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April is Child Abuse Awareness Month, so in this episode I am speaking with Dr. Antonia Chiesa, a Child Abuse Medicine Specialist. We discuss sentinel injuries and how to navigate evaluating and reporting these injuries, positive news about the demographics and trends in the US regarding child abuse rates, and the broader conversation about child abuse and child health outside of the acute setting.

I would like to add a clarification here regarding a statement I make in this episode - I talk about the low rates of child abuse in Costa Rica, where I live, and the social protective factors here. This is in reference to child physical abuse, but I did not talk about sex trafficking, including minors, which is rampant in Central America and Costa Rica. We will leave that topic for another conversation.

For a review of the TEN4-FACES Clinical Decision Rule for Sentinel Bruises, this recent article does a great job breaking down sensitivity, specificity, and predictive values:

Validation of a Clinical Decision Rule to Predict Abuse in Young Children Based on Bruising Characteristics

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In this episode, I meet with Dr. Chinni Pokala to talk about the assessment and management of hematologic disorders in the acute setting. We discuss how to think about kids presenting with signs and symptoms of new hematologic disorders as well as thrombotic and hemorrhagic risks for kids with established heme/onc diagnoses or other chronic medical conditions.  

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In this episode, I talk with Dr. Alana Arnold about our experiences with pediatric readiness projects in community and urgent care settings, both as partnering with academic pediatric centers and via private consulting. Below, in order, are the seminal paper regarding pediatric readiness in general emergency departments, its associated assessment tool, the Wall Street Journal article about pediatric readiness referenced in this episode, findings from the ImPACTS project, and contact information for Dr. Arnold. 

Gausche-Hill M, Ely M, Schmuhl P, et al. A national assessment of pediatric readiness of emergency departments [published correction appears in JAMA Pediatr. 2015 Aug;169(8):791]. JAMA Pediatr. 2015;169(6):527-534. doi:10.1001/jamapediatrics.2015.138

National Emergency Medical Services for Children Pediatric Readiness Assessment and Scoring Resource Document

https://www.wsj.com/health/healthcare/hospitals-emergency-rooms-cost-childrens-lives-d6c9fc23?reflink=desktopwebshare_permalink

Auerbach MA, Whitfill T, Montgomery E, et al. Factors Associated With Improved Pediatric Resuscitative Care in General Emergency Departments. Pediatrics. 2023;152(2):e2022060790. doi:10.1542/peds.2022-060790

Dr. Alana Arnold: email:  [email protected]
website: www.linktr.ee/pempal 

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In this episode I meet up with Dr. Dan Park, who is the medical director of the pediatric emergency department at University of North Carolina. We'll be talking about the components of leadership and navigating careers in medicine. We discuss metacognition and cognitive biases, developing our expertise, leadership skills, and resiliency, and how these all interplay. 

Here is Dan's article about cognitive biases that we discussed during this episode:
https://pubmed.ncbi.nlm.nih.gov/24488159/

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In this episode, I'm speaking with Drs. Fred Henretig (Penn) and Carl Baum (Yale) about career transitions and exiting medicine. We discuss the current literature surrounding retirement and attrition in medicine, reasons physicians cite for staying vs going, and strategies for handling major career and life transitions.

Below is the information for a few of the articles mentioned in this podcast:

Henretig F, et. al. PEM Physicians' Perceptions of Colleagues' Clinical Competencies Over Four Age Categories. Pediatrics (2022);149:457.
https://publications.aap.org/pediatrics/article/149/1%20Meeting%20Abstracts%20February%202022/457/186078/PEM-Physicians-Perceptions-of-Colleagues-Clinical

Pizzo PA. Navigating Transitions and Charting New Paths. JAMA (2017);317(16):1625-6.
https://jamanetwork.com/journals/jama/article-abstract/2620092

David Brooks - The New Old Age: https://www.theatlantic.com/culture/archive/2023/08/career-retirement-transition-academic-programs/675085/

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In this episode, I'll be talking with Dr. Matt Harris from Cohen Children's Hospital about medical transport of kids, both in the prehospital and interfacility settings. We will discuss level of skills, training, and equipment available with various teams, factors to consider when choosing transport options, safety and legal concerns, and transport cost.

After recording this episode, Dr. Harris and I were discussing the components of the safety checklist his institution uses for transport of kids with behavioral health emergencies. His team does a huddle prior to transfer and answers these questions:

1. Who participates in huddle (referring doc, EMS clinicians, occasionally tele-psych physician).
2. Was a complete report given?
3. Was the patient aware of the intent to transfer (transparency with patients reduces discord)
4. Type of transfer (voluntary, involuntary, etc)
5. Any concerns from the sending physician?
6. Does the patient appear compliant and willing to transfer?
7. Is crew comfortable transporting the patient as presented?

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In this episode, I talk with Dr. Sing-Yi Feng, a Pediatric Emergency Medicine physician and Toxicologist, about ingestions of acetaminophen and ibuprofen, and general guidelines for evaluation of ingestions. We discuss important knowledge points for diagnosis, management, and continuation of care for our patients at home, in the inpatient unit, and in the critical care setting. Although Dr. Feng is a pediatrician first, she reviews care for patients of all ages, as ibuprofen and acetaminophen are among the most common ingestions of people at any age.

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In this episode I chat with Dr. Chris Amato about pediatric fractures - management of pain, when to call Orthopedics, and practical tips on splinting and immobilization strategies.

Side note: I mention in this that a femur fracture will heal if you get the two ends "in the same room together" - I should clarify, "in the same room together AND in a spica cast." Cast those femur fractures, people!

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In this episode I talk with Dr. David Sas, a Pediatric Nephrologist from the Mayo Clinic, about kids and kidney stones, with a discussion of stone diagnosis, management, and complications. We also discuss pyelonephritis, dysfunctional voiding, and long-term management and recurrence prevention after the initial diagnosis of all of these issues.

Spoiler alert: Dr. Sas mentions briefly in this episode the work he has done to develop a CURE for a rare genetic cause of renal stones, and his team at Mayo has a special interest in the evaluation of kids with kidney stones for genetic and underlying causes that can be managed to prevent future stones and kidney injury. If you have a patient with renal stones who needs assessment, I have listed his contact information and department website here:

https://www.mayoclinic.org/departments-centers/pediatric-nephrology-clinic
[email protected]

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In this episode I speak with Dr. Deb Kahal, Medical Director of the Holloway Community Program in Delaware, which provides testing and treatment for HIV, AIDS, and Hep C, and with Dr. Steve Eppes, Pediatric Infectious Disease Physician. We'll be reviewing the epidemiology of adolescent STIs, screening recommendations, treatment, and why it's important for us non-PCPs to address adolescent STIs.

Here is the link for the USPSTF (US Preventive Services Task Force) Infectious Disease Screening Recommendations:  uspreventiveservicestaskforce.org. These are the summary statements and are pretty detailed if you like in-depth reviews of the literature behind the decision making.

For a quicker reference table, the CDC has a table of screening guidelines: https://www.cdc.gov/std/treatment-guidelines/screening-recommendations.htm