PEM Rules

Sometimes there are "odd reasons" for using a test, Getting a good history is key and some questions are more important than others and a bit about knowing what not to do. 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.

Just like I lost many of my “primary care” skills many primary care pediatrician feel uncomfortable treating emergencies or urgencies in their office. That is why I had a discussion with Dr. Noah (from a previous PEM Rules episode) about what to do when these situations arise. 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 do you do when the patient in front of you has no symptoms (at the moment). Why you should enjoy being in training and what all of us PEM clinicians should know very well. 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 do you do when a teenager with odd (and concerning) neurological symptoms walks into you ER and how do you apply the PEM Rules to work him up step by step?

Often times I see none verbal patients (be it newborns or children who are neurologically devastated) who come in by EMS or perhaps their parents / caregiver. In those situations, I find it important to be more conservative. How do I gain the parent’s trust? Simple gain the child’s first.

Hours after last weeks episode was published I heard from Dr. Jay Fisher about a very similar (and unfortunate) case one of his APP's had in their ED. I decide to bring Jay to the show (again) to discuss the case so we can all learn from this experience. Below is the link to the patient's Chest X rays. https://pemrules.com/pneumonia-patient/ 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 is the appropriate differential diagnosis for a well appearing child with fever for over 5 days and what is the best way to work these patients up? I discuss this important Issue with my Former colleague Dr. Fatma Levent, a pediatric Infectious Disease Attending.

There is a certain way to address the chief complaint in the ED and it is often advantageous to do it this way. Why is it important to know what syndrome the child has? and how can we all give better care to our patients?

As a PEM Physician, I get to take care of children with neurosurgical problems fairly often. Sometimes it is children with known issues such as hydrocephalus with a shunt and sometimes it is a patient with traumatic injury. Pediatric neurosergeons are often life savers in those situations. Here is a conversation I had with Dr. Todd Hankinson, a Pediatric Neurosurgeon at Children’s Hospital of Colorado.

As a good leader there are certain ways you can work with your team to let them excel. How do we work up our patients “appropriately”? and what can we learn from our patients?

Probably the Pediatric Sub-specialists I interact with the most are the pediatric hospitalists. Not only they accept my admissions but often give advice about the work up that the patient needs and serve as an extension of the Pediatric Emergency Department. That is why I invited Jason Zamkoff, a Pediatric Hospitalist from Denver CO to talk about the relationship between PEM Clinicians and the Peds Hospitalists. 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.

It is important to communicate to your consultants and hospitalists the way they want to be communicated to and “speak their language”. Why is it important not to think linearly and when is it “Not OK” to use antibiotics.

As a PEM physician, treating pain is a big part of my life and sometimes it is easier said than done. This why I invited Dr. Alan Bielskay, a Pediatric Anesthesiologist (and pain expert) from Denver CO to talk about pain treatment in 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.

Sometimes decisions are hard to make, nonetheless, in the ED world it is important to make a decision and sometimes sooner rather than later. Why getting a blood culture (without giving antibiotics) makes no sense to me and more about going with your gut feeling. 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.

As a PEM Physician, child abuse, sexual abuse and child neglect cases are those cases I never want to miss or overlook. That is often easier said than done. This is a discussion I had with Dr. Stephen Boos, a child abuse doctor in Western MA.

Probably the best advice I got in my career was to take care of myself before I take care of any patients and how I address some over-medicalized issues.

I am excited to announce the launch of the PEM Rules Facebook page. Please visit, become a follower and communicate what you like, wish to hear or just keep in touch. Here is the link to the page https://www.facebook.com/PEMRules 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 medicolegal aspects of medicine should we PEM Providers be familiar with and how can we all better protect ourselves while providing excellent care for our patients? I discuss these question and more with Dr. Brady Pregerson an expert in the field. 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.

My apologies to all of you who tried purchasing merchandise from Pickaso Guitar Bow and use PEM Rules Promo code. It came to my attention that the promo code stop working. Please be patient, check out the following link https://www.pickasobow.com , decide what you want to buy and be on the lookout for a new method of getting a discount via PEM Rules. The Pickaso Guitar Bow is fun to have and use to enrich your musical skills.

What should you do when things don’t seem to work they you want them to, what happens when a patient visits the Peds ED 3 times (or more) in a short time interval and what endorphins can potentially be.