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Special Patreon Release: Janelle Rupp Conversations with your Teen About Sex Puberty and Identity   *DISCLAIMER* This episode contains adult themes and is not intended for little ears.   "Walk with the wise and become wise, for a companion of fools suffers harm." Proverbs 13:20 (NIV)   *Transcript Below*   Questions We Discuss: Perhaps one of the most asked questions by Christian singles is, "How far is too far?" How do you respond to that question? Knowing the importance of educating ourselves as adults, what is the most popular sexual behavior among teens? What are some wise and age-appropriate guidelines recommend for teaching our kids about sex and sexuality?   Janelle Rupp is a Christ-follower, wife & mom of three (in that order).  Upon graduating from Cedarville University with a Bachelor's of Science in Nursing and a Minor in Biblical Studies, she worked nine years as a Pediatric ICU nurse before transitioning into nine years of nursing education for the Empower Life Center of Peoria, Illinois. There she specialized in Sexual Health with an emphasis on Sexual-Risk Avoidance. After moving to the Atlanta, Georgia area, Janelle developed a Biblically-based, Christian & Home school curriculum entitled “Remember Whose You Are: Rooting Human Sexuality in Gospel Identity." Using an expositional study of Genesis 1-3 alongside evidence-based scientific research, the four-unit program builds on itself to establish how gospel identity determines holy & healthy & holy sexuality. With a passion for both science & Scripture, Janelle is currently teaching the curriculum at North Cobb Christian School while watching the Lord grow the program at schools nation-wide.  She can be reached at jrupp.rememberwhoseyouare@gmail.com.   Recommended website for Parents: axis.org   Thank you to our sponsor: Daisy Kings Use code SAVVY to Save!   Connect with The Savvy Sauce on Facebook, Instagram or Our Website   Gospel Scripture: (all NIV) Romans 3:23 “for all have sinned and fall short of the glory of God,”   Romans 3:24 “and are justified freely by his grace through the redemption that came by Christ Jesus.”   Romans 3:25 (a) “God presented him as a sacrifice of atonement, through faith in his blood.”   Hebrews 9:22 (b) “without the shedding of blood there is no forgiveness.”   Romans 5:8 “But God demonstrates his own love for us in this: While we were still sinners, Christ died for us.”   Romans 5:11 “Not only is this so, but we also rejoice in God through our Lord Jesus Christ, through whom we have now received reconciliation.”   John 3:16 “For God so loved the world that he gave his one and only Son, that whoever believes in him shall not perish but have eternal life.”   Romans 10:9 “That if you confess with your mouth, “Jesus is Lord,” and believe in your heart that God raised him from the dead, you will be saved.”   Luke 15:10 says “In the same way, I tell you, there is rejoicing in the presence of the angels of God over one sinner who repents.”   Romans 8:1 “Therefore, there is now no condemnation for those who are in Christ Jesus”   Ephesians 1:13–14 “And you also were included in Christ when you heard the word of truth, the gospel of your salvation. Having believed, you were marked in him with a seal, the promised Holy Spirit, who is a deposit guaranteeing our inheritance until the redemption of those who are God's possession- to the praise of his glory.”   Ephesians 1:15–23 “For this reason, ever since I heard about your faith in the Lord Jesus and your love for all the saints, I have not stopped giving thanks for you, remembering you in my prayers. I keep asking that the God of our Lord Jesus Christ, the glorious Father, may give you the spirit of wisdom and revelation, so that you may know him better. I pray also that the eyes of your heart may be enlightened in order that you may know the hope to which he has called you, the riches of his glorious inheritance in the saints, and his incomparably great power for us who believe. That power is like the working of his mighty strength, which he exerted in Christ when he raised him from the dead and seated him at his right hand in the heavenly realms, far above all rule and authority, power and dominion, and every title that can be given, not only in the present age but also in the one to come. And God placed all things under his feet and appointed him to be head over everything for the church, which is his body, the fullness of him who fills everything in every way.”   Ephesians 2:8–10 “For it is by grace you have been saved, through faith – and this not from yourselves, it is the gift of God – not by works, so that no one can boast. For we are God‘s workmanship, created in Christ Jesus to do good works, which God prepared in advance for us to do.“   Ephesians 2:13 “But now in Christ Jesus you who once were far away have been brought near through the blood of Christ.“   Philippians 1:6 “being confident of this, that he who began a good work in you will carry it on to completion until the day of Christ Jesus.”   *Transcript*   Music: (0:00 – 0:09)   Laura Dugger: (0:09 - 1:31) Welcome to The Savvy Sauce, where we have practical chats for intentional living. I'm your host, Laura Dugger, and I'm so glad you're here. Today's message is not intended for little ears.   We'll be discussing some adult themes, and I want you to be aware before you listen to this message.   Thank you to Daisy King's, a skincare brand that meets simplicity. Their tallow-based products are made with wholesome, God-given ingredients to deeply nourish, restore, and protect your skin.   There are no toxins, no fillers, just pure, effective skincare. Visit DaisyKings.com to nourish, restore, and glow.   Janelle Rupp is my guest today, and she packed so much knowledge and inspiration into this time by educating us on a healthy view of sex, sharing God's holy and awe-inspiring design of our bodies, and ways that all of this points to Him.   She also is going to include meaningful conversations to have with our children throughout the years that they're in our home. Here's our chat. Welcome to The Savvy Sauce, Janelle.   Janelle Rupp: (1:32 - 1:35) Thanks so much, Laura. I'm so glad to be with you today.   Laura Dugger: (1:35 - 1:42) Will you just get us started by telling us a little bit about your faith journey and where it's brought you to today?   Janelle Rupp: (1:43 - 4:51) Sure. I was raised in a Christian home. I remember from a young age actually being struck with the realization that God loved me so much that He sent His own son for me.   But it really was probably more in my teenage years that I realized the depth of my sin, that it was great, and that Jesus was that bridge between who God was and who I was. Also, early on in my life, I knew I wanted to be a nurse, which is actually kind of interesting because there was no one in my family who was a nurse or in healthcare. But I had watched my mom care well for others in her family who had a myriad of mental and physical health problems.   So, I do think that the compassion that God put in my heart at a young age did find its place in a healthcare setting just over time and experiences I watched her. I really felt like my dream job would be to work in preventative healthcare, specifically with teenagers. And I had a heart for girls in really tough situations like teenage pregnancy.   It's a very marginalized group of humanity. And so, after college, I ended up in the pediatric intensive care unit at Riley Children's Hospital in Indianapolis for about seven years. And during that time, I met my husband.   We got married. We had our first child. And then while pregnant with our second, we decided to move closer to my extended family back in Illinois.   And a few years after I had our second child, I actually ended up landing that dream job that I felt like the Lord had laid on my heart way back in college. And so, I started the Empower Life Center in Peoria, Illinois in 2008. And I worked there for nearly 10 years as a nurse educator, teaching parenting and newborn classes.   But my primary role was a sexual risk avoidance educator, specializing in sexually transmitted disease and infections. And I would teach in public schools and private schools and charter schools. It's a junior high and high school level and also a guest lecturer at Bradley University in Peoria, Illinois.   And I always tell people that no one grows up and hopes to be a sex teacher one day. I did not envision that God would put me in that area of education, but he did. And so, after 10 years of doing that, when our family then transitioned down to Atlanta, Georgia for a job transfer for my husband, we had chosen to put our kids, now three kids at that point, in Christian education.   And within months, the middle school principal had heard about my background and approached me to create a curriculum for their fifth through eighth graders that was centered on a biblical view of sex and sexuality. So, I spent a series of months developing that curriculum. I then decided to go ahead and accept a teaching job to teach that curriculum.   And it's entitled Remember Whose You Are. And it's designed as a four unit developmentally appropriate program for Christian schools or homeschool environments. And currently we're in the beginning stages of equipping and training other schools to implement it at their school as well.   Laura Dugger: (4:52 - 5:17) Wow, that is so interesting to hear how you got interested in teaching others this healthy view of God and sex. And at the foundation of your teaching, you begin with a theology of God. So, I'd love to zero in on just one of your points that God is a relational God.   Will you elaborate on that and share how it ties into this topic we're discussing today?   Janelle Rupp: (5:18 - 7:13) For sure. One of my goals in teaching this is just to help my students see God for who he is, fall in love with who he is. And God being relational is one of the places where I always notice that beginning to take shape.   I find evidence for that in Genesis 1:26, where it says, “and God said, let us make man in our image after our likeness.” The definition of the word relational means a desire to pursue relationship or connection with another. And before we think of God pursuing relationship with us, it's actually really critical to look at that verse and note that God is already relational within himself. So, we see evidence in that verse that he's referring to himself in a plural sense.   And when we take that alongside other areas of Scripture as well, we see God existing as Trinity, Father, Son and Spirit, three in one, indicating that God does not need humanity for relationship. He only desires humanity for relationship. And one day, actually, when I was teaching that to a group of fifth grade boys last year, I said, God does not need you, but he wants you.   One of the fifth grade boys, in all complete sincerity, said, “Aww.” And it was one of the sweetest things I had ever heard because it was this very honest verbal expression of what it felt like to know that we are wanted by the God of the universe. I tell my students, “You know, someone only wants relationship with you when they love you.”   And so, while 1 John 4:8 tells us, “that God is love.” It's pretty amazing that way back in the first chapter of Genesis, as we find God creating man and creating woman, He's still incredibly loving that He even desired to create it in the first place. So, I think God being relational is such an important aspect to the who and the why of who He is.   Laura Dugger: (7:14 - 7:28) Absolutely. And I really envision this chat being a time when parents can listen alongside their teen or their tween or whenever it's age appropriate. So, will you just give us a glimpse of what you do teach in schools?   Janelle Rupp: (7:29 - 13:04) I would be happy too. The very first unit is just the who and the why of God. We focus on 10 characteristics of God, and then we transition to the who and the why of humanity.   What do all humans have in common? And we highlight eight characteristics that we all share in common. And then unit two, it's centered on the who and the why of me.   And specifically looking at Genesis 1:27, identity means that we're made in the image of God and that we are made male and female. So, Genesis 1:27 says, “So God made man in his own image, in the image of God, he made them male and female, he created them.” So, here we really want to introduce what does it mean to be made in the image of God as a social being, emotional being, a spiritual being, an intellectual being?   But also, what does it mean to be made with this physical body, male or female? And so, we introduced the reproductive system with an emphasis on puberty and human growth and development. And within that introduction, in that unit, I do something that's historically not been done in Christian settings, which is that I am teaching both the male and the female reproductive system to both genders.   And this next sentence may sound a little odd to some of your listeners. I know my students sometimes giggle when I say it, but I see the glory of God when I study the anatomy of both the male and the female reproductive systems and the intricacies of the design in order to see how they both work perfectly together. To me, it's awe-inspiring.   And so, I believe females have every right to see and begin to grasp the design of a male reproductive system. We use really basic anatomical diagrams for that. And then males equally have every right to see and begin to understand the basics of the female reproductive system using a diagram.   And my approach to that is clinical and scientific. It's definitely from an anatomy perspective. But I also make sure to take the time to point out some of, again, the beauty of the design.   For example, females, when they are born, are born with all the eggs that they will ever, ever have in their ovaries. And this design is super perfect because it means that you and I are not going to be 70 years old and find out that we're unexpectedly pregnant. Eventually, those eggs will run out about in our mid-40s.   And I always thank God for that design. It is a good design. Another one is just the female cervix.   The female cervix doesn't reach full maturity and protection until our early to mid-20s, where it then provides this wonderful protective barrier between the external and internal anatomy of the female reproductive system. When you explain things like that, I literally watch the kids have what I call light bulb moments, where they begin to see the why behind the design. And it's so important.   They've never taken the time to look at that and to hear it. In fact, I often call the reproductive system the forgotten body system. Christian kids in particular, they will get through a whole unit on the body having never talked about the reproductive system.   And if they are, then usually they're taught just about their own gender and they're missing that overarching beauty of what God designed. So, I think it's really important to highlight that reproductive system and for both genders. But in Unit 3, we move from the foundation of just gospel identity as made in His image and male and female into then specifically human sexuality.   And we use mostly Genesis 2 as we look through this about how God designed marriage and God designed sex, which is super clear in Genesis 2:24 and says, “Therefore, a man shall leave his father and mother and take hold of his wife and they will become one flesh.” And so, God's design for marriage and sex is clear that it's between a man and a woman. And also that that man and woman should follow the order of this verse.   First, that they leave and leaving might be dating. It might be courting. It might be pursuing a relationship.   However, we set those boundaries for our kids. And then second, that they would take hold and experience the intimacy and blessing of marriage, referencing that connection that God put Adam and Eve in through marriage. And third and last in that order, but that they become one flesh, which is referencing sex.   And so, after explaining that very good design, we transition into Genesis 3. And honestly, I love how Moses starts off the chapter here, Genesis 3, by saying, “Now the serpent.” And I always tell the kids that I hear that music in my head of dun, dun, dun. Like you just know that everything is going to change.   This good design is going to change and it's not changing for the better. And so, we start then looking at all the distortions that sin has caused within the overall topic of sex. And that means not just looking at premarital sex, but also adultery, pornography, sexting, gender identity, sexual identity.   And honestly, that list just keeps on growing every year that I teach. And so, then unit four, that last unit, is what I call the now what unit. In light of taking everything that we know now about gospel identity and human sexuality, I really encourage the kids to start really thinking about how they practically should be living in relationships with someone that they're attracted to and that they want to pursue.   And we use the entire Bible to help us answer that question. We actually end that unit with the question and answer panel discussion, using questions that the students have come up with through the course of that week. And it's always a sweet time of conversation focused on, again, gospel identity and human sexuality.   Laura Dugger: (13:06 - 13:19) Oh my goodness, that is so amazing and comprehensive. If parents are listening and they're wondering just about that diagram, what age do you recommend showing something like that? How would you respond to that question?   Janelle Rupp: (13:20 - 14:08) That's an excellent question. So, we're doing that in sixth grade. You know, it always depends on what your child's exposure and experience is, what their environment is, and their curiosity.   I think each child is so different. But in general, sixth grade would be age 11, 12, I think that's 10 to 12 for sure. But even you could probably push it as you're talking about puberty, which is where we interject it, just because it gives reference to what is a period for a girl?   Or what are the changes as a male that I'm having inside my body right now? Where's that coming from? So, I think starting as young as eight or nine to 10.   No later really than 12, I think would be really, really important.   Laura Dugger: (14:09 - 14:16) Thank you. That is helpful. I'm assuming that you're everybody's favorite teacher and that this is their favorite course to take.   Janelle Rupp: (14:17 - 14:48) We have a lot of fun. And I love when the kids buy into it. You know, sometimes I'll find that kids come in and they're a little hesitant to talk about this or they feel awkward by it.   But I think, you know, coming at it from both a clinical perspective, but also a biblical perspective, doing my best to keep them at ease and have fun as we have these conversations. Eventually, they loosen up over time. And it ends up being a really sweet time to talk about stuff that really, really matters in life.   Laura Dugger: (14:48 - 15:05) It does. And you're sharing so much truth. And it is the truth that sets us free.   And I can see where that would overcome so much confusion. So, let's even get really practical. When you're teaching these young people about sex, how do you define it?   Janelle Rupp: (15:06 - 19:12) This is such a great question. No one's ever actually asked me this. And I think it's so, so important.   The CDC definition of sex, it is very complete in its definition. It does a really good job covering what I believe are really important distinctives within that definition. And so, that definition is, quote, “Sex is defined as any part of your body and or specifically your reproductive area coming into contact with another person's body and or specifically their reproductive area.”   And one of the key points that I want to point out from this definition includes this phrase, reproductive area. I find my students have no reference for that, and even adults often don't. But simply put, the reproductive area is anything on the outside of the body that covers the reproductive system organs on the inside of the body.   So, this area actually extends from the belly button down to the genitals. A lot of times we only reference those genitals, but it actually extends belly button down to the genitals. And so, again, people are often surprised by that.   But at the same time, you know, whether it's called the reproductive area or maybe a private area, people do commonly recognize the importance of keeping that area safe and private. I often stick with that phrase, reproductive area, to reference the importance of trust when it comes to keeping things safe and private as a jumping off point to just help the kids see that a person is trustworthy if they keep you safe and if they keep things private. And again, such an important thing that we need to teach our children is that if someone pushes past what feels safe for us or pushes past areas on our body that are private, our children need to know, and we need to know those are not trustworthy people.   And furthermore, we should then give our children permission to tell someone that they do trust, hopefully us, but somebody that they do trust, somebody that keeps things safe and private about any person whose words or actions don't prove trustworthy. And as a side note, giving kids appropriate anatomical names is so important for this as well. But if you aren't using those terms and they don't understand it, we're speaking a language that they can't understand and maybe aren't able to convey.   And so, I think additionally, as children get older and you continue to reference that reproductive area as an area you keep private, I think it's super important to keep going back to theology and to Scripture. And in Genesis 1 and 2, we don't see anything having to be kept private because there was nothing that needed to be private. And in fact, the end of Genesis 2 says in verse 25, “And the man and his wife were both naked and were not ashamed.” My students giggle when we get to that verse because that sounds so foreign to them.   But reminding them that again, God's design was so good that there was nothing to be held back. They were fully intimately known by God and fully intimately known by each other and also without sin. But then when sin enters in Genesis 3, as Eve is tempted and enticed by the serpent, Adam is tempted, and enticed by Eve.   We see in that instant that sin changes every single thing because it causes Adam and Eve to then feel ashamed before God. They want to hide from God. It causes them to feel ashamed between each other.   They want to blame each other and it causes them to lose their sense of identity and purpose. And this is what happens to us, too, when sex and sin become entwined. It causes shame.   It causes us to hide. It makes us want to blame others. It causes us to question our identity and question our purpose.   But even though sexual sin changes the heart of man, it does not change the heart of God. And so, if our heart's desire is to love God in return for the love He's shown us, then our heart's desire should be to orient our lives around His design for our lives. And I would say even especially orienting our lives around His design for marriage and sex.   Laura Dugger: (19:13 - 19:23) Perhaps one of the most asked questions by Christian Singles is, How far is too far? So, how do you respond to that question?   Janelle Rupp: (19:24 - 25:50) Yes, I mean, this is the question that inevitably somebody's going to ask in my classes every single year. And no doubt, I mean, I think everyone has asked that question at some point or another in their lives. I certainly did.   And I was told that that was the wrong question. And I want to explain why first and then tell you how I answer it. But the reason was because when we look at Scripture in terms of holiness, which is having our heart completely for God versus idolatry, which means having our heart turned to something else, we see over and over and over in Scripture that we can't serve two masters.   We can't serve both holiness and idolatry. Matthew 6:24 is a great example. It's talking about the idolatry of money.   But it does say that whenever our heart is going after two things, we will either end up being devoted to the one and hate the other or devoted to the other and thus hate the one. And so, in other words, as we apply it to this question, we actually can't just straddle the line of both holiness and idolatry. And a lot of times that's where this heart of motivation of how far is too far is like, what line is the line that I can get to and still be holy?   But we really can't try to find and live on that line, because healthy and holy sexuality and sexual immorality doesn't exist. It is one or it is the other. And so, that's an important truth of Scripture.   I'm always in complete agreement with everything that I just said. But I also recognize that the Bible is really, really clear on how to give us direction in terms of setting boundaries and learning how to escape and endure temptation rather than to be enticed by it. And so, I teach my students a method to answer this question using an acronym called GRAY, G-R-A-Y, just to help them think biblically and critically about this question.   And actually it can be applied to any what I call the gray areas of life where Scripture may not specifically be very black and white about what we can and can't do. For example, another easy gray area topic within this same kind of umbrella idea would be dating. We aren't specifically told if we're to encourage our kids towards dating or courting or maybe arrange marriages.   Right. And yet I believe that there's four specific steps that we can use to determine the heart of God for our lives when it comes to gray areas of life. And so, the G in gray stands for go to God and it refers to prayer.   James 1:5 encourages believers to ask God for wisdom. It says, “He will give it generously to anyone who asks.” And I think praying for wisdom is such a foundational place to start on any topic, but specifically this one.   And then the R in the acronym stands for read the word. I always encourage my students and I would encourage parents as well, actively study the word of God, finding verses that give direction for decision making on this question. How far is too far?   One that I think jumped out at me is First Corinthians 10:23. As it's again, speaking of idolatry of the heart and it says, “all things are lawful, but not all things are helpful. All things are lawful. I can do all things, but not all things are building up. And so, let no one seek his own good, but the good of his neighbor.”   So, when you apply that verse to this question of how far is too far, you begin to see that the question isn't so much is kissing OK, is anything done with our clothes on OK? But the question is more what behavior is helpful for me as I try to honor Christ with my body? What behavior builds up my desire to honor Christ with my life and or what behavior seeks to honor the person that I'm with?   And so, again, I think reading scripture can help us be able to know how to reframe that question and create boundaries. And then the A in gray stands for ask for advice. And here I encourage teens to seek out someone who is doing relationships well.   In other words, is there a couple that they admire, someone older than them that they admire, maybe a friend or sibling or a friend of a sibling, a teacher, a parent, a youth group leader? I found in my own life that God often gives wisdom through people like that. And actually, in the last 10 years, as I've been teaching this type of material, I found that asking couples that I respect this very same question.   How did you answer? How far is too far? It brings some of the best responses and encouragement that then I can share with my students to help them learn and grow.   So, I think asking for advice is a vital part of this. And then lastly, the Y stands for yield. It is the last step.   And yet it's such an important part of answering this question. Yield just simply means to wait. And you and I both know this generation does not like to wait.   Instinct gratification is their thing. And yet teaching them that there's so much value in yielding when we don't have clear answers to critical questions like this. So, I actually love to literally walk this out in front of the classroom.   I will demonstrate how, when I yield, I hold back on decisions such as how far is too far. I am always allowing myself room to continue to walk forward as I feel more certainty over the answer or I feel more led with the wisdom that God is continuing to give. However, if I walk forward without clarity, if I'm pushing boundaries that are perhaps lawful, I can.   But they're not to my benefit, not to my partner's benefit. Then it's very realistic that I am going to push farther than I am able to handle. It's going to bring harm to the relationship that I am in.   And I can't ever go back. The truth is that the line between being enticed by sin versus escaping and enduring the temptation to turn from sin. It's a thin line.   And so, helping teenagers with these four steps, I think just think more critically about where to set those boundaries is important. And then I do usually go on to encourage students to be really specific in writing out those boundaries. I'm a big fan that writing is remembering.   It stores in our long-term memory. And then to even share those boundaries in order to have accountability with them.   Laura Dugger: (25:51 - 27:47) And now a brief message from our sponsor. I would like to specifically address the ladies. Because let's talk skin care.   As moms, as women, we spend so much time caring for everyone else. But what about us? If you're tired of dull or dry skin and products filled with chemicals and fillers, it is time for something better.   God designed our skin to thrive with real nourishing ingredients. 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But I think this is really helpful having you share statistics.   So, what are some statistics you think we need to be aware of to educate us on sexuality and youth in America right now?   Janelle Rupp: (27:49 - 29:55) Yes, you know, this is constantly changing. And so, I do look for these on the regular. And so, the ones I'm currently kind of using as I educate this year, the average age of first pornography exposure is currently 11 years old.   And 1 out of every 10 visitors to porn sites are actually under the age of 10. And 22% of those are regular visitors to those sites. It's not that they're just there once.   They're regular visitors. When you talk about that next age group, 11 to 17-year-olds, 53% of them are accessing pornography. In addition, 1 out of every 14 are receiving sexually explicit material through social media, through texting.   And 1 out of every 17 are sending it, which is an interesting thing. I always tell my students that means that as people are receiving it, they're sending it to more than one person. And so, you know, somehow we could think that it's a conversation maybe staying between two people.   And almost in every case, that is not the reality. 41% of teens are engaging in sexual behavior and oral sex and vaginal sex and anal sex and what I call outer course. Every 11 minutes, CPS finds evidence of sexual abuse claims.   And 2 out of every 3 of those are age 12 to 17 years old. And then lastly, and this is kind of newer from a research study that is an important one, but identifying as LGBTQ+, has actually risen in teens on average by 4% in the last 5 years. Girls being higher than boys.   Girls averaging about 5% increase and boys at 3%. And I think, you know, you give those 9 quick statistics, and I'll be honest, you know, even every time I have to say them, I get that sinking feeling in my stomach. It takes a lot to shock me after 10 years of working with teens on this topic.   But it never feels good to say those out loud. I think it just reflects such brokenness on behalf of our culture's view of sex and sexuality.   Laura Dugger: (29:57 - 30:09) Wow, that is sobering. And if that reality feels alarming or overwhelming to a parent listening, then how would you advise them to educate their son or daughter?   Janelle Rupp: (30:10 - 33:09) Yeah, I think the scariest thing is when we allow those feelings that we're having to really just cripple us and our ability to parent our children through them. I had a mom come up last year, and she said, I'm just really exhausted by it all. I'm tired of checking up on my kid.   And, you know, as a mom of teenagers, I hear that. I resonate with that. But I think we need to fight through those feelings and encourage each other to fight through those feelings in order to parent with intention and godliness when it comes to these subjects.   I developed this Remember Who's You Are curriculum for students, but I 100% believe that parents are to be the first go-to for our kids on these topics, whether they feel like they have all the answers or not. It's really not the role of the school, nor of the church, nor of the youth pastor. It is primarily and foundationally the role of parents, with ideally then the school and the church, you know, locking arms with parents, coming alongside with a similar message.   And so, when it comes to equipping parents, which is something I feel strongly about as well, in order to have these ongoing conversations, I break down educating parents with three regular statements to help them kind of combat those feelings of overwhelmed or anxiousness when it comes to these topics. And the first regular statement would be to regularly educate yourself. We can't teach what we don't know.   And so, parents need to have answers to questions, and I'm going to give a series of questions here that I think need to be answered as examples, but there's certainly more. But questions like, what is God's design? Again, what is the reproductive area?   What does sexting mean? What does sending nudes mean? Because that's becoming actually a more popular phrase right now than using the phrase sexting.   Why is not porn good for our brains if it actually keeps us from not having sex outside of God's design? That's a question I've been asked. And a follow-up to that, what does the Bible say about masturbation?   How does a condom work? I've been asked that one. What is the most popular sexual behavior among teens?   Those are some toughies. You don't just kind of like pop out an answer to that without dedicating some time to researching those answers. I don't think that this needs to be an overwhelming amount of time.   In fact, I actually just encourage parents to set aside 15 to 20 minutes once a week, maybe even once every other week, but just put it on the calendar so that you really devote yourself to that time. You know, I think we dedicate ourselves as parents to things we care about. And I don't mean to say this harshly, but many moms spend much more time exercising than they do in their Bibles and figuring out answers to these questions and apologetic type answers.   And parents, you know, we spend a lot of time talking to our kids about sports and grades. And yet these are topics that have lasting relational impacts for their lives, not just in our family, but in their family to come. And so, we have to be diligent to set aside time and regularly educate ourselves.   Laura Dugger: (33:09 - 33:38) Janelle, I love all of this that you're saying. And I just want to pause on this first step of educating ourselves as the adults and as the parents. So, listening to something like this, hopefully people feel encouraged already doing a great job educating yourself.   And so, let's just answer a couple of those questions because it can be hard to know where do I go to find out these answers. I'm careful to Google this because something may pop up that I don't want to see.   Janelle Rupp: (33:38 - 33:38) Right.   Laura Dugger: (33:38 - 33:46) So, let's go with two of them. One of them you said is what is the most popular sexual behavior among teens right now?   Janelle Rupp: (33:47 - 34:46) Yeah, I think that this one is a little bit shocking for parents. And they often are unaware of where their teens are at as they are pushing boundaries on sexual behavior. You know, when I was growing up, oral sex became, and that's mouth to genitals, but that became a really popular sexual behavior.   And I remember hearing people say, well, that makes me feel a virgin because I now have not had vaginal sex. And so, again, just continuing to push these boundaries. So, now today's teenagers are past oral sex.   That's become just something that's normal and acceptable. And the most popular sexual behavior right now that you'll actually they will talk about and do would be anal sex right now, which is the anal area, which is obviously I always point this out, not actually the reproductive system, but in fact, the expiratory or the end of the digestive system. But that is the most popular sexual behavior among teens currently.   Laura Dugger: (34:47 - 35:14) That is really helpful to hear. And even years ago, when I was practicing as a marriage and family therapist, something that we learned was that the rise in pornography exposure was also corresponding or correlating with this rise in pressure for women to engage in anal sex. And that was a lot of times where it was coming from.   I'm assuming very similar with teens.   Janelle Rupp: (35:15 - 35:59) Yes, absolutely. And as our culture continues to kind of push the envelope on trying to get teenagers and adults to accept pornography is a natural part of human sexuality. I think we will just continue to see that behavior pushed more and more and more just among teens and relationships in general, which is really devastating.   I think of so many of these behaviors that are very degrading, particularly to women, but even to men. And again, that women, that girls would be thinking that that is considered an acceptable part of a relationship is such a tragedy, really. And again, just so reflective of the brokenness of our culture.   Laura Dugger: (36:00 - 36:19) And you bring up another question I want to follow up with, Ben, because porn is so destructive for a lifetime. But how do you answer that question if parents want to educate themselves of somebody making an argument of why not pornography if it keeps them from engaging in penetrative sex?   Janelle Rupp: (36:20 - 38:18) Yeah, so, there's some excellent websites that you can find that talk about the damaging effects of pornography. And I found, you know, good resources. Anyone's welcome to email me.   I'll include that later. But to get some of those resources. But it really does change and alter, actually, the connections that are created in the brain.   And one of the, I think, more interesting studies on pornography in the brain, as they looked at men who were watching and engaging in pornography, it would continually light up an area of the brain and stimulate it, which is an area of the brain that is usually lit and stimulated when a man would use power tools. And that's concerning on, I think, a couple of levels. One, that is degrading.   And again, this human made in the image of God to something that is to be just used. Right. And then second, anytime we engage in pornography, we are we're engaging more with a screen than a person.   And so, that intimacy level, that is something that's so precious about sex. You know, sex isn't just for making babies. It isn't just for this intimate connection.   It isn't just for pleasure. But it is to be wholly represented, all three of those when we look at God's design. But when we engage with pornography, we're completely reducing it down to one person's pleasure, one person's use.   And so, again, those connections that are supposed to exist between people now exist between a person and their screen. And you'll see across the board, these are people who easily get addicted. It's meant to be addicted, experience increased levels of depression, anxiety, suicide.   Grades go down for teenagers. They lose friends. So much research showing the devastating impact of pornography.   Laura Dugger: (38:19 - 38:32) That is really helpful. Thank you for sharing that. And back to that greater question. So, when you're advising parents to educate themselves, that's the first step. What's the next step in the process?   Janelle Rupp: (38:33 - 41:29) So, the second step that I recommend is to regularly to enter in. We aren't called to be our kids' best friends. We're called to step into their lives.   And that means stepping into friendships and relationships. It actually means stepping into their phone. You know, the amount of parents that tell me, I feel really bad because it's their phone.   And yet it's something that the parent is paying for, right? And so, that is a part of our lives, too. Theirs and ours.   But stepping into social media pages, their schools, their activities. And I think we don't have to be creepy about it. And that's what I think parents most, they're like, I don't want to creep my kid out or make them pull away.   I just think we have to be really intentional beforehand that we're developing this relationship of trust and communication. So, Josh McDowell has said rules without relationship equal rebellion. And so, the flip side of that is that when I have rules where I'm entering in and I have relationships where I'm entering in, that will equal trust.   And so, we need to keep entering in because we want to keep earning their trust. It goes both ways. We want that trust and communication.   So, entering in out of a desire for relationship, but also entering in with boundaries and rules for our kids in order to continue to build that trust between us. And then the third regularly statement is to regularly extend grace to yourself. Guilt and shame cannot go away without grace.   And a lot of us live with guilt and shame when it comes to these subjects. I often hear that that's one of the key reasons that parents will hesitate to talk to their child. They'll say to me, I don't want them to ask me about what I did.   And the only remedy for shame is grace. It's why God's plan to extend grace in sending Jesus. It's the best plan for our world because we're literally drowning in guilt and shame over these subjects.   And so, as parents, we first have to learn and work through accepting grace for ourselves. But for the purpose of extending it to others, it's very, very hard to extend grace when we haven't accepted it ourselves. And so, I think it starts with us.   And then again, it extends out to our kids. My husband and I were working through something that was happening with our teenagers this year. And I thought it was so profound.   As he said this statement, by God's grace, our kids will never get caught up in it. But it's also that same grace that will provide a way for our kids to get out of it. And so, we need to remember God's grace is greater than all of our sins.   And we can rest in that even if we don't do everything perfectly as a parent. Even if we forget to answer one of the questions. Even if our kids choose a path that is different than what we had taught them.   God's grace is greater than all of our sins.   Laura Dugger: (41:30 - 43:53) And I don't think we can hear that enough. So, thank you for that reminder.   Did you know that we are now accepting donations online through Venmo?   It's just one of our additional ways that you can give to support the work of the Savvy Sauce Charities and keep us on the air where we can keep providing this content for free. We pray that you'll consider partnering with us and generously donating before your end. Thanks for your support.   Well, Janelle, I think that you're so wise to teach parents that there's obviously no formula, and that's why it's so vitally important to keep in step with the spirit as we have these conversations with our children. But also, I'm sure that you've learned some wise and age-appropriate guidelines for teaching our kids about sex and sexuality.   So, will you share those with us for the different age ranges?   Janelle Rupp: (43:55 - 50:10) Yes, I think you're exactly right. There isn't a set formula because, again, as I mentioned before, every kid is different. Every experience and exposure is different.   But there are some general guidelines in order to, again, have these regular conversations with our kids. So, beginning ages kind of three to seven, I think focusing on what it means to be made in God's image, what it means to have a male part versus female part, how that kind of defines each gender. And understanding also what is private and safe within that is important.   So, one of the things that I did with my kids is very early on, as we were bathing in those ages, we would say, Thank you, God, for our fingers and our noses, and thank you, God, for our toes, and say, Thank you, God, for a penis because you're a boy, and thank you, God, for a vagina because you're a girl, and thank you for parts that we can't see inside of us. And I would name some of those parts as well, because I think it just helps them start recognizing, again, the beauty of what it means to be created by God. And also highlighting safe pictures and unsafe pictures, safe touch and unsafe touch, and stuff that I touched on before.   I think that's important as well. But then I personally believe this is one of the best ages to begin forming a framework on the sanctity of human life, that all life is created by God and for God in the image of God. And therefore, all life should be treated with dignity, respect, and love, regardless of size, regardless of gender, regardless of skin color, regardless of neediness or challenges.   It's a really natural and important tie-in to the subject at this age. And then when you get into that next age, age 8 to 10, I kind of think of it a little bit like preteen. Just continuing on with that conversation but bringing up this word puberty.   And kids always look terrified when I say that word. And I always tell them, then puberty is not a scary word. And I'm sorry that you have this vision that it is.   But puberty really is just human growth and development that make us male and make us female. And so, I think teaching our kids not to be even afraid of that word. There are parts that we need to keep private.   And yes, we don't need to talk about that with everybody. But these are not wrong or bad parts. They're parts that are created by God for God.   And God is a good God. And God is a sovereign God. And so, He created it for our good with us in mind.   And so, just continuing to engage and encourage our kids on those ideas at age 10. And then 10 to 12, and some educators would say sex should be introduced by age 10. I found that based on just, again, the exposure that my kids had, we had this type of a conversation as they headed into more age 11.   I think it for sure should be talked about before age 12. But at that point, you want to make sure you're including just a framework on what biblical sex and marriage is and what it's purposed for. Again, purpose for procreation, making babies, purpose for intimacy, even purpose for pleasure.   Listen, no 10 to 12-year-old is going to understand that part yet, which is fine because you're going to revisit it later when they're kids. This is a regular thing, right? But you want them to hear it from you.   You want them to hear it from you first so they understand that you are trustworthy. And so, they should be taught that sex is best seen in that context of marriage. One man, one woman that have left their father and mother, they've taken hold of each other in marriage.   And as a result, then a parent and actually ideally both parents, mom and dad, are able to help a child understand that framework and also recognize basic deviations outside of that framework. Not just that sex before marriage is outside, but also sex outside of marriage, the sexual and gender identity confusion. Anything that's falling outside of God's design for marriage and sex is a deviation from what he designed.   And then in that kind of 13 and older, recommendations that I make is always that you begin to establish a really good framework on how to have God-honoring relationships with someone of the opposite gender. I actually highly recommend Ephesians chapter 5 as you make this plan with your child. And a couple key points that it talks about within that chapter is that we treat those in the faith, those that share our common belief in Jesus Christ as brothers and sisters in Christ, in friendship and in a possible relationship, but one that has a lot of purpose and a plan in place.   But then we treat those who are not sharing our faith with love, but yet an understanding that those aren't relationships that I can pursue because I can't have an expectation that they are going to bring me closer to Christ, whereas the other should. And so, as parents within that, again, 13 and older category, you really need to start paying very much attention and entering in into those relationships that they have with their friends and their peers, because this is the second biggest impact maker on their decision-making next to you. Proverbs 13:20 says, “He who walks with the wise will be wise, but a companion of fools suffers harm.”   I really believe in parents. If you need to change up their environment in order to help them form more God-honoring relationships in step with that Ephesians 5, we should not be afraid to do so. And again, continuing to expand on those other frameworks before, because regular conversations, but you're just getting into greater detail, more fine-tuning.   And I actually think at this age, too, you're digging deep into the truth of Scripture with your child. So, you let them come alongside you as you're learning how to answer these questions so that they can continue to refine who they are in Christ and to refine how to keep accountable with the Word of God and to refine how to set boundaries and how to navigate relationships in what I call purposeful dating versus purposeless dating. And purposeful dating, really just the overarching idea there is just that in the end, if it does end, that there may be sadness, but that there is also learning that comes so that I am lessening the brokenness and damage that may come as a result as well.   Laura Dugger: (50:11 - 50:30) And I love how also in your teaching, you lay out specific guidelines that don't fit within an age category, but they're more so for children who are at cell phone age or where they have unattended internet use. So, will you share some of those guidelines with us now, too?   Janelle Rupp: (50:31 - 54:54) Yes, for sure. You know, I always say when you introduce a cell phone to your child, especially one that has internet included with that phone, it does change a little of those guidelines that I just mentioned in that you need to increase the speed and the ages or decrease the ages, technically, in which you are discussing these things. Just because you're giving them a lot of access to things that will speak an opposite message from what you would be saying.   And so, when I encourage parents to look at a couple things as they're making the decisions about when to give a cell phone, I think you're specifically looking at does your child understand what it means to be indwelled by the Holy Spirit? And are they showing evidence of the fruits of his work in their lives? In other words, do I see evidence of the Spirit in the life of my child?   And so, that means does he or she recognize self-control? They know when they have it and they know when they don't. Do they recognize how to be a peacemaker?   Do they recognize how to be loving in what they say and what they do? Do they recognize and show faithfulness, kindness, gentleness, joy, patience, all of those fruits of the Spirit? And do they recognize and show that not just in person with someone, but even behind the screen when they don't see that person face to face?   And listen, no parent is going to say, oh, yeah, 100% of the time my kid is showing evidence of the fruits of the Spirit. But if I can honestly say yes, my child is showing that he is growing in evidence of that. And then you decide this is the age for him to have a phone.   Most educators, I'll just be super clear, most educators that work with teens, they recommend an age of anywhere from 13 to 15. But when you do give that, those same adults that work with those teens will also say the following, that a device should not be allowed in a private room or a private place. There should be a family charging place.   And we are on phones when we are around other people. And then that you should also have no phone zones for us. The dinner table is one of our very most important ones so that we are learning how to, again, continue to engage in conversation with one another without our phones, which is growing the relationship building that we want to grow.   And so, we hold to those boundaries. Understanding that an all access, unmonitored pass to the Internet does break down identity. It does work against.   And there's so much evidence to this. You know, even five years ago, I was less inclined to say hard and fast rules on the use of cell phones for teens. However, more and more and more and more, we continue to see research study after research study.   There's documentaries. Now there's reports about the dangers of the unlimited, unmonitored access to screens and how it hurts our kids emotionally, intellectually, socially, spiritually and even physically. I mean, I think of less sleep.   Right. Something that I've learned over these 10 years is that no kid stumbles into pornography with the use of their phone on purpose. So, so, so many times the first time is an accident and it happens again because that Internet use is unmonitored.   And so, here's another hard truth as well. It often also happens because someone else in the house or the family may be viewing pornography and it's in that browser history or it's in the logarithm of the device they're using. And so, understanding what drives that first use, but then the ramifications of that first look.   So, even if it's an inadvertent look, the hook to pornography is so addicting. And again, we talked about the damaging effects on our brains, our emotions and our relationship. So, I just think monitoring phones and Internet access is, yes, exhausting.   I mean, I feel it. But at the same time, the risk is so great that there's no way that we can stop while they are in our home. Because the worry and the regret of, oh, I should have done X, Y, Z, I think outweighs any type of temporary exhaustion for me in my day to have to check and monitor phone use.   Laura Dugger: (54:55 - 55:21) That's such a good point. It's going to cost us energy on one side or the other. But that is a wise choice to go with the hard choice first and hopefully more of an easier or more fruitful path.   When you reflect on our conversation so far, what hope do we all have for the gospel of grace impacting us specifically as it relates to our sexuality?   Janelle Rupp: (55:23 - 58:58) When I hear that question, I really love it. I instantly think shame is a result of sin, connecting that to the grace that is shown from our Creator and our Redeemer. And all of that, again, is really on display in Genesis 3.   And so, I want to take us there as I answer that question. I tell my students shame has two definitions. There is shame as a verb to shame someone.   And then there is shame as a noun to feel shame as a result of something that we have done wrong. Shame as a verb is something we never want to do. That's not a good thing, right?   But shame as a noun is actually a God-given gift that is meant to bring us back into relationship with God. And you look at how Adam and Eve in Genesis 3. It makes me chuckle, honestly, because as they feel the shame of their sin, their next step is to create garments to cover themselves.   And their shame was so great, but they went ahead and put these fig leaves on top of their bodies, these parts that now have to be private because of shame. And I just think to myself, those fig leaves had to have been so insufficient. We do this too, though.   We come up with ways to clothe ourselves to cover up the shame that we feel. It might be past sexual sin. It might be present sexual sin.   And we try our best to hide it. We try our best to make ourselves look presentable with our covering so that people won't see our sin and see our shame. I mean, all of that is that feeling that comes from that feeling of shame as a result of sin.   But what's beautiful when we look at Genesis 3, when Adam finally comes clean about his sin and shame. And I will say, listen, he doesn't do it perfectly because God has to literally say, where are you? Knowing where he is, but like basically saying, Adam, come out, come clean, right?   But as Adam does come clean about his sin and the shame that he's feeling, right? What does God do? God covers Adam and Eve with garments that He provides and He makes from the very first shedding of blood that we see recorded in Scripture.   And I'm doing it now. I weep every single time that I talk about this part, because God knows how to deal with shame so much better than we do. He knows how to deal with our shame in a way and cover us in a way that is a once for always.   And it's Genesis 3 is just a beautiful foreshadowing of how Christ is going to be sent. And there he comes in Matthew, right? To cover shame forever.   And so, as we remember that Jesus spilled his blood on a cross and then resurrected, conquering death and sin and the grave. We also get covered by that blood so that we no longer have to hide. We no longer have to feel that shame.   And we can stand, Romans 8 says, without condemnation. “Therefore, there is no condemnation for those who are in Christ,” because Christ has covered us with garments completely and perfectly for forever. And so, our hope in this for our own sin, our past sin, any present sin, any future sin, and our hope for any sin that may rise up out of the heart of our child.   It's in the gospel that the gracious and loving covering that God gives us through Jesus is complete, making us right before God for all time.   Laura Dugger: (58:58 - 1:00:05) I love that so much, Janelle. And it makes me think of, I can't remember the research study, but they tracked people's brains when they were feeling like shame or regret or guilt. And found that sometimes people who struggle with anxious thoughts, that they have an over-functioning part of their brain where they can have those feelings of shame, sometimes when they haven't done anything shameful.   So, there's almost like a real guilt or a false guilt. And all of this conversation brings me to 2 Corinthians 7:10, where God addressed that first, because in the Bible it says, “Godly sorrow brings repentance that leads to salvation and leaves no regret, but worldly sorrow brings death.” And so, if we're going like even a level deeper to tease out that shame, sometimes we've felt that before.   Maybe, let's say, if something was done to us, and that's not the same shame that requires repentance, which is the godly sorrow. So, does that make sense?   Janelle Rupp: (1:00:05 - 1:00:28) Yes, exactly. That's exactly my point. And getting the kids to understand the difference between those shames but then seeing shame as not something that I have to push against.   Because if it is that godly shame that comes after me making a wrong choice, that is that shame to bring me closer to God in and through repentance. And again, that's a beautiful thing.   Laura Dugger: (1:00:29 - 1:00:39) It is, and it leads to freedom, which we may not think of in the moment, but that confession and bringing something to the light, that that is the best way to live.   Janelle Rupp: (1:00:39 - 1:00:40) Exactly.   Laura Dugger: (1:00:40 - 1:00:48) Are there any other important takeaways that you want parents and their children to be aware of as it applies to sex and sexuality?   Janelle Rupp: (1:00:49 - 1:02:44) Yes, you know, I think of two things here. The first being that, you know, sexual sin is really just one of many sins that Christ covers that he died for. You know, the blood of Christ covers the adulterer just as much as it covers the gossiper.   It covers the pregnant teenager and her boyfriend just as much as it covers you and I. And I think in the past, the church has overemphasized this sin and underemphasized others. But yet on the flip side, I mean, I think we really can't deny these are sins.   And even when we look at Scripture, it doesn't deny this. These are sins that carry a greater consequence and potential for enticing us towards, again, more habitual, ongoing sin in ways that just affect us deeper than other sins, which is why 1 Corinthians 6:18 says “Flee from sexual immorality.” And I'm going to pause there for just a second, because the Greek word for sexual immorality is the word pornea.   And you and I can't hear the word pornea without immediately thinking of porn. And so, I think it's fascinating that the root word for pornography is literally translated as sexual immorality. It's really an important thing.   But 1 Corinthians 6:18, again, it starts saying “Flee from sexual immorality. Every other sin a person commits is outside of the body, but the sexually immoral person sins against his own body.” And this means that sexual sin at its root is a problem of identity, which is, again, why you have to link that human sexuality with gospel identity.   Our aim cannot be for our children to make it to marriage having never had sex or never getting pregnant. To me, that's a low fruit. That is a low aim.   Our aim needs to be raising children with a gospel identity that is rooted in the creative and redemptive work of Jesus Christ and seeing the outgrowth from there.   Laura Dugger: (1:02:44 - 1:02:56) Wow. Well said. And if we boil all of this down, what is just one action step that you first recommend for anyone who finishes this message today?   Janelle Rupp: (1:02:57 - 1:04:19) Yeah, I'm going to give you a three-in-one just tying back to those three key regularly statements. One of the primary resources that I love to recommend in terms of educating ourselves is for parents to go to axis.org. That is A-X-I-S dot org, and sign up to receive their free Culture Translator weekly newsletter. And that will be sent to your email on a weekly basis for free.   And it gives a whole rundown of what's been happening in teen culture for that week. And just by simply opening up your email, you're going to start educating yourself. And they also have a host of other excellent resources and podcasts and a ton of material on their website that I would recommend.   But that's just one little step. And then for the enter in, I would recommend scheduling a date now. Put it on your calendar.   Find a time to take your child on a shopping date, an ice cream date, so that you can begin to enter into their lives and keep building that relationship with them. And then lastly, between now and that date, just open up God's Word. Reflect on the grace of God.   Let it wash over your heart. Let it wash over your mind. Get engaged with worship.   All of those will equip you well to do that hard work of entering in with your child when you meet them for that date.   Laura Dugger: (1:04:20 - 1:04:29) I've loved this chat so much. And if anybody's wondering about

Nearly a quarter of a million children in the U.S. are admitted to pediatric intensive care units each year. Many of these emergencies can be reduced through vaccines, safe environments, and early treatment, but when they do happen, children often need the highest level of care hospitals can provide. On this Line One, host Dr. Jillian Woodruff and her guests discuss how critical care teams save young lives and support families through their most difficult moments.

Why would a healthy newborn suddenly stop eating and start vomiting? When a fussy baby comes into the ER, it's easy to assume it's nothing urgent — like colic or gas. But in today's case, there were small signs that pointed to something more.This episode unpacks the high-risk condition and treatment of neonatal cardiogenic shock with Natalie Pleiman, pediatric nurse and clinical coach. From the early (often misleading) signs to critical assessments, you'll learn what makes cardiogenic shock different in neonates (specifically ductal dependent lesions), what to look for in patient labs, and how to manage the risks of treatment.Tune in for insights that will help you on your next pediatric cardiac emergency!Topics discussed in this episode:Neonatal triage: initial assessment and red flagsPhysical exam and early diagnosticsDifferences in neonatal anatomy and physiologyPreductal vs. postductal vitalsSigns of coarctation of the aortaAssessing for sepsis vs. cardiogenic shockThe dangers of fluid bolusesHow to effectively administer prostaglandinsThe risk and process of neonatal intubationPathophysiology of coarctation of the aortaICU stabilization to optimize cardiac functionKey signs of congenital heart conditionsNatalie's framework for understanding congenital heart defectsConnect with Natalie:https://www.instagram.com/chatwithnat_rn/Listen to Chat with Nurse Nat on Spotify:https://open.spotify.com/show/7Jh2qe44KipudVKkdXFwWHListen to Chat with Nurse Nat on Apple Podcasts:https://podcasts.apple.com/us/podcast/chat-with-nurse-nat/id1815541418Mentioned in this episode:Listen to the In The Heart of Care Podcasthttps://link.cohostpodcasting.com/6598429e-e927-45b0-9b57-7dd34a09d803?d=seASyqjs7CONNECT

  It's time for the finale of our review of The Pit, a medical drama on HBO Max starring Noah Wyle. We've been going through the first season of this incredible show and how it's really captured a lot of the issues going on in medicine these days. This episode of The Pediatric Sports Medicine Podcast wcovers The Pit episodes 11 through 15 - listen in and tell us what YOU think of The Pitt on HBOMax!    Connect with The Host! Subscribe to This Podcast Now!     The ultimate success for every podcaster – is FEEDBACK! Be sure to take just a few minutes to tell the hosts of this podcast what YOU think over at Apple Podcasts! It takes only a few minutes but helps the hosts of this program pave the way to future greatness! Not an Apple Podcasts user? No problem! Be sure to check out any of the other many growing podcast directories online to find this and many other podcasts via The Podcaster Matrix!     Housekeeping -- Get the whole story about Dr. Mark and his launch into this program, by listing to his "101" episode that'll get you educated, caught up and in tune with the Doctor that's in the podcast house! Listen Now! -- Interested in being a Guest on The Pediatric Sports Medicine Podcast? Connect with Mark today!   Links from this Episode: -- Dr. Mark Halstead: On the Web -- On X    Calls to the Audience Inside this Episode: -- Be sure to interact with the host, send detailed feedback via our customized form and connect via ALL of our social media platforms! Do that over here now! -- Interested in being a guest inside The Pediatric Sports Medicine Podcast with Dr. Mark? Tell us now! -- Ready to share your business, organization or efforts message with Dr. Mark's focused audience? Let's have a chat! -- Do you have feedback you'd like to share with Dr. Mark from this episode? Share YOUR perspective!   Be an Advertiser/Sponsor for This Program!   Tell Us What You Think! Feedback is the cornerstone and engine of all great podcast. Be sure to chime in with your thoughts, perspective sand more.  Share your insight and experiences with Dr. Mark by clicking here!   The Host of this Program: Mark Halstead:  Dr. Mark Halstead received his medical degree from the University of Wisconsin Medical School. He stayed at the University of Wisconsin for his pediatric residency, followed by a year as the chief resident. Following residency, he completed a pediatric and adult sports medicine fellowship at Vanderbilt University. He has been an elected member to the American Academy of Pediatrics (AAP) Council on Sports Medicine and Fitness and the Board of Directors of the American Medical Society for Sports Medicine (AMSSM). He has served as a team physician or medical consultant to numerous high schools, Vanderbilt University, Belmont University, Washington University, St. Louis Cardinals, St. Louis Blues, St. Louis Athletica, and St. Louis Rams. He serves and has served on many local, regional and national committees as an advisor for sports medicine and concussions. Dr. Halstead is a national recognized expert in sport-related concussions and pediatric sports medicine. — Dr. Mark Halstead on Facebook — Dr. Mark Halstead on LinkedIn — Dr. Mark Halstead on X — Learn Why The Pediatric Sports Medicine Podcast Exists...   The Co-Host of this Program: Nicole Halstead:  Nicole Halstead received her bachelors degree in Nursing from the University of Wisconsin-Oshkosh. She worked in the Emergency Department, Pediatric ICU, and Adult ICU, and the Burn Unit while at the University of Wisconsin, Vanderbilt Children's Hospital and Barnes-Jewish Hospital. She currently works at a substitute school nurse in the Francis Howell School District.  

  You may love or hate medical TV shows. They seem to come in waves on TV. Right now, one of the best medical TV shows that I've seen, in my opinion, is “The Pitt.” We are taking a dive into this show talking about the themes it covers in medicine and sharing experiences my guest and I have that are so relatable. Who's ready for more of “The Pitt?” We are, so let's get started.    Connect with The Host! Subscribe to This Podcast Now!     The ultimate success for every podcaster – is FEEDBACK! Be sure to take just a few minutes to tell the hosts of this podcast what YOU think over at Apple Podcasts! It takes only a few minutes but helps the hosts of this program pave the way to future greatness! Not an Apple Podcasts user? No problem! Be sure to check out any of the other many growing podcast directories online to find this and many other podcasts via The Podcaster Matrix!     Housekeeping -- Get the whole story about Dr. Mark and his launch into this program, by listing to his "101" episode that'll get you educated, caught up and in tune with the Doctor that's in the podcast house! Listen Now! -- Interested in being a Guest on The Pediatric Sports Medicine Podcast? Connect with Mark today!   Links from this Episode: -- Dr. Mark Halstead: On the Web -- On X  -- American Sirens Book https://www.amazon.com/dp/0306926091?ref=ppx_yo2ov_dt_b_fed_asin_title   Calls to the Audience Inside this Episode: -- Be sure to interact with the host, send detailed feedback via our customized form and connect via ALL of our social media platforms! Do that over here now! -- Interested in being a guest inside The Pediatric Sports Medicine Podcast with Dr. Mark? Tell us now! -- Ready to share your business, organization or efforts message with Dr. Mark's focused audience? Let's have a chat! -- Do you have feedback you'd like to share with Dr. Mark from this episode? Share YOUR perspective!   Be an Advertiser/Sponsor for This Program!   Tell Us What You Think! Feedback is the cornerstone and engine of all great podcast. Be sure to chime in with your thoughts, perspective sand more.  Share your insight and experiences with Dr. Mark by clicking here!   The Host of this Program: Mark Halstead:  Dr. Mark Halstead received his medical degree from the University of Wisconsin Medical School. He stayed at the University of Wisconsin for his pediatric residency, followed by a year as the chief resident. Following residency, he completed a pediatric and adult sports medicine fellowship at Vanderbilt University. He has been an elected member to the American Academy of Pediatrics (AAP) Council on Sports Medicine and Fitness and the Board of Directors of the American Medical Society for Sports Medicine (AMSSM). He has served as a team physician or medical consultant to numerous high schools, Vanderbilt University, Belmont University, Washington University, St. Louis Cardinals, St. Louis Blues, St. Louis Athletica, and St. Louis Rams. He serves and has served on many local, regional and national committees as an advisor for sports medicine and concussions. Dr. Halstead is a national recognized expert in sport-related concussions and pediatric sports medicine. — Dr. Mark Halstead on Facebook — Dr. Mark Halstead on LinkedIn — Dr. Mark Halstead on X — Learn Why The Pediatric Sports Medicine Podcast Exists...   The Co-Host of this Program: Nicole Halstead:  Nicole Halstead received her bachelors degree in Nursing from the University of Wisconsin-Oshkosh. She worked in the Emergency Department, Pediatric ICU, and Adult ICU, and the Burn Unit while at the University of Wisconsin, Vanderbilt Children's Hospital and Barnes-Jewish Hospital. She currently works at a substitute school nurse in the Francis Howell School Distr...

Get ready for an insightful conversation with Dr. K. Amer Khan, Consultant Intensivist and General Pediatrician, as he takes us behind the scenes of pediatric critical care. With an MBBS, MD in Pediatrics, and a Fellowship in Pediatric Critical Care (IDPCCM), Dr. Khan brings over 6 years of hands-on experience from the Pediatric ICU. In this special interview hosted by Suhasini, we explore the clinical challenges, ethical decisions, and emotional resilience required in saving young lives. Catch this insightful episode on TALRadio English on Spotify and Apple Podcast!Host : SuhasiniGuest : Dr.K.Amer Khan#TALRadioEnglish #TALHospitals #DrAmerKhan #PediatricCare #PICUInsights #CriticalCareHeroes #InsideThePICU #ChildHealthMatters #MedicalStories #HealthcareWithHeart #PediatricIntensivist #DoctorDiaries #EthicsInMedicine #TouchALife #TALRadio

In this episode of Compassion and Courage, host Marcus Engel speaks with nurse Hannah Fowler about her journey into nursing, the realities of bedside care, and the importance of compassion in healthcare. Hannah shares her personal experiences as a patient and how they shaped her approach to nursing. She discusses her work in pediatric nursing, the challenges and joys of caring for children, and her involvement with Victory Junction, a camp for kids with chronic illnesses. The conversation emphasizes the significance of building relationships with patients and their families, and the profound impact of compassionate care. Resources for you: More communication tips and resources for how to cultivate compassion: https://marcusengel.com/freeresources/Connect with Marcus on LinkedIn: https://www.linkedin.com/in/marcusengel/Learn more about Victory Junction: https://victoryjunction.orgLearn more about Marcus' Books: https://marcusengel.com/store/Subscribe to our podcast through Apple: https://bit.ly/MarcusEngelPodcastSubscribe to our podcast through YouTube: https://bit.ly/Youtube-MarcusEngelPodcast More about Hannah Fowler, RN:I am Hannah Fowler. I have been a registered nurse for almost 3 years! I work in a Pediatric ICU as well as a pediatric doctor's office. I also love spending time a Victory Junction, a camp for children with chronic illnesses! Date: 6/2/2025 Name of show: Compassion & Courage: Conversations in Healthcare Episode number and title: Episode 169 – The Heart of Nursing – With Hannah Fowler, RNkeywordsnursing, compassion, healthcare, pediatric nursing, patient care, personal stories, resilience, Victory Junction, healthcare communication, nursing journey

About our Guest: Dr. Omar Alibrahim is a professor of pediatrics at Duke University and a pediatric intensivist at Duke Children's Hospital. He completed his Pediatric Residency and Chief Residency at St. Joseph's Children's Hospital, followed by Pediatric Critical Care Fellowship at the University of Buffalo. He served as the Pediatric Critical Care Division chief, the PICU Medical Director, and the PCCM fellowship Director in Buffalo, NY, for more than 8 years, during which he worked with the pulmonology and respiratory therapy divisions to develop a negative pressure ventilation program for acute respiratory failure. In 2021 Dr. Alibrahim was recruited to Duke Children's Hospital and now serves as the PICU Medical Director and the program director for the Pediatric Critical Care Fellowship. Learning Objectives: By the end of this podcast series, listeners should be able to: Critique the physiologic rationale for negative pressure ventilation (NPV) in acute respiratory failure.Understand the experience of introducing a novel form of respiratory support in a PICU.Describe the stepwise escalation of NPV settings often used in acute respiratory failure.References:Derusso, M., Miller, A. G., Caccamise, M., & Alibrahim, O. (2024). Negative-Pressure Ventilation in the Pediatric ICU. Respiratory Care, 69(3), 354–365. https://doi.org/10.4187/RESPCARE.11193Hassinger AB, Breuer RK, Nutty K, Ma CX, Al Ibrahim OS. Negative-Pressure Ventilation in Pediatric Acute Respiratory Failure. Respir Care. 2017 Dec;62(12):1540-1549. doi: 10.4187/respcare.05531. Epub 2017 Aug 31. PMID: 28860332.Deshpande SR, Maher KO. Long term negative pressure ventilation: Rescue for the failing fontan? World J Cardiol. 2014 Aug 26;6(8):861-4. doi: 10.4330/wjc.v6.i8.861. PMID: 25228965; PMCID: PMC4163715.Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show. Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.

About our Guest: Dr. Omar Alibrahim is a professor of pediatrics at Duke University and a pediatric intensivist at Duke Children's Hospital. He completed his Pediatric Residency and Chief Residency at St. Joseph's Children's Hospital, followed by Pediatric Critical Care Fellowship at the University of Buffalo. He served as the Pediatric Critical Care Division chief, the PICU Medical Director, and the PCCM fellowship Director in Buffalo, NY, for more than 8 years, during which he worked with the pulmonology and respiratory therapy divisions to develop a negative pressure ventilation program for acute respiratory failure. In 2021 Dr. Alibrahim was recruited to Duke Children's Hospital and now serves as the PICU Medical Director and the program director for the Pediatric Critical Care Fellowship. Learning Objectives: By the end of this podcast series, listeners should be able to: Critique the physiologic rationale for negative pressure ventilation (NPV) in acute respiratory failure.Understand the experience of introducing a novel form of respiratory support in a PICU.Describe the stepwise escalation of NPV settings often used in acute respiratory failure.References:Derusso, M., Miller, A. G., Caccamise, M., & Alibrahim, O. (2024). Negative-Pressure Ventilation in the Pediatric ICU. Respiratory Care, 69(3), 354–365. https://doi.org/10.4187/RESPCARE.11193Hassinger AB, Breuer RK, Nutty K, Ma CX, Al Ibrahim OS. Negative-Pressure Ventilation in Pediatric Acute Respiratory Failure. Respir Care. 2017 Dec;62(12):1540-1549. doi: 10.4187/respcare.05531. Epub 2017 Aug 31. PMID: 28860332.Deshpande SR, Maher KO. Long term negative pressure ventilation: Rescue for the failing fontan? World J Cardiol. 2014 Aug 26;6(8):861-4. doi: 10.4330/wjc.v6.i8.861. PMID: 25228965; PMCID: PMC4163715.Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show. Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.

No parent ever wants to end up in the Pediatric ICU; but we know it happens and we want you to be informed and know what to expect.  I invited my social media friend and Pediatric Critical Care Doctor, Dr. Anita Patel on the show to chat about the Pediatric ICU and what to expect.  We discuss:  The common reasons children end up in the Pediatric ICU and what to expect  The questions to ask your care team in the ICU How we manage health anxiety as a pediatric ICU doctor and general pediatrician  To connect with Dr. Anita Patel follow her on Instagram @anitakpatelmd and check out all her resources on https://linktr.ee/anitakpatelmd. 00:00 Introduction & Why This Conversation Matters 02:00 Meet Dr. Anita Patel 04:10 Common Reasons for Pediatric ICU Admissions 10:46 What Happens Inside the PICU? 14:23 Navigating the ICU Experience as a Parent 20:27 Key Questions Parents Should Ask the Care Team 24:46 The Emotional Toll on Parents & Doctors 31:14 Balancing Medical Knowledge with Parenting Anxiety 35:16 Final Thoughts & Words of Encouragement 37:59 Where to Follow Dr. Anita Patel & Closing Remarks We'd like to know who is listening! Please fill out our Listener Survey to help us improve the show and learn about you! Our podcasts are also now on YouTube. If you prefer a video podcast with closed captioning, check us out there and subscribe to PedsDocTalk. We love the sponsors that make this show possible! You can always find all the special deals and codes for all our current sponsors on the PedsDocTalk Podcast Sponsorships page of the website.  Learn more about your ad choices. Visit megaphone.fm/adchoices

No parent ever wants to end up in the Pediatric ICU; but we know it happens and we want you to be informed and know what to expect.  I invited my social media friend and Pediatric Critical Care Doctor, Dr. Anita Patel on the show to chat about the Pediatric ICU and what to expect.  We discuss:  The common reasons children end up in the Pediatric ICU and what to expect  The questions to ask your care team in the ICU How we manage health anxiety as a pediatric ICU doctor and general pediatrician  To connect with Dr. Anita Patel follow her on Instagram @anitakpatelmd and check out all her resources on https://linktr.ee/anitakpatelmd. 00:00 Introduction & Why This Conversation Matters 02:00 Meet Dr. Anita Patel 04:10 Common Reasons for Pediatric ICU Admissions 10:46 What Happens Inside the PICU? 14:23 Navigating the ICU Experience as a Parent 20:27 Key Questions Parents Should Ask the Care Team 24:46 The Emotional Toll on Parents & Doctors 31:14 Balancing Medical Knowledge with Parenting Anxiety 35:16 Final Thoughts & Words of Encouragement 37:59 Where to Follow Dr. Anita Patel & Closing Remarks We'd like to know who is listening! Please fill out our Listener Survey to help us improve the show and learn about you! Our podcasts are also now on YouTube. If you prefer a video podcast with closed captioning, check us out there and subscribe to PedsDocTalk. We love the sponsors that make this show possible! You can always find all the special deals and codes for all our current sponsors on the PedsDocTalk Podcast Sponsorships page of the website.  Learn more about your ad choices. Visit megaphone.fm/adchoices

Send us a textIn this conversation, Dr. Kyle Willse, a pediatric intensivist, shares insights on the Pediatric Intensive Care Unit (PICU).  The discussion is meant to provide a basic understanding as to how the  PICU operates and to help parents be an advocate for their children.   A must listen for anybody who has a child or a loved one in the PICU.Kyle Willse, DO, is board certified in Pediatrics and in Pediatric Critical Care.  For the past 5 years, he has worked at Cedars-Sinai hospital as an attending in the pediatric and congenital cardiac intensive care unit.  His comments in the podcast are his individual thoughts and opinions and do not represent Cedars Sinai.    Dr Jessica Hochman is a board certified pediatrician, mom to three children, and she is very passionate about the health and well being of children. Most of her educational videos are targeted towards general pediatric topics and presented in an easy to understand manner. For more content from Dr Jessica Hochman:Instagram: @AskDrJessicaYouTube channel: Ask Dr JessicaWebsite: www.askdrjessicamd.com-For a plant-based, USDA Organic certified vitamin supplement, check out : Llama Naturals Vitamin and use discount code: DRJESSICA20-To test your child's microbiome and get recommendations, check out: Tiny Health using code: DRJESSICA Do you have a future topic you'd like Dr Jessica Hochman to discuss? Email Dr Jessica Hochman askdrjessicamd@gmail.com.The information presented in Ask Dr Jessica is for general educational purposes only. She does not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your child's health care provider.

In this episode of Life Sciences 360, host Harsh Thakkar sits down with Marc Sheetz, Associate Dean of Research at Midwestern University's College of Pharmacy, to discuss the growing concern of antimicrobial resistance and the field of pharmacometrics. Marc sheds light on how pharmacometrics is shaping the future of medicine by using predictive models to personalize dosing, making drug treatments more effective while reducing toxicity. This episode dives deep into the intersection of pharmacometrics, AI, and machine learning, revealing how the future of patient care and treatment is rapidly evolving. Marc also shares insights from his current research in the infectious disease space, including his work with pediatric ICU patients.Chapters:00:00 Introduction00:03 Antibiotic Toxicity and Population Models01:02 The Importance of Antibiotics and Public Health Challenges01:22 Introduction to Pharmacometric Science03:12 Using Data in Medicine for Future Predictions06:01 Tailoring Drug Dosages for Individuals09:36 The Global Variation in Drug Dosages and Challenges14:44 The Future of Personalized Medicine and Precision Dosing21:39 The Intersection of AI, Machine Learning, and Pharmacometrics26:35 The Role of Technology in Medicine30:01 How Dosing Software and AI Are Enhancing Patient Care36:54 Innovation and Research Trends in Medicine- Connect with Marc Sheetz on Twitter: (https://twitter.com/IDPharmacometrics)  - Learn more about Midwestern University: (https://www.midwestern.edu)  - Follow Life Sciences 360 on LinkedIn (https://www.linkedin.com/company/life-sciences-360)--- Subscribe to our podcast for more insights on life sciences: 

Host Maureen A. Madden, DNP, RN, CPNC-AC, CCRN, FCCM, is joined by Michael C. McCrory, MD, MS, FCCM, to discuss a multicenter retrospective study evaluating the impact of neighborhood, as categorized by the Child Opportunity Index, on pediatric intensive care unit (PICU) outcomes such as mortality, illness severity, and PICU length of stay. The study highlights the disparities in PICU admissions based on socioeconomic factors (McCrory MC, et al. Pediatr Crit Care Med. 2024 Apr;25:323-334). Michael C. McCrory, MD, MS, FCCM, is an associate professor in the departments of Anesthesiology and Pediatrics at Wake Forest University School of Medicine in Winston-Salem, North Carolina.

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

When a couple finds themselves aligned in values and begins to take care of themselves, often they're in the position to fulfill dreams and callings in a gorgeous new way. Today we get to talk to Raeanne Newquist who, along with her husband, left a predictable and safe life for a glorious adventure on Mercy Ships, where she and her family got to help save the lives of thousands who get free and life-saving surgeries that will both help them to live as well as prevent them from being ostracized in their communities. Today we get to talk about how Raeanne and her family climbed heights together to find their dreams, as well as to learn about the inspiring outreach of Mercy Ships, endorsed over the last forty years by global leadership, including Nelson Mandela, Tony Blair, and many US leaders as well. Join us as we chat about ways you too can launch to make life changes happen across your part of the world! Watch on YouTube: https://youtu.be/truqwhKM4iM Show Links: Hop aboard by giving, going, or praying for Mercy Ships and the crew! www.MercyShips.com Listen to New Mercies, Raeanne's pod! https://open.spotify.com/show/0f1ocgAAOg6kRNC3xJ1gvy?si=152b5d678cea4279 More info about today's guest plus ways you can help with Mercy Ships amazing mission!! Raeanne, her husband, and 3 children joined Mercy Ships in 2019. After leaving everything behind in Southern California, they boarded the Africa Mercy in Las Palmas and made their first sail down to Dakar, Senegal for their first field service. On board, Raeanne volunteered in the communications department and later in chaplaincy. Currently, Raeanne works in the Mercy Ships U.S. Marketing department. Raeanne is the host of the New Mercies podcast, is the voice of the Mercy Minute daily radio broadcast and serves as a staff writer. Volunteer Each year, more than 3,000 volunteer professionals from over 60 countries serve on board, including surgeons, dentists, nurses, teachers, cooks, engineers, and others who dedicate their time and skills to accelerate access to safe surgical, obstetric and anesthetic care. With the recent addition of the Global Mercy in the last few years, the need for volunteers has increased with immediate needs in Senior Biomed Technician, OR Clinical Supervisor, PACU Nurse + Team Lead, OR Nurse + Team Lead, Ward Nurse in the Adult, Adult ICU, Pediatric, + Pediatric ICU departments, Senior Infection Preventionist, and Wound Care Team Nurse.  Volunteer commitments range from 2 weeks to 2+ years. Learn More: mercyships.org/serve  Facebook Instagram X YouTube Dive deeper into your pairing and Enneagram & Marriage love!

Send us a Text Message.Join us for an awe-inspiring episode of Sirens, Slammers, and Service as we sit down with the incredible Taylor Sullivan, a dedicated Registered Nurse working in the Pediatric ICU and a heroic flight transport nurse for pediatric patients. Taylor shares her compelling journey of providing life-saving care to children across western Canada, navigating challenging rescues, and ensuring her young patients receive the emergency treatment they desperately need.In this heartwarming and at times heart-wrenching episode, Taylor recounts some of her most memorable rescues, from remote northern extractions to high-stakes in-air emergencies and the challenges that arise working in a very small aircraft with limited space and room.Taylor also opens up about the emotional toll of her work, discussing the heartbreaking losses that can come with the job and the profound impact they leave on her. She shares her personal strategies for coping with these challenges, offering insights into the resilience and compassion that drive her every day.Tune in to hear Taylor's extraordinary stories of bravery, compassion, and unwavering dedication to saving young lives. This episode is a tribute to the strength and spirit of healthcare professionals who go above and beyond the call of duty.Don't miss this episode of Sirens, Slammers, and Service – available now on all major podcast platforms.

Dr. Jordan has over 12 years of experience caring for children, training the next generation of PNPs, and conducting research in pediatric injury. He is an Assistant Professor and Coordinator of the Acute Care PNP Track at the UAB School of Nursing and a practicing PNP in the Pediatric ICU at Children's of Alabama.Alexandra Armstrong is an Acute Care Pediatric Nurse Practitioner with over 10 years of experience working at Children's of Alabama in the inpatient and outpatient setting. She is a full-time instructor at the UAB School of Nursing. She is a current PhD student studying medically complex children in foster care, and a foster parent for Jefferson Country DHR. She has an interest in vulnerable and at-risk youth as well as youth with special health care needs.

Nurses Out Loud with Nurse Michele, RN – Mary is among the treasure of nurses with decades of experience who did their research and concluded the mantra of ‘safe and effective' did not outweigh the potential risks of the ‘mandated' EUA product being imposed upon the staff of her Georgia hospital. The Pediatric ICU, housing its fragile patients and parents who look to wise, experienced medical professionals, lost a...

Nurses Out Loud with Nurse Michele, RN – Mary is among the treasure of nurses with decades of experience who did their research and concluded the mantra of ‘safe and effective' did not outweigh the potential risks of the ‘mandated' EUA product being imposed upon the staff of her Georgia hospital. The Pediatric ICU, housing its fragile patients and parents who look to wise, experienced medical professionals, lost a...

Host Elizabeth H. Mack, MD, MS, FCCM, is joined by John Lin, MD, to discuss the transformative impact of the ICU Liberation Bundle (ABCDEF) on caring for critically ill children. This episode delves into the Pediatric Critical Care Medicine article, "Caring for Critically Ill Children With the ICU Liberation Bundle (ABCDEF): Results of the Pediatric Collaborative," exploring the implementation, outcomes, and the potential for enhancing pediatric ICU care (Pedtr Crit Care Med. August 2023; 24(8):636-651). Dr. Lin is Associate Professor of Pediatrics, Critical Care Medicine, and Service Chief for Respiratory Failure and Sepsis in the PICU, as well as the Medical Director of Respiratory Care at St. Louis Children's Hospital in St. Louis, Missouri.

This week I had an informative and fun conversation about money with my guest, nurse, and finance coach, April Waddell. Yes, you heard me right, I said fun. Talking about money can create anxiety in some and I'm no different but April's positive and hopeful spirit helped me keep calm and carry on.After retiring from her work as a Pediatric ICU nurse, April founded Nurse Money Date, a financial coaching business and you'll love hearing the reason behind the name. I never considered seeking out a fellow nurse for financial advice but this may have been a mistake because April helps nurses feel comfortable with money through leveraging their experience in nursing and by using language they understand: the nursing process. And this is genius.April's goal is to uplift nurses financially so they can stay in the profession they love and feel in control of the work they do. In the five-minute snippet: it's a 1970s disco flashback. LinkedInApril's websiteApril's InstagramApril's FacebookMoney Personality QuizContact The Conversing Nurse podcastInstagram: https://www.instagram.com/theconversingnursepodcast/Website: https://theconversingnursepodcast.comGive me feedback! Leave me a review! https://theconversingnursepodcast.com/leave-me-a-reviewWould you like to be a guest on my podcast? Pitch me! https://theconversingnursepodcast.com/intake-formCheck out my guests' book recommendations! https://bookshop.org/shop/theconversingnursepodcast Email: theconversingnursepodcast@gmail.comThank you and I'll see you soon!

In today's episode of Talent Hub Talk, we're joined by Eduardo Ferrao. Eduardo is a Senior Salesforce Healthcare Consultant and has an incredible story from working as a Pediatric ICU Nurse to transitioning into systems and now delivering Salesforce Health Cloud transformations. It was fascinating to hear more about Eduardo and his journey and how he is able to make a difference in the healthcare space. Throughout the episode, Eduardo highlights the importance of soft skills and how his nursing background has been valuable in his consulting role. He explains the potential use cases for Health Cloud in healthcare and the complexities of healthcare projects. The conversation with Eduardo covers the challenges of displaying correct information in digital solutions, the stress and potential adverse outcomes in healthcare, and Eduardo's journey and ability to add value in a different career.   Make sure you're following Eduardo on LinkedIn here, and we hope you enjoy the chat! https://www.linkedin.com/in/eduardo-ferrão-08050123b/   Episode takeaways: Transitioning to a new career is possible by leveraging existing knowledge and skills. Soft skills, such as communication, critical thinking, and adaptability, are transferable and valuable in different industries. Healthcare projects have unique complexities due to the industry's digital maturity, regulatory requirements, and specific integration protocols. Domain knowledge and understanding the language and requirements of healthcare are crucial for successful project implementation. Perspective is gained by comparing the stress and challenges of different roles, putting things into context. Displaying correct information in digital solutions is crucial, especially in healthcare where adverse outcomes can occur if the wrong information is presented. Eduardo Ferrao's journey showcases the ability to transition to a different career while still adding value in the health space. The conversation highlights the importance of sharing stories and experiences to inspire and educate others. Follow us: LinkedIn@ https://www.linkedin.com/company/talent-hub-global/ YouTube@ https://www.youtube.com/@talenthub1140 Facebook@ https://www.facebook.com/TalentHubGlobal/ Instagram @ https://www.instagram.com/talenthubglobal/ Twitter X @ https://twitter.com/TalentHubGlobal

Elizabeth Killien, MD MPH is an Assistant Professor of Pediatrics at the University of Washington and an attending physician in the Pediatric ICU at Seattle Children's. She earned her MD from Dartmouth Medical School in 2011. She completed her residency in General Pediatrics and fellowship in Pediatric Critical Care Medicine at the University of Washington. She underwent additional training in pediatric trauma research at the Harborview Injury Prevention and Research Center in the Pediatric Injury Research Training Program from 2017-2019, and completed her Master of Public Health degree in Epidemiology at the University of Washington in 2019. She is a member of the Society of Critical Care Medicine, Pediatric Acute Lung Injury and Sepsis Investigators, and American Thoracic Society. Her scholarly work focuses on organ failure after traumatic injury and long-term outcomes after critical illness.Learning Objectives:By the end of this podcast, listeners should be able to:Define post-intensive care syndrome, recognize the clinical presentation and make the presumptive diagnosis.Recognize common risk factors of post-intensive care syndrome in children.Discuss practical ways to reduce the risk of post-intensive care syndrome in children admitted to the pediatric ICU.Discuss management strategies to optimize the care provided to children suffering from post-intensive care syndrome.Recall key next steps in post-intensive care syndrome research.How to support PedsCrit:Please rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.References:Manning, Joseph C. RN, PhD1,2,3; Pinto, Neethi P. MD, MS4; Rennick, Janet E. RN, PhD5,6; Colville, Gillian MPhil, CPsychol7; Curley, Martha A. Q. RN, PhD8,9,10. Conceptualizing Post Intensive Care Syndrome in Children—The PICS-p Framework*. Pediatric Critical Care Medicine 19(4):p 298-300, April 2018. | DOI: 10.1097/PCC.0000000000001476 https://www.palisi.org/ Killien EY, Zimmerman JJ, Di Gennaro JL, Watson RS. Association of Illness Severity With Family Outcomes Following Pediatric Septic Shock. Crit Care Explor. 2022 Jun 15;4(6):e0716. doi: 10.1097/CCE.0000000000000716. PMID: 35733611; PMCID: PMC9203075.Smith MB, Killien EY, Dervan LA, Rivara FP, Weiss NS, Watson RS. The association of severe pain experienced in the pediatric intensive care unit and postdischarge health-related quality of life: A retrospective cohort study. Paediatr Anaesth. 2022 Aug;32(8):899-906. doi: 10.1111/pan.14460. Epub 2022 Apr 22. PMID: 35426458; PMCID: PMC9990726.Support the show

Elizabeth Killien, MD MPH is an Assistant Professor of Pediatrics at the University of Washington and an attending physician in the Pediatric ICU at Seattle Children's. She earned her MD from Dartmouth Medical School in 2011. She completed her residency in General Pediatrics and fellowship in Pediatric Critical Care Medicine at the University of Washington. She underwent additional training in pediatric trauma research at the Harborview Injury Prevention and Research Center in the Pediatric Injury Research Training Program from 2017-2019, and completed her Master of Public Health degree in Epidemiology at the University of Washington in 2019. She is a member of the Society of Critical Care Medicine, Pediatric Acute Lung Injury and Sepsis Investigators, and American Thoracic Society. Her scholarly work focuses on organ failure after traumatic injury and long-term outcomes after critical illness.Learning Objectives:By the end of this podcast, listeners should be able to:Define post-intensive care syndrome, recognize the clinical presentation and make the presumptive diagnosis.Recognize common risk factors of post-intensive care syndrome in children.Discuss practical ways to reduce the risk of post-intensive care syndrome in children admitted to the pediatric ICU.Discuss management strategies to optimize the care provided to children suffering from post-intensive care syndrome.Recall key next steps in post-intensive care syndrome research.How to support PedsCrit:Please rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.References:Manning, Joseph C. RN, PhD1,2,3; Pinto, Neethi P. MD, MS4; Rennick, Janet E. RN, PhD5,6; Colville, Gillian MPhil, CPsychol7; Curley, Martha A. Q. RN, PhD8,9,10. Conceptualizing Post Intensive Care Syndrome in Children—The PICS-p Framework*. Pediatric Critical Care Medicine 19(4):p 298-300, April 2018. | DOI: 10.1097/PCC.0000000000001476 https://www.palisi.org/ Killien EY, Zimmerman JJ, Di Gennaro JL, Watson RS. Association of Illness Severity With Family Outcomes Following Pediatric Septic Shock. Crit Care Explor. 2022 Jun 15;4(6):e0716. doi: 10.1097/CCE.0000000000000716. PMID: 35733611; PMCID: PMC9203075.Smith MB, Killien EY, Dervan LA, Rivara FP, Weiss NS, Watson RS. The association of severe pain experienced in the pediatric intensive care unit and postdischarge health-related quality of life: A retrospective cohort study. Paediatr Anaesth. 2022 Aug;32(8):899-906. doi: 10.1111/pan.14460. Epub 2022 Apr 22. PMID: 35426458; PMCID: PMC9990726.Support the show

Does this sound familiar? You're facing personal crises that are wreaking havoc on your well-being and your business. You've been told to tough it out and push through, but deep down, you know that approach isn't working. The pain of trying to handle it all alone is taking a toll on your mental and emotional health, leaving you feeling overwhelmed and burnt out. It's time to acknowledge the importance of seeking support during these difficult times and discover how it can empower you to navigate personal crises while maintaining success in your business.   Meet Kristin: Kristin Bentley is the founder and CEO of Elisely Publishing, a boutique traditional publishing house that launches changemakers with bold, uninhibited stories into bestselling authors. She is also an award-winning USA Today bestselling author and International Books for Peace Ambassador who has been in the writing industry for over 20 years. Her background includes experience as a journalist, recognition as the award-winning Editor-in-Chief of the National Infantry Association's official magazine, a nonprofit founder that supported women of the military in the Pacific Northwest, a creative executive for a startup that provided services to companies such as Hilton and US Foods, and the creative director behind the creation and launch of six successful global publications—one distributed to nominees of the 2021 Oscars & Grammys. Connect with Kristin: https://www.elisely.com/  hello@elisely.com

In this episode of PICU Doc On Call, your hosts Pradip Kamat and Rahul Damania, experienced Pediatric ICU physicians, take you on an enlightening journey through the intricate landscape of lactic acidosis. Join us as we unravel the complexities, share clinical insights, and provide practical guidance on diagnosing and managing this critical condition in the acute care pediatric setting.You will hear:Case Presentation:4-year-old boy with hypotension, fatigue, rash, and respiratory distressRecent COVID-19 exposure, concerning respiratory symptomsHypotensive, tachycardic, tachypneic, low pulse oximetry readingSwollen red lips, erythematous rash, hepatomegalyHigh-flow nasal cannula, resuscitation, epinephrine infusionInitial arterial blood gas: pH 7.22, lactate 4.5 mMol/LDefinition of Lactic Acidosis:Hyperlactatemia and lactic acidosis criteriaCauses: impaired tissue oxygenation or mitochondrial dysfunctionTypes of Lactic Acidosis:Type A: Impaired O2 delivery, shock-relatedType B: Impaired O2 utilization, toxins, infectionsLactate Measurement:Comparability between POCT and central lab analysisRole of lactate measurement in pediatric sepsisLactic Washout:Rising lactate with re-established oxygen deliveryImpaired clearance in microcirculation, liver, kidneyMonitoring trends with clinical exams and lab surrogatesBicarbonate Therapy:Role in Type A lactic acidosisControversy, indications, and potential complicationsConclusion:PICU Doc On Call podcast explores the intriguing case of a 4-year-old boy with lactic acidosis, highlighting the clinical intricacies of diagnosing and managing this condition. The hosts, Pradip Kamat and Rahul Damania provide insightful discussions on the different types of lactic acidosis, the physiological mechanisms behind it, and the role of bicarbonate therapy. The episode emphasizes the importance of addressing underlying causes and offers valuable clinical pearls for managing pediatric patients with lactic acidosis.Stay tuned for more engaging episodes from PICU Doc On Call! Don't forget to subscribe, share your feedback, and review the podcast on your preferred platform. For more information and resources, visit picudoconcall.org.

Each week, I usually find one main takeaway point from the podcast episode. After talking with Chris though, I learned two key things. As much as I tried to get it down to one point, I couldn't leave one out. They were both equally important. The first lesson Chris learned many years before she even had Becca, she was in the Pediatric ICU with one of the cardiac children that her family fostered from Korea. While there, Chris witnessed a family with a perfectly healthy child who went in for what was supposed to be a very simple medical procedure that resulted in many complications eventually leading to severe, irreversible brain damage. As Chris sat witnessing this horror, she found herself asking the question, 'Why?" As she pondered, Chris realized that she would never be able to answer that question and that it was not worth her time to even ask it. This was tremendously helpful to Chris later in life when raising many children with congenital heart disease, and even more so, after she lost her sweet daughter, Becca. The second lesson that Chris learned was much further into her grief journey. Chris found that in these last few years without Becca, she was becoming tired of her grief, and maybe even a little angry with grief. She felt like grief was her enemy, affecting her life negatively. She then had a profound thought. She had heard many people say over the years that grief is love. This definitely felt like a true statement. Certainly, the reason that she grieved her daughter so much was because of her overwhelming love for Becca. Chris thought, 'If grief is a manifestation of this love, then maybe grief misses Becca, too. Maybe grief shouldn't be my enemy. Maybe grief can be my friend.'  What a life-changing realization. Now, the challenges that I am giving to myself are to:  1.) Stop asking 'why' all of this has happened to Andy and my family, and 2.) Think of my grief as a 'friend' to keep beside me, not an enemy to hold at bay.

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

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

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

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

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

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

Casey is joined by pediatric ICU nurse, Kelsey Robison. Join them as they talk about the hardships, joys and hidden miracles working with kiddos in the ICU setting. The Lord can answer prayers and bring blessings in ways you might not realize. Plus you WON'T want to miss Kelsey's prescription for well being! Follow me on Instagram: @wellbeing.podcast @if.thats.the.case

On Friday's show: Hospitals in Texas and Greater Houston are facing a shortage of pediatric ICU beds. We learn why and discuss how family gatherings next week for Thanksgiving might exacerbate that. Also this hour: Columnist Dwight Silverman talks about recent developments in consumer technology. Then, we break down The Good, The Bad, and The Ugly of the week. And we talk with local chef and restauranteur Victoria Elizondo about her new taco cookbook, Taco-Tastic: Over 60 Recipes to Make Taco Tuesday Last All Week Long.

Pediatric ICU capacity is at or beyond its limits, and parents aren't far behind. Why is illness on the rise for kids across the province? For insight we welcome: Dr. Rod Lim, Site-Chief of the Paediatric Emergency Department at the Children's Hospital at London Health Sciences Centre, and an associate professor at Western University; and former director of the COVID-19 Science Advisory Table, Dr. Fahad Razak, who is an internist at St Michael's Hospital and assistant professor at the University of Toronto.See omnystudio.com/listener for privacy information.

Mychal Pilia's educational background includes a bachelor's in nutrition, bachelor's in Nursing, and a Masters in Nursing Midwifery. She has worked as a chef in various settings, then had a career as a Pediatric ICU nurse for 6 years. For the past 7 years she was catching babies as a nurse midwife. Last September she closed her birth center practice to pursue what God has called her to be and to do as a mother, a healer of hearts, and a protector of the innocent. #midwife #doula #midwifery #birth #pregnancy #homebirth #pregnant #baby #naturalbirth #newborn #childbirth #nurse #breastfeeding #postpartum #birthwithoutfear #midwifelife #midwives #waterbirth #motherhood #childbirtheducation #studentmidwife #empoweredbirth #birthdoula #hypnobirthing #bidan #laboranddelivery #midwiferycare #love #prenatal #obgyn --- Send in a voice message: https://podcasters.spotify.com/pod/show/alex-maison-podcast/message

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

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

Mychal Pilia's educational background includes a bachelor's in nutrition, bachelor's in Nursing, and a Masters in Nursing Midwifery. She has worked as a chef in various settings, then had a career as a Pediatric ICU nurse for 6 years. For the past 7 years she was catching babies as a nurse midwife. Last September she closed her birth center practice to pursue what God has called her to be and to do as a mother, a healer of hearts, and a protector of the innocent. #midwife #doula #midwifery #birth #pregnancy #homebirth #pregnant #baby #naturalbirth #newborn #childbirth #nurse #breastfeeding #postpartum #birthwithoutfear #midwifelife #midwives #waterbirth #motherhood #childbirtheducation #studentmidwife #empoweredbirth #birthdoula #hypnobirthing #bidan #laboranddelivery #midwiferycare #love #prenatal #obgyn --- Send in a voice message: https://podcasters.spotify.com/pod/show/alex-maison-podcast/message

Mychal Pilia's educational background includes a bachelor's in nutrition, bachelor's in Nursing, and a Masters in Nursing Midwifery. She has worked as a chef in various settings, then had a career as a Pediatric ICU nurse for 6 years. For the past 7 years she was catching babies as a nurse midwife. Last September she closed her birth center practice to pursue what God has called her to be and to do as a mother, a healer of hearts, and a protector of the innocent. #midwife #doula #midwifery #birth #pregnancy #homebirth #pregnant #baby #naturalbirth #newborn #childbirth #nurse #breastfeeding #postpartum #birthwithoutfear #midwifelife #midwives #waterbirth #motherhood #childbirtheducation #studentmidwife #empoweredbirth #birthdoula #hypnobirthing #bidan #laboranddelivery #midwiferycare #love #prenatal #obgyn --- Send in a voice message: https://podcasters.spotify.com/pod/show/alex-maison-podcast/message

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

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

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

In this Fight Back episode, we welcome Dr. Howard Zucker, former New York State Public Health Commissioner who led New York through the initial impact of COVID-19. He has held public health positions at the state, federal, and international levels and academic appointments at the Yale, Columbia, and Albert Einstein medical schools. He served as head of the Pediatric ICU at New York Presbyterian Hospital and was a research affiliate at MIT.Dr. Zucker shares New York's experience as the first hot spot for COVID-19, dealing with shutdowns, masks, vaccines, and overrun emergency rooms. Join us as we look back at the start of COVID-19 in New York and how local, state, and federal governments interfaced with the healthcare system.

This week on the podcast we have Tammi Boswell, MSN, NNP-BC. She graduated from East Carolina University 1992-BSN, at that time she worked one year in Pediatric ICU, then four years NICU RN, followed by six years NICU FLIGHT RN (1yr co director). During her graduate program at SUNY-STONYBROOK she finished her MSN-NNP in 2002 while giving birth to three of her own babies. She has worked for 15 years as staff NNP Level III/IV NICU and currently has worked for the last six years as a LOCUMS and Local PRN NNP! Neonatal NP's are advanced practice registered nurses (APRN) that help provide care to high-risk newborn infants who require postnatal care due to low birth weights, heart abnormalities, infections and other complications. Doctor Nurse Links: https://linktr.ee/DoctorNursePodcast Wanna start a side hustle? Subscribe to the Doctor Nurse Podcast and I will show you how to start: https://view.flodesk.com/pages/625318... Networth Nurse Course: https://networthnurse.co/courses/ Tammi's Links: Follow Tammi on Instagram @nurse2nnp https://www.linkedin.com/in/tammi-boswell-msn-aprn-nnp-bc-4b93b229/

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

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

Introducing Avery...you see Avery's name used to be Heather!  Heather was working as an RN and was working loooong shifts.  Christmas morning of 2018, the Charge Nurse, of the pediatric ICU, "commanded" her to go home saying she didn't look too well.  Heather would find herself so sick that she was bedridden. Heather was newly married and "In sickness and in health" came a lot soon than either of them had expected!  Heather officially had a chronic illness and disability overnight.  Heather mourned the loss of who she used to be.  She decided two years later to make a fresh start and changing her name felt right.  After sifting through baby names, the one that stood out to her was Avery.  Fast forward to current day Avery is going through the legal process to be Avery officially and feels as though she has truly found herself!  Avery now helps highly sensitive people prevent and reverse the negative health effects of stress. Full Show Notes