Category: Pediatric Emergency Medicine

“Hot” Off the Press: Infant Fever Rule

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“Hot” Off the Press: Infant Fever Rule – Episode 15

Talking about neonatal fever makes most people hot under the collar! Fortunately, PECARN is on the case. Their latest paper was just published TODAY in JAMA Peds: A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections. In this month’s episode, we learn about some the challenges of having a febrile infant – from a mom’s perspective. Then we discuss when, why, and how to apply the latest PECARN rule with the notorious DNK, also known as Dr. Nate Kuppermann! 

What is your approach to the febrile infant? What are some of the hardest parts about providing care to our hot little ones? We want to know! Share your thoughts on social media, @empulsepodcast, or on our website, ucdavisem.com. 

Hosts:

Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis

Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis

Guest:

Dr. Nate Kuppermann, Pediatric Emergency Physician, Professor and Chair of the UC Davis Department of Emergency Medicine, Founding Chair of the PECARN Steering Committee

Resources:

A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections. 

Nathan Kuppermann, MD, MPH1; Peter S. Dayan, MD, MSc2; Deborah A. Levine, MD3; et al. JAMA Pediatr. Published online February 18, 2019. doi:10.1001/jamapediatrics.2018.5501

Validation of the “Step-by-Step” Approach in the Management of Young Febrile Infants.

Gomez B, Mintegi S, Bressan S, Da Dalt L, et. al. Pediatrics. 2016 Aug;138(2). pii: e20154381. doi: 10.1542/peds.2015-4381. Epub 2016 Jul 5.

Management of the Febrile Young Infant: Update for the 21st Century. 

Woll C, Neuman MI, Aronson PL. Pediatr Emerg Care. 2017 Nov;33(11):748-753. doi: 10.1097/PEC.0000000000001303.

Accuracy of Complete Blood Cell Counts to Identify Febrile Infants 60 Days or Younger with Invasive Bacterial Infections. 

Cruz AT, Mahajan P, Bonsu BK, Bennett JE et. al. JAMA Pediatr. 2017 Nov 6;171(11):e172927. doi: 10.1001/jamapediatrics.2017.2927. Epub 2017 Nov 6.

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Ski and CME! Join us for the,UC Davis Emergency Medicine Winter Conference, March 4th-8th at the Ritz Carlton in Lake Tahoe, CA.

Come play and learn with us at the Western Regional SAEM Annual Meeting, March 21-22 in beautiful Napa, CA! #WRSAEM19 

Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

  • Dr. Nathan Kuppermann
  • Sarah and Julia
by Categories: featured, FOAM, Full Episode, Medical Education, PECARN, Pediatric Emergency Medicine, Research Leave a comment

#Thisismylane– Episode 14

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#Thisismylane– Episode 14

If you work in the ED, you’ve likely seen your fair share of victims of gun violence. Though mass shootings have brought this issue into the public eye, firearm violence has been a public issue in our country for decades. In this episode, you’ll hear some powerful stories from providers about their experiences with people killed and injured by firearms. Then, we talk with researcher and expert, Dr. Garen Wintemute, about trends he’s seen, and discuss how we, as physicians and medical providers, can be part of the solution. 

Clearly this is a charged and complex topic. Let’s respectfully share our thoughts on how we can help prevent gun violence. We want to know! Share your thoughts on social media, @empulsepodcast, or on our website, ucdavisem.com. 

Hosts:

Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis

Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis

Guest:

Dr. Garen Wintemute Professor of Emergency Medicine, Susan P. Baker-Stephen P. Teret Chair in Violence Prevention at UC Davis, and Director, Violence Prevention Research Program  

Resources:

UC Davis Violence Prevention Research Program Toolkit: What You Can Do to Stop Firearm Violence https://health.ucdavis.edu/vprp/WYCD.html

Annals of Internal Medicine commitment and op ed: What You Can Do to Stop Firearm Violence http://annals.org/aim/pages/commitment-to-stop-firearm-violence

Speak For Safety

Video of Garen Talking about gun retailers taking a hard line against illegal gun sales: https://health.ucdavis.edu/publish/facultybio/search/faculty/242

Ski and CME! Join us for the,UC Davis Emergency Medicine Winter Conference March 4th-8th at the Ritz Carlton in Lake Tahoe.

Come play and learn with at the Western Regional SAEM Annual Meeting, March 21-22 in beautiful Napa, CA! #WRSAEM19 

Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

While this is a UC Davis EM podcast and many of the voices you hear today, including our own, are those of UC Davis EM Physicians, the opinions expressed may not be those of the UC DAVIS institution and Health System.  

by Categories: Emergency Medicine, featured, FOAM, Full Episode, Medical Education, Pediatric Emergency MedicineTags: , , , , , , , , , , Leave a comment

Bonus Episode: 2018 in Review

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Bonus Episode: 2018 in Review

Happy New Year! 2018 was a big year for us, thanks to all of you! Here we are, almost 365 days since publishing our first episode, so let’s take a moment to reflect on our first year. We’re closing in on 30,000 downloads and have listeners in all 50 states, 2 territories, and 94 countries. We’ve been featured by several local news outlets, and one of our favorite EM blogs, lifeinthefastlane.com. And we even won an eHealthcare Leadership award! Wow. We are so grateful to you all for listening, subscribing, supporting, rating, reviewing, and sharing! 

In this episode, Sarah and Julia recall some of their moments – see below for links to the episodes mentioned. We look forward to bringing you many more great episodes in 2019!

What were your favorite moments? Did a particular episode resonate with you? Let us know on social media, @empulsepodcast, or at ucdavisem.com. 

Hosts:

Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis

Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis

Episodes Referenced:

Pot Tarts

Sold for a Chrysler 300

The Game has Changed

Don’t be a Jerk

The Price of Beauty

Toddlers Will Sell Their Souls for Stickers

Last Stand in Santa Rosa

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Ski and CME! Join us for the UC Davis Emergency Medicine Winter Conference, March 4th-8th at the Ritz Carlton in Lake Tahoe.

Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

by Categories: Disaster Medicine, Drugs, Emergency Medicine, FOAM, Full Episode, Heartbeat, Medical Education, Pediatric Emergency Medicine, Research, Social JusticeTags: , , , , , , , , , , , , , , , , , , Leave a comment

Last Stand in Santa Rosa – Episode 13

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Last Stand in Santa Rosa – Episode 13

Imagine you’re working a shift in the Emergency Department when a fast moving wildfire hits. What would you do if you found out your home was burning? Or your family was in danger? And how do you react when the Fire Department tells you they are making a last stand a block away from your hospital? This situation is all too real for many physicians and providers affected by devastating wildfires in California. In this episode, we follow the story of the 2017 Santa Rosa fires from the perspective of three Emergency Physicians, Dr. Josh Weil, Dr. Suzy Fitzgerald, and Dr. Dane Stevenson. Their powerful story, and the lessons learned from their experience, are guaranteed to improve your personal and professional disaster preparedness. 

Please also consider donating to ongoing relief efforts following the 2018 California wildfires through the Red Cross. 

Do you know your hospital’s disaster plan? Do you have a personal plan? Have you lived through a disaster? Share your experience with us on social media, @empulsepodcast, or on our website, ucdavisem.com. 

Hosts:

Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis

Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis

Guests:

Dr. Susan Fitzgerald, Emergency Physician at Kaiser Santa Rosa and Emergency Management Physician Lead in the Diablo Service Area; Kaiser Permanente Northern California (KPNC) Regional Emergency Management Drill and Training Director and the Pediatric Surge Planning Chair for the KPNC Regional Emergency Management Committee.

Dr. Joshua Weil, Emergency Physician at Kaiser Santa Rosa and Assistant Physician-in-Chief for Hospital Operations; Member of the American Red Cross Board of Directors, Board Chair for the Ceres Project, and Medical Director for the Jewish Community Free Clinic in Santa Rosa. Dr. Weil has been involved in major disaster relief efforts in the US and internationally, including Sri Lanka, Louisiana, Haiti, and the Philippines.

Dr. Dane Stevenson, Emergency Physician at Kaiser Santa Rosa, with a Fellowship in Geriatric Emergency Medicine from UC Davis.

Resources:

ACEP Disaster Medicine Resources

American College of Emergency Physicians Disaster Medicine resources, policies, and public training, including hospital disaster preparedness self assessment tool and hospital evacuation plan template. 

“Healing and History after fire & Weil-Mollard Household” 

Dr. Josh Weil and his wife, Claire Mollard, share their story on YouTube

The story of Josh’s goats! on NPR/Capitol Public Radio

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Ski and CME! Join us for the UC Davis Emergency Medicine Winter Conference, March 4th-8th at the Ritz Carlton in Lake Tahoe.

Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

 

  • Dr. Joshua Weil
  • Dr. Susan Fitzgerald
  • Dr. Dane Stevenson
  • Drs. Magaña and Medeiros
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Toddlers Will Sell Their Souls for Stickers – Episode 12

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Toddlers Will Sell Their Souls for Stickers – Episode 12

Caring for kids in the ED can be challenging – they often can’t (or won’t) tell you what’s wrong or where it hurts; they may have trouble sitting still during an exam or procedure; and their screams put everyone on edge. But let’s think about it from their perspective. It must be pretty confusing and frightening at times. Did you ever have to go to the ED as a kid? Do you remember what it was like? We ask some kids to share their thoughts and experiences. Then we get some valuable tips from the experts – Child Life Specialists, Pediatric ED Nurses, and Pediatric Emergency Medicine Physicians, including our own Dr. Julia Magaña. Learn what you can do to improve the ED experience for both you and your young patients. 

What tips do you have for taking care of kids in the ED? Did you try any of the things we mentioned in this episode? If so, did they work for you? We want to know! Share your thoughts on social media, @empulsepodcast, or on our website, ucdavisem.com. 

Hosts:

Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis

Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis

Guests:

The kids: Isa, Jordan, Benny, Katelyn, Wesley and Elia

UC Davis Department of Emergency Medicine Child Life Specialists, Nurses and Pediatric Emergency Medicine Physicians.

Resources:

DistrACTION Cards that Julia mentioned

Information and protocols for using intranasal medications at www.intranasal.net

Wong-Baker FACES pain scale

FLACC Score for pain in infants

ACEP Guidelines for Procedural Sedation and Analgesia in the Emergency Department (2013)

An Evidence-Based Approach to Minimizing Acute Procedural Pain in the Emergency Department and Beyond.

Ali S, McGrath T, Drendel AL. Pediatr Emerg Care. 2016 Jan;32(1):36-42; quiz 43-4. doi: 10.1097/PEC.0000000000000669. Review.

Patient- and family-centered care of children in the emergency department.

Dudley N, Ackerman A, Brown KM, Snow SK; American Academy of Pediatrics Committee on Pediatric Emergency Medicine; American College of Emergency Physicians Pediatric Emergency Medicine Committee; Emergency Nurses Association Pediatric Committee.

Pediatrics. 2015 Jan;135(1):e255-72. doi: 10.1542/peds.2014-3424.

Ten Practical Ways to Make Your ED Practice Less Painful and More Child-Friendly

Amy L.DrendelDO, MS*SaminaAliMDCM, Clinical Pediatric Emergency Medicine

Volume 18, Issue 4, December 2017, Pages 242-255

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Ski and CME! Join us for the UC Davis Emergency Medicine Winter Conference, March 4th-8th at the Ritz Carlton in Lake Tahoe.

Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

by Categories: Emergency Medicine, Full Episode, Medical Education, Pediatric Emergency MedicineTags: , , , , , , , , , , , 1 Comment

A cool tool.

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A cool tool.

In this episode Dr. Nate Kuppermann (@nkuppermann) discusses another amazing article on the PECARN TBI decision rule just published in JAMA Network Open. The article, Effect of the Head Computed Tomography Choice Decision Aid in Parents of Children With Minor Head Trauma: A Cluster Randomized Trial, and this episode explores shared decision making in the ED and a cool tool we can use to aid this process.

Send us your questions and continue the conversation on social media @empulsepodcast or at ucdavisem.com.

Hosts:

Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis

Guest:

Dr. Nate Kuppermann, Pediatric Emergency Physician, Professor and Chair of the UC Davis Department of Emergency Medicine, Founding Chair of the PECARN Steering Committee

Resources:

Effect of the Head Computed Tomography Choice Decision Aid in Parents of Children With Minor Head Trauma: A Cluster Randomized Trial.

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2703135

Erik P. Hess, MD, MSc1,2,3; James L. Homme, MD4,5; Anupam B. Kharbanda, MD, MSc6; Leah Tzimenatos, MD7; Jeffrey P. Louie, MD8; Daniel M. Cohen, MD9; Lise E. Nigrovic, MD, MPH10; Jessica J. Westphal11; Nilay D. Shah, PhD12,13; Jonathan Inselman, MS13; Michael J. Ferrara2,14; Jeph Herrin, PhD15; Victor M. Montori, MD, MSc3; Nathan Kuppermann, MD, MPH6,16

JAMA Network Open. 2018;1(5):e182430. 

Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. (https://www.ncbi.nlm.nih.gov/pubmed/19758692)

Kuppermann  N, Holmes  JF, Dayan  PS,  et al; Pediatric Emergency Care Applied Research Network.  Lancet. 2009;374(9696):1160-1170. 

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Excuse me, Your Bias is Showing – Episode 10

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Excuse Me, Your Bias is Showing – Episode 10

We all have biases lurking in our unconscious mind. These are our implicit biases, and they affect how we relate to patients and, in turn, how they relate to us. But if these biases are unconscious, how do we identify them? And is it possible to change them? We share our own experiences with implicit bias, and we hear Dr. Rupa Marya’s story that went viral on social media. Then we dive a little deeper with researcher and pediatric emergency medicine physician, Dr. Tiffani Johnson.

Want to check your own biases? Take an implicit association test (IAT) through Project Implicit. Let us know what you found and let’s continue the discussion on social media, @empulsepodcast. If you’d like to keep your results more private, send us a comment on our website, ucdavisem.com.

Hosts:

Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis

Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis

Guests:

Dr. Tiffani Johnson, Pediatric Emergency Medicine Physician and Faculty at the Policy Lab at Children’s Hospital of Philadelphia (CHOP) 

Special thanks to Dr. Rupa Marya and Bonnie Castillo for allowing us to use the audio from this video that was featured on NowThis Politics

Resources:

The Impact of Cognitive Stressors in the Emergency Department on Physician Implicit Racial Bias.

Johnson TJ, Hickey RW, Switzer GE, Miller E, Winger DG, Nguyen M, Saladino RA, Hausmann LR. Acad Emerg Med. 2016 Mar;23(3):297-305. doi: 10.1111/acem.12901. Epub 2016 Feb 22. PMID: 26763939

Comparison of Physician Implicit Racial Bias Toward Adults Versus Children.

Johnson TJ, Winger DG, Hickey RW, Switzer GE, Miller E, Nguyen MB, Saladino RA, Hausmann LR. Acad Pediatr. 2017 Mar;17(2):120-126. doi: 10.1016/j.acap.2016.08.010. Epub 2016 Sep 13. PMID: 27620844

Project Implicit – take an IAT!

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November 6-10, 2018. Registration is now open!

Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

Dr. Tiffany Johnson (center)

 

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Thriving not Surviving – Episode 9

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Thriving, not Surviving – Episode 9

Are you well? In this episode we tackle the issue of physician wellness. What does that mean? Why is it a problem? And what can we do to thrive, not just survive, in medicine? We discuss strategies with EM physicians of all levels, including Cal ACEP President, Dr. Aimee Moulin, and Dr. Katren Tyler, Vice Chair of Wellness for the UC Davis Department of Emergency Medicine.

How do you define physician wellness? What is your personal recipe for THRIVING, not just surviving? Join the conversation on social media, @empulsepodcast, or at ucdavisem.com.

Hosts:

Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis

Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis

Guests:

Dr. Aimee Moulin, Associate Professor of Emergency Medicine at UC Davis and President of California ACEP

Dr. Katren Tyler, Professor of Emergency Medicine and Vice Chair for Faculty Development, Wellness and Outreach in the UC Davis Department of Emergency Medicine

Various UC Davis Department of Emergency Medicine residents, fellows, and faculty.

Resources:

Ten commandments of physician wellness.

Krall EJ. Clin Med Res. 2014 Sep;12(1-2):6-9. doi: 10.3121/cmr.2013.1211. Epub 2014 Jan 10. No abstract available. PMID: 24415746

What Do We Mean by Physician Wellness? A Systematic Review of Its Definition and Measurement.

Brady KJS, Trockel MT, Khan CT, Raj KS, Murphy ML, Bohman B, Frank E, Louie AK, Roberts LW.

Acad Psychiatry. 2018 Feb;42(1):94-108. doi: 10.1007/s40596-017-0781-6. Epub 2017 Sep 14. Review. PMID: 28913621

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Join us in Maui for Emergency Medicine Hot Topics! 

November 6-10, 2018. Registration is now open!

Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

 

 

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If it Hurts, Don’t do it!

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If it Hurts, Don’t do it!

Let’s revisit concussion and return to play with UC Davis Head Team Physician, Dr. Jeremiah Ray. This Heartbeat was originally recorded as a Facebook LIVE for the UC Davis Health page. We first talked about concussion in May’s episode, “Breaking Out of Concussion Jail“. This Heartbeat is a little more casual and offers some practical information for how to recognize and manage concussion in athletes – plus, it provides a little spaced repetition to help us remember what we learned! 

Send us your questions and continue the conversation on social media @empulsepodcast or at ucdavisem.com.

Host:

Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis

Guest:

Dr. Jeremiah Ray, Head Team Physician for UC Davis Intercollegiate Athletics

Resources:

SCAT 5 (Sports Concussion Assessment Tool – 5th Edition)

CDC HEADS UP to Brain Injury Awareness

NCAA Concussion Diagnosis and Management Best Practices

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Join us in Maui for Emergency Medicine Hot Topics! 

November 6-10, 2018. Registration is now open at www.cevs.ucdavis.edu/confreg/?confid=960

Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

by Categories: Emergency Medicine, FOAM, Heartbeat, Medical Education, Pediatric Emergency MedicineTags: , , , , , , , , , , , Leave a comment

DKA: It’s Not About the Fluids! – Episode 7

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DKA: It’s Not About the Fluids! – Episode 7

Hot of the presses! We are thrilled to speak with the amazing husband and wife research team of Dr. Nate Kuppermann and Dr. Nicole Glaser, on their practice changing paper that was just, and we mean JUST, published in the New England Journal of Medicine. DKA (diabetic ketoacidosis) is a potentially life threatening condition that can be complicated to treat, especially in children. First, we’ll hear from 9-year-old Whitley and her mom, Amanda, about what it’s like to be a kid living with diabetes, and what it feels like to have the dreaded DKA. Then we’ll dive into the research with Drs. Kuppermann and Glaser and learn how their findings revolutionize the way we treat DKA in kids.

How does this paper change the way you approach children with DKA in your practice? Continue the conversation on social media @empulsepodcast or at ucdavisem.com.

Hosts:

Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis

Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis

Guests:

Whitley and Amanda, a mother and daughter team living with diabetes

Dr. Nate Kuppermann, Pediatric Emergency Physician, Professor and Chair of the UC Davis Department of Emergency Medicine, Founding Chair of the PECARN Steering Committee

Dr. Nicole Glaser, Professor of Pediatric Endocrinology at UC Davis

Resources:

Clinical Trial of Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis

Nathan Kuppermann, M.D., M.P.H., Simona Ghetti, Ph.D., Jeff E. Schunk, M.D., Michael J. Stoner, M.D., Arleta Rewers, M.D., Ph.D., Julie K. McManemy, M.D., M.P.H., Sage R. Myers, M.D., M.S.C.E., Lise E. Nigrovic, M.D., M.P.H., Aris Garro, M.D., M.P.H., Kathleen M. Brown, M.D., Kimberly S. Quayle, M.D., Jennifer L. Trainor, M.D., Leah Tzimenatos, M.D., Jonathan E. Bennett, M.D., Andrew D. DePiero, M.D., Maria Y. Kwok, M.D., M.P.H., Clinton S. Perry, III, Ph.D., Cody S. Olsen, M.S., T. Charles Casper, Ph.D., J. Michael Dean, M.D., and Nicole S. Glaser, M.D. for the PECARN DKA FLUID Study Group.

N Engl J Med. 2018 June 14, 378:2275-2287

Risk factors for cerebral edema in children with diabetic ketoacidosis. The Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics.

Glaser N, Barnett P, McCaslin I, Nelson D, Trainor J, Louie J, Kaufman F, Quayle K, Roback M, Malley R, Kuppermann N; Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. N Engl J Med. 2001 Jan 25;344(4):264-9. 

PMID: 11172153 

PECARN (Pediatric Emergency Care Applied Research Network)

For those of you who want more, here is the unedited interview: Drs. Kuppermann and Glaser

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November 6-10, 2018. Registration is now open at www.cevs.ucdavis.edu/confreg/?confid=960

Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

by Categories: FOAM, Medical Education, Pediatric Emergency Medicine, ResearchTags: , , , , , , , , , , , 1 Comment