Shows
JCO Oncology Practice PodcastPark the Parking: Patient and Caregiver Perspectives on Transportation Barriers in CancerFrustrations regarding the costs and difficulties with parking at hospitals is a common concern voiced by patients, families, and healthcare providers. Transportation barriers to receiving cancer care are incredibly common despite what appears to be relatively straightforward solutions. Dr. Chino welcomes two patient-centered health policy experts to discuss this: Dr. Arjun Gupta, MBBS, an Assistant Professor at the University of Minnesota; and Dr. Shakira Grant, MBBS, MSCR, the Founder & CEO of CROSS Global Research & Strategy. Transcript Dr. Fumiko Chino: Hello, and welcome to Put Into Practice, the podcast for JCO Oncology Practice. I'm Dr. Fumiko Chino, an...2025-06-1631 min
CCO Infectious Disease PodcastSimplifying HBV Screening and Care: Paths to EliminationIn this episode, Patricia D. Jones, MD, MSCR; Mindie H. Nguyen, MD, MAS, AGAF, FAASLD; and patient advocate, Jennifer Wild, MS, RN, OCN, discuss practical strategies to overcome barriers to hepatitis B virus (HBV) care, including: Overcoming health insurance navigation Improving access to HBV care in immigrant communitiesDispelling HBV myths and stigmaSolutions to language barriersCommunity-based interventionsPresenters:Patricia D. Jones, MD, MSCRAssociate Professor of Clinical MedicineDirector of Clinical Operations-HepatologyDivision of Digestive Health and Liver DiseasesDepartment of MedicineUniversity of Miami Miller School of MedicineSy...2025-03-1019 min
CCO Infectious Disease PodcastDefining Best Practices in HBV CareIn this episode, Patricia D. Jones, MD, MSCR; Mindie H. Nguyen, MD, MAS, AGAF, FAASLD; and patient advocate, Jennifer Wild, MS, RN, OCN, discuss best practices in hepatitis B virus (HBV) care, including: 2023 CDC HBV screening recommendationsSummary of guideline recommendations for hepatitis delta virus (HDV) screening Use of HDV reflex testing to avoid loss to follow-up2024 WHO HBV treatment recommendations, including recommendations for pregnant persons Presenters:Patricia D. Jones, MD, MSCRAssociate Professor of Clinical MedicineDirector of Clinical Operations-HepatologyDivision of Digestive Health and Liver DiseasesDepartment of Med...2025-02-0534 min
Unscripted51. Annie Andrews, MD, MSCR - Pediatrician on running for Congress, then starting a Political Action Committee focused on childrenAnnie Andrews, MD, MSCR, is a Professor of Pediatrics at the Medical University of South Carolina (MUSC) College of Medicine, Pediatric Hospitalist at MUSC Health and ran for the Congressional seat of SC-1 in 2022. After the election she founded a political action committee (PAC), one of the first focused on children, called ‘Their Future. Our Vote.’ We talk through her decision to shift careers away from medicine and run for Congress as well as her campaign experience. In addition to being a pediatrician she is recognized as an expert in gun violence prevention. We also talk through her n...2023-05-0331 min
Unscripted42. Andrea Sikora, PharmD, MSCR, BCCCP, FCCM - Rethinking Critical Care Practice Models and Mentorship, Author of "Pay it Forward: a map to mentorship in medicine"Andrea Sikora, PharmD, MSCR, BCCCP, FCCM, is a Clinical Associate Professor at the University of Georgia College of Pharmacy and is a critical care clinical pharmacist at Augusta University Medical Center.We talk through critical care pharmacist practice models, her recently awarded RO1 grant funding, and her new book “Pay it Forward: a map to mentorship in medicine.” You can purchase the book on Amazon!2022-11-1155 min
Medicine Redefined78. Understanding Sleep Apnea & The Current State of Research for Physicians | Raj Dedhia, MD, MSCRDr. Raj Dedhia, MD, MSCR, is the Director of the Sleep Surgery Division at the University of Pennsylvania. He is a leading researcher and surgeon in the field of sleep apnea - studying better ways to predict response to obstructive sleep apnea surgery as well as the effects of current therapies on patient health. Dr. Dedhia obtained his medical degree from Northwestern University and trained in Otorhinolaryngology - Head & Neck Surgery at the University of Pittsburgh Medical Center. He completed Sleep Medicine fellowship at the University of Washington.
Snore Lab App
Sleep Cycle App
CPAP vs. Oxygen in Obstructive Sleep...2022-11-071h 12
Pap TalkBeating burnout: Habit-hacking tips for bringing wellness back into your lifeBurnout is uniquely pervasive in medicine, regardless of specialty, making physicians more susceptible than the average person. In this episode, Matthew T. Siedhoff, MD, MSCR, discusses warning signs to watch for and shares his habit-hacking tips to refocus your routines and bring wellness back into your life. Watch it here.
Resources in this episode
Matthew T. Siedhoff, MD, MSCR, is vice chair of gynecology, an associate professor of obstetrics and gynecology, and a minimally invasive gynecologic surgeon at Cedars-Sinai Medical Center, Los Angeles, CA.2022-03-3015 min
Road to ResilienceBest of R2R: Three Good ThingsJordyn Feingold, MD, MSCR, MAPP, shares three evidenced-based techniques for harnessing the power of the positive in bleak times. Dr. Feingold is a PGY1 in psychiatry at Mount Sinai, working on research and interventions aimed at promoting the well-being of medical students, residents, and physicians.A version of this episode originally aired in June 2020. (Click here to view.)The Office of Well-Being and Resilience at the Icahn School of MedicineMount Sinai Center for Stress, Resilience, and Personal GrowthCharacter Strengths SurveyPositive Medicine (a program designed to help physicians live better)Follow Dr. Feingold on TwitterGet...2021-08-1910 min
Pediatric Emergency PlaybookFocus On: Pediatric Emergency Eye ExamPEMplaybook.org2021-08-0120 min
CHEST PulseUpdates on Coma Science and Sedation Practices for Patients With COVID-19 and BeyondComa science is a rapidly evolving field. In this episode, expert panelists share how our understanding of coma and consciousness recovery is changing for patients with and without COVID-19. They also discuss how COVID-19 forced us to rethink and adapt sedation practices for critically ill patients and how this may have contributed to increasing delirium and disorders of consciousness. (Originally recorded July 15, 2021) Moderator: Neha Subhash Dangayach, MD, MSCR. Panelists: Brian L. Edlow, MD; Sherry H-Y. Chou, MD, MSc; and Casey Cable, MD, MSc. For more tools to help in the fight against COVID-19, visit CHEST’s COVID-19 Resource Center at chestn...2021-07-2300 min
Live Yes! With ArthritisArthritis Related ConditionsArthritis rarely comes alone. Learn about related conditions and diseases that commonly occur with various types of arthritis, how they are related, and what you can do to prevent them or reduce their effects.
Visit the Live Yes! With Arthritis Podcast site to read the blog and get show notes and a full transcript: https://arthritis.org/liveyes/podcast
We want to hear from you. Tell us what you think about the Live Yes! With Arthritis Podcast. Get started by emailing podcast@arthritis.org.Special Guest: Amanda Nelson, MD MSCR RhMSUS.2021-07-0636 minPediatric Emergency PlaybookFocus On: Breath Holding SpellsPEMplaybook.org2021-07-0114 minPediatric Emergency PlaybookOverdose: Just Right (?)PEMplaybook.org2021-06-0132 min
The Whole Health Cure"The Link Between the Brain, the Stress and the Heart" with Amit Shah, MDAmit Shah, MD, MSCR is an Assistant Professor of Epidemiology with an adjunct appointment in Medicine (Cardiology) at Emory University. He is also Chief of Preventive Cardiology and Director of Cardiac Rehabilitation at the Atlanta VA Healthcare System.Dr. Shah completed his undergraduate degree in physics, and certificate in biophysics, at Princeton University, and his medical degree at the University of Pennsylvania in 2006. He completed residency in Social Internal Medicine at Albert Einstein, Montefiore in 2009, and cardiology fellowship at Emory University in the Clinical Investigator Track in 2013, where he also earned a Master of Science in Clinical...2021-05-2034 minPediatric Emergency PlaybookOverdose: Too Cold!PEMplaybook.org2021-05-0142 min
Yes to Youth!Mary Sun: The Good Spiral | Neurodivergence & navigating differences to make an impactContent warning: Rape (mentioned in spoken word poem performance)
Often, we overlook the power of young people to create change. Yes to Youth is a podcast series getting to know changemakers who started early and are making a real impact, in spite of and often because of their age and identity. Yes to Youth is presented by Let’s Care in collaboration with LearnServe International. Your host is Matt Scott, creator of Let's Care and longtime LearnServe volunteer.
Today's episode features Mary Sun, Dermatology Research Fellow at Memorial Sloan Kettering Cancer Center, Clinical Product Fellow at...2021-04-0835 minPediatric Emergency PlaybookOverdose: Too Hot!PEMplaybook.org2021-04-0137 minPediatric Emergency PlaybookConstipation and the way outConstipation as a diagnosis can be dangerous, mainly because it is a powerful anchor in our medical decision-making. Chances are, you’d be right to chalk up the pain to functional constipation — 90% of pediatric constipation is functional, multifactorial, and mostly benign — as long as it is addressed. We’re not here for “chances are“; we’re here for “why isn’t it?“ Ask yourself, could it be: Anatomic malformations: anal stenosis, anterior displaced anus, sacral hematoma Metabolic: hypothyroidism, hypercalcemia, hypokalemia, cystic fibrosis, diabetes mellitus, gluten enteropathy Neuropathic: spinal cord abnormalitie...2021-03-0148 minPediatric Emergency PlaybookPediatric IV Tips and TricksTop 10 [details in audio] Set the stage – exude confidence and be prepared Choose the right cannula size – a smaller working IV is infinitely better than none Feeling is better than looking – trust yourself Mark the site – things get wonky when you take your hands off to disinfect Tourniquets can mess you up – try to use a holder’s hand to occlude the vein The holder rules – get as many hands on deck as you need. Tension is good – a little counter traction on the skin with you...2021-02-0126 minPediatric Emergency PlaybookVagal Maneuvers In Childrenhttps://pemplaybook.org/?p=22342021-01-0128 minPediatric Emergency PlaybookConjunctivitis2020-12-0144 minPediatric Emergency PlaybookGo or No Go: Pediatric Presedation Assessmenthttps://pemplaybook.org/?p=22112020-11-0143 minPediatric Emergency PlaybookCaustic Ingestionshttps://wp.me/p6B1Mm-zr2020-10-0132 minPediatric Emergency PlaybookPediatric Hand FracturesTuft Fracture Yeh PC et al. Pediatric Hand Fractures. Techniques in Orthopaedics. 2009. Seymour Fracture Nellans et al. Pediatric Hand Injuires. Hand Clin. 2013 November ; 29(4): 569–578 Yeh PC et al. Pediatric Hand Fractures. Techniques in Orthopaedics. 2009. Mallet Fracture Adolescent with mallet finger and Kirschner wire fixation. Nellans et al. Pediatric Hand Injuires. Hand Clin. 2013 November ; 29(4): 569–578 Mallet finger in splint. Yeh PC et al. Pediatric Hand Fractures. Techniques in Orthopaedics. 2009. Volar Plate Injury Yeh PC et al. Pediatric Hand Fractures. Techniques in Orthopaedics. 2009. Central Slip Injury Lee SA et al. Ultrasonography of t...2020-09-0143 minPediatric Emergency PlaybookHeat-Related IllnessA spectrum — but will you recognize the blurry signposts? Temperature (core) Presentation Management Miliaria Crystallina Normal Salt-colored tiny papules, easily burst; not pruritic Modify environment; light clothing; hydration Miliaria Rubra Normal Discrimiate, red papules, not assocaited with follicles; pruritic Above plus cool compresses; calamine lotion; symptomatic tx for pruritis Miliaria Profunda Normal Confluent flesh-colored, “lumpy-bumpy”; burning Same as rubra Miliaria Pustulosa Normal May resemble rubra and/or crustallina, but pustular; h/o previous dermatitis Same as above, but may may need antibiotic if no improvement over time Heat edema Normal Swelling of feet, ankles, and/or lower legs Modify environment; elev...2020-08-0144 min
ATS Breathe EasyThe Art of Contract NegotiationGuest: Dr. Gerard Silvestri, MD MS. Professor of Medicine - Medical University of South CarolinaHost: Dr. Nichole Tanner, MD MSCR. Associate Professor Medicine - Medical University of South Carolina2020-07-0733 minPediatric Emergency PlaybookDiarrhea Traditional Approach: Secretory -- poisoned mucosal villi -- "the sieve" Cytotoxic -- destroyed mucosal villi -- "the shred" Osmotic -- malabsorption -- "the pull" Inflammatory -- edema, motility -- "the push" Lots of overlap, difficult to apply to clinical signs and symptoms. Bedside Approach: Fever/No Fever, Bloody/No Blood Non-bloody, febrile -- most likely viral Non-bloody, afebrile -- may be viral Bloody, febrile -- likely bacterial Non-bloody, afebrile -- full stop. Eval f...2020-07-0150 minPediatric Emergency PlaybookDKA Like A BossPEMplaybook.org2020-06-0145 minPediatric Emergency PlaybookZen and the Art of Pediatric Readiness Pediatric Readiness is not just an ideal -- it's a tangible plan, a toolkit, and even better, an attitude How to improve your institution, and your own personal pediatric readiness. National Pediatric Readiness Project (NPRP) Los Angeles County Pediatric Readiness Project 2020-05-0130 minPediatric Emergency PlaybookPediatric DysrhythmiasPEMplaybook.org2020-04-0144 minPediatric Emergency PlaybookOtitis MediaPEMplaybook.org2020-03-0150 minPediatric Emergency PlaybookMajor Burns in Children Lund and Browder Chart to Estimate Burn Size in Children 2020-02-0143 minPediatric Emergency PlaybookAnemia. Now What?PEMplaybook.org2020-01-0143 minPediatric Emergency PlaybookPediatric Sports InjuriesPEMplaybook.org2019-12-0139 min
Inside StoriesINSIDE STORIES: Debi Kennedy(Consider contributing to Inside Stories to help us cover our production costs: https://www.rubinjen.com/the-podcast.html) We listen to a story Debi Kennedy told at the Madison Moth StorySlam, explore the themes in the story and discuss how she crafted the story. (Told at the Moth in Madison StorySlam in 2017. Audio recording by Oddly Arranged Media).Email us at insidestoriespodcast@gmail.com and find us on twitter at @InsideStoryPod and Facebook at @insidestoriespodcast.Debi will be teaching workshops through MSCR called, "The Glappiness Hour" (glad + happiness, an Ellie created wor...2019-11-0629 minPediatric Emergency PlaybookEtCO2 Masterclass2019-11-0145 minPediatric Emergency PlaybookNeck Masses in ChildrenThe differential diagnosis is long... You need an approach. The Rule of 3s: 3 minutes -- Traumatic 3 days -- Inflammatory 3 months -- Neoplastic 3 years -- Congenital 3 Minutes? Traumatic 3 Days? Inflammatory [caption id="attachment_1777" align="alignnone" width="262"] Cervical Node Chain; Lymphadenopathy[/caption] [caption id="attachment_1773" align="alignnone" width="298"] Bacterial Lymphadenitis[/caption] [caption id="attachment_1772" align="alignnone" width="300"] Bacterial lymphadenitis with small abscess[/caption] [caption id="attachment_1771" align="alignnone" width="300"] Large Abscess[/caption] 3 M...2019-10-0139 minPediatric Emergency PlaybookIntraosseous Devices https://www.youtube.com/watch?v=cQVKIpLc8bk Selected References Barnard, et al. Rapid sequence induction of anaesthesia via the intraosseous route: a prospective observational study. Emerg Med J. 2014; Jun 24. pii: emermed-2014-203740. Jousi M, Saikko S, Nurmi J. Intraosseous blood samples for point-of-care analysis: agreement between intraosseous and arterial analyses. Scand J Trauma Resusc Emerg Med. 2017;25(1):92. Published 2017 Sep 11. doi:10.1186/s13049-017-0435-4 Knuth, et al. Intraosseous Injection of Iodinated Computed Tomography Contrast Agent in an Adult Blunt Trauma Patient. Annals o...2019-09-0146 minPediatric Emergency PlaybookCyanosis Your eyes may fool you... Keep your differential diagnosis open. Selected References Aravindhan N, Chisholm DG. Sulfhemoglobinemia presenting as pulse oximetry desaturations. Anesthesiology. 2000;93:883–884. Gharahbaghian L et al. Methemoglobinemia and Sulfhemoglobinemia in Two Pediatric Patients after Ingestion of Hydroxylamine Sulfate. West J Emerg Med. 2009 Aug; 10(3): 197–201 2019-08-0136 minPediatric Emergency PlaybookFailure to Thrive Failure to Thrive (FTT) is not just for the clinics. We need to be on the lookout, because if we find it, there is already a big problem. Definitions of Failure to Thrive may quibble on the details, but for us in the ED: Consistently under 2nd percentile in weight over time "Falling off" the growth curve over 2 or more points We can get around the longitudinal requirement by looking at weight as a "spot check" -- if grossly below weight without any other chronic condition, be...2019-07-0136 minPediatric Emergency PlaybookMass Casualty Incident No one ever wants to find himself in this situation. A factory explodes. A building catches fire. A multi-vehicle traffic collision. Or an act of terrorism. Very quickly, we have to scrap business as usual. We have to adapt to our new circumstances. Definition of a mass casualty incident (MCI): An incident which produces multiple casualties such that emergency services, medical personnel and referral systems within the normal catchment area cannot provide adequate and timely response and care without unacceptable mortality and/or morbidity. In other words, our demand far outpaces our reso...2019-06-0132 min
Women's Wisdom: Our Journey in Emergency MedicineLisa Moreno, MD MS MSCR FAAEMIn this episode, Faith Quenzer, DO, PGY-4 at Desert Regional Medical Center and Adria Ottoboni, MD FAAEM, Associate Professor at UCLA speak with Lisa Moreno, MD MS MSCR FAAEM, Professor of Emergency Medicine, Director of Research, Director of Diversity and Director of HIV and Viral Testing at Louisiana State University Health Sciences Center, and President-Elect of AAEM about her journey in emergency medicine. Intro music by RogerThat, 'Uplifting Positive Corporate,' powered by JAMENDO.2019-05-2425 min
American Academy of Emergency MedicineLisa Moreno, MD MS MSCR FAAEMIn this episode, Faith Quenzer, DO, PGY-4 at Desert Regional Medical Center and Adria Ottoboni, MD FAAEM, Associate Professor at UCLA speak with Lisa Moreno, MD MS MSCR FAAEM, Professor of Emergency Medicine, Director of Research, Director of Diversity and Director of HIV and Viral Testing at Louisiana State University Health Sciences Center, and President-Elect of AAEM about her journey in emergency medicine. Intro music by RogerThat, 'Uplifting Positive Corporate,' powered by JAMENDO.2019-05-2325 minAmerican Academy of Emergency MedicineLisa Moreno, MD MS MSCR FAAEMIn this episode, Faith Quenzer, DO, PGY-4 at Desert Regional Medical Center and Adria Ottoboni, MD FAAEM, Associate Professor at UCLA speak with Lisa Moreno, MD MS MSCR FAAEM, Professor of Emergency Medicine, Director of Research, Director of Diversity and Director of HIV and Viral Testing at Louisiana State University Health Sciences Center, and President-Elect of AAEM about her journey in emergency medicine. Intro music by RogerThat, 'Uplifting Positive Corporate,' powered by JAMENDO.2019-05-2325 minWomen's Wisdom: Our Journey in Emergency MedicineLisa Moreno, MD MS MSCR FAAEMIn this episode, Faith Quenzer, DO, PGY-4 at Desert Regional Medical Center and Adria Ottoboni, MD FAAEM, Associate Professor at UCLA speak with Lisa Moreno, MD MS MSCR FAAEM, Professor of Emergency Medicine, Director of Research, Director of Diversity and Director of HIV and Viral Testing at Louisiana State University Health Sciences Center, and President-Elect of AAEM about her journey in emergency medicine. Intro music by RogerThat, 'Uplifting Positive Corporate,' powered by JAMENDO.2019-05-2325 minAAEM Podcasts: Emergency Medicine Breve Dulce TalksLisa Moreno, MD MS MSCR FAAEMIn this episode, Faith Quenzer, DO, PGY-4 at Desert Regional Medical Center and Adria Ottoboni, MD FAAEM, Associate Professor at UCLA speak with Lisa Moreno, MD MS MSCR FAAEM, Professor of Emergency Medicine, Director of Research, Director of Diversity and Director of HIV and Viral Testing at Louisiana State University Health Sciences Center, and President-Elect of AAEM about her journey in emergency medicine. Intro music by RogerThat, 'Uplifting Positive Corporate,' powered by JAMENDO.2019-05-2325 minAmerican Academy of Emergency MedicineLisa Moreno, MD MS MSCR FAAEMIn this episode, Faith Quenzer, DO, PGY-4 at Desert Regional Medical Center and Adria Ottoboni, MD FAAEM, Associate Professor at UCLA speak with Lisa Moreno, MD MS MSCR FAAEM, Professor of Emergency Medicine, Director of Research, Director of Diversity and Director of HIV and Viral Testing at Louisiana State University Health Sciences Center, and President-Elect of AAEM about her journey in emergency medicine. Intro music by RogerThat, 'Uplifting Positive Corporate,' powered by JAMENDO.2019-05-2325 min
American Academy of Emergency MedicineWiEM Women's Wisdom: Lisa Moreno, MD MS MSCR FAAEMIn this episode, Faith Quenzer, DO, PGY-4 at Desert Regional Medical Center and Adria Ottoboni, MD FAAEM, Associate Professor at UCLA speak with Lisa Moreno, MD MS MSCR FAAEM, Professor of Emergency Medicine, Director of Research, Director of Diversity and Director of HIV and Viral Testing at Louisiana State University Health Sciences Center, and President-Elect of AAEM about her journey in emergency medicine. Intro music by RogerThat, 'Uplifting Positive Corporate,' powered by JAMENDO.2019-05-2225 minPediatric Emergency PlaybookAltered Mental Status in Children (REBROADCAST)PEMplaybook.org2019-05-0136 minPediatric Emergency PlaybookMyocarditisPEMplaybook.org2019-04-0134 minPediatric Emergency PlaybookMedical Errors Waiting to Happen2019-03-0143 min
About IBDYou Are Only 1% Human With Dr Sarina PasrichaWhat is the microbiome, how might it be connected to IBD and other conditions, and how can it affect health when it's pushed out of balance? Dr Sarina Pasricha of the Christiana Care Health System gives me the scoop on how the microbiome is created when we are young and how it changes with our activities and diet, as well as why we should not try fecal transplants at home, and how a little bit of dirt is good for our kids. Concepts and ideas discussed in this episode: Christiana Care Health System 2nd Annual GI Symposium: https://events.christianacare.org...2019-02-1234 minPediatric Emergency PlaybookThe Notorious VBG2019-02-0126 min
JAMA Surgery Author InterviewsAssociation Between Postoperative Delirium and Long-term Cognitive Function After Major SurgeryInterview with Charles Adrian Austin, MD, MSCR, and Jan Busby-Whitehead, MD, authors of Association Between Postoperative Delirium and Long-term Cognitive Function After Major Nonemergent Surgery2019-01-1618 minPediatric Emergency PlaybookGuess or Process? Abductive Clinical Reasoning: a PEM Primer2019-01-0112 minPediatric Emergency PlaybookList or Gist? Inductive Clinical Reasoning: a PEM Primer2018-12-0114 minPediatric Emergency PlaybookHarpoon or Hook? Deductive Clinical Reasoning: a PEM Primer2018-11-0121 minPediatric Emergency PlaybookKnee PainPEMplaybook.org2018-10-0133 minPediatric Emergency PlaybookAnaphylaxisPEMplaybook.org2018-09-0134 minPediatric Emergency PlaybookStrep ThroatDoes Your Patient Have Streptococcal Pharyngitis? No Problem -- I'll just Swab. Not So Fast... Fagan Nomogram for Likelihood Ratios 1. Decide on your pre-test probability of the disease (choose an approximate probability based on our assessment) 2. Use the likelihood ratio that correlates to your exam. 3. Draw a straight line frm your pre-test probability starting point, to the LR of the feauture/test, take it through to find your post-test probability 4. Use this new post-test probability to help in your decision Your patient has palatal petechiae, which confers a positive likelihood ratio (LR+) of 2.7 S...2018-08-0141 minPediatric Emergency PlaybookConcussionHow do we make the diagnosis? What now? Concussion in Sport Group Guidelines Concussion Recognition Tool (for coaches, trainers on field) Child Sports Concussion Assessment Tool, 5th Ed. (Child SCAT); Ages 5-12 Sports Concussion Assessment Tool, 5th Ed. (SCAT5); Ages 13 and Up This post and podcast are dedicated to the great K Kay Moody, DO, MPH for her stalwart effort to care for both patient and doctor. Thank you for all that you do to help us to be our best and for promoting #FOAMed #F...2018-07-0134 minPediatric Emergency PlaybookEKG Killers: Part TwoPEMplaybook.org2018-06-0120 minPediatric Emergency PlaybookEKG Killers: Part OnePEMplaybook.org2018-05-0137 minPediatric Emergency PlaybookHypertension in Children References Baracco R et al. Pediatric Hypertensive Emergencies. Curr Hypertens Rep. 2014; 16:456. Belsha CW. Pediatric Hypertension in the Emergency Department. Ann Emerg Med. 2008; 51(3):21-24. Chandar J et al. Hypertensive crisis in children. Pediatr Nephrol. 2012; 27:741-751. Dionne JM et al. Hypertension Canada’s 2017 Guidelines for the Diagnosis, Assessment, Prevention, and Treatment of Pediatric Hypertension. Canadian J Cardiol. 2017; 33:577-585 *Flynn JT, Kaelber DC, Baker-Smith CM, et al; SUBCOMMITTEE ON SCREENING AND MANAGEMENT OF HIGH BLOOD PRESSURE IN CHILDREN. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Chi...2018-04-0130 minPediatric Emergency PlaybookThe Fussy InfantA Social Visit or Your Most Dangerous Presentation Tonight? [Details in Audio] This post and podcast are dedicated to Henry Goldstein, B.Pharm, MBBS for his tireless dedication to all things #FOAMed, #FOAMped, and #MedEd. You are awesome. Make sure to visit 2018-03-0146 minPediatric Emergency PlaybookAirway Master MovesYou know how to intubate safely. You can recite all of the Ps backwards and forwards. Until you can't. Real-time trouble-shooting. [Details in Audio] This post and podcast are dedicated to Mads Astvad for sharing his enthusiasm, clinical excellence, and #FOAMed warrior spirit. Tak, min ven! #SMACConia #Vikingeblod2018-02-0120 minPediatric Emergency PlaybookOvarian TorsionOvarian torsion is like the MI of the pelvis. Sometimes all it takes is a good story to investigate. When to worry, when to walk it off, and when to work it up: What is the typical presentation of ovarian torsion? There is none. The presentation varies so much, we need a rule to live by: Unilateral pelvic pain in a girl is ovarian torsion until proven otherwise. This includes the cases in which you are concerned about appendicitis. They both can be fake-outs. Often the pain is severe and abrupt, but tr...2018-01-0124 minPediatric Emergency PlaybookJust Say No To (These) DrugsDogma often dictates routine care. There are times when we have to attend to paradigm shifts. An easy way to save lives? Just say no to (these) drugs: Codeine Normally metabolized into codeine-6-glucuronide (50-70%) and norcodeine (10-15%). Codeine, codeine-6-glucuronide, and norcodeine have low affinity for the μ (mu) receptor. However, the most active metabolite of codeine is morphine with 200x the affinity for the mu receptor as the codeine derivates. The problem is, people vary in its metabolism from 0-15% of codeine is metabolized to morphine. Ok, codeine is lame at best, unpredictable at worst...2017-12-0125 min
CHEST Journal PodcastsPhysician Assessment of Probability in Predicting Malignancy and Adherence with GuidelinesNichole T. Tanner, MD, MSCR, FCCP, and editorialist Jonathan M. Iaccarino, MD, join CHEST Podcast Editor, D. Kyle Hogarth, MD, FCCP, to discuss the accuracy of physician assessment in predicting malignancy in pulmonary nodules. Although adept at recognizing the pretest probability of malignancy, physicians would provide better patient care if they had followed guideline-recommended next steps in evaluation.
2017-11-2232 minPediatric Emergency PlaybookBlunt Head TraumaNot all head trauma is minor. Not all minor head trauma is clinically significant. How can we sort out the overtly ok from the sneakily serious? Mnemonics for bedside risk stratification of minor pediatric blunt head trauma, based on PECARN studies: [Details in Audio] Blunt Head Trauma in Children < > Blunt Head Trauma in Children ≥ 2 years of Age Image Gently Campaign Medical Imaging Record (main...2017-11-0130 minPediatric Emergency PlaybookThe Higher Tech Kid in the EDComfortable with G-tubes, tracheostomies, and VP shunts? Good. Get ready for the next level: Vagus Nerve Stimulators, Intrathecal Pumps, and Ventricular Assist Devices. Details in Audio: Vagus Nerve Stimulators For intractable epilepsy; sends retrograde signal up corona radiata Also may be used in: depression, bulimia, Alzheimer, narcolepsy, addiction, and others VNS magnets Are VNS safe in MRI? Are VNS safe in everyday life? Intrathecal Pumps Used to infuse basal rate of drug, usually baclofen for spasticity, but pump may contain morphine, bupivicaine, clonidine. Also used for...2017-10-0131 min
Pediatric Emergency PlaybookVaccine Preventable Illness Part TwoPEMplaybook.org2017-09-0135 min
Hey OAAmanda Nelson, MD, MSCR, University of North Carolina, Chapel Hill, NC, USADr. Amanda Nelson, an assistant professor of medicine at the University of North Carolina at Chapel Hill in the United States, discusses imaging, the Walk with a Doc program, developing OARSI guidelines, and barriers preventing clinician scientists from staying in research. More information can be found at: Faculty website: https://www.med.unc.edu/tarc/people/amanda-e-nelson-md-mscr Walk With a Doc: http://walkwithadoc.org/ OA Action Alliance: http://oaaction.unc.edu/2017-08-1522 minPediatric Emergency PlaybookThe Pediatric Surgical AbdomenAbdominal pain is common; so are strongly held myths and legends about what is concerning, and what is not. One of our largest responsibilities in the Emergency Department is sorting out benign from surgical or medical causes of abdominal pain. Morbidity and mortality varies by age and condition. Abdominal Surgical Emergencies in Children: A Relative Timeline General Advice Neonate (birth to one month) Necrotizing Enterocolitis Pneumatosis Intestinalis. Essentials: Typically presents in 1st week of life (case reports to 6 months in chronically ill children) Extend suspicion longer in NICU graduates Up to...2017-08-0130 min
The Golf Affect Radio ShowMSCR on Golf Affect Radio ShowSharon Neylon from MSCR discusses their upcoming golf outing at Cherokee.2017-07-1304 min
Pediatric Emergency PlaybookVaccine Preventable Illness Part OnePEMplaybook.org2017-07-0139 minPediatric Emergency PlaybookMI in ChildrenMyocardial infarction (MI) in children is uncommon, but underdiagnosed. This is due to two main factors: the etiologies are varied; and the presenting symptoms are “atypical”. We need a mental metal detector! Case examples Congenital Two main presentations of MI due to congenital lesions: novel and known. The novel presentation is at risk for underdiagnosis, due to its uncommonness and vague, atypical symptoms. There are usually some red flags with a careful H&P. The known presentation is a child with a history of congenital heart disease, addressed by corrective or palliative surgery. This child is at risk...2017-06-0136 minPediatric Emergency PlaybookNeonatal JaundiceMost newborns will have some jaundice. Most jaundice is benign. So, how can we sort through the various presentations and keep our newborns safe? Pathologic Jaundice When a baby is born with jaundice, it’s always bad. This is pathologic jaundice, and it’s almost always caught before the baby goes home. Think about ABO-incompatbility, G6PD deficiency, Crigler-Najjar, metabolic disturbances, and infections to name a few. Newborns are typically screened and managed. Physiologic Jaundice Physiologic jaundice, on the other hand, is usually fine, until it’s not. All babies have some inclination to develop jaundice. ...2017-05-0139 minPediatric Emergency PlaybookForeign Bodies in the Head and NeckChildren the world over are fascinated with what can possibly “fit” in their orifices. Diagnosis is often delayed. Anxiety abounds before and during evaluation and management. Most common objects:1,2 Food Coins Toys Insects Balls, marbles Balloons Magnets Crayon Hair accessories, bows Beads Pebbles Erasers Pen/marker caps Button batteries Plastic bags, packaging Non-pharmacologic techniques Set the scene and control the environment. Limit the number of people in the room, the noise level, and minimize “cross-talk”. The focus should be on engaging, calming, and distracting the child. Quiet room; calm parent; “burrito wrap”; guided imagery; have a willing parent restrain th...2017-04-0146 minPediatric Emergency PlaybookSupraglottic AirwaysWhen you give only after you're asked, you've waited too long. – John Mason First, learn to bag Place a towel roll under the scapulae to align oral, pharyngeal, and tracheal axes: Karsli C. Can J Anesth. 2015. Use airway adjuncts such as the oropharyngeal airway or a nasal trumpet. Use the two-hand ventilation technique whenever possible: (See Adventures in RSI for more) Supraglottic Airways: for difficult bag-valve-mask ventilation or a difficult airway (details in audio) LMA Classic Pros: Best studied; sizes for all a...2017-03-0132 min
Pediatric Emergency PlaybookUrine TroubleWhen should you commit to getting urine? When can you wait? When should you forgo testing altogether? When do I get urine? Symptoms – either typical dysuria, urgency, frequency in a verbal child, or non-descript abdominal pain or vomiting in a well appearing child. Fever – but first look for an obvious alternative source, especially viral signs or symptoms. No obvious source? Risk stratify before “just getting a urine”. In a low risk child, with obviously very vigilant parents, who is well appearing, you may choose not to test now, and ensure c...2017-02-0152 minPediatric Emergency PlaybookPediatric PainN.B.: This month's show notes are a departure from the usual summary. Below is a reprint (with permission) of a soon-to-be released chapter, Horeczko T. "Acute Pain in Children". In Management of Pain and Procedural Sedation in Acute Care. Strayer R, Motov S, Nelson L (eds). 2017. Rather than the customary blog post summary, the full chapter (with links) is provided as a virtual reference. INTRODUCTION Pain is multifactorial: it is comprised of physical, psychological, emotional, cultural, and contextual features. In children often the predominant feature may not be initially apparent. Although clinicians may focus on the phys...2017-01-0151 minPediatric Emergency PlaybookBronchiolitis"By the pricking of my thumbs, Something wheezing this way comes." -- Witches in Macbeth, with apologies to William Shakespeare "Bronchiolitis is like a pneumonia you can’t treat. We support, while the patient heals." -- Coach, still apologetic to the Bard The Who The U.S. definition is for children less than two years of age, while the European committee includes infants less than one year of age. This is important: toddlerhood brings with it other conditions that mimic bronchiolitis – the first-time wheeze in a toddler may be...2016-12-0137 min
Pediatric Emergency PlaybookPediatric Elbow InjuriesJohnny has fallen on an outstretched hand, and comes to you with a swollen, painful elbow. Position of comfort, analgesia, xrays, and now what? What am I seeing -- or not seeing -- here? First a refresher on radiographic anatomy of the elbow -- Images courtesy of Radioglypics (Open Access Radiology Education). Used with permission. Now that we have our adult anatomy reviewed, let's go through the development of the elbow in a child. We are all born with primary ossification centers -- the basic shapes of our l...2016-11-0141 minPediatric Emergency PlaybookGI Bleeding in ChildrenBlood in the vomit. Blood in the stool. Blood in the diaper. How far do I go in my investigation? What do I really have to worry about? The differential diagnosis of GI bleeding in children is broad. (Here is the complete differential diagnosis) In the ED, we can simplify by categorizing by age and appearance. Neonates GI bleeding in the neonate (less than one month of age) is serious until proven otherwise. Well appearing? If this in obvious anal fissure, then no further work-up is necessary. Counsel on proper feeding and...2016-10-0133 minPediatric Emergency PlaybookPediatric Headache: Some Relief for AllSeemingly vague, but potentially dangerous... common, but possibly with consequences... ...or maybe just plain frustrating. Let's talk risk stratification, diagnosis, and management. Primary or Secondary? We can make headache as easy or as complicated as we like, but let's break it down to what we need to know now, and what the parents need to know when they go home. Primary headaches: headaches with no sinister secondary cause – like tension or migraine – are of course diagnoses of exclusion (cluster headache is exceedingly rare in children). Secondary headaches: headaches due to some underlying cause -- are what...2016-09-0130 minPediatric Emergency PlaybookSubcutaneous RehydrationHave you ever been in any of these situations? ⇒ You have a stable child who just needs fluids, but no laboratory tests ⇒ You’ve tried PO hydration, to no avail, despite anti-emetics ⇒ You’re poking the stable, but dehydrated child repeatedly without success What now? Hypodermoclysis, otherwise known as subcutaneous rehydration. [Insert Player] Clysis comes from the same Greek word that “a flood” – hypodermoclysis refers to flooding the subcutaneous space with fluid, so that it can be absorbed systemically. Sound far-fetched? Well, it turns out, what is old is new again. In 1913, Dr Day first described th...2016-08-0129 minPediatric Emergency PlaybookPlease STOP LIMPING!"She won't walk", or "He just looks like he's limping". So many things can be going on -- how do we tackle this chief complaint? You’re dreading a big work-up. You almost want to tell the kid – please, STOP LIMPING... STOP LIMPING! S – Septic Arthritis The most urgent part of our differential diagnosis. The hip is the most common joint affected, followed by the knee. Lab work can be helpful, as well as US of the hip to look for an effusion, but sometimes, regardless of the results, the joint just has to be tapped to know for s...2016-07-0133 minPediatric Emergency PlaybookApproach to ShockDo we recognize shock early enough?
How do we prioritize our interventions?
How can we tell whether we’re making our patient better or worse?
World wide, shock is a leading cause of morbidity and mortality in children, mostly for failure to recognize or to treat adequately.
So, what is shock?
Simply put, shock is the inadequate delivery of oxygen to your tissues. That’s it. Our main focus is on improving our patient’s perfusion.
Oxygen delivery to the tissues depends on cardiac output, hemoglobin concentration, the oxygen saturation of the hemoglobin you have...2016-06-0138 minPediatric Emergency PlaybookAltered Mental Status in ChildrenHow do you approach the child who may be altered?
Altered mental status in children can be subtle. Look for age-specific behaviors that range from irritability to anger to sleepiness to decreased interaction.
In the altered child, anchoring bias is your biggest enemy. Keep your mind open to the possibilities, and be ready to change it, when new information becomes available.
For altered adults, use AEIOU TIPS (Alcohol-Epilepsy-Insulin-Overdose-Uremia-Trauma-Infection-Psychosis-Stroke).
Try this for altered children: remember that they need their VITAMINS!
V – Vascular (e.g. arteriovenous malformation, systemic vasculitis)
I – In...2016-05-0136 minPediatric Emergency PlaybookBig Labs, Little PeopleIt's a busy shift. Today no one seems to have a chief complaint.
Someone sends a troponin on a child. Good, bad, or ugly, how are you going to interpret the result?
And while we’re at it – what labs do I need to be careful with in children – sometimes the normal ranges of common labs can have our heads spinning!
Read on to go from bread-and-butter pediatric blood work to answer the question – what’s up with troponin, lactate, d-dimer, and BNP in kids?
A fundamental tenet of emergency medicine:
We balance our obligation to d...2016-04-0131 minPediatric Emergency PlaybookMultisystem Trauma in Children, Part Two: Massive Transfusion, Trauma Imaging, and Resuscitative PearlsA 5-year-old boy was playing with his older brother in front of their home when he was struck by a car. He sustained a femur fracture, splenic laceration, and blunt head trauma – the so-called Waddell’s triad.
On arrival, he was in compensated shock, with tachycardia.
He decompensates and needs blood.
How do we manage his hemodynamics and when do we perform massive transfusion?
Pediatric Massive Transfusion
40 mL/kg of blood products given at any time within the first 24 hours.
Adolescents and Adult Massive Transfusion
6-8 units of packed red blood cells (PRBCs)
...2016-03-0137 minPediatric Emergency PlaybookMultisystem Trauma in Children, Part One: Airway, Chest Tubes, and Resuscitative ThoracotomyTraumatized children need your full attention.
Protocols work well for adults, but trauma in children requires that we exercise our clinical muscles just a bit more.
Two main reasons:
Children have specific injury patterns
Their physiologic response to trauma is unique.
Crash course in pediatric anatomy and physiology in trauma
When you think of trauma in children, think of Charlie Brown. Large head, no neck, his chest and abdomen form an underdeveloped, amorphous shape.
Alternatively, think of children as apples – they are rounder than they are tall, with a large increased surface area. Apples don’t have a hard s...2016-02-0135 minPediatric Emergency PlaybookVomiting in the Young Child: Nothing or NightmareIn the young child, vomiting is the great imitator:
Gastrointestinal, Neurologic, Metabolic, Respiratory, Renal, Infectious, Endocrine, Toxin-related, even Behavioral.
To help us organize, below is a review of can't-miss diagnoses by age.
The Neonate: Malrotation with Volvulus
In children with malrotation, 50% present within the first month of life, with the majority occurring in the first week after birth. 90% of children with malrotation with volvulus will present by one year of age. This is a pre-verbal child’s disease – which makes it even more of a challenge to recognize quickly.
The sequence of events usually is fussiness, irritability, and fo...2016-01-0147 minCHEST Journal PodcastsPulmonary Nodules: Do Guidelines Affect Patient Care?Renda Soylenz Wiener, MD, MPH; Nichole T. Tanner, MD, MSCR; and editorialist David R. Baldwin, MD, join CHEST Podcast Editor, D. Kyle Hogarth, MD, FCCP, to discuss a series of articles in this month's issue of CHEST focusing on pulmonary nodules and whether guidelines affect decisions on patient diagnosis and treatment.
2015-12-0142 minPediatric Emergency PlaybookElectrical Injuries: Hertz So BadVictims of electrical injuries present either in extremis or as the seeming well patient with insidious, developing disease.
A targeted history usually gets you the information you need.
Four main things to find out:
1. Household or Industrial electricity?
Household electricity uses alternating current, or AC. Voltages across the world range anywhere from 100 to 240 V. Here in North America, most outlets and appliances use 120 volts, which is the measure of electrical tension, or the potential difference in electrical charge.
Cut-off between low voltage and high voltage is 1000 V.
Industrial energy may be AC or dire...2015-12-0135 min
Before The White CoatDanielle Scheurer, MD, MSCR, SFHMWatch out, Sanjay Gupta! SHM board member and physician editor of The Hospitalist Danielle Scheurer may be coming for your job.
"To this day, my dream job is to be a newscaster," says Danielle Scheurer, MD, MSCR, SFHM in her interview with SHM CEO Larry Wellikson. But before that, Dr. Scheurer traces her career from summer jobs to providing care in Africa, which included her own ailments by hanging an IV bag by candlelight.
If you enjoy Before the White Coat, please share it with others and rate it on iTunes.2015-11-1726 minPediatric Emergency PlaybookAdventures in RSIPediatric airway management is a skill that integrates the three types of knowledge as described by the ancient Greeks: episteme, or theoretical knowledge, techne, or technical knowledge, and phronesis, or practical wisdom, also called prudence.
Here we’ll invoke each type of knowledge and understanding as we go beyond the anatomical issues in pediatric airway management – to the advanced decision-making aspect of RSI and the what-to-do-when the rubber-hits-the road.
Case 1: Sepsis
Laura is a 2-month-old baby girl born at 32 weeks gestational age who today has been “breathing fast” per mother. On arrival she is in severe respiratory distress with nasal fla...2015-11-0151 minPediatric Emergency PlaybookThe Technologically Dependent Child in the EDEMS is bringing you a child with a VP shunt, port-a-cath, trached on a vent, seizing, hypotensive, and now desaturating – ETA – 3 minutes. Are you ready?
Medicine is evolving. As technology advances, we need to meet the challenge of taking care of our patients who have come to rely on this technology for their basic needs. Before we go further, remember to assess the parent and the child as a unit. The caregiver who is usually the parent, is a rich source of knowledge about the child’s particular condition and past experience. Take them seriously, and be on the lookout f...2015-10-0135 min
Blog - PEM ED PodcastAsthma Andrews Style - What's the best oral steroid you ask?
What's the best oral steroid to treat acute asthma exacerbations you may ask? Well, we're here to answer that for you. Please welcome Dr. Annie Andrews, MD, MSCR who has written all the articles you will find listed below on just that subject. In this podcast we will prove that dexamethasone is not only the most cost effective steroid to prescribe in asthma exacerbations, decreases recidivism, and has the best compliance rates, but it tastes great too! http://www.paramedictorn.org/trauma-care.htmlAndrews AL, Simpson AN. Dexamethasone may be a viable...2014-07-0149 min