listening.

Merhaba, Bugün aslında daha büyük dertlerimiz olmasa yaz aylarında acil servislerde sıklıkla karşımıza çıkacak vakalar olan pediyatrik travmalardan bahsedeceğiz. Pediyatrik hasta populasyonunda, muayene ve öykünün güvenilmezliği yanında, anatomik farklılıklara bağlı olarak yaralanmaların değişkenlik göstermesi sebebiyle hepimiz biraz daha temkinli yaklaşma eğilimindeyiz. Aslında bölgesel yaralanmalarda klinik karar verme kuralları (PECARN, NEXUS gibi) bu hastaların değerlendirmesinde elimizdeki en önemli koz. Fakat multitravma durumlarında, özellikle de ikiden fazla vücut bölgesini görüntüleme ihtiyacımız olduğunda erişkinlerde hem yaralanma atlamama hem de hızlı tanı koyma adına çok sevdiğimiz tüm vücut bilgisayarlı tomografi (TVBT) çocuklar söz konusu olduğunda hala tartışmalı. (Daha önce TVBT ile ilgili soru işaretlerinin derlendiği acilci.net yazısına da buradan ulaşabilirsiniz.) Yeni nesil BT cihazlarının daha düşük doz radyasyon etkisinin olması sebebiyle erişkinlerde kâr zarar oranına bakarak sıklıkla göz ardı ettiğimiz radyasyon meselesi iş çocuklara geldiğinde maalesef hala ciddi bir risk. 2009 yılında Gonzalez ve ark.​1​ yaptığı çalışmadaki risk hesaplamalarına göre alınan radyasyonun miktarının yanında radyasyona maruz kalınan yaş da direkt olarak kanser riskini arttırıyor (Tablo 1). Peki TVBT ile göze aldığımız bu zarara karşı ne kadar bir kârımız olacak? Bu noktada güncel literatürde yer alan büyük çalışmaları gözden geçirmekte fayda var. 2018 yılında Meltzer ve ark.​2​ yayınladığı çok merkezli retrospektif çalışmada künt travma sonrası acil servise getirilen ve 2 saat içinde BT çekilen (TVBT veya beyin/toraks/abdomen/pelvis selektif BT) 8757 çocuk hastada (6 ay – 14 yaş); TVBT’nin selektif BT’ye göre 7 günlük mortalite üzerine etkisine bakılmış. Başlangıçta TVBT çekilen hastalarda mortalite daha yüksek gibi görünse de, travmanın şiddetine ve hastanın kliniğine (GKS, hipotansiyon, YBÜ ihtiyacı) göre “propensity” skor değerlendirmesi yapıldığında TVBT çekilen hastalar ile selektif BT çekilen hastalar arasında mortalite farkı gösterilememiş. Mortalitede kâr edemiyor gibiyiz. Başta söylediğimiz “daha hızlı tanı koyma” noktasında da bu çalışmada TVBT’nin acil serviste kalış süresini ortalama 25 dk kadar kısalttığı görülmüş. Bir multitravma hastasını 25 dk erken taburcu etmek bu zararı göze almaya değmiyor gibi. Çalışmanın sonunda araştırmacıların da söylediği gibi “TVBT daha çok bilgi sağlasa da bu bilgi hayat kurtarıcı değil.” 2019 yılında Abe ve ark.ın​3​ Japonya’da yaptıkları çok merkezli retrospektif çalışmada, TVBT veya selektif BT çekilen ≤16 yaş travma hastaları değerlendirilmiş. Selektif BT grubunda (%1,4), TVBT’ye (%2,9) göre daha düşük mortalite oranı tespit edilmiş. Yine bu oran bu grubun daha az ciddi yaralanmalarına bağlanmış. Meltzer ve ark. çalışmasına benzer şekilde, pediyatrik travma hastalarında TVBT’nin hayatı tehdit edici yaralanmaları tespit etmede selektif BT’ye üstünlüğü olmadığı ifade edilmiş. Son olarak, Temmuz 2020 tarihli Wiitala ve ark.nın​4​ çalışmasından da bahsedelim. Bu çalışmada önceki çalışmalardan farklı olarak düzey 1 pediyatrik travma merkezleri (PTM) ile düzey 2 PTM ve düzey 1-2 erişkin travma merkezleri (ETM) de karşılaştırılmış. “Propensity” skor değerlendirmeleri de yapıldıktan sonra elde edilen sonuca göre, düzey 1 PTM’de değerlendirilen hastalara daha az oranda torasik ve abdominal BT çekilmiş olmasına rağmen gruplar arasında mortalite farkı gösterilmemiş. Yani ETM’de daha çok BT çekiliyor ve buna rağmen mortalite üzerinde belirgin bir fayda sağlanmıyor. Tüm bu çalışmalar göz önünde bulundurulduğunda pediyatrik travma hastalarında TVBT günden güne değer kaybediyor gibi görünüyor. Aslında her çocuk hastada TVBT istediğimizde aklımızdan “kanser riski o kadar da çok değil ya” cümlesi geçiyor. Fakat bir nöbette istediğimiz TVBT sayısını, sonra kaç nöbet tuttuğumuzu, sonra toplamda kaç TVBT istediğimizi düşünürsek o “o kadar da çok” olmayan kanser risk...

Merhaba, Bugün aslında daha büyük dertlerimiz olmasa yaz aylarında acil servislerde sıklıkla karşımıza çıkacak vakalar olan pediyatrik travmalardan bahsedeceğiz. Pediyatrik hasta populasyonunda, muayene ve öykünün güvenilmezliği yanında, anatomik farklılıklara bağlı olarak yaralanmaların değişkenlik göstermesi sebebiyle hepimiz biraz daha temkinli yaklaşma eğilimindeyiz. Aslında bölgesel yaralanmalarda klinik karar verme kuralları (PECARN, NEXUS gibi) bu hastaların değerlendirmesinde elimizdeki en önemli koz. Fakat multitravma durumlarında, özellikle de ikiden fazla vücut bölgesini görüntüleme ihtiyacımız olduğunda erişkinlerde hem yaralanma atlamama hem de hızlı tanı koyma adına çok sevdiğimiz tüm vücut bilgisayarlı tomografi (TVBT) çocuklar söz konusu olduğunda hala tartışmalı. (Daha önce TVBT ile ilgili soru işaretlerinin derlendiği acilci.net yazısına da buradan ulaşabilirsiniz.) Yeni nesil BT cihazlarının daha düşük doz radyasyon etkisinin olması sebebiyle erişkinlerde kâr zarar oranına bakarak sıklıkla göz ardı ettiğimiz radyasyon meselesi iş çocuklara geldiğinde maalesef hala ciddi bir risk. 2009 yılında Gonzalez ve ark.​1​ yaptığı çalışmadaki risk hesaplamalarına göre alınan radyasyonun miktarının yanında radyasyona maruz kalınan yaş da direkt olarak kanser riskini arttırıyor (Tablo 1). Peki TVBT ile göze aldığımız bu zarara karşı ne kadar bir kârımız olacak? Bu noktada güncel literatürde yer alan büyük çalışmaları gözden geçirmekte fayda var. 2018 yılında Meltzer ve ark.​2​ yayınladığı çok merkezli retrospektif çalışmada künt travma sonrası acil servise getirilen ve 2 saat içinde BT çekilen (TVBT veya beyin/toraks/abdomen/pelvis selektif BT) 8757 çocuk hastada (6 ay – 14 yaş); TVBT’nin selektif BT’ye göre 7 günlük mortalite üzerine etkisine bakılmış. Başlangıçta TVBT çekilen hastalarda mortalite daha yüksek gibi görünse de, travmanın şiddetine ve hastanın kliniğine (GKS, hipotansiyon, YBÜ ihtiyacı) göre “propensity” skor değerlendirmesi yapıldığında TVBT çekilen hastalar ile selektif BT çekilen hastalar arasında mortalite farkı gösterilememiş. Mortalitede kâr edemiyor gibiyiz. Başta söylediğimiz “daha hızlı tanı koyma” noktasında da bu çalışmada TVBT’nin acil serviste kalış süresini ortalama 25 dk kadar kısalttığı görülmüş. Bir multitravma hastasını 25 dk erken taburcu etmek bu zararı göze almaya değmiyor gibi. Çalışmanın sonunda araştırmacıların da söylediği gibi “TVBT daha çok bilgi sağlasa da bu bilgi hayat kurtarıcı değil.” 2019 yılında Abe ve ark.ın​3​ Japonya’da yaptıkları çok merkezli retrospektif çalışmada, TVBT veya selektif BT çekilen ≤16 yaş travma hastaları değerlendirilmiş. Selektif BT grubunda (%1,4), TVBT’ye (%2,9) göre daha düşük mortalite oranı tespit edilmiş. Yine bu oran bu grubun daha az ciddi yaralanmalarına bağlanmış. Meltzer ve ark. çalışmasına benzer şekilde, pediyatrik travma hastalarında TVBT’nin hayatı tehdit edici yaralanmaları tespit etmede selektif BT’ye üstünlüğü olmadığı ifade edilmiş. Son olarak, Temmuz 2020 tarihli Wiitala ve ark.nın​4​ çalışmasından da bahsedelim. Bu çalışmada önceki çalışmalardan farklı olarak düzey 1 pediyatrik travma merkezleri (PTM) ile düzey 2 PTM ve düzey 1-2 erişkin travma merkezleri (ETM) de karşılaştırılmış. “Propensity” skor değerlendirmeleri de yapıldıktan sonra elde edilen sonuca göre, düzey 1 PTM’de değerlendirilen hastalara daha az oranda torasik ve abdominal BT çekilmiş olmasına rağmen gruplar arasında mortalite farkı gösterilmemiş. Yani ETM’de daha çok BT çekiliyor ve buna rağmen mortalite üzerinde belirgin bir fayda sağlanmıyor. Tüm bu çalışmalar göz önünde bulundurulduğunda pediyatrik travma hastalarında TVBT günden güne değer kaybediyor gibi görünüyor. Aslında her çocuk hastada TVBT istediğimizde aklımızdan “kanser riski o kadar da çok değil ya” cümlesi geçiyor. Fakat bir nöbette istediğimiz TVBT sayısını, sonra kaç nöbet tuttuğumuzu, sonra toplamda kaç TVBT istediğimizi düşünürsek o “o kadar da çok” olmayan kanser risk...

If you want to claim CME credit for listening to this podcast series, you must listen here: https://californiaacep.org/page/CalACEP-MAT-Podcast-Disclosure. CalACEP MAT Podcast Episode 5: Implementation   We've covered why we should treat opioid use disorder in the ED, how to identify, then approach patients who might benefit from MAT, and lastly how to appropriately use buprenorphine. You're ready to change your practice, but where do you start? Our experts offer their advice for how to get buy-in from leadership and your colleagues, as well as some specifics on how to start a MAT program in your ED. If you enjoyed this podcast let us know! Connect with us on social media at @californiaacep. Hosts: Julia Magaña, MD, FAAP. Assistant Professor of Pediatric Emergency Medicine at UC Davis Sarah Medeiros, MD, MPH, FACEP. Assistant Professor of Emergency Medicine at UC Davis Guests: Dr. Aimee Moulin, Associate Professor of Emergency Medicine at UC Davis and Past President of California ACEP Dr. Hannah Snyder, Assistant Professor of Family Community Medicine and Associate Director of the Addiction Consult Team at UC San Francisco Dr. Reb Close, Emergency Medicine Physician at Community Hospital of Monterey Peninsula Resources: California ACEP Medication Assisted Treatment Resources California Bridge “We're developing hospitals and emergency rooms into primary access points for addiction treatment. This intensive program provides training and technical assistance to acute care providers to encourage patients to enter and remain in treatment.” Substance Abuse and Mental Health Services Administration (SAMHSA) Medication-Assisted Treatment Resources “The Game Has Changed”. Featuring Dr. Gail D'Onofrio. EM Pulse Podcast. 2018 March 15. https://ucdavisem.com/2018/03/15/the-game-has-changed-episode-4/ Apply for your DEA-X Waiver! SAMHSA GetWaivered.com *** This series is a part of a chapter grant from the American College of Emergency Physicians (ACEP) and is made to compliment the online California ACEP MAT resources. California ACEP is a wealth of information. Check out our website, californiaacep.org, where you'll find resources beyond the MAT toolkit, including our mental health toolkit, ED violence prevention resources, human trafficking guidebook, safe prescribing guidelines for opioids, palliative care toolkit, PECARN decisions guides, and much more. Thank you to Drs. Hannah Snyder, Aimee Moulin, and Reb Close for your expertise. Also, a big thanks to Kelsey McQuaid for all of your hard work on this project. EM Pulse is a podcast from the UC Davis Department of Emergency Medicine dedicated to bringing research and expert opinion to the bedside. Check it out and subscribe on iTunes, or wherever you get your podcasts. And follow us on social media @empulsepodcast. Thanks to OM Audio Productions for audio production services.  

If you want to claim CME credit for listening to this podcast series, you must listen here: https://californiaacep.org/page/CalACEP-MAT-Podcast-Disclosure. Episode 1: Kayce was my daughter The opioid crisis is a reality for all of us. In this series, we go in-depth on what YOU can do about it in your emergency department (ED). This is the first of six episodes brought to you by California ACEP on medication assisted treatment or MAT. Dr. Steve Anderson, an experienced emergency physician, tells his own compelling story of why he is leading the charge in his ED to combat opioid addiction. If you enjoyed this podcast let us know! Connect with us on social media at @californiaacep. Hosts: Julia Magaña, MD, FAAP. Assistant Professor of Pediatric Emergency Medicine at UC Davis Sarah Medeiros, MD, MPH, FACEP. Assistant Professor of Emergency Medicine at UC Davis Guest: Stephen H. Anderson, MD, FACEP. Emergency Medicine Physician, and Chair of the National ACEP Board of Directors. Resources: California ACEP Medication Assisted Treatment Resources California Bridge “We're developing hospitals and emergency rooms into primary access points for addiction treatment. This intensive program provides training and technical assistance to acute care providers to encourage patients to enter and remain in treatment.” “Steve's Story: Fighting for Kayce” Real Talk Podcast. Recorded Apr 4th 2019 at the Washington ACEP “Summit to Sound” Conference in Seattle. Speaker: Steve Anderson, MD, FACEP with Alicia Kurtz, MD. https://www.vituity.com/realtalk Substance Abuse and Mental Health Services Administration (SAMHSA) Medication-Assisted Treatment Resources Apply for your DEA-X Waiver! SAMHSA GetWaivered.com *** Thank you to Dr. Alicia Kurtz and Marco Gonzalez from Real Talk Podcast for facilitating this recording. Real Talk is a space for doctors and other healthcare professionals to share their real, human experiences from working in medicine. Thank you to Dr. Steve Anderson for sharing his personal story. This series is a part of a chapter grant from the American College of Emergency Physicians (ACEP) and is made to compliment the online California ACEP MAT resources. California ACEP is a wealth of information. Check out our website, californiaacep.org, where you'll find resources beyond the MAT toolkit, including our mental health toolkit, ED violence prevention resources, human trafficking guidebook, safe prescribing guidelines for opioids, palliative care toolkit, PECARN decisions guides, and much more. Thank you to Drs. Hannah Snyder, Aimee Moulin, and Reb Close for your expertise. Also, a big thanks to Kelsey McQuaid for all of your hard work on this project. EM Pulse is a podcast from the UC Davis Department of Emergency Medicine dedicated to bringing research and expert opinion to the bedside. Check it out and subscribe on iTunes, or wherever you get your podcasts. And follow us on social media @empulsepodcast. Thanks to OM Audio Productions for audio production services.

If you want to claim CME credit for listening to this podcast series, you must listen here: https://californiaacep.org/page/CalACEP-MAT-Podcast-Disclosure. CalACEP MAT Podcast Episode 2: Opioid Overview In this episode we explore what the opioid crisis is, who it impacts, and why we care as emergency medicine providers. We discuss the options that are out there and what our experts believe is the best for the ED setting. If you enjoyed this podcast let us know! Connect with us on social media at @californiaacep. Hosts: Julia Magaña, MD, FAAP. Assistant Professor of Pediatric Emergency Medicine at UC Davis Sarah Medeiros, MD, MPH, FACEP. Assistant Professor of Emergency Medicine at UC Davis Guests: Dr. Aimee Moulin, Associate Professor of Emergency Medicine at UC Davis and Past President of California ACEP Dr. Hannah Snyder, Assistant Professor of Family Community Medicine and Associate Director of the Addiction Consult Team at UC San Francisco Dr. Reb Close, Emergency Medicine Physician at Community Hospital of Monterey Peninsula Resources: California ACEP Medication Assisted Treatment Resources California Bridge “We're developing hospitals and emergency rooms into primary access points for addiction treatment. This intensive program provides training and technical assistance to acute care providers to encourage patients to enter and remain in treatment.” Substance Abuse and Mental Health Services Administration (SAMHSA) Medication-Assisted Treatment Resources Apply for your DEA-X Waiver! SAMHSA GetWaivered.com *** This series is a part of a chapter grant from the American College of Emergency Physicians (ACEP) and is made to compliment the online California ACEP MAT resources. California ACEP is a wealth of information. Check out our website, californiaacep.org, where you'll find resources beyond the MAT toolkit, including our mental health toolkit, ED violence prevention resources, human trafficking guidebook, safe prescribing guidelines for opioids, palliative care toolkit, PECARN decisions guides, and much more. Thank you to Drs. Hannah Snyder, Aimee Moulin, and Reb Close for your expertise. Also, a big thanks to Kelsey McQuaid for all of your hard work on this project. EM Pulse is a podcast from the UC Davis Department of Emergency Medicine dedicated to bringing research and expert opinion to the bedside. Check it out and subscribe on iTunes, or wherever you get your podcasts. And follow us on social media @empulsepodcast. Thanks to OM Audio Productions for audio production services.  

If you want to claim CME credit for listening to this podcast series, you must listen here: https://californiaacep.org/page/CalACEP-MAT-Podcast-Disclosure. CalACEP MAT Podcast Episode 3: Treatment Options In this episode, our experts discuss various treatment options available for opioid use disorder. What do you need to know? How do you approach a patient? What do you need from the patient? Turns out all you need from them is to be willing! If you enjoyed this podcast let us know! Connect with us on social media at @californiaacep. Hosts: Julia Magaña, MD, FAAP. Assistant Professor of Pediatric Emergency Medicine at UC Davis Sarah Medeiros, MD, MPH, FACEP. Assistant Professor of Emergency Medicine at UC Davis Guests: Dr. Aimee Moulin, Associate Professor of Emergency Medicine at UC Davis and Past President of California ACEP Dr. Hannah Snyder, Assistant Professor of Family Community Medicine and Associate Director of the Addiction Consult Team at UC San Francisco Dr. Reb Close, Emergency Medicine Physician at Community Hospital of Monterey Peninsula Resources: California ACEP Medication Assisted Treatment Resources California Bridge “We're developing hospitals and emergency rooms into primary access points for addiction treatment. This intensive program provides training and technical assistance to acute care providers to encourage patients to enter and remain in treatment.” Substance Abuse and Mental Health Services Administration (SAMHSA) Medication-Assisted Treatment Resources “The Game Has Changed”. Featuring Dr. Gail D'Onofrio. EM Pulse Podcast. 2018 March 15. https://ucdavisem.com/2018/03/15/the-game-has-changed-episode-4/ Apply for your DEA-X Waiver! SAMHSA GetWaivered.com *** This series is a part of a chapter grant from the American College of Emergency Physicians (ACEP) and is made to compliment the online California ACEP MAT resources. California ACEP is a wealth of information. Check out our website, californiaacep.org, where you'll find resources beyond the MAT toolkit, including our mental health toolkit, ED violence prevention resources, human trafficking guidebook, safe prescribing guidelines for opioids, palliative care toolkit, PECARN decisions guides, and much more. Thank you to Drs. Hannah Snyder, Aimee Moulin, and Reb Close for your expertise. Also, a big thanks to Kelsey McQuaid for all of your hard work on this project. EM Pulse is a podcast from the UC Davis Department of Emergency Medicine dedicated to bringing research and expert opinion to the bedside. Check it out and subscribe on iTunes, or wherever you get your podcasts. And follow us on social media @empulsepodcast. Thanks to OM Audio Productions for audio production services.

If you want to claim CME credit for listening to this podcast series, you must listen here: https://californiaacep.org/page/CalACEP-MAT-Podcast-Disclosure. CalACEP MAT Podcast Episode 4: Treating with Buprenorphine   In the fourth episode of our series, we get into the nitty gritty of MAT in the ED. Our experts cover appropriate dosing, potential side effects and contraindications, and so more. See below for links to the California ACEP MAT Toolkit and other resources. If you enjoyed this podcast let us know! Connect with us on social media at @californiaacep. Hosts: Julia Magaña, MD, FAAP. Assistant Professor of Pediatric Emergency Medicine at UC Davis Sarah Medeiros, MD, MPH, FACEP. Assistant Professor of Emergency Medicine at UC Davis Guests: Dr. Aimee Moulin, Associate Professor of Emergency Medicine at UC Davis and Past President of California ACEP Dr. Hannah Snyder, Assistant Professor of Family Community Medicine and Associate Director of the Addiction Consult Team at UC San Francisco Dr. Reb Close, Emergency Medicine Physician at Community Hospital of Monterey Peninsula Resources: California ACEP Medication Assisted Treatment Resources California Bridge “We're developing hospitals and emergency rooms into primary access points for addiction treatment. This intensive program provides training and technical assistance to acute care providers to encourage patients to enter and remain in treatment.” Substance Abuse and Mental Health Services Administration (SAMHSA) Medication-Assisted Treatment Resources “The Game Has Changed”. Featuring Dr. Gail D'Onofrio. EM Pulse Podcast. 2018 March 15. https://ucdavisem.com/2018/03/15/the-game-has-changed-episode-4/ Apply for your DEA-X Waiver! SAMHSA GetWaivered.com *** This series is a part of a chapter grant from the American College of Emergency Physicians (ACEP) and is made to compliment the online California ACEP MAT resources. California ACEP is a wealth of information. Check out our website, californiaacep.org, where you'll find resources beyond the MAT toolkit, including our mental health toolkit, ED violence prevention resources, human trafficking guidebook, safe prescribing guidelines for opioids, palliative care toolkit, PECARN decisions guides, and much more. Thank you to Drs. Hannah Snyder, Aimee Moulin, and Reb Close for your expertise. Also, a big thanks to Kelsey McQuaid for all of your hard work on this project. EM Pulse is a podcast from the UC Davis Department of Emergency Medicine dedicated to bringing research and expert opinion to the bedside. Check it out and subscribe on iTunes, or wherever you get your podcasts. And follow us on social media @empulsepodcast. Thanks to OM Audio Productions for audio production services.  

If you want to claim CME credit for listening to this podcast series, you must listen here: https://californiaacep.org/page/CalACEP-MAT-Podcast-Disclosure. CalACEP MAT Podcast Episode 6: MAT FAQ   In the final episode of this series, our experts answer some of the most frequently asked questions about MAT. You should now have all the tools and information you need to get started with MAT in your ED. See the links below for more resources and reach out to California ACEP with any questions. Remember Kayce's story and commit to saving a life! If you enjoyed this podcast let us know! Connect with us on social media at @californiaacep. Hosts: Julia Magaña, MD, FAAP. Assistant Professor of Pediatric Emergency Medicine at UC Davis Sarah Medeiros, MD, MPH, FACEP. Assistant Professor of Emergency Medicine at UC Davis Guests: Dr. Aimee Moulin, Associate Professor of Emergency Medicine at UC Davis and Past President of California ACEP Dr. Hannah Snyder, Assistant Professor of Family Community Medicine and Associate Director of the Addiction Consult Team at UC San Francisco Dr. Reb Close, Emergency Medicine Physician at Community Hospital of Monterey Peninsula Resources: California ACEP Medication Assisted Treatment Resources California Bridge “We're developing hospitals and emergency rooms into primary access points for addiction treatment. This intensive program provides training and technical assistance to acute care providers to encourage patients to enter and remain in treatment.” Substance Abuse and Mental Health Services Administration (SAMHSA) Medication-Assisted Treatment Resources “The Game Has Changed”. Featuring Dr. Gail D'Onofrio. EM Pulse Podcast. 2018 March 15. https://ucdavisem.com/2018/03/15/the-game-has-changed-episode-4/ Apply for your DEA-X Waiver! SAMHSA GetWaivered.com *** This series is a part of a chapter grant from the American College of Emergency Physicians (ACEP) and is made to compliment the online California ACEP MAT resources. California ACEP is a wealth of information. Check out our website, californiaacep.org, where you'll find resources beyond the MAT toolkit, including our mental health toolkit, ED violence prevention resources, human trafficking guidebook, safe prescribing guidelines for opioids, palliative care toolkit, PECARN decisions guides, and much more. Thank you to Drs. Hannah Snyder, Aimee Moulin, and Reb Close for your expertise. Also, a big thanks to Kelsey McQuaid for all of your hard work on this project. EM Pulse is a podcast from the UC Davis Department of Emergency Medicine dedicated to bringing research and expert opinion to the bedside. Check it out and subscribe on iTunes, or wherever you get your podcasts. And follow us on social media @empulsepodcast. Thanks to OM Audio Productions for audio production services. References (from Dr. Snyder): (https://discovery.cdph.ca.gov/CDIC/ODdash/). Nationally, deaths from the opioid epidemic annually exceed those at the peak of the HIV epidemic. We've had more drug overdose deaths in 2017 than Americans that died in the entire Vietnam war (https://www.economist.com/briefing/2019/02/23/tens-of-thousands-of-americans-die-each-year-from-opioid-overdoses). Here's a cool graph that trends ED visits https://www.hcup-us.ahrq.gov/faststats/OpioidUseServlet?radio-3=on&location1=CA&characteristic1=01&setting1=ED&location2=US&characteristic2=01&setting2=ED&expansionInfoState=hide&dataTablesState=hide&definitionsState=hide&exportState=hide Kashef Z. Starting opioid addiction treatment in the ED is cost-effective, says study. Yale News. August 16, 2017. Health media overview of landmark Yale MAT study and its effectiveness in guiding patients to treatment. Initiating medication-assisted treatment for patients presenting with opioid withdrawal. ED Management. August 1, 2017. Health media overview of the effectiveness of MAT with a focus on the experiences of a program initiated in Washington state. Emergency department initiation of medication-assisted treatment for opioid addiction: Strategies for success. California Health Care Foundation. Published August 2016. Report on launching an opioid addiction treatment program with visual guide to setting up an effective MAT program. Emergency department treatment and follow-up strategies for opioid use disorder. Centers for Medicare & Medicaid Services. December 13, 2017. PowerPoint presentation outlining CMS-sponsored lectures on ED treatment and follow-up planning for patients presenting with opioid use disorder. Robeznieks A. For patients struggling with opioids, ED visit can mark new start. AMA Wire. November 22, 2017. Brief AMA article outlining MAT therapy in the ED at Washington University Medical Center in St. Louis. Frazier WT. Medication-assisted treatments and opioid use response to opioid overdose sentinel events. Master essay, University of Pittsburgh. Comprehensive overview of MAT response to opioid overdose to determine treatment utilization before and after nonfatal overdose using a longitudinal retrospective cohort of the Pennsylvania Medicaid population 2008-2013. Martin A, Kunstler NM. Opinion: We have effective treatments for opioids addiction - why don't we use them?” ACEPNow. December 12, 2017. Article on some barriers to the widespread adoption of MAT and a call to overcome these barriers for the sake of our patients. Addressing the opioid crisis - an ACH collaboration. Washington State Hospital Association, Washington State Medical Association. Set of strategies outlined by the Accountable Communities of Health for communities, hospitals, and providers to better combat the opioid epidemic, of which MAT is a main component. Research D'Onofrio G, O'Connor PG, Pantalon MV, et al. Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial. JAMA. 2015 Apr 28;313(16):1636-44. “The D'Onofrio Trial,” a randomized clinical trial performed at Yale showing the effectiveness of ED initiated MAT. Does initiating medication assisted treatment in the emergency room result in better outcome? Recovery Research Institute. An organized breakdown and summary of the D'Onofrio study highlighting the effectiveness of ED initiated MAT. Protocols SBIRT and Buprenorphine/Naloxone Administration in the ED for Acute Withdrawal: St Agnes Hospital (PDF). California ED-Bridge/ Emergency Buprenorphine Treatment Project: Guide for Emergency Buprenorphine Treatment (PDF). ED Initiation of Buprenorphine in the Emergency Department: Natividad Medical Center (PDF). Opioid Withdrawal Protocol: Zuckerberg San Francisco General Hospital and Trauma Center (PDF includes pocket card).  

Nöbetçisiniz. Ekranda sinsi sinsi yanan hasta çağırma butonuna tıklıyorsunuz. Kapıdan bir hasta giriyor. 30’lu yaşlarında, yüzünden kan damlayan, atik ve çevik bir delikanlı. Yeşil alan kapısından masanıza kadar olan 4-5 metreyi bir çırpıda geçiveriyor. Elinde bir EKG. Belli ki triyaj hemşireniz şikayetlerinin kardiyak olabileceğini düşünerek EKG’sini muayene öncesinde çekmiş. Çok güzel. EKG’yi elinden alıp bir çırpıda bakıyorsunuz. Jilet gibi. Temel EKG derslerine koyun, üzerinden ders işlensin, öylesine güzel. Şikayetini soruyorsunuz. “Hocam” diyor. “Benim göğsüm ağrıyor.” Hayda! Anamnezi yazmaya başlarken beyninizin Troponin lobu kaşınmaya başlıyor. Ağrısını tarif etmesini istiyorsunuz. “Ağrıyor işte” diyor. “Ha, bir de sol koluma vuruyor. Tıpkı internette söylendiği gibi.” Kimin ağrısı sol koluna vurmuyor ki? “Baskı tarzında mı?” deseniz de “Evet” diyor, “İğne gibi batıyor mu?” deseniz de. İhtimal, “Yürürken mi oluyor?” diye soracak olsanız, “Bazen yürürken, bazen otururken, yer yer de yatarken. En çok da düşünürken…” diyecek. Sigara içiyorsa asla “fazla” içmeyecek, aile hikayesini sorsanız “Kalp krizi var ama yaşlılıkta” diyecek.   Muayeneniz bitince olası tanıları düşünüyorsunuz. Karşınızda pek de MI’a benzemeyen bir göğüs ağrısı hastası var. Ancak göğüs ağrısını tipik tarifliyor. EKG’si normal. Fizik muayenesi normal. Şimdi ne yapacaksınız? Beyninizdeki sarkaç, “Miyalji reçetesiyle taburcu” ile “Kardiyoloji konsültasyonu ve 3 saat arayla 3 troponin takibi” arasında salınıp duruyor. Neden Göğüs Ağrılarında Risk Skorlaması Yapıyoruz? Göğüs ağrısı, acile en sık başvuru nedenlerinden biri. Yılda yaklaşık 100.000 hastanın başvurduğu bir acil servise, başvuruların 6.000’i “göğüs ağrısı” nedeniyle gerçekleşiyor (Neyse ki bunların küçük bir bölümü gerçekten kardiyak hadiselere bağlı oluyor). Üstelik MI’dan Pulmoner Emboliye kadar bir çok morbiditesi ve mortalitesi yüksek tanı, bu şikayet altında kümeleniyor ve bu nedenle hastalar sıklıkla acil serviste takibe alınıyor. Amacımız, her zaman olduğu gibi, hem hızlı, hem de doğru kararlar verebilmek. Bu konuda “iç güdülerimize” güvenmemizin yeterli olmadığı biliniyor. Konu göğüs ağrısı olduğunda, kullanabileceğimiz çeşitli Göğüs Ağrısı Sınıflandırma Skorları ön plana çıkıyor. HEART, TIMI, GRACE, T-MACS, EDACS vs. Skorlama sistemleri dünya genelinde o kadar benimsenmiş durumda ki, Annals of Emergency Medicine podcastinin geçtiğimiz aylardaki bir bölümünde, Rory Spiegel,  “Artık HEART skoru veya PECARN vs. uygulamanın etkilerini inceleyen çalışmaların sonuçlarında büyük yararlar görülmemesinin sebebi, klinisyenlerin zaten bunları kliniklerinde her hastaya uygulamaya başlamış olmaları” diyordu. Haksız sayılmaz. Özünde bütün göğüs ağrısı skorlama sistemlerinin amacı aynı: “Acil servise göğüs ağrısı ile başvuran hastalarda majör kardiyak olumsuz olayı (MACE) öngördürmek.” Peki ya MACE? MACE ise şu demek: Miyokard Enfarktüsü, koroner vaskülarizasyon veya herhangi bir nedenden ölüm. Göğüs Ağrısı Skorlama sistemleri arasında sıklıkla öne çıkan biri var: HEART Skoru (1-2). Amacı, göğüs ağrısı ile acil servise başvuran hastaları 30 günlük MACE yönünden düşük, orta ve yüksek riskli olarak sınıflandırmak. HEART, çeşitli kelimelerin baş harflerinden oluşuyor: Hikaye (History), EKG (ECG), Yaş (age), Risk Faktörleri (risk factors) ve troponin. Bunlardan her biri 0, 1 veya 2 puan olarak puanlanıyor ve toplamı hastanın HEART skorunu oluşturuyor. HEART Skoru Kimlerde Kullanılır veya Kullanılmaz? HEART Skoru, AKS düşündüren semptomlarla gelen ≥21 yaş hastalarda kullanılır. ≥1 mm yeni ST elevasyonu veya başka yeni EKG değişikliği varsa, hipotansiyon mevcutsa, beklenen yaşam süresi 1 yıldan az ise, yatış gerektiren başka nonkardiyak dahili, cerrahi, psikiyatrik sorun varsa kullanılmaz. Nasıl Hesaplanır?   0 puan 1 puan 2 puan Hikaye1 Düşük şüphe Orta şüphe Yüksek şüphe EKG Normal

Welcome back and happy new year! If you are an EM or peds provider you likely know the name PECARN (Pediatric Emergency Care Applied Research Network).  This powerhouse was the first federally funded pediatric emergency medicine research network in the US and generates quality studies like nobody’s business.  We have reviewed three landmark PECARN studies: Hot off the Press infant fever rule, DKA it’s not about the fluids, A Cool Tool. And in the next few months we will discuss seizure management and talk about PERN.  So we thought this was a good time to really understand the machine of PECARN that is affecting us shift to shift. What is the history, why is it important, and what does the future look like?  In this podcast Dr. Nate Kuppermann tells it all. What is the best way investigators can get evidence into your hands?  How do you keep up with the onslaught of data being generated?  Lectures/conferences? Tweets? Podcasts? Friends? Let’s continue the conversation on social media @empulsepodcast or at ucdavisem.com. Please subscribe and rate us on iTunes – it helps us reach more people!  Host: Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis Guest: Dr. Nate Kuppermann, Pediatric Emergency Physician, Professor and Chair of the UC Davis Department of Emergency Medicine, Founding Chair of the PECARN Steering Committee Resources: Academic Life in Emergency Medicine (ALiEM) P3 App: https://www.aliem.com/p3-app-pecarn-publication-prospectus/ PECARN’s home website: https://www.pecarn.org ***REGISTER for the 43rd annual UC Davis Emergency Medicine Winter Conference, February 24th-28th at the Ritz Carlton in Lake Tahoe*** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services. Dr. Nate KuppermannDr. Julia Magana

Dr Colin Gilhooley, consultant in Paediatric Emergency Medicine, joins Take Aurally once again to go through Head Injury in Children including: - NICE Guidelines - Other guidelines in use including CHALICE, PECARN and CATCH - How to take a history when assessing a young person with a head injury You can find the blog for this episode at https://www.takeaurally.com/paediatric-emergency-medicine/2019/7/3/the-child-with-a-head-injury As ever you can subscribe to Take Aurally through Apple Podcasts and Soundcloud AND we're also on Spotify: open.spotify.com/user/hk2tt55xd97pcz4xoj43nydyy Remember to follow us and NUH DREEAM on Facebook and Twitter We're now also on Instagram where you can find our whole collection of Take Visually infographics: www.instagram.com/takeaurally/

Happy May everyone!   We conclude our saga of 90’s EBM nostalgia with a look at the recent PECARN article that proposes a new method for the evaluation of the febrile neonate. Dr. Chan Lowe and I continue the discussion with a deep dive into the study and a deep discussion of what it means for clinical practice. They always say you never want to be the first or the last to adopt new evidence into your practice. But this is a truly unique situation where a decades old paradigm of EM and pediatric practice is really made anew. Now that it’s out there, what are you going to do about it?   This and more on this month's AZEMCast.   The AZEMCast Team   Peer Review by Dr. Anna McFarlin   Email: aleetch@aemrc.arizona.edu Twitter: @arizonaemcast   https://itunes.apple.com/us/podcast/arizona-emcast/id685439303?mt=2 https://azemcast.podbean.com/feed/

Host Jason Woods discusses the new PECARN Infant Fever Prediction Rule with lead author Dr. Nate Kuppermann. They review how this rule is different than its predecessors, understanding recursive partitioning, and how/when to use this rule in clinical practice. Article: Kuppermann et al. A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections. JAMA Peds. Feb 2019.

Guest Jeff Schunk, MD, FAAP Host Paul Wirkus, MD, FAAP. New in episode 1: Care process models, evaluation of head injury and the use of CT scan and the PECARN study will be discussed. For show notes visit vCurb.com. Send your questions to questions@vcurb.com now.

“Hot” Off the Press: Infant Fever Rule - Episode 15 Talking about neonatal fever makes most people hot under the collar! Fortunately, PECARN is on the case. Their latest paper was just published TODAY in JAMA Peds: A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections. In this month’s episode, we learn about some the challenges of having a febrile infant - from a mom’s perspective. Then we discuss when, why, and how to apply the latest PECARN rule with the notorious DNK, also known as Dr. Nate Kuppermann!  What is your approach to the febrile infant? What are some of the hardest parts about providing care to our hot little ones? We want to know! Share your thoughts on social media, @empulsepodcast, or on our website, ucdavisem.com.  Hosts: Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis Guest: Dr. Nate Kuppermann, Pediatric Emergency Physician, Professor and Chair of the UC Davis Department of Emergency Medicine, Founding Chair of the PECARN Steering Committee Resources: A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections.  Nathan Kuppermann, MD, MPH1; Peter S. Dayan, MD, MSc2; Deborah A. Levine, MD3; et al. JAMA Pediatr. Published online February 18, 2019. doi:10.1001/jamapediatrics.2018.5501 Validation of the “Step-by-Step” Approach in the Management of Young Febrile Infants. Gomez B, Mintegi S, Bressan S, Da Dalt L, et. al. Pediatrics. 2016 Aug;138(2). pii: e20154381. doi: 10.1542/peds.2015-4381. Epub 2016 Jul 5. Management of the Febrile Young Infant: Update for the 21st Century.  Woll C, Neuman MI, Aronson PL. Pediatr Emerg Care. 2017 Nov;33(11):748-753. doi: 10.1097/PEC.0000000000001303. Accuracy of Complete Blood Cell Counts to Identify Febrile Infants 60 Days or Younger with Invasive Bacterial Infections.  Cruz AT, Mahajan P, Bonsu BK, Bennett JE et. al. JAMA Pediatr. 2017 Nov 6;171(11):e172927. doi: 10.1001/jamapediatrics.2017.2927. Epub 2017 Nov 6. *************************************** Ski and CME! Join us for the,UC Davis Emergency Medicine Winter Conference, March 4th-8th at the Ritz Carlton in Lake Tahoe, CA. Come play and learn with us at the Western Regional SAEM Annual Meeting, March 21-22 in beautiful Napa, CA! #WRSAEM19  Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services. Dr. Nathan KuppermannSarah and Julia

In this PECARN series, Dr. Jason Woods discusses the sensitivity and specificity of the urinalysis for febrile infants ≤60 days old with the first authors of the 2018 Pediatrics article, Dr. Leah Tzimenatos. Tzimenatos L, Mahajan P, Dayan PS, et al; Pediatric Emergency Care Applied Research Network (PECARN). Accuracy of the Urinalysis for Urinary Tract Infections in Febrile Infants 60 Days and Younger. Pediatrics. 2018 Feb;141(2). https://www.ncbi.nlm.nih.gov/pubmed/29339564

This is a discussion on the CT head decision rule for pediatric head trauma.

Hosted by Dr. Derek Monette (ALiEM Deputy Editor in Chief), this podcast discusses the hot-off-the-press New England Journal of Medicine publication on diabetic ketoacidosis (DKA), fluid resuscitation, and cerebral edema. Authors Dr. Nathan Kuppermann and Dr. Nicole Glaser explain the importance of their groundbreaking RCT and challenge the theoretical association between IV fluids and the development of cerebral edema during pediatric DKA treatment. Kuppermann N, Ghetti S, Schunk JE, et al; PECARN DKA FLUID Study Group. Clinical Trial of Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis. N Engl J Med. 2018 Jun 14;378(24):2275-2287. https://www.ncbi.nlm.nih.gov/pubmed/29897851

Not all head trauma is minor. Not all minor head trauma is clinically significant.   How can we sort out the overtly ok from the sneakily serious?     Mnemonics for bedside risk stratification of minor pediatric blunt head trauma, based on PECARN studies: [Details in Audio]   Blunt Head Trauma in Children < 2 years of Age     Blunt Head Trauma in Children ≥ 2 years of Age     Image Gently Campaign   Medical Imaging Record (maintain like an immunization card)   Brochure for Parents: Just in Time Education   Selected References Dayan PS et al. Association of Traumatic Brain Injuries with Vomiting in Children with Blunt Head Trauma. Ann Emerg Med. 2014; 63(6):657-665. Dayan PS et al. Headache in Traumatic Brain Injuries from Blunt Head Trauma. Pediatrics. 2015; 135(3):504-512. Horeczko T, Kuppermann N. To scan or not to scan: pediatric minor head trauma in your office, clinic or emergency department. Contemporary Pediatrics. 2012;29(8):40-47. Kupperman et al. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet. 2009;374(9696):1160-70. Lee LK et al. Isolated Loss of Consciousness in Children with Minor Blunt Head Trauma. JAMA Pediatr. 2014; 168(9):837-843. Magana JN, Kuppermann N. The PECARN TBI Rules Do Not Apply To Abusive Head Trauma. Acad Emerg Med. 2017; 24(3)382-384. Rogers AJ et al. Children with Arachnoid Cysts who Sustain Blunt Head Trauma: Injury Mechanisms and Outcomes. Acad Emerg Med. 2016; 23:358-361.   This post and podcast are dedicated to Kevin Klauer, DO, EJD, FACEP for his dedication to education, and for his unique balance of safety and keeping it real.  Thank you.

We interview Dr Patrick Carter of the University of Michigan Injury Center on his upcoming AEM Article looking at non-fatal pediatric firearm injury data from the PECARN network.  

In this mini FOAMcast, we introduce a new segment - statistics.   We cover inter-rater reliability, or, the kappa coefficient, using the PECARN head trauma decision aid as a tool. As always, visit foamcast.org for show notes and the generously donated Rosh Review questions. Thanks y'all! -Jeremy Faust and Lauren Westafer

This episode reviews the article that most people call the PECARN head CT rule or the Kupperman head CT rule (named for the first author). This is an easy to use clinical decision rule that can help us reduce the number of head CTs that we do on children with minor head injury. We owe it to our patients to spare them excess radiation, cost, and time in the ED and this rules helps us do this. In order to use this rule effectively, you need to read this article and understand how the study was done.  This allows us to understand the strengths and weaknesses of this rule and helps us apply it in our everyday practice.