Categories
Resuscitation

Pulmonary Embolism

Yes, PEM Currents is a Pediatric Emergency Medicine podcast, but during the COVID-19 pandemic we may be tasked with seeing patients outside of our area of expertise. Plus, there’s a lot we can learn from big people that we can extrapolate to children. I have partnered with POPCoRN, the Pediatric Overflow Planning Contingency Response Network to deliver content that will benefit those of us who may have been asked to care for adults both in their native habitat, and in our pediatric facilities. David Shore, a 4th year Internal Medicine/Pediatrics Resident from Penn State delivers some timely content on PE diagnosis and management, including an instructive case of a young adult that is very applicable to the Pediatric Emergency Department in this brief, focused episode.

References

Aujesky et al. Outpatient versus inpatient treatment for patients with acute pulmonary embolism: an international, open-label, randomised, non-inferiority trial. Lancet. 2011 Jul 2;378(9785):41-8. doi: 10.1016/S0140-6736(11)60824-6. Epub 2011 Jun 22.

Aujesky et al. Derivation and validation of a prognostic model for pulmonary embolism. Am J Respir Crit Care Med. 2005 Oct 15;172(8):1041-6. Epub 2005 Jul 14.

Kline et al. Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. J Thromb Haemost 2004; 2: 1247–55.

Stein et al. Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. Chest. 1991;100(3):598.

Wells et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med. 2001 Jul 17;135(2):98-107. PubMed PMID: 11453709.

Categories
Resuscitation

Vasopressors

Vasopressor use in the Pediatric Emergency Department has been a moving target for my entire career. Back when I was a resident and fellow we used Dopamine. Then we went to epinephrine because it can be given through a peripheral IV because norepinephrine was too dangerous to run peripherally. But maybe that’s not entirely true. I talked about initial pressor choice and more in a recent recorded Zoom conference call with Critical Care Attending Matt Zackoff from Cincinnati Children’s. I hope you find his thoughts on vasopressor selection, pitfalls, and the emerging therapies as illuminating as I did.

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References

Sadoway et al. A systematic review of local complications from central and peripheral administration of vasopressors in the pediatric population. Canadian Journal of Emergency Medicine, 2019.

Surviving Sepsis Campaign: Initial Algorithm for Children

Weiss et al. Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children.Pediatr Crit Care Med. 2020;21(2):e52. 

Categories
Resuscitation

Anaphylaxis: Admit or Discharge?

You will no doubt see a child with anaphylaxis in the Emergency Department. Recognition, management and disposition are all key questions that feel incredibly fluid at this juncture. I had the pleasure of interviewing Tim Dribin, an Emergency Medicine Attending from Cincinnati Children’s who recently published a paper in PLUS ONE focusing on admissions for children with anaphylaxis. Should we move the observation time from four to two hours? Who is most at risk for biphasic reaction? And how can we use data form kids that were admitted, and received no interventions, to inform practice in the ED?

Read the article from Dribin et al. right here! 

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References

Dribin TE, Michelson KA, Monuteaux MC, Stack AM, Farbman KS, et al. (2019) Identification of children with anaphylaxis at low risk of receiving acute inpatient therapies. PLOS ONE 14(2): e0211949. 

Categories
Resuscitation

Hyperkalemia

Hyperkalemia is more than just peaked T-waves on an EKG. Learn why an elevated serum potassium level can put patients in the danger zone and how to acutely manage patients in a goal directed manner.

Check out more great educational content on PEMBlog.com

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Categories
Podcast Resuscitation

Rapid Sequence Intubation

This episode of PEM Currents, featuring Preston Dean – @prestonndean on Twitter, a senior Pediatric Resident at Cincinnati Children’s, is about all things Rapid Sequence Intubation. You’ll learn about equipment, techniques, drugs and more!

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Categories
Podcast Resuscitation Trauma

Management of Elevated ICP

Get ahead of your peers and listen to this episode of PEM Currents, the Pediatric Emergency Medicine podcast where you’ll learn all about the management of acutely elevated intracranial pressure. You’ll learn about common maneuvers such as optimizing the ABCs, Keeping the head elevated and midline as well as thermoregulation. I also discuss osmotic therapies and make the case for one agent versus another.

As always you can check out more great educational content at PEMBlog.com

Categories
Podcast Respiratory Resuscitation

Interview with Ben Kerrey about Pediatric Rapid Sequence Intubation

Ben Kerrey is a rising star in Pediatric Emergency Medicine and is the point man for an ongoing initiative at Cincinnati Children’s centered around improving safety and limiting complications during rapid sequence intubation. I recently sat down with Ben to talk about the state of RSI in pediatric patients, the difference between a checklist and a a true cognitive aid, the role of residents during RSI and more.

You can check out several related articles right here – all provided by Dr. Kerrey.

Categories
Resuscitation Trauma

Heat Illness

The heat is on! With warm weather comes a plethora of heat-related problems in the ED. That’s why I’m sharing this edition of PEM Currents, the Pediatric Emergency Medicine Podcast. The focus is on heat illness in its many forms. Learn about everything from the benign prickly heat, to life threatening heat stroke. Stay cool and learn something all right?

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Read more at PEMBlog.com