PEM Rules

Probably one of the most important (and most challenging) situation in PEM is how do we identify the child with none accidental trauma among the see of true / innocent accidental injuries. That is why I asked Toni Laskey, a child abuse physician in Utah to come and talk about this very important topic.

Sometimes it is worth going the extra mile in order to (maybe) prevent the next ED visit. Always try to take the Chief Complaint seriously though it is not always as easy as it sounds and why it is important to validate the parents or patient's concerns

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DISCLAIMER

By listening to this podcast, you agree not to use these resources as medical advice to treat any medical conditions in either yourself or others, including, but not limited to, patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast or website. Under no circumstances shall PEM Rules, the PEM Rules podcast or any guests or affiliated entities be responsible for damages arising from their use.

This podcast should not be used in any legal capacity whatsoever, including, but not limited to, establishing "standard of care" in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the website or in the podcast.

Trauma is often scary and small children may be intimidating. Admitting to this is a good first step. In this Episode Dr. Nir Samuel and I talk about how to fall on our feet, get better about treating injured children (or at least effectively cheat!)

Dr. Jay Fisher is back on PEM Rules to discuss his experience with Bacterial Meningitis, a rare (and terrible) condition that is high on my list of "I Never Want to Miss It".

Here are the articles Jay discussed:

References

Clinical Features Suggestive of Meningitis in Children:A Systematic Review of Prospective Data. Pediatrics 2010;126(5);952-960.

https://pubmed.ncbi.nlm.nih.gov/20974781/

Bulging fontanelle in febrile infants as a predictorof bacterial meningitis. European Journal of Pediatrics (2021) 180:1243–1248.

https://pubmed.ncbi.nlm.nih.gov/33169238/

Here is the link to the picture of the CSF of the patient discussed in the episode.

https://pemrules.com/wp-content/uploads/2024/12/csf.png

As a PEM physician I am fairly good (and confident) about intubating children and passing that ET tube beyond the vocal cords. Managing the vent, however is a whole different ballgame. That is why I asked Jared to come and teach us some basic vent setting for our children.

Many PEM physicians I meet have some rules of their own or interesting interpretations of my PEM Rules. Here are some of Carla Laos's (a PEM Physician and medical director in Las Vegas) rules she uses in her practice.

As a leader it is important to take responsibility for anything that happened "under your watch". Yes, you can check many things but do you actually need to? And what should you think about when you initiate treatment with antibiotics on an admitted patient.

With the concerning rise of antibiotic resistance I asked Dr. Fatima Levent to come back to PEM Rules and review with us the appropriate choice of antibiotics for our patients.

Pediatric Gastroenterological Chief Complaints is something we do in the Pediatric Emergency Department a considerable part of our time. That is why I invited Howard Baron to come on the show and talk about his advice for investigating and treating common GI conditions.

PEM Rules will take a short summer break for the months of July and August and will be back in September again with (hopefully) more exciting episodes. Thank you for all the support.

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