PEM Rules

In this new (not so new anymore) segment of PEM Rules Dr. Jay Fisher, who has been practicing PEM since 1992 came back to discuss an interesting case of something we don't see very often in the Peds ER and NEVER want to miss.

Despite working in a very busy Pediatric Emergency Department, Urological emergencies are not too common and often those patients challenge us. That is why I invited Dr. Jessica Casey whom I sometimes consult from the Pediatric ER to talk about common urological emergencies. Here are two links Jessica recommends us PEM providers Article on Priapism in children https://pubmed.ncbi.nlm.nih.gov/24135215/ The TWIST score calculator. https://www.mdcalc.com/calc/10440/testicular-workup-ischemia-suspected-torsion-twist 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.

Good rule for physical exam, why seeing patients in fast track is so important (as a trainee or an attending) and what I think of blood pressure in pediatric patients.

It is not often that I see a child with possible rheumatologic disease in the pediatric ER. What to ask, what to check for and what labs to order are always important things to think about. That is why I asked Dr. Robert Lowe to come on the show and discuss the management of those patients. Dr. Lowe Advice on Labs to order when suspecting Rheumatological condition: For suspected JIA. Most important to confirm joint swelling on physical exam AND a history of one or more joints being swollen continuously for 6 weeks or longer. Systemic JIA (only 15% of kids with JIA) ESR and CRP are both elevated like you would see with an infection or with inflammatory bowel disease with the added presence of significant joint swelling and daily recurring high fevers (>102F usually) without other symptoms of infection for Systemic JIA. For other systemic autoimmune disease High ESR with normal or near normal CRP can suggest the presence of another systemic autoimmune disease such as SLE Dont order ANA and instead check ONLY the following: 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.

What should your next step be if your screening tests are negative. How worried should you be about child abuse in the setting of a femur fracture and when to pay attention to the exceptions. Here is the link to the study I refer to in the episode. https://pubmed.ncbi.nlm.nih.gov/20373153/ Please consider contributing to PEM Rules at https://ko-fi.com/pemrules And check out www.pemrules.com and the PEM Rules Store at https://www.redbubble.com/shop/ap/164385928 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.

ENT related illness are very high on the list of conditions I treat from the mild AOM or Strep Pharyngitis and beyond. That is why I asked Dr. Jeremy Prager to come on PEM Rules and discuss some common ENT related problems.

Why is it important to leave your shift with NO unresolved issues. How to advance your education and be your own best advocate and what is an important questions on any afebrile (or febrile) child.

Listen to the discussion I had with EM physician Dr. Patricia Capone and PEM physician Delia Gold from Nationwide children's Hospital about the field of Pediatric EM and what advice we, PEM specialists, have for the medical students, residents and anyone who is "scared" of children

We heavily relay on radiologists these days so why not helping them out and making it easy for them to help you? What to be aware of when you are ordering tests on your patients and a bit about X ray views.

Probably one of the most important (and most challenging) situation in PEM is how do we identify the child with none accidental trauma among the see of true / innocent accidental injuries. That is why I asked Toni Laskey, a child abuse physician in Utah to come and talk about this very important topic.

Sometimes it is worth going the extra mile in order to (maybe) prevent the next ED visit. Always try to take the Chief Complaint seriously though it is not always as easy as it sounds and why it is important to validate the parents or patient's concerns Please consider contributing to PEM Rules at https://ko-fi.com/pemrules And check out www.pemrules.com and the PEM Rules Store at https://www.redbubble.com/shop/ap/164385928 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.

Trauma is often scary and small children may be intimidating. Admitting to this is a good first step. In this Episode Dr. Nir Samuel and I talk about how to fall on our feet, get better about treating injured children (or at least effectively cheat!)

Dr. Jay Fisher is back on PEM Rules to discuss his experience with Bacterial Meningitis, a rare (and terrible) condition that is high on my list of "I Never Want to Miss It". Here are the articles Jay discussed: References Clinical Features Suggestive of Meningitis in Children:A Systematic Review of Prospective Data. Pediatrics 2010;126(5);952-960. https://pubmed.ncbi.nlm.nih.gov/20974781/ Bulging fontanelle in febrile infants as a predictorof bacterial meningitis. European Journal of Pediatrics (2021) 180:1243–1248. https://pubmed.ncbi.nlm.nih.gov/33169238/ Here is the link to the picture of the CSF of the patient discussed in the episode. https://pemrules.com/wp-content/uploads/2024/12/csf.png

As a PEM physician I am fairly good (and confident) about intubating children and passing that ET tube beyond the vocal cords. Managing the vent, however is a whole different ballgame. That is why I asked Jared to come and teach us some basic vent setting for our children.

Many PEM physicians I meet have some rules of their own or interesting interpretations of my PEM Rules. Here are some of Carla Laos’s (a PEM Physician and medical director in Las Vegas) rules she uses in her practice.

As a leader it is important to take responsibility for anything that happened “under your watch”. Yes, you can check many things but do you actually need to? And what should you think about when you initiate treatment with antibiotics on an admitted patient.

With the concerning rise of antibiotic resistance I asked Dr. Fatima Levent to come back to PEM Rules and review with us the appropriate choice of antibiotics for our patients.

Pediatric Gastroenterological Chief Complaints is something we do in the Pediatric Emergency Department a considerable part of our time. That is why I invited Howard Baron to come on the show and talk about his advice for investigating and treating common GI conditions.

PEM Rules will take a short summer break for the months of July and August and will be back in September again with (hopefully) more exciting episodes. Thank you for all the support. Please check out the PEM Rules store at https://www.redbubble.com/shop/ap/164385928 at the Facebook page https://www.facebook.com/PEMRules And please keep in touch.

Like many other "adult diagnosis" Cannabinoid hyperemesis syndrome is something we see in the Pediatric ER more and more of. That is why I invited Biren to come on the show and talk to us about this condition.