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 pain treatment in children.

Please consider contributing to PEM Rules at

https://ko-fi.com/pemrules

And check out www.pemrules.com 

Copyright PEM Rules LLC

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.

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 going with your gut feeling.

Please consider contributing to PEM Rules at

https://ko-fi.com/pemrules

And check out www.pemrules.com 

Copyright PEM Rules LLC

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.

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 child abuse doctor in Western MA.

Thank you all for listening to PEM Rules!  As requested, please see list of references below used for Dr. Boos’s Child Abuse guidelines as well as the guidelines used at the Childrens’ Hospital of Pittsburgh,

References:

Hymel KP, Laskey AL, Crowell KR et al. Racial and ethnic disparities and bias in the evaluation and reporting of abusive head trauma. J Pediatr. 2018; DOI:10.1080/10538712.2018.1443303

Rinney LC, Frey TM, Fain ET, et al. Standardizing the evaluation of nonaccidental trauma in a large pediatric emergency department. Pediatr. 2018; DOI:10.1542/peds.2017‐1994

Wood JN, Fakeye O, Mondestin V, et al. Development of hospital‐based guidelines for skeletal survey in young children with bruises. Pdiatr. 2015; DOI:10.1542/peds.2014‐2169

Wood JN, Fakeye O, Feudtner C, et al. Development of guidelines for skeletal survey in young children with fractures. Pediatr. 2014; DOI:10.1542/peds.2013‐3242

Wootton‐Gorges SL, Soares BP, Alazraki AL, et al. ACR appropriateness criteria suspected physical abuse‐ child. J Am Coll Radiol. 2017; 14: S338‐S349

Pierce MC, et al. Validation of a Clinical Decision Rule to Predict Abuse in Young Children Based on Bruising Characteristics. JAMA Netw Open. 2021 Apr 1;4(4):e215832. doi: 10.1001/jamanetworkopen.2021.5832.

Escobar, M. A,. Flynn-O’Brien, K. T., et al… (2017). The association of nonaccidental trauma with historical factors, examination findings, and diagnostic testing during the initial trauma evaluation. Journal of Acute Care Surgery, 82(6), pp. 1147-1157

ACS Trauma Quality Programs Best Practices Guidelines for Trauma center Recognition of Child Abuse, Elder Abuse, and Intimate Partner Violence Abuse-Violence.pdf (pediatrictraumasociety.org)

Berger RP, Fromkin ,J Herman B, Pierce MC, Saladino RA, Flom L, Tyler-Kabara EC, McGinn T, Richichi R, Kochanek PM. Validation of the Pittsburgh Infant Brain Injury Score for Abusive Head Trauma. Pediatrics. 2016 Jul;138(1):e20153756. doi: 10.1542/peds.2015-3756. Epub 2016 Jun 23. PMID: 27338699; PMCID: PMC4925074.

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.

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 consider contributing to PEM Rules at

https://ko-fi.com/pemrules

And check out www.pemrules.com 

Copyright PEM Rules LLC

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.

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 the field.

Copyright PEM Rules LLC

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.

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 , decide what you want to buy and be on the lookout for a new method of getting a discount via PEM Rules. The Pickaso Guitar Bow is fun to have and use to enrich your musical skills. 

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.

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.

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.