We are honoured to be joined by an expert in the field of ethical decision making in CPR, Dr Barbara Hayes. Join us for a lively discussion as we navigate the perils of talking about death and dying, and the role of CPR.

ACEM 2013 Winter Symposium in Broome was amazing. Here is Colin Parker's talk about Holmesian Diagnostics for a Nautical Model. A bit left-field, but we think you'll pick up a few handy hints... Scroll through the slides as you listen - on empem.org.

This debate is going to be HUGE… Does paracetamol (acetaminophen) cause asthma?

A series of large international studies and reviews dedicated to the question raise some interesting questions.  There appears to be an epidemiological association – not the same as a causal association – but something’s going on…

For those of us who have been using APAP (=acetaminophen, =paracetamol) liberally throughout our paediatric careers, this new evidence comes as bit of a shock.  You can hear it in the way we talk about these studies – trying not to let evidence get in the way of our own prejudices!

Outline: ISAAC vs APAP

[cp] Welcome, introduction, disclaimer

[cp] Background

Previous PEMcasts on fever and antipyretics

Advantages of antipyretics:

relieve pain

improve comfort

can facilitate clinical assessment

[sf] Disadvantages of antipyretics:

Do not prevent febrile convulsions

May increase fever phobia

Unhelpful in risk stratifying Fever Without Source

May prolong infective illness

Impair immune response to vaccination

[RR] APAP = N-Acetyl Para-Amino-Phenol

= acetaminophen = paracetamol

Most widely used drug in pediatrics, increasing use in last 30 years.

Recent market favour towards ibuprofen despite concerns of gastric inflammation, renal damage, wheezing.

[cp] Several papers now added to initial ISAAC 2008 publication; lessons from history include aspirin, phenacetin, thalidomide.

[cp] Beasley 2008 & accompanying editorial (Barr 2008)

[sf] Etminan 2009

[cp] Beasley 2011

[RR] McBride 2011

Often referenced: Lesko 2002

[all] Conclusions, goodbye

References

Beasley R, Clayton T, Crane J, von Mutius E, Lai CK, Montefort S, Stewart A;

ISAAC Phase Three Study Group.

Association between paracetamol use in infancy and childhood, and risk of asthma, rhinoconjunctivitis, and eczema in children aged 6-7 years: analysis from Phase Three of the ISAAC programme.

Lancet. 2008 Sep 20;372(9643):1039-48. PubMed PMID: 18805332.

Barr RG.

Does paracetamol cause asthma in children? Time to remove the guesswork.

Lancet. 2008 Sep 20;372(9643):1011-2. PubMed PMID: 18805311.

Etminan M, Sadatsafavi M, Jafari S, Doyle-Waters M, Aminzadeh K, Fitzgerald JM.

Acetaminophen use and the risk of asthma in children and adults: a systematic

review and metaanalysis.

Chest. 2009 Nov;136(5):1316-23. Epub 2009 Aug 20. Review. PubMed PMID: 19696122.

Beasley RW, Clayton TO, Crane J, Lai CK, Montefort SR, Mutius E, Stewart AW;

ISAAC Phase Three Study Group.

Acetaminophen use and risk of asthma, rhinoconjunctivitis, and eczema in adolescents: International Study of Asthma and Allergies in Childhood Phase Three.

Am J Respir Crit Care Med. 2011 Jan 15;183(2):171-8. Epub 2010 Aug 13. PubMed PMID: 20709817.

McBride JT.

The association of acetaminophen and asthma prevalence and severity.

Pediatrics. 2011 Dec;128(6):1181-5. Epub 2011 Nov 7. PubMed PMID: 22065272.

Lesko SM, Louik C, Vezina RM, Mitchell AA.

Asthma morbidity after the short-term use of ibuprofen in children.

Pediatrics. 2002 Feb;109(2):E20. PubMed PMID: 11826230.

ISAAC Website: http://isaac.auckland.ac.nz/

Some lessons for Pediatric Emergency Medicine, from 1971 - a children's book, about a boy who hurts his finger at school, and has to see the school nurse. James feels Just Awful - until after the 3-part treatment...

Some lessons for Pediatric Emergency Medicine, from 1971 - a children's book, about a boy who hurts his finger at school, and has to see the school nurse. James feels Just Awful - until after the 3-part treatment...

A tiny, frightening little bug: Neisseria meningitidis. Join us for a discussion of ways to protect yourself, and your patients, against the nasty threat of meningococcal disease. It creeps up on you... when you least expect.

The role of steroids as adjunctive treatment for meningitis seems a bit unclear... A recent Cochrane review goes a long way to pointing us in the right direction, but still leaves a few questions open. Join us for a quick tour of the literature and guidelines, in our quest for the truth about using steroids in children with meningitis.

Meningitis: dangerous, scary, tricky. The clinical features of meningitis are less straightforward in younger children, and some aspects of diagnosis and treatment are still up for discussion. Join us for a discussion with our local Paediatric Infectious Diseases consultant.

In this episode, we discuss the evolution of bedside clinical ultrasound use in the pediatric emergency medicine setting. Is it time for your Pediatric ED to join the UltraSound craze?

Discussing vaccine efficacy and risks often engenders strong feelings from both sides of the river... the traditional believers AND the 'anti-vaxxers'. In this episode, we try to discover whether there is a real link between rotavirus vaccines and this rare cause of abdominal pain in infants.