PEM CHATT

In this episode of PEM CHATT, host Toni Dobson is joined by Dr. Sarah Sterner, a pediatric emergency medicine physician and medical director at Children's at Erlanger, to discuss chest pain in children. The discussion delves into the differences between pediatric and adult chest pain presentations, common causes, high-risk diagnoses, and appropriate workup strategies. The episode includes discussions on real-life case scenarios, covering conditions such as hypertrophic cardiomyopathy, myocarditis, pericarditis, pneumothorax, and more. Dr Sterner also discusses why it is important to admit children with persistent tachycardia. The importance of a systematic approach, thorough history-taking, and recognizing potential red flags in pediatric patients is highlighted.

00:00 Introduction to PEM CHATT

00:19 Understanding Pediatric Chest Pain

01:28 Introducing Dr. Sarah Sterner

03:22 Common Causes of Chest Pain in Children

04:05 Don't Miss Diagnoses

05:03 Approach to Pediatric Chest Pain Workup

06:31 Case Study: 14-Year-Old Male with Chest Pain

11:54 Case Study: 5-Year-Old Female with Chest Pain

22:23 Understanding Myocarditis

23:05 Pericarditis in Children

24:59 Pneumonia Management

25:56 Case Study: 9-Year-Old with Chest Pain

29:25 Case Study: 16-Year-Old with Pneumothorax

32:19 Case Study: 15-Year-Old with Pneumomediastinum

35:03 Rare but Serious: ACS and PE in Kids

39:58 Conclusion and Final Thoughts

Exploring Mental Models in Emergency Medicine with Dr. Dan France

In this episode of PEM CHATT, host Toni discusses the importance of mental models in emergency medicine with Dr. Dan France, a professor at Vanderbilt University. They examine how mental models influence decision-making, resilience, and teamwork in high-pressure medical settings. Dr. France shares his journey and explains how mental models have played a significant role in his career, providing practical examples from healthcare and personal experiences. Listeners are encouraged to reflect on their mental models to improve their clinical practice and patient interactions.

#PEM #NP #APP #PA #pediatrics #emergencymedicine #emergencynurse practitioner #fellowship #medicaleducation #podcast #children #nursepractitioner #mentalmodels #criticalthinking #mentalevolution #pediatricemergencymedicine

00:00 Introduction to Mental Models in Emergency Medicine

02:00 Meet Dr. Dan France: A Pioneer in Patient Safety

04:32 Understanding Mental Models: A Deep Dive

06:57 Developing Mental Models: Influences and Examples

07:38 The Ladder of Inference: How We Form Beliefs

09:29 The Evolution of Mental Models: Adapting to Change

15:52 The Shadows of the Neanderthal: A Book Discussion

26:55 Personal Reflections on Mental Models

36:44 Personal Reflections on Palliative Care

38:09 Navigating Family Dynamics in Healthcare

40:07 Professional Growth and Conflict Resolution

43:32 Addressing Vaccine Hesitancy in the ER

51:50 The Importance of Mental Models in Medicine

53:36 Building a Culture of Safety and Reliability

59:25 Final Thoughts and Reflections

Link to Shadows of the Neanderthal on Amazon: https://www.amazon.com/Shadows-Neanderthal-Illuminating-Beliefs-Organizations/dp/1883823307

You can WATCH this episode now on YouTube! https://youtu.be/lH4dYBOVihc

In this episode of PEM CHATT, Toni sits down with nurse practitioner, June Bryant, and Cheryl Fabor, Director of Education for the Dysautonomia Project, to discuss the common yet rarely diagnosed condition of dysautonomia. They focus on this impact, symptoms, and treatment options. The conversation sheds light on conditions like POTS that falls under the umbrella of dysautonomia. The discussion includes real-life patient scenarios, diagnostic criteria, and both non-pharmacological and pharmacological treatment options. The episode aims to educate providers and raise awareness of autonomic nervous system disorders, with a focus on understanding patients' experiences and symptoms.

**The details of any patient encounters discussed in this episode have been changed to protect the privacy of patients.

Resources:

https://thedysautonomiaproject.org/

Cheryl Fabor, Director of Education for the Dysautonomia Project

Contact information: [email protected]

Book Referenced in Podcast: https://thedysautonomiaproject.org/get-a-book/

Reach out to Cheryl for a FREE copy!

Follow PEM CHATT on Instagram, Facebook, and YouTube!

https://www.instagram.com/pemchatt/

https://www.facebook.com/profile.php?id=61575207741783#

https://youtu.be/lH4dYBOVihc

Timeline:

00:00 Introduction to PEM CHATT

00:26 Understanding dysautonomia

00:55 Case Study: 16 y/o F with syncope

01:32 Meet the Experts: Cheryl Fabor and June Bryant

03:06 What is dysautonomia?

04:30 Common symptoms and misconceptions.

06:31 Prevalence and types of dysautonomia

08:27 Causes and triggers of dysautonomia

10:53 Diagnosing dysautonomia

16:49 Tilt table test explained

22:10 Non-pharm treatments

27:11 Pharmacologic treatments

28:47 Understanding patient symptoms and treatments

31:05 The role of mental health in dysautonomia

32:53 Challenges faced by adolescents with dysautonomia

34:09 Parental involvement in misconceptions

34:50 Lack of education among healthcare providers

34:50 Recovery and management of dysautonomia

39:20 Case study discussed

45:59 Resources and support for dysautonomia

50:02 Conclusion and final thoughts

NEXT MONTH: Dr Dan France from Vanderbilt University will be sitting down with Toni to discuss Mental Models and how they shape the way we think and interact with others.

In this episode of PEM Chatt, Toni talks with Dr. Whitney Buss about Diabetic Ketoacidosis (DKA) in children. Dr. Buss, a pediatric emergency medicine doctor and type 1 diabetic herself, shares her personal experience with DKA and her expert advice on how to recognize, diagnose, and treat DKA. They discuss how DKA can show up in both kids with newly diagnosed diabetes and those already living with the condition. Dr. Buss highlights the importance of paying attention to early warning signs, especially in young kids, where symptoms can be subtle and easy to miss.

The conversation also covers how to safely manage DKA, including when to give fluids, how to use insulin carefully, and how to watch for serious complications like cerebral edema (brain swelling). They discuss real-life cases, common mistakes in diagnosing DKA, and how to handle Hyperosmolar Hyperglycemic State (HHS), another dangerous diabetes emergency. Dr. Buss gives helpful tips for monitoring patients, following treatment protocols, and knowing when to call for extra help.

Resources Mentioned:

🎧 Listen now on your favorite podcast platform!

Episode Summary:

In this two-part series, we sit down with Dr. Chuck Gomez, a pediatric orthopedic surgeon, and John Appel, PA, a seasoned emergency medicine provider, to discuss common pediatric orthopedic emergencies. In Part 1, we cover upper extremity injuries, including forearm fractures, supracondylar fractures, lateral condyle fractures, nursemaid’s elbow, elbow dislocations, and clavicle fractures. Dr. Gomez and John share insights on pain management strategies, splinting techniques, and key imaging considerations, ensuring listeners know when to consult orthopedics and how to manage common injuries.

In Part 2, we shift focus to lower extremity orthopedic emergencies, covering conditions such as Slipped Capital Femoral Epiphysis (SCFE), patella dislocations, tibial tubercle fractures, toddler’s fractures, and osteomyelitis/septic arthritis. Dr. Gomez provides guidance on recognizing urgent injuries, including red flags for compartment syndrome and infections, while John shares practical advice for ER-based assessment and initial management. Throughout the discussion, we emphasize when to splint, when to allow weight-bearing, and when orthopedic consultation is critical.

Resources Mentioned:

Next Episode:

Join us next month as we talk with Dr. Whitney Buss about pediatric DKA management. As both a pediatric emergency physician and a Type 1 diabetic, Dr. Buss brings unique insights into how DKA presents in children, key management strategies, and common pitfalls to avoid. Don’t miss this deep dive into a critical pediatric emergency!

🔔 Subscribe to PEM Chatt for more expert insights into pediatric emergency medicine!

In this episode of PEM Chatt, we explore common pediatric orthopedic emergencies with Dr. Chuck Gomez, a pediatric orthopedic surgeon, and John Appel, PA, an experienced emergency medicine provider. We discuss why children's bones differ from adult bones, how this affects fracture patterns, and the best approaches for diagnosis and treatment. Our conversation focuses on upper extremity injuries, including forearm fractures, supracondylar fractures, lateral condyle fractures, nursemaid’s elbow, elbow dislocations, and clavicle fractures. We cover key clinical pearls, such as recognizing subtle fractures that may not appear on initial imaging and ensuring proper splinting techniques to prevent complications.

Along the way, Dr. Gomez and John share insights on pain management, including the ongoing discussion around NSAIDs and bone healing, as well as best practices for determining when orthopedic consultation is needed. They emphasize the importance of early recognition of serious fractures, such as Monteggia fractures, and the role of follow-up imaging in cases where occult fractures may become more apparent over time. The episode also highlights practical reduction techniques for nursemaid’s elbow and explains why certain fractures, like clavicle injuries, rarely require surgery despite their dramatic appearance on X-rays.

Resources Mentioned:

Radiographic Interpretation Guide: Dr. Stewart Braden’s Orthopedics PowerPoint – Includes imaging examples and tips for recognizing key fractures. https://www.scribd.com/document/792597792/Bradin-Orthopedic-Emergencies

Montagia Fracture Reference: Ensuring proper radial head alignment on imaging.

Pediatric Ortho Follow-Up Recommendations: General guidelines for when to refer and how soon.

Coming Next:

This was a two-part episode! Stay tuned next month for Part 2, where we’ll discuss lower extremity orthopedic emergencies, including:

Toni sits down with the ever-popular Dr. Beachgem, a pediatric emergency medicine physician and social media sensation, to discuss managing pneumonia and other respiratory illnesses in children. They highlight this year’s unique respiratory illness trends, such as a surge in mycoplasma cases and challenges in managing pertussis and flu-related complications.

Dr. Beachgem shares practical insights from her experience and emphasizes the art of patient communication, especially with vaccine-hesitant families. The conversation is informative, engaging, and packed with actionable advice for both medical professionals and caregivers. Plus, they explore lighter topics like the joy of curing a nursemaid's elbow and navigating the surreal world of social media fame as a practicing doctor.

1. Dr. Beachgem on Social Media

• Follow Dr. Beachgem for relatable, practical, and insightful pediatric content on [TikTok/Instagram/etc.].

1. Respiratory Illness Management Guidelines

1. Mycoplasma Resources

• Overview of Mycoplasma in Pediatrics: MedlinePlus

1. Vaccination Guidance

• CDC's Vaccination Schedule: CDC Immunization Schedule

Jennifer Stanfield, PA, with more than 20 years of experience talks about the very important and serious topic of child sexual abuse and sexual assault. Jennifer explains that 1 out of 4 girls and 1 out of 6 boys will face sexual abuse before they turn 18. She shares that most of the time, the person who hurts the child is someone they already know and trust. Jennifer talks about how abusers can trick families and kids (this is called "grooming"), how abuse happens, and why it’s so important for doctors and nurses to know the signs.

Jennifer also talks about what happens in the emergency room (ER) when a child comes in for help. She explains how to check the child safely, when to collect evidence, and how doctors work with DCS (Department of Child Services) and the police to keep kids safe. She shares tips on how to talk with parents and how to get help from special places like Children’s Advocacy Centers.

The episode also covers what happens when a child or teenager has been sexually assaulted, including how the law works, checking for injuries, preventing infections, and finding counseling to help kids heal. Jen reminds doctors and nurses to take care of themselves too, because helping kids through hard situations can be very tough. She also talks about working together with police, social workers, and local centers to make sure kids are safe and get the care they need.

- National Child Abuse Hotline: 1-800-4-A-CHILD (1-800-422-4453)

- Child Advocacy Centers: Local centers that provide forensic interviews and support for child abuse victims.

Jennifer Stanfield , PA, a pediatric emergency medicine provider with over 21 years of experience, talks about the important topic of childhood physical abuse, focusing on non-accidental trauma (NAT). She explains that there were 3 million cases of child abuse reported in the U.S. in 2022 and shares tools like the TEN4 FACES-P rule to help spot sentinel injuries that could lead to more serious harm. Jen stresses how important it is to check carefully, follow clear steps, and treat every case fairly to keep kids safe. She also talks about how hard this work can be for doctors and advanced practice providers and gives tips to help them stay strong and caring while doing this important job.

State of TN NAT Guidelines:

https://drive.google.com/file/d/1zoVFx0Vah9magAEwy4uPpGvUWWFkbbcB/view?usp=drive_link

TN Child Abuse Hotline:

https://www.tn.gov/dcs/program-areas/child-safety/reporting/child-abuse.html

TEN4 FACES-P:

https://faceitabuse.org/ten4rule/

Imaging examples (bucket handle fracture, corner fracture, metaphyseal fractures):

https://wikem.org/wiki/Nonaccidental_trauma

References:

https://ct-aap.org/wp-content/uploads/2020/03/Sheets.pdf

Resources:

Books on Trauma and Abuse:

A Place Called Home by David Ambrose

The Body Keeps the Score by Bessel van der Kolk

Child Welfare Information Gateway: Offers resources and support for child abuse prevention. Visit the website.

National Child Abuse Hotline: 1-800-4-A-CHILD (1-800-422-4453).