PEM Rules

By Yaron Ivan

What's PEM Rules about?

PEM Rules is a dedicated Pediatric Emergency Medicine Podcast designed to help students, residents, physicians and anyone who takes care of children in the acute setting.

Find out more and www.pemrules.com

Contents does not constitute medical advice

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PEM Rules episodes:

05.06.2024
Episode 87: Clinical Care Tips - Testing, Asking the Right Questions and What Not To Do
Sometimes there are "odd reasons" for using a test, Getting a good history is key and some questions are more important than others and a bit about knowing what not to do. Please consider contributing to PEM...
04.22.2024
Episode 86: Emergencies in the Primary Care Office. What to Do and When to Send?
Just like I lost many of my “primary care” skills many primary care pediatrician feel uncomfortable treating emergencies or urgencies in their office. That is why I had a discussion with Dr. Noah (from a previous PEM Rules episode) about...
04.08.2024
Episode 85: Clinical care Tips – Intermittent Conditions, being a Trainee and Starting with The Basics
What do you do when the patient in front of you has no symptoms (at the moment). Why you should enjoy being in training and what all of us PEM clinicians should know very well. Please consider contributing to...
03.25.2024
Episode 84: Interesting Case In the Peds ER. By Codey Pedersen
What do you do when a teenager with odd (and concerning) neurological symptoms walks into you ER and how do you apply the PEM Rules to work him up step by step?
03.11.2024
Episode 83: Clinical Care Tips – Your Limited Exam, the Patient’s Trust and Your Compassion
Often times I see none verbal patients (be it newborns or children who are neurologically devastated) who come in by EMS or perhaps their parents / caregiver. In those situations, I find it important to be more conservative. How do...
03.04.2024
Off Schedule Episode: (Another) Case of Pediatric Acute Pneumonia
Hours after last weeks episode was published I heard from Dr. Jay Fisher about a very similar (and unfortunate) case one of his APP's had in their ED. I decide to bring Jay to the show (again) to discuss the...
02.26.2024
Episode 82: The “Fever for Over 5 days Patient”. What to Do, What to Think About and How to Make Sure You Are Not Missing Anything”?
What is the appropriate differential diagnosis for a well appearing child with fever for over 5 days and what is the best way to work these patients up? I discuss this important Issue with my Former colleague Dr. Fatma Levent,...
02.12.2024
Episode 81: Clinical Care Tips – Addressing “Issues”, Pin-Pointing The Syndromes and Adjusting Your Care
There is a certain way to address the chief complaint in the ED and it is often advantageous to do it this way. Why is it important to know what syndrome the child has? and how can we all give...
01.29.2024
Episode 80: How to Handle Neurosurgical Emergencies in the Peds ER? Interview with a Pediatric Neurosurgeon Dr. Todd Hankinson
As a PEM Physician, I get to take care of children with neurosurgical problems fairly often. Sometimes it is children with known issues such as hydrocephalus with a shunt and sometimes it is a patient with traumatic injury. Pediatric neurosergeons...
01.15.2024
Episode 79: Clinical Care Tips - What to Do with Your Team, What To Look For and How To Learn From Each of Your Patients.
As a good leader there are certain ways you can work with your team to let them excel. How do we work up our patients “appropriately”? and what can we learn from our patients?
01.01.2024
Episode 78: Interview with Jason Zamkoff, a Pediatric Hospitalist In Denver CO.
Probably the Pediatric Sub-specialists I interact with the most are the pediatric hospitalists. Not only they accept my admissions but often give advice about the work up that the patient needs and serve as an extension of the Pediatric Emergency...
12.18.2023
Episode 77: Clinical Care Tips – Consultants, Boxes and Antibiotics
It is important to communicate to your consultants and hospitalists the way they want to be communicated to and “speak their language”. Why is it important not to think linearly and when is it “Not OK” to use antibiotics.
12.04.2023
Episode 76: Dealing with Acute (and Chronic) Pain in the Pediatric Emergency Department
As a PEM physician, treating pain is a big part of my life and sometimes it is easier said than done. This why I invited Dr. Alan Bielskay, a Pediatric Anesthesiologist (and pain expert) from Denver CO to talk about...
11.20.2023
Episode 75: Clinical Care Tips – Making Decisions, Testing for Bacteremia and “Going with Your Gut”
Sometimes decisions are hard to make, nonetheless, in the ED world it is important to make a decision and sometimes sooner rather than later. Why getting a blood culture (without giving antibiotics) makes no sense to me and more about...
11.06.2023
Episode 74: Child Abuse in the Pediatric Emergency Department, How Can We Make Things Better?
As a PEM Physician, child abuse, sexual abuse and child neglect cases are those cases I never want to miss or overlook. That is often easier said than done. This is a discussion I had with Dr. Stephen Boos, a...
10.23.2023
Episode 73: Clinical Care Tips – Taking care of yourself and Making Big Deals Small ones.
Probably the best advice I got in my career was to take care of myself before I take care of any patients and how I address some over-medicalized issues.
10.19.2023
The PEM Rules Facebook Page
I am excited to announce the launch of the PEM Rules Facebook page. Please visit, become a follower and communicate what you like, wish to hear or just keep in touch. Here is the link to the page https://www.facebook.com/PEMRules Please...
10.09.2023
Episode 72: The Medicolegal World of PEM With Brady Pregerson
What medicolegal aspects of medicine should we PEM Providers be familiar with and how can we all better protect ourselves while providing excellent care for our patients? I discuss these question and more with Dr. Brady Pregerson an expert in...
09.29.2023
Pickaso Guitar Bow Promo Code - Coming Back Soon.
My apologies to all of you who tried purchasing merchandise from Pickaso Guitar Bow and use PEM Rules Promo code. It came to my attention that the promo code stop working. Please be patient, check out the following link https://www.pickasobow.com...
09.25.2023
Episode 71: Clinical Care Tips – When Things Don’t Work, Strikes and Endorphins.
What should you do when things don’t seem to work they you want them to, what happens when a patient visits the Peds ED 3 times (or more) in a short time interval and what endorphins can potentially be.
09.12.2023
Episode 70: PEM Education with Michael Mojica.
What makes a good PEM teacher and how can we PEM providers be better educators for the next generation. I discuss this and More with Dr. Michael Mojica a PEM attending and educator for over 30 years.
08.28.2023
Episode 69: Clinical Care Tips – More About Fever and Making Recommendations
Why fever in children does not really scare me much how I recommend you speak to the parents and what I do when the patient has had a fever for over 5 days.
08.21.2023
Bonus Episode - Child Psychiatry In the Pediatric ED. Interview With Dr. Victor Fornari
Due to the pediatric Mental Health Crisis and increase in psychiatric presentations to the Pediatric Emergency Departments across the nation, I decide to have this off-schedule / bonus episode and interview Dr. Victor Fornari, an experienced Child Psychiatrist from New...
08.14.2023
Episode 68: Applying The rules, A PEM Fellow Experience (2.0) and What Emergencies Can Be Revealed By The Growth Chart?
Sophia Wang is a PEM Fellow in Mississippi who has been on the show once before and told us how she applied the PEM Rules in her clinical work as a PEM Fellow. She returned to share some more interesting...
07.31.2023
Episode 67: Clinical Care Tips – Having Another Way, Tips on Management of (most) Knee Injuries, and "Going All the Way"
In the Pediatric ER (like in life) there is always more than one way to do things. I try to remind that to myself. How do I manage (almost) all knee injuries, and what I try to be always be...
07.24.2023
PEM Rules Special Announcement - Pickaso Guitar Bow Collaboration with PEM Rules
I am excited to announce my new collaboration with Pickaso Guitar Bow. This item is a really cool tool that makes your guitar sound like a violin or a cello. It’s a lot of fun and you will be hearing...
07.04.2023
2023 July / Summer Break Announcement
PEM Rules (and I) will be taking a short break for July 2023. THANK YOU ALL for your support, your emails and interest. Will see you again on July 31st 2023. Hope everyone has a safe, restful, fun summer.
07.03.2023
Episode 66: Why Do Children Make General EM Providers Nervous? a Discussions with My Friends at The EM Over Easy Podcast
While some of us who take care of children for a living feel comfortable around sick kids’ others disagree and get a bit nervous under the same circumstances. Why is that? and how can we change that? This is a...
06.19.2023
Episode 65: Clinical Care Tips – What Is Colic, What Is The “Best Way” to Take Care of Patients, and a Bit More About Fractures.
I entertain the possibility of Colic in many patients but try to keep in mind it is a diagnosis of exclusion. It is important for me to follow some guidelines when I take care of patients and this is how...
06.05.2023
Episode 64: Applying The rules, a PEM Fellow Experience
Sophia Wang is a PEM Fellow in Mississippi who applied the PEM Rules and wanted to share her story. Thank you, Sophia, for sharing your thoughts and thank you for listening to PEM Rules.
05.22.2023
Episode 63: PEM Past Present and Future with Jay Fisher
How did PEM Start? what is it like now? and where is it going? I discuss those questions and more with Dr. Jay Fisher, PEM Attending for almost 30 years.
05.08.2023
Episode 62: Clinical Care Tips – Where Is A Good Place to Start, How to Think Of Fever And When Do Children Need Reduction
Sometimes it is helpful to start thinking about patient disposition early so you can make plans appropriately. Here is what I teach parents about fever and what it really means and a very important rule for fracture reduction.
04.24.2023
Episode 61: Interview With Noel Spears and Mel Tavarez Who Trained Me Back At the Children’s Hospital of Pittsburgh
How has the training in PEM changed over the years and what makes a good PEM fellow or provider. I discuss those questions with Mel and Noel, two very influential individuals in my career.
04.10.2023
Episode 60: Clinical Care Tips – Using D10, Thinking About Your Differential and Debriefing with Your Team
What is a good starting point for treatment of most metabolic emergencies? How not to miss a serious diagnosis, and what to do with your team so you can all do a better job next time.
03.27.2023
Episode 59: Interview with Noah Makovsky, Primary Care Pediatrician in Denver, Colorado
It is the General Pediatricians that often sends the child to the Pediatric ED. How the PCP and PEM doctor better communicate to help their patients.
03.13.2023
Episode 58: Clinical Care Tips – Ketamine Sedation, The Doctor and The Parent Perspective.
I don’t know what I would do without Ketamine. My favorite drug to use for procedures. Here is how I use it and what I tell the parents…
03.06.2023
Helping a PEM Fellow With a Research Project
Dear Listener, If you are a PEM provider in the US in a Pediatric ER that has rotating residents and/or fellows please take a moment and click on the link below and help Sophia Wang (a PEM fellow in the...
02.27.2023
Episode 57: Clinical Care Tips – All About My Favorite Procedure. Suturing Those Lacerations
Probably the most common procedure I perform in the Pediatric ER and one I particularly like. Suturing. Which rules do I use and what is my anticipatory guidance for these parents.
02.13.2023
Episode 56: Interview With My Favorite Pediatric Dermatologist, Dr. Tace Rico
Rashes always makes us, none dermatologist worry and maybe a bit anxious. Which rashes are worrisome? and what should we look for as the red flags of pediatric rashes. I discuss this and more With Dr. Tace Rico our Pediatric...
01.30.2023
Episode 55: The Art of Talking To Consultants
Talking to a consultant so your patient can benefit the most is an art and a science. Here are some rules I have already discussed (and some new ones) that help me make the best of those contestations on the...
01.16.2023
Episode 54: Clinical Care Tips – Documentation, Important S&S and Communicating with Parents and Trainees
There is a certain art to how to document to your advantage? And what s&s; should scare you more. Are Bilateral complaints really worse? Most importantly, how to speak to parents and trainees. Please consider contributing to PEM Rules at...
01.02.2023
Episode 53: Interview with My Favorite Pediatric Anesthesiologist Adam Adler
What is the best approach to the patient with the difficult airway? and how can we improve our sedations? I discuss these topics (and others) with Dr. Adam Adler, a pediatric Anesthesiologist and a friend. Please consider contributing to PEM...
11.28.2022
Quick Announcement - Thank You For All Your Support
PEM Rules will be taking a short winter vacation for the month of December. Really appreciate everyone's support over the last 2 years. Will see you again in the new year.
11.21.2022
Episode 52: Clinical Care Tips – Some More Rules About Vomiting and PO Challenge, and Having a Good Backup Plan
Does every child who is vomiting need Zofran? What is the “best” thing to do for a vomiting child and how do we set our PO challenge for success? What do we do when things don’t go as planned? Please...
11.07.2022
Episode 51: EBM Review with Victoria. All about Bronchiolitis
Despite so much research and evidence there are still so many questions and uncertainties. Victoria and I review the clinical presentation, diagnosis, current and future treatment. Please consider contributing to PEM Rules at https://ko-fi.com/pemrules And check out www.pemrules.com Copyright PEM...
10.24.2022
Episode 50: Clinical Care Tips – Talking About True Emergencies, Hypoglycemia, and Importance of Knowing the Epidemiology.
As a PEM physician I must worry (and therefore rule out and treat) the true emergencies first. That is why I first check for what is emergent and what I can fix. Since my patient population varies greatly with regards...
10.10.2022
Episode 49: PEM Research. Why, How, What and When...
Research is one of the most intimidating aspects of medicine for us clinicians. Why is that ? and where is a good place to start? I discuss these topics and much more with Dr. Bob Hickey from the Children's Hospital...
09.26.2022
Episode 48- Clinical Care Tips – More About Mistakes, Smiling Children and the Precious IV access
What is the best way to view mistakes and how to reap some benefits from them. How I go about "working up" smiling children and what to do first with that IV access. Please consider contributing to PEM Rules on ...
09.12.2022
Episode 47: Interview With My Favorite Pediatric Nephrologist, Dr. Craig Woda.
My Nephrology professor in Medical school used to say that “The kidney is an easy organ to master, but you truly need to understand it”. My friend Craig Woda (an astute Pediatric Nephrologist) helps me better understand how we can...
09.05.2022
Special Announcement: Research Article Published and Some More
Hope you like the news I have to share and check out the link below. As usual please check out www.pemrules.com and consider contributing by clicking below. https://ko-fi.com/pemrules Best, Yaron Ivan PEM Rules LLC.

What's PEM Rules about?

Download our free app to listen on your phone

PEM Rules episodes:

Episode 87: Clinical Care Tips - Testing, Asking the Right Questions and What Not To Do

Episode 86: Emergencies in the Primary Care Office. What to Do and When to Send?

Episode 85: Clinical care Tips – Intermittent Conditions, being a Trainee and Starting with The Basics

Episode 84: Interesting Case In the Peds ER. By Codey Pedersen

Episode 83: Clinical Care Tips – Your Limited Exam, the Patient’s Trust and Your Compassion

Off Schedule Episode: (Another) Case of Pediatric Acute Pneumonia

Episode 82: The “Fever for Over 5 days Patient”. What to Do, What to Think About and How to Make Sure You Are Not Missing Anything”?

Episode 81: Clinical Care Tips – Addressing “Issues”, Pin-Pointing The Syndromes and Adjusting Your Care

Episode 80: How to Handle Neurosurgical Emergencies in the Peds ER? Interview with a Pediatric Neurosurgeon Dr. Todd Hankinson

Episode 79: Clinical Care Tips - What to Do with Your Team, What To Look For and How To Learn From Each of Your Patients.

Episode 78: Interview with Jason Zamkoff, a Pediatric Hospitalist In Denver CO.

Episode 77: Clinical Care Tips – Consultants, Boxes and Antibiotics

Episode 76: Dealing with Acute (and Chronic) Pain in the Pediatric Emergency Department

Episode 75: Clinical Care Tips – Making Decisions, Testing for Bacteremia and “Going with Your Gut”

Episode 74: Child Abuse in the Pediatric Emergency Department, How Can We Make Things Better?

Episode 73: Clinical Care Tips – Taking care of yourself and Making Big Deals Small ones.

The PEM Rules Facebook Page

Episode 72: The Medicolegal World of PEM With Brady Pregerson

Pickaso Guitar Bow Promo Code - Coming Back Soon.

Episode 71: Clinical Care Tips – When Things Don’t Work, Strikes and Endorphins.

Episode 70: PEM Education with Michael Mojica.

Episode 69: Clinical Care Tips – More About Fever and Making Recommendations

Bonus Episode - Child Psychiatry In the Pediatric ED. Interview With Dr. Victor Fornari

Episode 68: Applying The rules, A PEM Fellow Experience (2.0) and What Emergencies Can Be Revealed By The Growth Chart?

Episode 67: Clinical Care Tips – Having Another Way, Tips on Management of (most) Knee Injuries, and "Going All the Way"

PEM Rules Special Announcement - Pickaso Guitar Bow Collaboration with PEM Rules

2023 July / Summer Break Announcement

Episode 66: Why Do Children Make General EM Providers Nervous? a Discussions with My Friends at The EM Over Easy Podcast

Episode 65: Clinical Care Tips – What Is Colic, What Is The “Best Way” to Take Care of Patients, and a Bit More About Fractures.

Episode 64: Applying The rules, a PEM Fellow Experience

Episode 63: PEM Past Present and Future with Jay Fisher

Episode 62: Clinical Care Tips – Where Is A Good Place to Start, How to Think Of Fever And When Do Children Need Reduction

Episode 61: Interview With Noel Spears and Mel Tavarez Who Trained Me Back At the Children’s Hospital of Pittsburgh

Episode 60: Clinical Care Tips – Using D10, Thinking About Your Differential and Debriefing with Your Team

Episode 59: Interview with Noah Makovsky, Primary Care Pediatrician in Denver, Colorado

Episode 58: Clinical Care Tips – Ketamine Sedation, The Doctor and The Parent Perspective.

Helping a PEM Fellow With a Research Project

Episode 57: Clinical Care Tips – All About My Favorite Procedure. Suturing Those Lacerations

Episode 56: Interview With My Favorite Pediatric Dermatologist, Dr. Tace Rico

Episode 55: The Art of Talking To Consultants

Episode 54: Clinical Care Tips – Documentation, Important S&S and Communicating with Parents and Trainees

Episode 53: Interview with My Favorite Pediatric Anesthesiologist Adam Adler

Quick Announcement - Thank You For All Your Support

Episode 52: Clinical Care Tips – Some More Rules About Vomiting and PO Challenge, and Having a Good Backup Plan

Episode 51: EBM Review with Victoria. All about Bronchiolitis

Episode 50: Clinical Care Tips – Talking About True Emergencies, Hypoglycemia, and Importance of Knowing the Epidemiology.

Episode 49: PEM Research. Why, How, What and When...

Episode 48- Clinical Care Tips – More About Mistakes, Smiling Children and the Precious IV access

Episode 47: Interview With My Favorite Pediatric Nephrologist, Dr. Craig Woda.

Special Announcement: Research Article Published and Some More