A cool tool.

In this episode Dr. Nate Kuppermann (@nkuppermann) discusses another amazing article on the PECARN TBI decision rule just published in JAMA Network Open. The article, Effect of the Head Computed Tomography Choice Decision Aid in Parents of Children With Minor Head Trauma: A Cluster Randomized Trial, and this episode explores shared decision making in the ED and a cool tool we can use to aid this process.

Send us your questions and continue the conversation on social media @empulsepodcast or at ucdavisem.com.

Hosts:

Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis

Guest:

Dr. Nate Kuppermann, Pediatric Emergency Physician, Professor and Chair of the UC Davis Department of Emergency Medicine, Founding Chair of the PECARN Steering Committee

Resources:

Effect of the Head Computed Tomography Choice Decision Aid in Parents of Children With Minor Head Trauma: A Cluster Randomized Trial.

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2703135

Erik P. Hess, MD, MSc1,2,3; James L. Homme, MD4,5; Anupam B. Kharbanda, MD, MSc6; Leah Tzimenatos, MD7; Jeffrey P. Louie, MD8; Daniel M. Cohen, MD9; Lise E. Nigrovic, MD, MPH10; Jessica J. Westphal11; Nilay D. Shah, PhD12,13; Jonathan Inselman, MS13; Michael J. Ferrara2,14; Jeph Herrin, PhD15; Victor M. Montori, MD, MSc3; Nathan Kuppermann, MD, MPH6,16

JAMA Network Open. 2018;1(5):e182430. 

Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. (https://www.ncbi.nlm.nih.gov/pubmed/19758692)

Kuppermann  N, Holmes  JF, Dayan  PS,  et al; Pediatric Emergency Care Applied Research Network.  Lancet. 2009;374(9696):1160-1170.

Excuse Me, Your Bias is Showing - Episode 10

We all have biases lurking in our unconscious mind. These are our implicit biases, and they affect how we relate to patients and, in turn, how they relate to us. But if these biases are unconscious, how do we identify them? And is it possible to change them? We share our own experiences with implicit bias, and we hear Dr. Rupa Marya’s story that went viral on social media. Then we dive a little deeper with researcher and pediatric emergency medicine physician, Dr. Tiffani Johnson.

Want to check your own biases? Take an implicit association test (IAT) through Project Implicit. Let us know what you found and let’s continue the discussion on social media, @empulsepodcast. If you’d like to keep your results more private, send us a comment on our website, ucdavisem.com.

Hosts:

Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis

Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis

Guests:

Dr. Tiffani Johnson, Pediatric Emergency Medicine Physician and Faculty at the Policy Lab at Children’s Hospital of Philadelphia (CHOP) 

Special thanks to Dr. Rupa Marya and Bonnie Castillo for allowing us to use the audio from this video that was featured on NowThis Politics

Resources:

The Impact of Cognitive Stressors in the Emergency Department on Physician Implicit Racial Bias.

Johnson TJ, Hickey RW, Switzer GE, Miller E, Winger DG, Nguyen M, Saladino RA, Hausmann LR. Acad Emerg Med. 2016 Mar;23(3):297-305. doi: 10.1111/acem.12901. Epub 2016 Feb 22. PMID: 26763939

Comparison of Physician Implicit Racial Bias Toward Adults Versus Children.

Johnson TJ, Winger DG, Hickey RW, Switzer GE, Miller E, Nguyen MB, Saladino RA, Hausmann LR. Acad Pediatr. 2017 Mar;17(2):120-126. doi: 10.1016/j.acap.2016.08.010. Epub 2016 Sep 13. PMID: 27620844

Project Implicit - take an IAT!

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Join us in Maui for Emergency Medicine Hot Topics! 

November 6-10, 2018. Registration is now open!

Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

Dr. Tiffany Johnson (center)

It’s all about Tommie.

Way back in March we discussed how “The Game has Changed” with Dr. Dr. Gail D’Onofrio and Dr. Josh Elder (https://twitter.com/joshuawelder).  They discussed how emergency departments can be a positive part of the opiate epidemic by offering buprenorphine (suboxone). In this episode we find out how the program is going and how the human element (aka Tommie, our substance use counselor) is helping it succeed.

Send us your questions and continue the conversation on social media @empulsepodcast or at ucdavisem.com.

Hosts:

Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis

Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis

Guest:

Dr. Aimee Moulin, Associate Professor of Emergency Medicine at UC Davis and President of California ACEP

Resources:

ED Bridge (https://ed-bridge.org) emergency department support for development and implementation of buprenorphine treatment

AMA END the EPIDEMIC (https://www.end-opioid-epidemic.org/resources/california-acep-safe-prescribing-guidelines/) multi-specialty resources 

California ACEP (https://californiaacep.site-ym.com/forums/posts.aspx?group=&topic=1427775&page=1&hhSearchTerms=%22buprenorphine%22#post_1427775) Dr. A Moulin’s message on Substance Use Disorder Treatment in the ED-stay tuned for more resources at this website

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Join us in Maui for Emergency Medicine Hot Topics! 

November 6-10, 2018. Registration is now open at www.cevs.ucdavis.edu/confreg/?confid=960

Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

Thriving, not Surviving - Episode 9

Are you well? In this episode we tackle the issue of physician wellness. What does that mean? Why is it a problem? And what can we do to thrive, not just survive, in medicine? We discuss strategies with EM physicians of all levels, including Cal ACEP President, Dr. Aimee Moulin, and Dr. Katren Tyler, Vice Chair of Wellness for the UC Davis Department of Emergency Medicine.

How do you define physician wellness? What is your personal recipe for THRIVING, not just surviving? Join the conversation on social media, @empulsepodcast, or at ucdavisem.com.

Hosts:

Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis

Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis

Guests:

Dr. Aimee Moulin, Associate Professor of Emergency Medicine at UC Davis and President of California ACEP

Dr. Katren Tyler, Professor of Emergency Medicine and Vice Chair for Faculty Development, Wellness and Outreach in the UC Davis Department of Emergency Medicine

Various UC Davis Department of Emergency Medicine residents, fellows, and faculty.

Resources:

Ten commandments of physician wellness.

Krall EJ. Clin Med Res. 2014 Sep;12(1-2):6-9. doi: 10.3121/cmr.2013.1211. Epub 2014 Jan 10. No abstract available. PMID: 24415746

What Do We Mean by Physician Wellness? A Systematic Review of Its Definition and Measurement.

Brady KJS, Trockel MT, Khan CT, Raj KS, Murphy ML, Bohman B, Frank E, Louie AK, Roberts LW.

Acad Psychiatry. 2018 Feb;42(1):94-108. doi: 10.1007/s40596-017-0781-6. Epub 2017 Sep 14. Review. PMID: 28913621

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Join us in Maui for Emergency Medicine Hot Topics! 

November 6-10, 2018. Registration is now open!

Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

If it Hurts, Don’t do it!

Let’s revisit concussion and return to play with UC Davis Head Team Physician, Dr. Jeremiah Ray. This Heartbeat was originally recorded as a Facebook LIVE for the UC Davis Health page. We first talked about concussion in May’s episode, “Breaking Out of Concussion Jail". This Heartbeat is a little more casual and offers some practical information for how to recognize and manage concussion in athletes - plus, it provides a little spaced repetition to help us remember what we learned! 

Send us your questions and continue the conversation on social media @empulsepodcast or at ucdavisem.com.

Host:

Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis

Guest:

Dr. Jeremiah Ray, Head Team Physician for UC Davis Intercollegiate Athletics

Resources:

SCAT 5 (Sports Concussion Assessment Tool - 5th Edition)

CDC HEADS UP to Brain Injury Awareness

Resources for Health Care Providers

Resources for Parents

NCAA Concussion Diagnosis and Management Best Practices

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Join us in Maui for Emergency Medicine Hot Topics! 

November 6-10, 2018. Registration is now open at www.cevs.ucdavis.edu/confreg/?confid=960

Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

Dr. R Nick Gorton and Dr. Kara Toles are back to talk about transgender care in the Emergency Department. Did you know you already have the skills to advocate for and care for transgender patients? You do! Let’s sum it up in four words: DON’T BE A JERK! Treat your patients like you’d want your family member to be treated. We’ll explore some of the challenges and concerns specific to transgender patients — JM Jaffe shares a very personal account of their experience. Drs. Gorton and Toles then review Nick’s recent paper on the topic and give us some practical tips to help us gracefully navigate the complexities of the gender spectrum in the ED. 

How does your department (or residency, med school, etc.) address the topic of transgender care? Join the conversation on social media, @empulsepodcast, or at ucdavisem.com.

Hosts:

Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis

Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis

Guests:

JM Jaffe, Trans Health Manager at Lyon Martin Clinic

Dr. Kara Toles, Assistant professor of Emergency Medicine at UC Davis and Emergency Physician at UTMB Health. 

Dr. R. Nick Gorton, Emergency Physician at Sutter Davis, and Primary Care Physician at the Lyon-Martino Clinic in San Francisco. 

Resources:

TRANSLINE national online transgender medical consultation service - free and confidential. 

Lyon-Martin Health Services, San Francisco, CA.

Improving the Quality of Emergency Care for Transgender Patients

Gorton RN, Berdahl CT. Ann Emerg Med. 2018 Feb;71(2):189-192.e1. doi: 10.1016/j.annemergmed.2017.12.003. Epub 2018 Feb 5.

“Sometimes You Feel Like the Freak Show”: A Qualitative Assessment of Emergency Care Experiences Among Transgender and Gender-Nonconforming Patients

Elizabeth A. Samuels, Chantal Tape, Naomi Garber, Sarah Bowman, Esther K. Choo

Ann Emerg Med. 2018 Feb;71(2):170-182.e1. doi: 10.1016/j.annemergmed.2017.05.002. Epub 2017 Jul 14.

Transgender and Gender-Nonconforming Patients in the Emergency Department: What Physicians Know, Think, and Do

Makini Chisolm-Straker, Cathleen Willging, Adrian D. Daul, Shannon McNamara, S. Cham Sante, Daniel G. Shattuck II, Cameron S. Crandall

Ann Emerg Med. 2018 Feb;71(2):183-188.e1. doi: 10.1016/j.annemergmed.2017.09.042. Epub 2017 Nov 3.

Improving Care for Lesbian, Gay, Bisexual, and Transgender Patients in the Emergency Department 

Ann Emerg Med. 2015 Oct;66(4):417-23. doi: 10.1016/j.annemergmed.2015.02.004. Epub 2015 Mar 5.

Sara Jalali, Lauren M. Sauer

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Join us in Maui for Emergency Medicine Hot Topics! 

November 6-10, 2018. Registration is now open at www.cevs.ucdavis.edu/confreg/?confid=960

Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

LGBTQI, MD

Happy Pride, everyone! June is coming to an end and we’ve enjoyed celebrating all the diverse and beautiful people in our communities. In the spirit of Pride month, this Heartbeat explores what it’s like to be an LGBTQI physician. For those unaware, LGBTQI stands for lesbian, gay, bisexual, transgender, queer (or questioning), and intersex. Many people also add an A for asexual, or allies. Dr. Kara Toles and Dr. Nick Gorton graciously share their stories with us, as well as their advice for future doctors who may identify with any of the letters in the acronym. Dr. Gorton and Dr. Toles will also be joining us in an upcoming full episode that we are really excited about. Stay tuned!

Do you identify as LGBTQIA? We’d love to hear your story. Please send us your thoughts or experiences through our website, ucdavisem.com, or on social media, @empulsepodcast. We look forward to hearing from you!

Hosts:

Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis

Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis

Guests:

Dr. Kara Toles, Assistant professor of Emergency Medicine at UC Davis and Emergency Physician at UTMB Health. 

Dr. R. Nick Gorton, Emergency Physician at Sutter Davis, and Primary Care Physician at the Lyon-Martino Clinic in San Francisco. 

Resources:

GLMA - Gay and Lesbian Medical Association - Ensuring equality in healthcare for LGBT individuals and healthcare professionals. 

It Gets Better Project

Lyon-Martin Health Services, San Francisco, CA. 

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Join us in Maui for Emergency Medicine Hot Topics! 

November 6-10, 2018. Registration is now open at www.cevs.ucdavis.edu/confreg/?confid=960

Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

DKA: It’s Not About the Fluids! - Episode 7

Hot of the presses! We are thrilled to speak with the amazing husband and wife research team of Dr. Nate Kuppermann and Dr. Nicole Glaser, on their practice changing paper that was just, and we mean JUST, published in the New England Journal of Medicine. DKA (diabetic ketoacidosis) is a potentially life threatening condition that can be complicated to treat, especially in children. First, we’ll hear from 9-year-old Whitley and her mom, Amanda, about what it’s like to be a kid living with diabetes, and what it feels like to have the dreaded DKA. Then we’ll dive into the research with Drs. Kuppermann and Glaser and learn how their findings revolutionize the way we treat DKA in kids.

How does this paper change the way you approach children with DKA in your practice? Continue the conversation on social media @empulsepodcast or at ucdavisem.com.

Hosts:

Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis

Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis

Guests:

Whitley and Amanda, a mother and daughter team living with diabetes

Dr. Nate Kuppermann, Pediatric Emergency Physician, Professor and Chair of the UC Davis Department of Emergency Medicine, Founding Chair of the PECARN Steering Committee

Dr. Nicole Glaser, Professor of Pediatric Endocrinology at UC Davis

Resources:

Clinical Trial of Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis

Nathan Kuppermann, M.D., M.P.H., Simona Ghetti, Ph.D., Jeff E. Schunk, M.D., Michael J. Stoner, M.D., Arleta Rewers, M.D., Ph.D., Julie K. McManemy, M.D., M.P.H., Sage R. Myers, M.D., M.S.C.E., Lise E. Nigrovic, M.D., M.P.H., Aris Garro, M.D., M.P.H., Kathleen M. Brown, M.D., Kimberly S. Quayle, M.D., Jennifer L. Trainor, M.D., Leah Tzimenatos, M.D., Jonathan E. Bennett, M.D., Andrew D. DePiero, M.D., Maria Y. Kwok, M.D., M.P.H., Clinton S. Perry, III, Ph.D., Cody S. Olsen, M.S., T. Charles Casper, Ph.D., J. Michael Dean, M.D., and Nicole S. Glaser, M.D. for the PECARN DKA FLUID Study Group.

N Engl J Med. 2018 June 14, 378:2275-2287

Risk factors for cerebral edema in children with diabetic ketoacidosis. The Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics.

Glaser N, Barnett P, McCaslin I, Nelson D, Trainor J, Louie J, Kaufman F, Quayle K, Roback M, Malley R, Kuppermann N; Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. N Engl J Med. 2001 Jan 25;344(4):264-9. 

PMID: 11172153 

PECARN (Pediatric Emergency Care Applied Research Network)

For those of you who want more, here is the unedited interview: Drs. Kuppermann and Glaser

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Join us in Maui for Emergency Medicine Hot Topics! 

November 6-10, 2018. Registration is now open at www.cevs.ucdavis.edu/confreg/?confid=960

Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

Catching Pee in the ED

In this Heartbeat we go over two alternatives to cathing that infant in your ED.  If you had an infant who needed to be cathed, ever seen an infant cathed, or even heard a child cathed, you know it is less than fun. Here are two different, published methods that we attempted, back to back, on an infant…then we ended up doing the cath anyway!

Join the conversation on Social Media @empulsepodcast or at ucdavisem.com

Host:

Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis.

Guest:

Keyon Mitchell, UC Davis Medical School Graduate Class of 2018.

Resources:

Hall-million S, Howard PK. Does Suprapubic Stimulation in Infants Facilitate Collection of a Clean Catch Urine Specimen? Adv Emerg Nurs J. 2017 Oct/Dec;39(4):236-239. https://www.ncbi.nlm.nih.gov/pubmed/29095174

Kaufman J, Tosif S, Fitzpatrick P, Hopper SM, Bryant PA, Donath SM, Babi FE. Quick Wee: a novel non-invasive urine collection method. Emerg Med J. 2017 jan;34(1):63-64. https://www.ncbi.nlm.nih.gov/pubmed/27565196

Kaufman J, Fitzpatrick P, Tosif S, Hopper SM, Donath SM, Vryant PA, Babe FE. Faster clean catch urine collection (Quick-Wee method) from infants: randomized controlled trial. BMJ 2017 Apr 7; 356:j1341. https://www.ncbi.nlm.nih.gov/pubmed/28389435

Labrosse M, Levy A, Autmizguine J, Gravel J. Evaluation of a New Strategy for Clean-Catch Urine in Infants. Pediatrics. 2016 Sep;138(3). pie:e20160573. https://www.ncbi.nlm.nih.gov/pubmed/27542848

Ray S, Forbes O. Quick-Wee is an effective technique for urine collection in infants. Arch Dis Child Edu Pract Ed. 2017 Oct 9. https://www.ncbi.nlm.nih.gov/pubmed/28993431

Tran A, Fortier C, Giovanni-chami L, demnchy D, Caci H, Desmontilis J, Montaudie-Dumas I, Bensaid R, Haas H, Berard E. Evaluation of the Bladder Stimulation Technique to Collect Midstream Urine in Infants in a Pediatric Emergency Department. PLoS one. 2016 mar 31;11(3):e0152598. https://www.ncbi.nlm.nih.gov/pubmed/?term=Evaluation+of+the+Bladder+Stimulation+technique+to+collect+midstream+urine

Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

Breaking Out of Concussion Jail - Episode 6

Suffering a concussion can make you feel like a prisoner, especially if you’re a student athlete. Cameron Wright, a division I water polo player who suffered a concussion last year, knows this first hand. In this episode, he shares his experience with concussion, and how he finally returned to the sport he loves. Dr. Roger Zemek, one of the leading investigators studying concussion and return to play, discusses how recent research is changing our approach to recovery. Finally, Dr. Jeremiah Ray, a Sports Medicine and Emergency trained physician, talks about how he manages concussion in his college athletes, and gives us his recommendations for assessing and counseling patients in the ED. 

How do you manage concussion in your practice? Does what you’ve heard change anything for you? Continue the conversation on social media @empulsepodcast or at ucdavisem.com.

Hosts:

Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis

Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis

Guests:

Cameron Wright, Men’s Water Polo Player at UC Berkeley

Dr. Roger Zemek, FRCPC Associate Professor Pediatrics and Emergency Medicine University of Ottawa, Vice chair pediatric emergency research Canada (PERC), Clinical Research chair in Pediatric Concussion University of Ottawa 

Dr. Jeremiah Ray, Head Team Physician for UC Davis Intercollegiate Athletics

Resources:

SCAT 5 (Sports Concussion Assessment Tool - 5th Edition)

CDC HEADS UP to Brain Injury Awareness

Resources for Health Care Providers

Resources for Parents

NCAA Concussion Diagnosis and Management Best Practices

The National Institute of Neurological Disorders and Stroke and Department of Defense Sport-Related Concussion Common Data Elements Version 1.0 Recommendations.

Broglio SP, Kontos AP, Levin H, Schneider K, Wilde EA, Cantu RC, Feddermann-Demont N, Fuller G, Gagnon I, Gioia G, Giza CC, Griesbach GS, Leddy JJ, Lipton ML, Mayer A, McAllister T, McCrea M, McKenzie L, Putukian M, Signoretti S, Suskauer SJ, Tamburro R, Turner M, Yeates KO, Zemek R, Ala'i S, Esterlitz J, Gay K, Bellgowan PSF, Joseph K. J Neurotrauma. 2018 May 2. doi: 10.1089/neu.2018.5643. [Epub ahead of print] PMID: 29717643

Full Interview with Dr. Roger Zemek