PEM Rules

Newborns are small and examining them the “right way” does not take much and is worth doing, and why it is important (and helpful) to look at Pediatric Emergency Medicine as Simple.

The further away I am from my general pediatric training the more I forget how to manage chronic complaints and “primary care like” presentations. That is why I brought Dr. Noah Makovsky again to help us (PEM clinicians) do a better job with those patients.

Sometimes enemas are not just for treatment only. Why is it important to keep making decision and not dwell and contemplate for too long and what is the best thing to do after intubations.

We all meet some people in our life that inspire us to do better. For me Dr. Ellen Fitzpatrick is one of those people. Listen to her truly amazing life story.

Why is it useful to sometimes “consult” with your patient’s parents. What tests you should really never do and why cant we just make everyone happy

In this new segment of PEM Rules Dr. Jay Fisher, who has been practicing PEM since 1992 came back to discuss intussusception and how can we all do a better job identifying those children among the see of children with constipation.

With the exception of corneal abrasions and conjunctivitis, ophthalmological presentations always make me a bit nervous. That is why I invited Dr. Mitchell Strominger to talk about some common ophthalmological emergencies. Please consider contributing to PEM Rules at https://ko-fi.com/pemrules And check out www.pemrules.com Copyright PEM Rules LLC DISCLAIMER By listening to this podcast, you agree not to use these resources as medical advice to treat any medical conditions in either yourself or others, including, but not limited to, patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast or website. Under no circumstances shall PEM Rules, the PEM Rules podcast or any guests or affiliated entities be responsible for damages arising from their use. This podcast should not be used in any legal capacity whatsoever, including, but not limited to, establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the website or in the podcast.

Distracting injuries can be tricky but should always be taken into account. What should you think about in a child with LLQ abdominal pain and odd Neurological complaints and more about giving yourself a break.

Thank you all for listening and supporting PEM Rules. I will be taking a short winter break to collect more material and enjoy the cold Nevada Winter (which I love). PEM Rules will be back in four weeks with more information, more medicine, more rules and, of course more music.

I (finally) got a pediatric surgeon to come and talk on the show. Most importantly I was curious to know what he thinks about my Rule of 6. Listen to Dr. Erik Pearson and his wonderful advice. Here is the link to Erik's Website https://www.citizensurgeon.com/recourses consider contributing to PEM Rules at https://ko-fi.com/pemrules And check out www.pemrules.com Copyright PEM Rules LLC DISCLAIMER By listening to this podcast, you agree not to use these resources as medical advice to treat any medical conditions in either yourself or others, including, but not limited to, patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast or website. Under no circumstances shall PEM Rules, the PEM Rules podcast or any guests or affiliated entities be responsible for damages arising from their use. This podcast should not be used in any legal capacity whatsoever, including, but not limited to, establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the website or in the podcast.

How prepared should you be? Maybe Over-prepared? What to do with your trainees and why it wise to buy time (if you can).

It seems to me that due to the obesity epidemic more and more children suffer from "adult problems" such as Type 2 diabetes, hypertension etc. That is why I decided to bring Seth Ball, a PEM physician who is also trained in General EM to the show to discuss the management of those children. Please consider contributing to PEM Rules at https://ko-fi.com/pemrules And check out www.pemrules.com Copyright PEM Rules LLC DISCLAIMER By listening to this podcast, you agree not to use these resources as medical advice to treat any medical conditions in either yourself or others, including, but not limited to, patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast or website. Under no circumstances shall PEM Rules, the PEM Rules podcast or any guests or affiliated entities be responsible for damages arising from their use. This podcast should not be used in any legal capacity whatsoever, including, but not limited to, establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the website or in the podcast.

So apparently I am not the only one with "rules". Dr. Rammy Assaf contacted me via the PEM Rules website and wanted to share some of the rules and wisdom he has learned over the year. Thank you Rammy for coming on the show and sharing you knowledge.

The goal of our long (and exhausting) training is to find the ultimate job. Here are some tips from Dr. Rick Saladino (my fellowship mentor and the inspiration behind PEM Rules) on the process.

What is the “best way” to take history, talking about patients expectations and what you must do before calling your consultants.

Children with Neurological complaints represent a significant portion of what we see in the Peds ED. From Status Epilepticus to febrile seizures to the child who (maybe) had a seizure at home. This is a discussion I had with Dr. Amy Goldstein, a Pediatric Neurologist at CHOP. Please consider contributing to PEM Rules at https://ko-fi.com/pemrules And check out www.pemrules.com Copyright PEM Rules LLC DISCLAIMER By listening to this podcast, you agree not to use these resources as medical advice to treat any medical conditions in either yourself or others, including, but not limited to, patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast or website. Under no circumstances shall PEM Rules, the PEM Rules podcast or any guests or affiliated entities be responsible for damages arising from their use. This podcast should not be used in any legal capacity whatsoever, including, but not limited to, establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the website or in the podcast.

There are many “unanswered” questions in Pediatric EM where the scientific literature does not have a good, definitive answer. Whether to use or not to use steroids in anaphylaxis is one of them. Sophia Wang (our PEM fellow from previous episodes) looked into it. Here are some of the articles Sophia used in her research Alqurashi W, Ellis AK. Do Corticosteroids Prevent Biphasic Anaphylaxis?. J Allergy Clin Immunol Pract. 2017;5(5):1194-1205. doi:10.1016/j.jaip.2017.05.022 Gaffney LK, Porter J, Gerling M, Schneider LC, Stack AM, Shah D, Michelson KA. Safely Reducing Hospitalizations for Anaphylaxis in Children Through an Evidence-Based Guideline. Pediatrics. 2022 Feb 1;149(2):e2020045831. doi: 10.1542/peds.2020-045831. PMID: 35059724; PMCID: PMC9250079. Lieberman P, Nicklas RA, Randolph C, et al. Anaphylaxis--a practice parameter update 2015. Ann Allergy Asthma Immunol. 2015;115(5):341-384. doi:10.1016/j.anai.2015.07.019 Michelson KA, Dribin TE, Vyles D, Neuman MI. Trends in emergency care for anaphylaxis. J Allergy Clin Immunol Pract. 2020;8(2):767-768.e2. doi:10.1016/j.jaip.2019.07.018 Shaker MS, Wallace DV, Golden DBK, et al. Anaphylaxis-a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis. J Allergy Clin Immunol. 2020;145(4):1082-1123. doi:10.1016/j.jaci.2020.01.017 Please consider contributing to PEM Rules at https://ko-fi.com/pemrules And check out www.pemrules.com Copyright PEM Rules LLC DISCLAIMER By listening to this podcast, you agree not to use these resources as medical advice to treat any medical conditions in either yourself or others, including, but not limited to, patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast or website. Under no circumstances shall PEM Rules, the PEM Rules podcast or any guests or affiliated entities be responsible for damages arising from their use. This podcast should not be used in any legal capacity whatsoever, including, but not limited to, establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the website or in the podcast.

Sometimes it is good to give your patients (or parents) some options regarding their care (some people call it shared decision making). How a short conversation can help you better understand your patients and their needs.

After many months of work and some requests I am excited to open my online PEM Rules Store where listeners can order some fun PEM Rules merchandise. Please click the link below to check out the store and maybe purchase a T-shirt, a hat or whatever product you like. Thank you for all the support, the downloads, comments and requests. Yaron Ivan PEM Rules Online Store. https://www.redbubble.com/shop/ap/164385928 www.pemrules.com

Every once in a while I meet a physician who does a great job “taking care of himself / herself”. He or she are engaged in multipule activities or hobbies and don’t seem to be suffering “burnout”. Listen to my discussion with Dr. Snow and his advice on how to achieve wellness.