HEMOPHILIA EMERGENCIES

Tara's kids...doing all the same things other kids do!!!

A while back now, I got an email from Weingart stating that he had received correspondence form a Canadian paramedic by the name of Tara Anema.  Tara really wanted to get the word out about a particular pediatric patient population that she had seen mismanaged by all levels of emergency provider in all types of situations.  Why all the hubbub about this particular group…well the condition is hemophilia and her own two sons are effected.  After speaking to Tara I knew her passion and message was perfect for the show.  I have also brought in our hemophilia expert from the University of Kentucky, Dr. Vlad Radulescu to answer all your burning questions about how we SHOULD be taking care of these children.

As a bonus this month, stay tuned to the end of the show when Dr. Marianne Gausche-Hill and I do a little update on Pediatric Readiness and be sure to check out her most recent publication below!!

http://www.pediatricreadiness.org/

 PEDIATRIC READINESS CHECKLIST

JAMA PEDIATRIC READINESS ARTICLE JUNE 2015

ACEP Policy Statement on the Care of Children in Emergency Departments

 

BASICS OF EMERGENCY MEDICINE POCKET GUIDE

BASICS OF EMERGENCY MEDICINE: PEDIATRIC POCKET GUIDE

 

REBEL EM TXA POST

SGEM TXA POST

Pediatric Syncope Part Deux...Still Fell Out

Buck Kyle MD...AKA pediatric cardiologist extraordinaire... is back to finish up part two of our in-depth look at pediatric syncope and the thirteen causes of sudden cardiac death.  Never feel threatened by the patient with a chief complaint of DFO (done fell out) again!  For the next hour we will cover the rest of the electrical, structural, and miscellaneous conditions that are responsible for V Tach/DFO, which may can ultimately to sudden cardiac death.

Pediatric Syncope and POC Echo Article

Pediatric ECG Cardiomyopathy 8mm Q-wave lead III

Pediatric Syncope (DFO ~ Done Fell Out)

Welcome back to the show Dr. Buck Kyle!  Dr. Kyle is a attending pediatric cardiologist at Texas Children’s Hospital and on  this episode we will discuss what causes all those little kids to pass out before they come to your ER and then look so fantastic.  Are they all OK to go home?  Is there anyone in there that’s truly sick and if so how do we identify that subset?  Sit back, hold on tight, and try not to DFO (done fell out) because it’s going to be fast, fun, and may leave you a little mareado….

The Five Canons of Levitan - Difficult Airway Part 3

Canon - a general law, rule, principle, or criterion by which something is judged

No one has changed the face of how we approach difficult airway more than Rich Levitan, MD.  In this episode I review five of Rich's most important contributions to how we approach emergent intubations.  These are techniques you can take to the department tomorrow to improve your view, increase your success, and save your patient's life! 

 
Click here to follow Dr. Levitan on twitter.

Click here to follow Dr. Levitan on twitter.

Levitan's best bougie techniques (includes Shaka, Kiwi and Ducanto)!

Levitan's best bougie techniques (includes Shaka, Kiwi and Ducanto)!

Child Abuse

It is hard to put into words or even imagine the concept of someone intentionally hurting a child, but it happens more frequently than we'd like to believe.  In this episode, I had the privilege of discussing some of the cornerstone exam findings and history flags for occult abuse with Marci Donaruma-Kowh, MD a child abuse expert from the Baylor College of Medicine ~ Texas Children's Hospital.  This episode will change the lens you view your pediatric patients through; even with those who have what appears to be the most mundane of injuries.  Unfortunately, abuse is not always overt and Dr. Donaruma is an expert in identifying the subtleties of this diagnosis, nailing the perpetrator, and making sure they go away for a long-long time...

If you know of a child that is being abused call the police now.  If you would like to refer a case and you are in the Houston area please click here: Children's Assessment Center.

Asthma and the Vent

                                                           …

                                                              TOP  =  AUTO PEEP        BOTTOM  =  NORMAL FLOW

“Set the Vent in SIMV at 7cc/kg and an I:E ratio of 1:4/1:5 and check a blood gas!”
— Andrew Sloas, DO, RDMS, FAAEM

iTunes Link

Wow!  We've made it to the end of three episodes on asthma.  We've covered everything from diagnosis to treatment and everything in between.  We now know how to best educate our patients to empower them to treat their disease at home and prevent recitivism! 

Tune in this episode for the specifics on how to use a Peak Flow Meter, Bi-Pap, EtCO2 and of course how to set-up the ventilator in a way to maximize support and minimize chances of injury in your asthmatics. 

EM Crit - Infamous Awake Sedated Video

EM Crit - Dominating the Vent Part 1

EM Crit - Dominating the Vent Part 2

Asthma 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.html

Andrews AL, Simpson AN. Dexamethasone may be a viable alternative to

prednisone/prednisolone for the treatment of acute asthma exacerbation in the

paediatric emergency department. Evid Based Med. 2014 Jun 10. pii:

ebmed-2014-110006. doi: 10.1136/eb-2014-110006. [Epub ahead of print] PubMed

PMID: 24919976.

Andrews AL, Wong KA, Heine D, Scott Russell W. A cost-effectiveness analysis

of dexamethasone versus prednisone in pediatric acute asthma exacerbations. Acad

Emerg Med. 2012 Aug;19(8):943-8. doi: 10.1111/j.1553-2712.2012.01418.x. Epub 2012

Jul 31. PubMed PMID: 22849379.

Andrews AL, Teufel RJ, 2nd, Basco WT, Jr., Simpson KN. A Cost-Effectiveness Analysis of Inhaled Corticosteroid Delivery for Children with Asthma in the Emergency Department. Journal of Pediatrics. 2012 Nov;161(5):903-907

Keeney GE, Gray MP, Morrison AK, Levas MN, Kessler EA, Hill GD, Gorelick MH, Jackson JL. Dexamethasone for acute asthma exacerbations in children: a meta-analysis. Pediatrics. 2014 Mar;133(3):493-9. doi: 10.1542/peds.2013-2273. Epub 2014 Feb 10. Review. PubMed PMID: 24515516; PubMed Central PMCID: PMC3934336.

Podcast 25 ~ Asthma and Steroids

Asthma...The Music Of The Night

In this episode, the first of a three part series on asthma, we will cover the diagnostic and treatment strategies that will help you rapidly move patients through your ED.  No, of course you don't need the patient's asthma classification, but you DO NEED to understand which patients need more treatment and when it's OK to stop.  I will break that all down for you with the aid of the algorithm above.  We'll talk in depth about who can go home safely and who should be in the Unit! Download the flow sheet from the link above, put it in your smart-phone so you have it for your next asthma encounter, and follow along.  It's going to get musical..

Anyone Seen My Corn? Pediatric Foreign Bodies

THE DERMA-Q

How many times have you seen a square object inserted into a round hole.....of an ear canal???  It's quite a quandary and can be the source of frustration for both you and the patient.  You may end up waiting two to three hours just to be able to sedate the little bugger because they have usually just choked down a cheese burger and fries (if your in Britain it may be bangers and mash, Australia a vegemite sandwich, Russia borscht, etc, etc) and then even after you have them sedated, you don't have the right tool to get the foreign body out because the right tool was never created… that is, until now!  Thanks to Dr. David DeLemos from the Texas Children's Pediatric Emergency Medicine program, we now have the solution to the round (or square) object in the ear canal. Let me be the first to introduce you to the "Derma-Q."  The Derma-Q is a contraption created from the plunger of a small syringe or a Q-tip, which has then been tipped (like a tribal dart) with a minute amount of Dermabond.  The Derma-Q provides the perfect rescue technique to get those tough foreign bodies out of almost any orifice. Also making her debut this month on the PEM ED Podcast, my wife, Dr. Holly Sparks will risk life, limb, and my ear canal by getting a cheap piece of plastic jewelry out of my EAC for your viewing pleasure.

Rich Levitan's Yellowstone Advanced Airway Critical Care Course

Cabo CME Course - Levitan, Weingart, Matt & Mike, Orman, and Sloas

Podcast 23 ~ DermaQ Pediatric Foreign Body

Are You Ready...For Little Patients?

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Dr. Facilier begged the question..."Are you ready for Transformation Central?"  Transformation?  My ER runs just fine.  What could I need to be ready for or transform my ER into???  Well, there's this little thing standing between you and poop in your underwear; most of us call them pediatric patients.  What should scare you is that 30% of the hospitals in the US are not ready and by not ready I mean that they do not have the proper equipment or training necessary to take care of critically ill patients.  So I say again, ask yourself, what is the most stressful patient whom you to take care?  Is it the little old urosepsis patient that needs an art line, central line and intubation or the neonate that needs the same procedures.  OK, the procedures are stressful, but what if you don't have the equipment to to do them.  Do you know if your ER stocks a size 1 LMA?  Now's the time to figure it out, not once the patient is staring you in the face (probably wide eyed).  This month we are fortunate enough to be joined by the esteemed Dr. Marianne Gausche-Hill who is the creator and lead investigator on the Pediatric Readiness Project.  We now know from a decade of research that 30% of hospitals in the US are missing the equipment needed to take care of these patients do you work at one of those????

http://www.pediatricreadiness.org/

 PEDIATRIC READINESS CHECKLIST

Dr. Gauche Hill would like to thank:  Dr. Kate Remick, The Federal EMS for Children Program Director Elizabeth Edgerton, National EMS for Children Data Analysis and Resource Center, American College of Emergency Physicians, American Academy of Pediatrics, the Emergency Nurses Association, State of California EMS Authority, and all the EMS for Children’s Coordinators in the US and its territories.

ACEP Policy Statement on the Care of Children in Emergency Departments

Rich Levitan's Yellowstone Critical Care Airway Course - May/June 2014

See you in CABO!!!  The new Podcaster's CME conference put on by EB Medicine:

Cabo CME Course - Levitan, Weingart, Mike & Matt, Orman and Sloas

Cabo CME Video

Podcast 22 ~ Pediatric Readiness

Thin Kids, Gallbladders Too

JJ.jpg

Now I've got your mind palatable to the fact that young thin kids can get cholecystitis too, lets figure out how to weed those kids out from the hundreds of gastroenteritis that you're still going to see each week.  On this episode we'll explore which labs and rads get you to the place you want to be.... not just a disposition, but the correct disposition.  Dr. Doug Fishman is back to get you on the right track to making the right diagnosis!

Podcast 21 ~ Pediatric Cholecystitis 2

Great Pedi Gallbladders of Fire

GB Kid 2.jpg

You may think that Miley Cyrus' on-stage theatrics was the most shocking thing to happen in 2013, but au contraire mon frère.  Hold on tight, because the most outrageous thing you've heard between stanzas of "Auld Lang Syn" is that kid's are getting gallbladder disease.  This is especially frequent in the good ole US of A where we have mid-morning cheese burgers for a snack.  Shocking I know.  In this episode Pediatric Gastroenterologist Dr. Doug Fishman, from the Texas Children's Hospital, is going to go through the In-N-Outs of pediatric cholecystitis.  Not that In-N-Out is in anyway responsible for pediatric gallstones...they make a tasty burger....try the double-meat animal style...it's fantastic....

Thanks to Doug Fishman, MD.  Director, Gastrointestinal Endoscopy

Texas Children's Hospital

Associate Professor of Pediatrics

Please visit his website devoted to education and treatment of Celiac Disease below

Check out the Celiac Universe Here

Park that Shoulder in Place - Shoulder Reductions & One Hip

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FinaltentcardYellowstone.pdf

How many times have you been involved in an adult or pediatric shoulder reduction that you just can't relocate.  Very frustrating, but here's your solution: Dr. Jay Park has invented a method that allows you to reduce a shoulder without sedation (RNs love that) and without any pain to your patient (Press Ganey scores will rise faster than your salary).  Listen up, this defines cool!

Jay Park, MD

Contact Jay For Website Design:  http://jayparkmd.com

Dr. Park is involved in numerous medical missions, if you would like to contact Dr. Park to see how you can get involved or make a donation email him at:  jayparkmd@yahoo.com

Shoulder Dislocation Video

Hip Dislocation Video

Levitan Airway

Contact CEME.org (1-800-651-2363 ext. 1312) for enrollment.

http://www.airwaycam.com/custom-intubation-training.html

info@airwaycam.com  

877-EPIGLOTTIS

fax: 610-341-1866

2 - Red Eyes

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Red eyes usually come in pairs and so do podcasts on the subject.  In part two of the red eye disorders we discuss the non-threatening maladies that can turn into eye threatening disorders if missed.  Sit back and relax and let dear ole' dad tell you one more time why it's going to be OK...If you listen to him.  Otherwise you may get spanked.  I'm serious he spanked me a lot for not listening.  Call CPS; there's still a chance for me....

Eye Show Notes

Dr. Shenoi's Emergency Preparedness Book

PEM ED Podcast iTunes Link

Podcast 18 ~ The Non-Threatening Red Eye

The Eyes Have It..... Or At Least The Red Eyes Do

Eye Threat.jpg

Harold Andrew Sloas Jr, DO, CAPT, USN-R is a board certified ophthalmologist (and my dad).  He had a competition with his son Harold Andrew Sloas III, DO, RDMS, FAAEM to see who could get get more letters behind their name. As it turns out none of those letters have any bearing on what we'll be talking about today. 

You're in for a real treat because I got to sit down with dear ole' dad and talk about some red eye disorders.  We explore all the threatening causes of the red eye on this podcast and move into the non-threatening red eye disorders on the next episode.  You need to know something about both so you can distinguish between the two.  Pull out your Kleenex and dry your eyes; you're going to need to see this. 

Eye Show Notes

iTunes Link

Podcast 17 ~ The Threatening Red Eye

Pediatric Concussion

knock out.jpg

I have had the opportunity to work with some truly amazing people in my life and Dr. Matt Bayes, sports medicine physician extraordinaire, is no exception.  Dr. Bayes is the only person I have known to successfully ask about a “code red” and somehow avoid receiving one.  Dr. Bayes now resides in St. Louis, Missouri (Bayes from The Lou) and has been part of the sports medicine team that delivers care to the St Louis Cardinals.   On this episode Dr. Bayes takes me through the intricacies of diagnosing and managing a pediatric concussion from the ER perspective. Hold on to your head because you’re about to get knocked out....Smokey

ARTICLES:

Kupperman N, Holmes JF, Dayan PS, et al. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet. 2009;374:1160-1170.

William R. Mower, MD.  What Rules Should Guide Imaging Decisions in Injured Children?  Medscape.  Posted: 02/23/2010. http://www.medscape.com/viewarticle/717110

Evaluating Minor Head Injury - Sports Medicine Update

Pediatrics - Sports Related Concussions and Management

Pediatrics - Emergency Department Visits for Concussion in Young Athletes

Misconceptions Common With Pediatric Concussions

José Álvarez-Sabín, MD; Antoni Turon; Manuel Lozano-Sánchez; José Vázquez, MD; Agustí Codina, MD Delayed Posttraumatic Hemorrhage "Spät-Apoplexie"Stroke. 1995;26:1531-1535doi: 10.1161/01.STR.26.9.1531

SCAT 2 iPhone App

Dr Matt Bayes Contact Info:  

12855 North Forty Drive

Suite 380

St Louis, MO 63141

Ph: 314-434-7784

Fax: 314-434-4775

www.bluetailmedicalgroup.com

iTunes Link

Podcast 16 ~ Pediatric Concussion

Calcium Channel Blockers, Beta Blockers and Undifferentiated Hypotension....OH MY!

CCB.jpg

One of the most sphincter tightening overdoses to deal with in adults and pediatrics is the CCB overdose.  In this podcast I cover all the treatments that work, don't work, and you would think should work to give you a recipe for success.  Hold on to your insulin; it's not just for diabetics and critically ill patients anymore.  Intralipids???  How the heck does that help???  Well you need to tune in to find out......

CCB/BB/Undifferentiated Show Notes

CCB/BB PDA Companion

Hypotension Slide

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Pediatric ECG Basics ~ Part 2

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Cards 2.bmp

Our resident cardiologist Dr. Buck Kyle completes the second part of his lecture series on pediatric ECG reading.  This time we get into the most common cardiac disease processes that occur in the pediatric population.  What’s black and white and read all over??? OK, yes the newspaper, but ECGs are too....don’t steal my punch lines.....

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Pediatric (and some adult) ECG Basics

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Cards Logo.png

The Squiggly Line Rule: The more squiggly lines in the outline/border lines of a state, the cooler/more fun it is to live in that state. In, for example, the state of California, the squiggly lines are found on the coastline adjacent to the pacific ocean ~ Urban Dictionary

It also happens to be true that if you are an electrocardiogramophile than the more abundant the squigglies, the more stimulating and salacious the ECG is to read (and you probably have eroticism issues).  While it is also true that if you do not find electrocardiogram interruption to be lascivious than you probably find it to be frustrating (and you may have ECG performance issues).  Either way, have I got a tonic for you.  It cures all of the above (except the obvious sexual innuendo problems, you need to see a therapist for that soon). 

In this episode, we start a two part series on the basics of pediatric ECG interruption with Dr. Buck Kyle, pediatric cardiologist and electrocardiogram aficionado.  Sit back and relax as Dr. Kyle makes everything clear and really...see the therapist soon......