PEM GEMS

The pediatric oncology population is an emotionally challenging, high-risk group and a classic example of one Joe's laws of PEM: kids with chronic medical conditions must be treated with kid gloves. Let’s think about some incident presentations (including a few with unusual symptoms) and then consider complications of both the underlying malignancy and its treatment.

If last time was wires, this time it's all about the pump. The totality of congential heart disease could be a Tolstoy novel-length podcast; the aim of this recap is to give you the CliffsNotes to help troubleshoot common presentations and complications. Listen in to learn Joe's three questions for kids with congenital heart disease.

As Gloria Estefan would say, "The rhythm is gonna get ya!" Children presenting in an abnormal rhythm can cause palpitations for everyone involved. In a crisis, you can always fall back on PALS/ACLS since algorithms are for doing and not thinking. But if you have time to think, a better understanding of the dysrhythmia will help you stay calm and speak intelligently with your cardiology and critical care colleagues.

Asthma is a spectrum disease: from viral wheezing (which may or may not be asthma), to the well appearing patient with a mild exacerbation, all the way to the crashing kid.  A lot of asthma care is algorithmic -- steroids and nebs, then discharge -- but let's get subtle with some nuance plus some tips for the terrifying sceniro of an intubated asthmatic.

All cultures have myths. Many myths have the dual effects of explaining why something is the way it is while at the same time warning us against danger. These two tennants are certainly the corner stones of most medical myths. Let's dive into three myths in pediatric EM, examine their roots, and think critically about changing our practice - in this episode of pediatric myth busters.

...And now the exciting conclusion! If the last podcast took the anxiety out of pediatric airway, here's a scareway story to ramp it back up!  Plus we troubleshoot common airway problems and cover some survival techniques (for both you and the patient) for when you have one of those nightmare cases. 

This podcast is brought to you by the letter "U". Pediatric intubations are Uncommon, use Unusual equipment sizes, and can be Upsetting cases. It's no surprise that these cases can cause a great deal of anxiety.  So let's talk about the steps we can take to set ourselves and our patients up for success the next time we have to manage a pediatric airway.

Non-Accidental Trauma (NAT) is a tough thing to talk about. While almost all parents just want what is best for their kids, we cannot ignore the statistics that NAT (aka child abuse or child mal-treatment) is one of the leading causes of morbidity and mortality -  particularly in young children. Even more concerning: the vast majority of children with bad outcomes have some form of prior medical contact. So let's acknowledge the difficulty, then talk about some subtle signs of abuse that you need to look out for that may just save a kids life.

Whether it's doom in the diaper, a three-nager with a UTI, a bashful preteen or a rare disease in a 14-year-old, the GU area can harbor serious pathology. While it's easy enough if the complaint is, "You need to take a look down there," we must consider how different symptoms or body bashfulness can hinder our ability to make a diagnosis. Luckily, for many of these diagnoses, you don't need labs or a CT; all you need is a pair of eyes and 30 seconds to take a look.

Well-appearing, otherwise healthy, immunized children, who are over 3 months old and have short duration of fever is the bread and butter of PEM. How many times can we say, "it's just a virus?" While the vast majority of infections are viral, lets talk about an approach that will help you not miss anything and leave the patient and family happy when they leave the ED.