PEM CHATT

Kaley Mounce, a nurse practitioner specializing in pediatric neurology, discusses febrile seizures. The episode covers the basics, including their causes, symptoms, and classification into simple and complex categories. Practical advice is offered on assessing and managing children who present with febrile seizures in the emergency room. The discussion provides insights into history taking, physical examination, appropriate diagnostic tests, and strategies for educating and reassuring anxious parents. Complex febrile seizures and febrile status epilepticus are also examined, with recommendations on when to seek a neurology consultation. Personal anecdotes and case studies add valuable context, rounding out the episode with actionable and practical information.

Link to references: 

https://pmc.ncbi.nlm.nih.gov/articles/PMC9396974/

https://www.uptodate.com/contents/clinical-features-and-evaluation-of-febrile-seizures?search=febril...

In this episode of PEM Chatt, Dr. Jordan Foutch discusses the approach to evaluating a limping child in the pediatric emergency department. He emphasizes the importance of considering septic arthritis as a possibility, especially when fever is present. Dr. Foutch outlines the initial workup, including physical examination techniques, lab tests like CBC, inflammatory markers, and imaging studies. He explains the Kocher criteria for risk stratification and discusses the management approach, including when to involve orthopedics and consider joint aspiration or MRI. The conversation also covers various mimickers of septic joint, such as transient synovitis, osteomyelitis, and non-orthopedic conditions. Dr. Foutch provides valuable insights on communicating with parents, making admission decisions, and key pearls for diagnosing and managing limping children in the emergency setting.

Link to Kocker Criteria:

https://www.mdcalc.com/calc/1817/kocher-criteria-septic-arthritis

Link to references:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10974044/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774603/

https://www.uptodate.com/contents/evaluation-of-limp-in-children?search=limp child&source=search_result&selectedTitle=1~113&usage_type=default&display_rank=1

https://www.uptodate.com/contents/bacterial-arthritis-clinical-features-and-diagnosis-in-infants-and-children?search=septic arthritis child&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

Dr. Tamarrah Davis, a pediatric emergency medicine physician, joins PEM Chatt to discuss the diagnosis and management of preceptal and orbital cellulitis in children. This episode covers key differences between the two conditions, examination techniques, treatment options, and important considerations for emergency advanced practice providers. Throughout the episode, Dr. Davis shares practical advice on communicating with families about treatment decisions and imaging, as well as pitfalls and pearls for managing these eye infections in the pediatric emergency setting.

Great illustrations of the anatomy: 

https://jamanetwork.com/journals/jama/fullarticle/2758601

Link to References:

https://www.uptodate.com/contents/preseptal-cellulitis?search=periorbital%20cellutlis&source=search_result&selectedTitle=1%7E21&usage_type=default&display_rank=1

https://www.uptodate.com/contents/orbital-cellulitis?search=orbital%20cellulitis&source=search_result&selectedTitle=1%7E28&usage_type=default&display_rank=1

Dr. Shelley Murphy discusses evidence-based bronchiolitis management in pediatric patients. She explains that bronchiolitis is a viral infection affecting the airways, commonly caused by RSV, rhinovirus, or human metapneumovirus. Key points include the importance of nasal suctioning as primary treatment, using a scoring system to assess severity and guide management, avoiding unnecessary treatments like albuterol or steroids unless specifically indicated, and criteria for admission. Dr. Murphy also covers the use of high-flow nasal cannula, fluid management, and considerations for intubation. She emphasizes effective communication with parents, clear discharge instructions, and recognizing when hospital admission is necessary. The episode provides valuable insights into evidence-based management of bronchiolitis in the pediatric emergency setting, including common pitfalls and practical advice for healthcare providers dealing with this common condition.

Link to Scoring Tool and Protocol:

https://docs.google.com/document/d/1w7ecR09iy5oqLHmNPWcCymT2XYUAz2oH/edit?usp=sharing&ouid=114761811370298938575&rtpof=true&sd=true

Link to References:

https://www.uptodate.com/contents/bronchiolitis-in-infants-and-children-treatment-outcome-and-prevention?search=bronchiolitis&source=search_result&selectedTitle=1%7E150&usage_type=default&display_rank=1

https://journals.lww.com/jpcr/fulltext/2020/07050/acute_bronchiolitis_in_children.16.aspx