PEM Chatt

In this episode of PEM Chatt, Toni talks with Dr. Whitney Buss about Diabetic Ketoacidosis (DKA) in children. Dr. Buss, a pediatric emergency medicine doctor and type 1 diabetic herself, shares her personal experience with DKA and her expert advice on how to recognize, diagnose, and treat DKA. They discuss how DKA can show up in both kids with newly diagnosed diabetes and those already living with the condition. Dr. Buss highlights the importance of paying attention to early warning signs, especially in young kids, where symptoms can be subtle and easy to miss. The conversation also covers how to safely manage DKA, including when to give fluids, how to use insulin carefully, and how to watch for serious complications like cerebral edema (brain swelling). They discuss real-life cases, common mistakes in diagnosing DKA, and how to handle Hyperosmolar Hyperglycemic State (HHS), another dangerous diabetes emergency. Dr. Buss gives helpful tips for monitoring patients, following treatment protocols, and knowing when to call for extra help. Resources Mentioned: CHOP DKA Algorithm: https://pathways.chop.edu/clinical-pathway/diabetes-type1-with-dka-clinical-pathway Cerebral Edema and Muir Criteria:https://achpccg.com/wp-content/uploads/2021/06/tms-picuc-physician-diabetic-ketoacidosis-cerebral-edema-dka-guideline.pdf Sick Day Management: Tips for families on managing diabetes during illness to prevent DKA episodes. 🎧 Listen now on your favorite podcast platform!

Episode Summary: In this two-part series, we sit down with Dr. Chuck Gomez, a pediatric orthopedic surgeon, and John Appel, PA, a seasoned emergency medicine provider, to discuss common pediatric orthopedic emergencies. In Part 1, we cover upper extremity injuries, including forearm fractures, supracondylar fractures, lateral condyle fractures, nursemaid’s elbow, elbow dislocations, and clavicle fractures. Dr. Gomez and John share insights on pain management strategies, splinting techniques, and key imaging considerations, ensuring listeners know when to consult orthopedics and how to manage common injuries. In Part 2, we shift focus to lower extremity orthopedic emergencies, covering conditions such as Slipped Capital Femoral Epiphysis (SCFE), patella dislocations, tibial tubercle fractures, toddler’s fractures, and osteomyelitis/septic arthritis. Dr. Gomez provides guidance on recognizing urgent injuries, including red flags for compartment syndrome and infections, while John shares practical advice for ER-based assessment and initial management. Throughout the discussion, we emphasize when to splint, when to allow weight-bearing, and when orthopedic consultation is critical. Resources Mentioned: Radiographic Interpretation Guide: Dr. Stewart Braden’s Orthopedic PowerPoint – Includes imaging examples and fracture patterns. https://www.scribd.com/document/792597792/Bradin-Orthopedic-Emergencies Ortho References: OrthoBullets for quick reference, UpToDate for evidence-based management, and pediatric orthopedic textbooks for deeper dives. Pain Control & NSAID Debate: Recommendations on NSAID use in fractures and multimodal pain management approaches. Septic Joint & Osteomyelitis Workup: Review of inflammatory markers, bedside ultrasound utility, and joint aspiration protocols. Clinical Pearls for Fracture Management: Guidelines for splinting, weight-bearing restrictions, and follow-up timing. Next Episode: Join us next month as we talk with Dr. Whitney Buss about pediatric DKA management. As both a pediatric emergency physician and a Type 1 diabetic, Dr. Buss brings unique insights into how DKA presents in children, key management strategies, and common pitfalls to avoid. Don’t miss this deep dive into a critical pediatric emergency! 🔔 Subscribe to PEM Chatt for more expert insights into pediatric emergency medicine!

In this episode of PEM Chatt, we explore common pediatric orthopedic emergencies with Dr. Chuck Gomez, a pediatric orthopedic surgeon, and John Appel, PA, an experienced emergency medicine provider. We discuss why children's bones differ from adult bones, how this affects fracture patterns, and the best approaches for diagnosis and treatment. Our conversation focuses on upper extremity injuries, including forearm fractures, supracondylar fractures, lateral condyle fractures, nursemaid’s elbow, elbow dislocations, and clavicle fractures. We cover key clinical pearls, such as recognizing subtle fractures that may not appear on initial imaging and ensuring proper splinting techniques to prevent complications. Along the way, Dr. Gomez and John share insights on pain management, including the ongoing discussion around NSAIDs and bone healing, as well as best practices for determining when orthopedic consultation is needed. They emphasize the importance of early recognition of serious fractures, such as Monteggia fractures, and the role of follow-up imaging in cases where occult fractures may become more apparent over time. The episode also highlights practical reduction techniques for nursemaid’s elbow and explains why certain fractures, like clavicle injuries, rarely require surgery despite their dramatic appearance on X-rays. Resources Mentioned: Radiographic Interpretation Guide: Dr. Stewart Braden’s Orthopedics PowerPoint – Includes imaging examples and tips for recognizing key fractures. https://www.scribd.com/document/792597792/Bradin-Orthopedic-Emergencies Montagia Fracture Reference: Ensuring proper radial head alignment on imaging. Pediatric Ortho Follow-Up Recommendations: General guidelines for when to refer and how soon. Coming Next: This was a two-part episode! Stay tuned next month for Part 2, where we’ll discuss lower extremity orthopedic emergencies, including: Femur and tibia fractures Ankle injuries in kids Slipped Capital Femoral Epiphysis (SCFE) Toddler’s fractures And more!

Toni sits down with the ever-popular Dr. Beachgem, a pediatric emergency medicine physician and social media sensation, to discuss managing pneumonia and other respiratory illnesses in children. They highlight this year’s unique respiratory illness trends, such as a surge in mycoplasma cases and challenges in managing pertussis and flu-related complications. Dr. Beachgem shares practical insights from her experience and emphasizes the art of patient communication, especially with vaccine-hesitant families. The conversation is informative, engaging, and packed with actionable advice for both medical professionals and caregivers. Plus, they explore lighter topics like the joy of curing a nursemaid's elbow and navigating the surreal world of social media fame as a practicing doctor. Resources:Dr. Beachgem on Social Media Follow Dr. Beachgem for relatable, practical, and insightful pediatric content on [TikTok/Instagram/etc.]. Respiratory Illness Management Guidelines American Academy of Pediatrics (AAP) Guidelines on Pneumonia Centers for Disease Control and Prevention (CDC) Recommendations on Pertussis Mycoplasma Resources Overview of Mycoplasma in Pediatrics: MedlinePlus Vaccination Guidance CDC's Vaccination Schedule: CDC Immunization Schedule

Jennifer Stanfield, PA, with more than 20 years of experience talks about the very important and serious topic of child sexual abuse and sexual assault. Jennifer explains that 1 out of 4 girls and 1 out of 6 boys will face sexual abuse before they turn 18. She shares that most of the time, the person who hurts the child is someone they already know and trust. Jennifer talks about how abusers can trick families and kids (this is called "grooming"), how abuse happens, and why it’s so important for doctors and nurses to know the signs. Jennifer also talks about what happens in the emergency room (ER) when a child comes in for help. She explains how to check the child safely, when to collect evidence, and how doctors work with DCS (Department of Child Services) and the police to keep kids safe. She shares tips on how to talk with parents and how to get help from special places like Children’s Advocacy Centers. The episode also covers what happens when a child or teenager has been sexually assaulted, including how the law works, checking for injuries, preventing infections, and finding counseling to help kids heal. Jen reminds doctors and nurses to take care of themselves too, because helping kids through hard situations can be very tough. She also talks about working together with police, social workers, and local centers to make sure kids are safe and get the care they need. Resources:- National Child Abuse Hotline: 1-800-4-A-CHILD (1-800-422-4453) - Child Advocacy Centers: Local centers that provide forensic interviews and support for child abuse victims.

Jennifer Stanfield , PA, a pediatric emergency medicine provider with over 21 years of experience, talks about the important topic of childhood physical abuse, focusing on non-accidental trauma (NAT). She explains that there were 3 million cases of child abuse reported in the U.S. in 2022 and shares tools like the TEN4 FACES-P rule to help spot sentinel injuries that could lead to more serious harm. Jen stresses how important it is to check carefully, follow clear steps, and treat every case fairly to keep kids safe. She also talks about how hard this work can be for doctors and advanced practice providers and gives tips to help them stay strong and caring while doing this important job. State of TN NAT Guidelines: https://drive.google.com/file/d/1zoVFx0Vah9magAEwy4uPpGvUWWFkbbcB/view?usp=drive_link TN Child Abuse Hotline: https://www.tn.gov/dcs/program-areas/child-safety/reporting/child-abuse.html TEN4 FACES-P: https://faceitabuse.org/ten4rule/ Imaging examples (bucket handle fracture, corner fracture, metaphyseal fractures): https://wikem.org/wiki/Nonaccidental_trauma References: https://ct-aap.org/wp-content/uploads/2020/03/Sheets.pdf Resources: Books on Trauma and Abuse: A Place Called Home by David Ambrose The Body Keeps the Score by Bessel van der Kolk Child Welfare Information Gateway: Offers resources and support for child abuse prevention. Visit the website. National Child Abuse Hotline: 1-800-4-A-CHILD (1-800-422-4453).

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