Navigating breastfeeding as an EM physician

In the previous two episodes, we explored some of the challenges related to fertility and pregnancy for EM physicians. In the final episode of our three part series, we take it one step further to discuss yet another challenge: breastfeeding. Of course, fed is always best, and there are many reasons to formula feed, but providing breastmilk is very important to many families. For EM physicians, choosing to breastfeed usually means figuring out how to pump and store milk while you’re on shift. This can be daunting, especially for residents and junior physicians. How do you find time to sneak away? Is there an easily accessible pumping room close by? Will you feel supported by colleagues and your department? We cover these questions and much more with experts, Dr. Claire Abramoff, and Dr. Shada Rouhani. 

Does your ED have policies to support breastfeeding and pumping? Share your experience with us on social media @empulsepodcast or at ucdavisem.com

Hosts:

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

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

Guests:

Dr. Claire Abramoff, Assistant professor at Jefferson, Sidney Kimmel Medical Center College and Assistant Residency Program Director, Department of Emergency Medicine, Einstein Medical Center in Philadelphia, PA

Dr. Shada Rouhani, Assistant Professor of Emergency Medicine at Harvard Medical School and Emergency Physician at Brigham and Women’s Hospital in Boston, MA

Resources:

Practice Management Breastfeeding Disasters and Solutions for EPs, by Claire Abramoff, MD, for Emergency Medicine News, March 14, 2023. 

Cleveland Manchanda EC, Vogel LD, Kass D, Rouhani SA. Best Practices for Lactation Support at Conferences and Standardized Testing Centers. Obstet Gynecol. 2020 Feb;135(2):475-478. doi: 10.1097/AOG.0000000000003661. PMID: 31923075.

McDonald L, Illg Z, Dow A, Gunaga S. Maternity Experiences and Perceptions of Emergency Medicine Physicians. Spartan Med Res J. 2021 Apr 13;6(1):22009. doi: 10.51894/001c.22009. PMID: 33870004; PMCID: PMC8043905.

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

In this episode, we delve into a pivotal multi-center study validating the Pediatric Emergency Care Applied Research Network (PECARN) prediction rules for using CT imaging in children with blunt abdominal and minor head trauma. We discuss with the authors the study's impact, how these validated rules can optimize pediatric trauma care, minimize radiation risks, and what this means for emergency practices worldwide. This conversation not only sheds light on the study's intricate processes and outcomes, but also emphasizes the vital role of evidence-based guidelines in enhancing patient safety and care quality.

Host:

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

Guests:

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. James Holmes, Professor of Emergency Medicine at UC Davis

Resources:

Holmes JF, Yen K, Ugalde IT, Ishimine P, Chaudhari PP, Atigapramoj N, Badawy M, McCarten-Gibbs KA, Nielsen D, Sage AC, Tatro G, Upperman JS, Adelson PD, Tancredi DJ, Kuppermann N. PECARN prediction rules for CT imaging of children presenting to the emergency department with blunt abdominal or minor head trauma: a multicentre prospective validation study. Lancet Child Adolesc Health. 2024 May;8(5):339-347. doi: 10.1016/S2352-4642(24)00029-4. PMID: 38609287.

https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(24)00029-4/abstract

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

Pregnancy is common during medical training and in the early years as an attending physician, as these stages often align with individuals’ reproductive potential. The experience can vary widely depending on factors such as workplace dynamics, scheduling, and the physical demands of the job. But let’s be real - running around a busy ED while carrying extra weight, feeling nauseated (maybe vomiting), and managing all of the physical and emotional changes that come with pregnancy is a real challenge that many of us have lived. There are numerous considerations to navigate, from how we wish to be perceived as a team member to the risks posed by the workload on our bodies. Additionally, departmental or hospital policies may have financial implications that further complicate the situation. Join us as and Dr. Katren Tyler - EM physician and mother of two - as we break it all down.

This the second episode in our three part series on infertility, pregnancy and breastfeeding as an Emergency Physician. If  you missed it, go back and check out part 1! And stay tuned for our final episode of the series where we’ll delve into some of the challenges surrounding breastfeeding and pumping in the ED. 

Does your ED have policies to help support people through pregnancy? Share your experience with us on social media @empulsepodcast or at ucdavisem.com

Hosts:

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

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

Guests:

Katren Tyler, Professor of Emergency Medicine and Vice Chair of Geriatric Emergency Medicine and Wellness at UC Davis

Resources:

Tips for Pregnancy EM Physicians, by Sandra Williams, DO (ACEP)

MacVane CZ, Fix ML, Strout TD, et al. Congratulations, You're Pregnant! Now About Your Shifts . . . : The State of Maternity Leave Attitudes and Culture in EM. West J Emerg Med. 2017 Aug;18(5):800-810. doi: 10.5811/westjem.2017.6.33843. Epub 2017 Jul 17. PMID: 28874931; PMCID: PMC5576615.

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

This the first episode in our three part series on infertility, pregnancy and breastfeeding as an Emergency Physician. In this installment, we shine a light on the often unspoken struggles of infertility among physicians, specifically focusing on the emergency medicine community. Join us and expert, Dr. Melissa Parsons, as we delve into the personal experiences, professional challenges, and nuanced perspectives of emergency physicians navigating the complex journey of infertility.

In part two, we’ll explore what it’s like to be a pregnant as an EM physician, and in our final episode of the series, we’ll talk about some of the challenges surrounding breastfeeding and pumping in the ED. 

Do you have questions about fertility as an EM Physician? Or want to share your own experience?  Hit us up on social media @empulsepodcast or at ucdavisem.com

Hosts:

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

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

Guests:

Dr. Melissa Parsons, Associate Professor of Emergency Medicine and Associate Residency Program Director at University of Florida College of Medicine in Jacksonville, FL

Resources:

Physicians should talk about the F word: fertility. Melissa E. Parsons, MD Physician  March 3, 2019. KevinMD.com 

Levy MS, Kelly AG, Mueller C, et al. Psychosocial Burdens Associated With Family Building Among Physicians and Medical Students. JAMA Intern Med. 2023 Sep 1;183(9):1018-1021. doi: 10.1001/jamainternmed.2023.2570. PMID: 37486671; PMCID: PMC10366942.

Parsons M, Mannix A, Gore K, et al. The current landscape of emergency medicine resident scheduling. AEM Educ Train. 2024 Jan 16;8(1):e10926. doi: 10.1002/aet2.10926. PMID: 38235394; PMCID: PMC10790185..

Pfennig CL, Wilson CA, Britt TW, et al. A comparative analysis on fertility success among physician specialties. Acad Emerg Med. 2022 Jun;29(6):792-794. doi: 10.1111/acem.14463. Epub 2022 Feb 27. PMID: 35178827; PMCID: PMC9305146.

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

If you practice in emergency medicine you probably live on the look out for sepsis.  You likely follow the 2016 Sepsis-3 guidelines for adults which really was a paradigm shift from an infection-associated SIRS, to infection-associated organ dysfunction with the SOFA score or sequential organ failure assessment score of at least 2 points in patients with suspected infection. However, the definition of sepsis in kids was not updated at that time in part because SOFA was not studied in children. That means that our current pediatric guidelines are from 2005! Good news though! The Phoenix sepsis criteria for sepsis and septic shock in children were derived and validated by the international SCCM Pediatric Sepsis Definition Task Force and we interviewed two of the task force members to help us operationalize it on our podcast.

Connect with us on social media @empulsepodcast or at ucdavisem.com

Host:

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

Guests:

Dr. Halden Scott, Associate Professor of pediatrics a the university of Colorado and pediatric emergency physician at the children’s hospital Colorado

Dr. Fran Balamuth, Associate professor of pediatrics at Perlman school of medicine at the university of Pennsylvania, attending physician in the ED at CHOP, co-director of the pediatric sepsis program at CHOP

Resources:

The Phoenix sepsis criteria for sepsis and septic shock in children. Schlapbach LJ, Watson RS, Sorce LR, Argent AC, Menon K, Hall MW, Akech S, Albers DJ, Alpern ER, Balamuth F, Bembea M, Biban P, Carrol ED, Chiotos K, Chisti MJ, DeWitt PE, Evans I, Flauzino de Oliveira C, Horvat CM, Inwald D, Ishimine P, Jaramillo-Bustamante JC, Levin M, Lodha R, Martin B, Nadel S, Nakagawa S, Peters MJ, Randolph AG, Ranjit S, Rebull MN, Russell S, Scott HF, de Souza DC, Tissieres P, Weiss SL, Wiens MO, Wynn JL, Kissoon N, Zimmerman JJ, Sanchez-Pinto LN, Bennett TD; Society of Critical Care Medicine Pediatric Sepsis Definition Task Force. International Consensus Criteria for Pediatric Sepsis and Septic Shock. JAMA. 2024 Feb 27;331(8):665-674. doi: 10.1001/jama.2024.0179. PMID: 38245889; PMCID: PMC10900966.

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

People living with sickle cell disease can experience severe “pain crises”, or vaso-occlusive episodes (VOE), and are at increased risk for infections, strokes, heart failure, and other serious disease processes. When patients are out sickle cell present to the ED, it is crucial to initiate their evaluation and treatment as soon as possible. So what does this mean practically for us as clinicians? Hematologist and Sickle Cell expert, Dr. Bimpe Adesina, and Emergency Physician and researcher, Dr. Bryn Mumma, join us to explore this topic in depth. 

In part 1, we delved into assessment and management of patients presenting with VOE. In part 2, we spoke with Dr. Chris Rees about the benefits of early opioid pain control for kids presenting with VOE.  

In the final episode of our series we’re back with Dr. Mumma and Dr. Adesina to discuss the management of other emergent presentations related to sickle cell disease.

Did this episode change your practice? Let us know on social media @empulsepodcast or at ucdavisem.com

Hosts:

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

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

Guests:

Dr. Oyebimpe Adesina, Assistant Professor of Hematology and Oncology and Co-Director of the Adult Sickle Cell Clinical Program at UC Davis

Dr. Bryn Mumma, Professor of Emergency Medicine and Leader of the Research Subcommittee of CARPE DIEM at UC Davis 

Resources:

ACEP Emergency Department Sickle Cell Care Coalition Resources

CHOP Emergency Department Clinical Pathway for Evaluation/Treatment of Children with Sickle Cell Disease with Fever

DeBaun MR, Jordan LC, King AA, et al. American Society of Hematology 2020 guidelines for sickle cell disease: prevention, diagnosis, and treatment of cerebrovascular disease in children and adults. Blood Adv. 2020 Apr 28;4(8):1554-1588. doi: 10.1182/bloodadvances.2019001142. PMID: 32298430; PMCID: PMC7189278..

Chou ST, Alsawas M, Fasano RM, et al. American Society of Hematology 2020 guidelines for sickle cell disease: transfusion support. Blood Adv. 2020 Jan 28;4(2):327-355. doi: 10.1182/bloodadvances.2019001143. PMID: 31985807; PMCID: PMC6988392.

People living with sickle cell disease can experience severe “pain crises”, or vaso-occlusive episodes (VOE), and are at increased risk for infections, strokes, heart failure, and other serious disease processes. In this 3 part series, we’re talking with experts to learn more about sickle cell disease and its complications and how we can best advocate for and treat these patients in the ED. In part 1, we delved into assessment and management of patients presenting with VOE.

In this episode, we focus specifically on kids presenting with VOE. We know these patients have usually exhausted their home pain control options and are still in excruciating pain when they arrive in the ED. We interviewed Dr. Chris Rees about his recent paper on the benefits of treating kids with VOE with an initial dose of intranasal fentanyl.  The results are pretty impressive! 

Stay tuned for Part 3 of our series where we’ll explore the management of other emergent presentations related to sickle cell disease!

Did this episode change your practice? Let us know on social media @empulsepodcast or at ucdavisem.com

Hosts:

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

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

Guests:

Dr. Chris Rees, Assistant Professor of Pediatrics and Emergency Medicine at Emory University

Resources:

Rees CA, Brousseau DC, Ahmad FA, et al; SCD Arginine Study Group and PECARN. Intranasal fentanyl and discharge from the emergency department among children with sickle cell disease and vaso-occlusive pain: A multicenter pediatric emergency medicine perspective. Am J Hematol. 2023 Apr;98(4):620-627. doi: 10.1002/ajh.26837. Epub 2023 Feb 6. PMID: 36606705; PMCID: PMC10023395..

Pediatric Emergency Care Applied Research Network (PECARN)

ACEP Emergency Department Sickle Cell Care Coalition Resources

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

People living with sickle cell disease can experience severe “pain crises”, or vaso-occlusive episodes (VOE), and are at increased risk for infections, strokes, heart failure, and other serious disease processes. When patients are out sickle cell present to the ED, it is crucial to initiate their evaluation and treatment as soon as possible. So what does this mean practically for us as clinicians? Hematologist and Sickle Cell expert, Dr. Bimpe Adesina, and Emergency Physician and researcher, Dr. Bryn Mumma, join us to explore this topic in depth. 

In part 1, we delve into assessment and management of patients presenting with VOE. Stay tuned for parts 2 and 3, where we’ll explore the use of intranasal fentanyl and the management of other emergent presentations related to sickle cell disease!

Did this episode change your practice? Let us know on social media @empulsepodcast or at ucdavisem.com

Hosts:

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

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

Guests:

Dr. Oyebimpe Adesina, Assistant Professor of Hematology and Oncology and Co-Director of the Adult Sickle Cell Clinical Program at UC Davis

Dr. Bryn Mumma, Professor of Emergency Medicine and Leader of the Research Subcommittee of CARPE DIEM at UC Davis 

Resources:

ACEP Emergency Department Sickle Cell Care Coalition Resources

CHOP Emergency Department Clinical Pathway for Evaluation/Treatment of Children with Sickle Cell Disease with Fever

DeBaun MR, Jordan LC, King AA, et al. American Society of Hematology 2020 guidelines for sickle cell disease: prevention, diagnosis, and treatment of cerebrovascular disease in children and adults. Blood Adv. 2020 Apr 28;4(8):1554-1588. doi: 10.1182/bloodadvances.2019001142. PMID: 32298430; PMCID: PMC7189278..

Chou ST, Alsawas M, Fasano RM, et al. American Society of Hematology 2020 guidelines for sickle cell disease: transfusion support. Blood Adv. 2020 Jan 28;4(2):327-355. doi: 10.1182/bloodadvances.2019001143. PMID: 31985807; PMCID: PMC6988392.

NIH Expert Panel Report, 2014: Evidence Based Management of Sickle Cell Disease

This is the next episode of our Push Dose Pearls miniseries with ED Clinical Pharmacist, Chris Adams. In this ongoing series we’ll dig into some of the questions we all have about medications we commonly see and use in the ED. This episode focuses on RSI (rapid sequence intubation) meds - stuff every ED doc needs to know! What has changed and what are the latest recommendations? We’ll answer these questions and more! 

Did this episode change your practice? Let us know on social media @empulsepodcast or at ucdavisem.com

Hosts:

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

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

Guests:

Christopher Adams, PharmD, Emergency Department Senior Clinical Pharmacist and Assistant Professor at UC Davis

Resources:

Acquisto NM, Mosier JM, Bittner EA, Patanwala AE, Hirsch KG, Hargwood P, Oropello JM, Bodkin RP, Groth CM, Kaucher KA, Slampak-Cindric AA, Manno EM, Mayer SA, Peterson LN, Fulmer J, Galton C, Bleck TP, Chase K, Heffner AC, Gunnerson KJ, Boling B, Murray MJ. Society of Critical Care Medicine Clinical Practice Guidelines for Rapid Sequence Intubation in the Critically Ill Adult Patient. Crit Care Med. 2023 Oct 1;51(10):1411-1430. doi: 10.1097/CCM.0000000000006000. Epub 2023 Sep 14. PMID: 37707379.

Engstrom K, Brown CS, Mattson AE, Lyons N, Rech MA. Pharmacotherapy optimization for rapid sequence intubation in the emergency department. Am J Emerg Med. 2023 Aug;70:19-29. doi: 10.1016/j.ajem.2023.05.004. Epub 2023 May 10. PMID: 37196592.

Bennett BL, Scherzer D, Gold D, Buckingham D, McClain A, Hill E, Andoh A, Christman J, Shonk A, Spencer SP. Optimizing Rapid Sequence Intubation for Medical and Trauma Patients in the Pediatric Emergency Department. Pediatr Qual Saf. 2020 Sep 25;5(5):e353. doi: 10.1097/pq9.0000000000000353. PMID: 33062904; PMCID: PMC7523837..

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

If you work in an ED, you’ve probably heard of EMTALA, or the Emergency Medical Treatment and Active Labor Act. But how much do you really know about this law? When does it apply and when does it not? EMTALA expert, Dr. Sophie Terp, helps us understand the history of EMTALA and what we need to know to ensure we provide the best care for our ED patients. 

Do you have more questions about EMTALA? Have you ever witnessed a violation? Share your thoughts with us on social media @empulsepodcast or at ucdavisem.com

Hosts:

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

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

Guests:

Dr. Sophie Terp, Associate Clinical Professor of Emergency Medicine at the Keck Schoo

of Medicine at the University if Southern California, and Quintiles Clinical Fellow at the Schaeffer Center for Health Policy and Economics

Resources:

The EMTALA origin story

U.S. Center for Medicare and Medicaid Services Interpretive Guidelines 

Terp S, Seabury SA, Arora S, et al. Enforcement of the Emergency Medical Treatment and Labor Act, 2005 to 2014. Ann Emerg Med. 2017 Feb;69(2):155-162.e1. doi: 10.1016/j.annemergmed.2016.05.021. Epub 2016 Aug 2. PMID: 27496388; PMCID: PMC7176068..

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