PEM GEMS

Thanks to people who get concussions for a living, like boxers or NFL players, we know a lot more about the long-term effects of hits to the head than we did 30 years ago.  Given this explosion of research and tons of good, bad, and ugly information available to patients and families, what are the best evidence-based recommendations for the next time you see a pediatric patient who has a concussion.

We have all had the experience of something going “down the wrong pipe” or having the wrong thing down the right pipe.  Any way you slice it, things end up in the GI tract or bronchial tree that shouldn’t be there.  Try not to get choked up as we cover how to figure out what went where and, more importantly, what to do about it.

Taking care of three kids in cardiac arrest in the span of one month has been rough, to say the least. The very nature of the disease makes a good outcome unlikely, which can be emotionally devastating and can cause us to question our careers. So what do we do when a pediatric cardiac case comes through the door? How can we stay organized and do our very best, which, at the end of the day, is all we are capable of?

 Needles in haystacks can poke and zebras can bite. Pediatric stroke is one of those occurrences so rare that diagnosis can be delayed simply because we don’t think of it. Tune in as we put our minds to the pediatric brain, cogitate about how this disease can present, and how we can be ready to recognize and manage it. 

Nothing underscores the adage “Don’t just do something- stand there” like a simple febrile seizure. The terror level in parents is often mega high and the temptation may be to go quickly to IVs and CTs.  But if the kid is well and back to baseline, one approach is a chair, 5 minutes and the FAQs- it might just save you an invasive work up.

There is no getting around it: rashes are rough. Different pathologies can have the same sympotoms; the same pathologies can look completely different on different skin tones. I realized that if I'm to have any street cred as a PEM physician, I need to either memorize the Atlas of Dermatology or come up with another approach for the ED. After making it through a few pages of the Atlas, I gave up and created Joe's Three Step Approach to Rashes. 

For the most part young and healthy kids have young and healthy kidneys. However, for a small subset there is either acute or chronic renal disease. In this episode I spill the beans on some common presentations and not so obvious complications. 

The management of BRUE is based partly on historic etymology and partly on medicine. This episode will walk through the history of the events now known as BRUEs, which are as old as time, and focus on how the name change encapsulates the management. What is and what is not a BRUE? If it is a BRUE what do we do?  All this and a quick sample from George Carlin!   

 Kudos to AAP for trying to tackle one of the toughest questions in PEM: what do we do with the febrile neonate? The PEM community is fired up to get its hot little hands on consensus guidelines about which neonates are low risk for an invasive bacterial infection. Tune in to this special, mid-hiatus episode of PEM GEMS as we explore the recommendations or, for a medium-length dive, check out the accompanying review on EMdocs.net.  

Full disclosure: I am not a toxicologist, but I do know a thing or two about pediatric ingestions. Witnessed ingestions are easy: call poison control and spend as much time as you want reviewing pharmacology and biochemistry.  But what about the unwitnessed ingestion, or the altered and sick kid? Its important to keep Tox on the differential- also remember the medications where one pill can kill or make very ill.