Agitation in Neurodivergent Children

“Neurodivergent” is a term used to describe brain functionality and how it differs in some people. These individuals perceive, interpret and interact with the world in ways that are different than what we typically encounter. The Emergency Department is a potentially challenging and stressful place for Neurodivergent children, and this episode discusses strategies to help make their experience just a little bit better.

This episode features the talents of Ilene Claudius, MD, the Director of Quality and Process Improvement for the Emergency Department at and Alice Kuo, MD, Professor and Chief of Medicine-Pediatrics and Preventive Medicine – both at UCLA.

It is also a co-production of the Emergency Medical Services for Children Innovation and Improvement Center whose mission is to minimize morbidity and mortality of acutely ill and injured children across the EMS for children continuum.

To learn more about the Emergency Medical Services for Children Innovation and Improvement Center visit


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Contact Ilene Claudius, MD

Contact Alice Kuo, MD


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EMSC IIC Pediatric Education and Advocacy Kit (PEAK): Agitation

De-escalation tips for pediatric agitation: EMSC Innovation & Improvement Center


The Emergency Medical Services for Children Innovation and Improvement Center is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award (U07MC37471) totaling $3 million with zero percent financed with nongovernmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit



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. This episode, brought to you by yours truly and Barrett Burger, a Medicine-Pediatrics Resident from the University of Arkansas focuses on delirium and confusional states and delivers some sound advice on how to address the confused patient. Though this is geared towards the care of adults there are some great pearls to help with patients of any age.

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Things We Do for No Reason: Neuroimaging for Hospitalized Patients with Delirium. J. Hosp. Med. 2019 July;14(7):441-444. March 20, 2019. | DOI 10.12788/jhm.3167

Inouye SK. The dilemma of delirium: clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalized elderly medical patients. Am J Med 1994; 97:278.

Inouye S, Westendorp R, Saczynski J. Delirium in elderly people. Lancet. 2014;383(9920):911-922.

Marcantonio. Delirium in Hospitalized Older Adults, NEJM, 2017.

Setters B, Solberg LM. Delirium. Prim Care 2017; 44:541.

Shenvi. Assessing and Managing Delirium and Older Adults. Academic Life in Emergency Medicine. July 25, 2015. Accessed June 7, 2020.



Factor First!

OK, did I get your attention? Hopefully I did, because giving replacement factor to children with hemophilia presenting to the Emergency Department as soon as possible is the most important thing that you can do to positively impact outcomes. This episode of PEM Currents focuses on the different bleeding complications seen in Hemophilia and Von Willebrands and reviews basic management. There is a companion post on that has more detailed information that you should check out as well.

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I am proud to offer CME for this podcast episode through Cincinnati Children’s. To claim CME & ABP MOC Part 2, visit Cincinnati Children’s Online Courses and search ‘PEM Currents’.


Di Michele D, Neufeld EJ. Hemophilia: a new approach to an old disease. Hematol Oncol Clin North Am. 1998;12(6):1315- 1344.

Di Michele D. Inhibitor treatment in haemophilias A and B: inhibitor diagnosis. Haemophilia. 2006;12(Suppl 6):37-42.

Labarque V, Stain AM, Blanchette V, et al. Intracranial haem- orrhage in von Willebrand disease: a report on six cases. Heamophilia. 2013;19(4):602-606.

Melchiorre D, Linari S, Innocenti M, et al. Ultrasound detects joint damage and bleeding in haemophilic arthropathy: a proposal of a score. Haemophilia. 2011;17(1):112-117.

Nagel K, Pai MK, Paes BA, et al. Diagnosis and treatment of intracranial hemorrhage in children with hemophilia. Blood Coagul Fibrinolysis. 2013;24(1):23-27. 

Oren H, Yaprak I, Irken G. Factor VIII inhibitors in patients with hemophilia A. Acta Haematologica. 1999;102(1):42-46.

Schwartz et al. Hemophilia And Von Willebrand Disease In Children: Emergency Department Evaluation And Management. EB Medicine, 2015.

Witmer C, Presley R, Kulkarni J, et al. Associations between intracranial haemorrhage and prescribed prophylaxis in a large cohort of haemophilia patients in the United States. Br J Haematol. 2010;152(2):211-216. 

Witmer CM, Raffini LJ, Manno CS. Utility of computed tomography of the head following head trauma in boys wth haemophilia. Haemophilia. 2007;13(5):560-566. 



I never thought that this particular disease would make a comeback in the United States. But here we are. Measles. As of May 2019 there have been cases reported in over 20 states. Declining vaccine rates and international travel to areas with local measles epidemics have led to a sharp rise in the number of cases in the US. The goal of this epode of PEM Currents is to discuss the diagnosis, treatment and prevention of measles, as well as how you can recognize it and appropriately diagnose and report cases.

You should definitely check out the following resources – since measles is a visual illness with a memorable rash (not that most of us have actually seen it). as well as learn about local hospital and health department procedures for treating, isolating and reporting confirmed and suspected cases.

Check out PEMBlog for more great educational content.

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CDC – Measles (Rubeola) – Main Page

CDC – Photos of People With Measles

CDC – Measles Cases and Outbreaks

AAP – RedBook Measles


Otitis Externa

With summer pool season in full swing allow me to freestyle a little on a common topic that many Emergency Departments and Urgent Cares seem to be swimming in every summer. This episode of PEM Currents dives right into Otitis  Externa – AKA Swimmer’s Ear and reviews diagnosis and treatment. If you were treading water and looking for this topic the wade is over.



Beers SL, Abramo TJ. Otitis externa review. Pediatr Emerg Care. 2004;20(4):250.

Osguthorpe JD, Nielsen DR. Otitis externa: Review and clinical update.. Am Fam Physician. 2006;74(9):1510.

Roland PS, Younis R, Wall GM. A comparison of ciprofloxacin/dexamethasone with neomycin/polymyxin/hydrocortisone for otitis externa pain. Adv Ther. 2007;24(3):671.

Rosenfeld RM, Singer M, Wasserman JM, Stinnett SS. Systematic review of topical antimicrobial therapy for acute otitis externa. Otolaryngol Head Neck Surg. 2006;134(4 Suppl):S24. 

Russell JD, Donnelly M, McShane DP, Alun-Jones T, Walsh M. What causes acute otitis externa?J Laryngol Otol. 1993;107(10):898.


Respiratory Distress

Take a deep breath and PEEP this – PEM Currents, the Pediatric Emergency Medicine podcast proudly brings you an episode dedicated to the initial assessment and management of respiratory distress. Whether you’ve been practicing in the field for 20 years or are fresh out of medical school it is important to recognize key symptoms in children with difficultly breathing, and to avoid delaying essential supportive care.


Upper Gastrointestinal Tract Bleeds

This episode focuses on upper GI bleeds. Serious UGI bleeds – you know, the ones with shock, massive transfusions and more – are fortunately rare in the Pediatric Emergency Department. However, there is a growing population of patients with chronic diseases that can lead to portal hypertension, varies and other causes of bleeding from the upper GI tract.



With the recent influenza epidemic you may have also seen a rise in the number of cases of parotitis. This should not be a surprise, as acute parotitis is usually viral, self-limited and treated with supportive measures – just like the flu! Learn more by listening to this edition of PEM Currents, which is all about acute parotitis.


Topical Anesthetics

PEM Currents returns with a look at topical anesthetics used in the Emergency Department. Specifically this edition of the podcast will focus on LET, EMLA and LMX and discuss typical use.


Convulsive syncope

Don’t swoon with excitement because the latest episode of PEM Currents, the Pediatric Emergency Medicine podcast is here! The focus is on convulsive syncope – essentially patients who faint and have movements that could be construed as seizures. You’ll learn how common convulsions with syncope are and what to do if you encounter them in the Emergency Department.