Camp Fire medicine

Camp Fire medicine

What are the medical needs when your WHOLE town burns down? What is it like to walk into a shelter with over a thousand friends and family still missing? What if the evacuees you are caring for are your neighbors? The California wildfires have been huge part of our personal and professional lives at UC Davis. In this Heartbeat we spoke with an EM resident who volunteered at a shelter in Chico, CA. Dr. Molly Hallweaver discusses what she saw, treated, and learned taking care of the victims of the Camp Fire. Burn care and inhalation injuries were not the most common needs in the shelter. More often people needed a shoulder on which to cry and treatment of chronic medical needs. 

We challenge you to think about what you would do if your community was burning down?  What if your hospital caught on fire? On our next episode we hear the story of Dane Stevenson, a Kaiser EM Physician, whose hospital caught on fire and the experts who can help the rest of us know what we can do to prepare for those moments. Let’s continue the conversation on social media @empulsepodcast or at ucdavisem.com.

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

Guest: Dr. Molly Hallweaver  Emergency Medicine Resident at UC Davis

Resources: If you want to help the victims of the Camp Fire, monetary donations may be made to the American Red Cross. Visit www.redcross.org, call 1-800-RED CROSS, or text the word REDCROSS to 90999 to make a $10 donation.

The United Way of Northern California is taking donations for its NorCal Fire Relief Fund through its website and by text: send the message BUTTEFIRE to 91999.

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Join us in Tahoe, March 4-8, at the 42nd Annual UC Davis Emergency Medicine Winter Conference!

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.

NASA Image of the Camp Fire

Toddlers Will Sell Their Souls for Stickers – Episode 12

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.

The Price of Beauty

Heartbeat: The Price of Beauty

As Emergency Physicians, we pride ourselves on recognizing and treating life-threatening conditions. But what if we’re missing important diagnoses and we don’t even know it? In this Heartbeat, we explore acute and chronic silicone syndromes, two potentially serious conditions caused by injecting liquid silicone into the body. Dr. Nick Gorton, previously featured on Episode 8: Don’t be a Jerk! and the LGBTQI, MD Heartbeat, joins us again with advice on how to diagnose and manage these conditions that predominantly affect women, especially transgender women. 

Are these diagnoses new to you? Have you seen and treated either of these conditions? Let’s 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. R. Nick Gorton, Emergency Physician at Sutter Davis, and Primary Care Physician at the Lyon-Martino Clinic in San Francisco. 

Resources:

Silicone Pumping Harm Reduction Pamphlet

Dying to be a Woman trailer by TransLatin@ Coalition

TRANSLINE national online transgender medical consultation service – free and confidential. 

Lyon-Martin Health Services, San Francisco, CA.

Silicone embolism syndrome: a case report, review of the literature, and comparison with fat embolism syndrome.

Schmid A, Tzur A, Leshko L, Krieger BP.

Chest. 2005 Jun;127(6):2276-81. Review.

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Join us in Maui for Emergency Medicine Hot Topics! November 6-10, 2018.

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. Nick Gorton
Dr. Sarah Medeiros

These Are Our People – Episode 11

These Are Our People – Episode 11

If you have ever worked in an ED, you have taken care of a homeless patient. In fact, you’ve probably taken care of many patients you didn’t even know were struggling with homelessness. As providers, we know these people well. They are often labeled “superusers” and, in addition to sometimes acting as their primary care physicians, we often find ourselves trying to sort out their myriad social issues. In this episode, we talk with a homeless patient, multiple ED providers, and expert Dr. Bisan Salhi, about some of the health challenges that our undomiciled patients face, and what role the ED should play in caring for these patients. You’ll hear a variety of opinions on this controversial topic. We then talk with health policy experts, Dr. Nick Sawyer and Dr. Aimee Moulin, about the recently signed California Senate Bill 1152, and how it will affect hour care and discharge of self-identified homeless patients. 

Do you screen for homelessness? How do you care for homeless patients in your ED? Will you be affected by CA Senate Bill 1152? This topic is likely to generate some heated conversation. Join us on social media, @empulsepodcast, or on our website, ucdavisem.com, to keep the discussion going. 

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. Bisan Salhi,  Assistant Professor of Emergency Medicine at Emory and PhD in Anthropology

Dr. Nick Sawyer, Assistant Professor of Emergency Medicine at UC Davis, California ACEP Board Member

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

Resources:

Homelessness and Emergency Medicine: A Review of the Literature.

Salhi BA, White MH, Pitts SR, Wright DW.

Acad Emerg Med. 2018 May;25(5):577-593. doi: 10.1111/acem.13358. Epub 2018 Jan 11.

Get involved through California ACEP!

Read the complete California Senate Bill 1152.

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What better place to earn CME than Maui! There’s still time to register for the 15th Annual Emergency Medicine Hot Topics conference taking place Nov. 6-10, 2018 in Hawaii. Earn up to 20.5 CME credits!

Register today at tinyurl.com/EMHOTTOPICS

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.

A cool tool.

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. 

Excuse me, Your Bias is Showing – Episode 10

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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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.

Dr. Tiffany Johnson (center)

 

It’s all about Tommie

It’s all about Tommie.

Way back in March we discussed how “The Game has Changed” with Dr. Dr. Gail D’Onofrio and Dr. Josh Elder (https://twitter.com/joshuawelder).  They discussed how emergency departments can be a positive part of the opiate epidemic by offering buprenorphine (suboxone). In this episode we find out how the program is going and how the human element (aka Tommie, our substance use counselor) is helping it succeed.

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

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

Guest:

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

Resources:

ED Bridge (https://ed-bridge.org) emergency department support for development and implementation of buprenorphine treatment

AMA END the EPIDEMIC (https://www.end-opioid-epidemic.org/resources/california-acep-safe-prescribing-guidelines/) multi-specialty resources 

California ACEP (https://californiaacep.site-ym.com/forums/posts.aspx?group=&topic=1427775&page=1&hhSearchTerms=%22buprenorphine%22#post_1427775) Dr. A Moulin’s message on Substance Use Disorder Treatment in the ED-stay tuned for more resources at this website

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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.

Thriving not Surviving – Episode 9

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.

 

 

If it Hurts, Don’t do it!

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.

Don’t Be A Jerk – Episode 8

Don’t be a Jerk – Episode 8

Dr. R Nick Gorton and Dr. Kara Toles are back to talk about transgender care in the Emergency Department. Did you know you already have the skills to advocate for and care for transgender patients? You do! Let’s sum it up in four words: DON’T BE A JERK! Treat your patients like you’d want your family member to be treated. We’ll explore some of the challenges and concerns specific to transgender patients — JM Jaffe shares a very personal account of their experience. Drs. Gorton and Toles then review Nick’s recent paper on the topic and give us some practical tips to help us gracefully navigate the complexities of the gender spectrum in the ED. 

How does your department (or residency, med school, etc.) address the topic of transgender care? 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:

JM Jaffe, Trans Health Manager at Lyon Martin Clinic

Dr. Kara Toles, Assistant professor of Emergency Medicine at UC Davis and Emergency Physician at UTMB Health. 

Dr. R. Nick Gorton, Emergency Physician at Sutter Davis, and Primary Care Physician at the Lyon-Martino Clinic in San Francisco. 

Resources:

TRANSLINE national online transgender medical consultation service – free and confidential. 

Lyon-Martin Health Services, San Francisco, CA.

Improving the Quality of Emergency Care for Transgender Patients

Gorton RN, Berdahl CT. Ann Emerg Med. 2018 Feb;71(2):189-192.e1. doi: 10.1016/j.annemergmed.2017.12.003. Epub 2018 Feb 5.

“Sometimes You Feel Like the Freak Show”: A Qualitative Assessment of Emergency Care Experiences Among Transgender and Gender-Nonconforming Patients

Elizabeth A. Samuels, Chantal Tape, Naomi Garber, Sarah Bowman, Esther K. Choo

Ann Emerg Med. 2018 Feb;71(2):170-182.e1. doi: 10.1016/j.annemergmed.2017.05.002. Epub 2017 Jul 14.

Transgender and Gender-Nonconforming Patients in the Emergency Department: What Physicians Know, Think, and Do

Makini Chisolm-Straker, Cathleen Willging, Adrian D. Daul, Shannon McNamara, S. Cham Sante, Daniel G. Shattuck II, Cameron S. Crandall

Ann Emerg Med. 2018 Feb;71(2):183-188.e1. doi: 10.1016/j.annemergmed.2017.09.042. Epub 2017 Nov 3.

Improving Care for Lesbian, Gay, Bisexual, and Transgender Patients in the Emergency Department 

Ann Emerg Med. 2015 Oct;66(4):417-23. doi: 10.1016/j.annemergmed.2015.02.004. Epub 2015 Mar 5.

Sara Jalali, Lauren M. Sauer

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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.

 

 

 

LGBTQI, MD

LGBTQI, MD

Happy Pride, everyone! June is coming to an end and we’ve enjoyed celebrating all the diverse and beautiful people in our communities. In the spirit of Pride month, this Heartbeat explores what it’s like to be an LGBTQI physician. For those unaware, LGBTQI stands for lesbian, gay, bisexual, transgender, queer (or questioning), and intersex. Many people also add an A for asexual, or allies. Dr. Kara Toles and Dr. Nick Gorton graciously share their stories with us, as well as their advice for future doctors who may identify with any of the letters in the acronym. Dr. Gorton and Dr. Toles will also be joining us in an upcoming full episode that we are really excited about. Stay tuned!

Do you identify as LGBTQIA? We’d love to hear your story. Please send us your thoughts or experiences through our website, ucdavisem.com, or on social media, @empulsepodcast. We look forward to hearing from you!

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. Kara Toles, Assistant professor of Emergency Medicine at UC Davis and Emergency Physician at UTMB Health. 

Dr. R. Nick Gorton, Emergency Physician at Sutter Davis, and Primary Care Physician at the Lyon-Martino Clinic in San Francisco. 

Resources:

GLMA – Gay and Lesbian Medical Association – Ensuring equality in healthcare for LGBT individuals and healthcare professionals. 

It Gets Better Project

Lyon-Martin Health Services, San Francisco, CA. 

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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.

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

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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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.

Catching Pee in the ED

Catching Pee in the ED

In this Heartbeat we go over two alternatives to cathing that infant in your ED.  If you had an infant who needed to be cathed, ever seen an infant cathed, or even heard a child cathed, you know it is less than fun. Here are two different, published methods that we attempted, back to back, on an infant…then we ended up doing the cath anyway!

Join the conversation on Social Media @empulsepodcast or at ucdavisem.com

Host:

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

Guest:

Keyon Mitchell, UC Davis Medical School Graduate Class of 2018.

Resources:

Hall-million S, Howard PK. Does Suprapubic Stimulation in Infants Facilitate Collection of a Clean Catch Urine Specimen? Adv Emerg Nurs J. 2017 Oct/Dec;39(4):236-239. https://www.ncbi.nlm.nih.gov/pubmed/29095174

Kaufman J, Tosif S, Fitzpatrick P, Hopper SM, Bryant PA, Donath SM, Babi FE. Quick Wee: a novel non-invasive urine collection method. Emerg Med J. 2017 jan;34(1):63-64. https://www.ncbi.nlm.nih.gov/pubmed/27565196

Kaufman J, Fitzpatrick P, Tosif S, Hopper SM, Donath SM, Vryant PA, Babe FE. Faster clean catch urine collection (Quick-Wee method) from infants: randomized controlled trial. BMJ 2017 Apr 7; 356:j1341. https://www.ncbi.nlm.nih.gov/pubmed/28389435

Labrosse M, Levy A, Autmizguine J, Gravel J. Evaluation of a New Strategy for Clean-Catch Urine in Infants. Pediatrics. 2016 Sep;138(3). pie:e20160573. https://www.ncbi.nlm.nih.gov/pubmed/27542848

Ray S, Forbes O. Quick-Wee is an effective technique for urine collection in infants. Arch Dis Child Edu Pract Ed. 2017 Oct 9. https://www.ncbi.nlm.nih.gov/pubmed/28993431

Tran A, Fortier C, Giovanni-chami L, demnchy D, Caci H, Desmontilis J, Montaudie-Dumas I, Bensaid R, Haas H, Berard E. Evaluation of the Bladder Stimulation Technique to Collect Midstream Urine in Infants in a Pediatric Emergency Department. PLoS one. 2016 mar 31;11(3):e0152598. https://www.ncbi.nlm.nih.gov/pubmed/?term=Evaluation+of+the+Bladder+Stimulation+technique+to+collect+midstream+urine

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.

Breaking Out of Concussion Jail – Episode 6

Breaking Out of Concussion Jail – Episode 6

Suffering a concussion can make you feel like a prisoner, especially if you’re a student athlete. Cameron Wright, a division I water polo player who suffered a concussion last year, knows this first hand. In this episode, he shares his experience with concussion, and how he finally returned to the sport he loves. Dr. Roger Zemek, one of the leading investigators studying concussion and return to play, discusses how recent research is changing our approach to recovery. Finally, Dr. Jeremiah Ray, a Sports Medicine and Emergency trained physician, talks about how he manages concussion in his college athletes, and gives us his recommendations for assessing and counseling patients in the ED. 

How do you manage concussion in your practice? Does what you’ve heard change anything for you? 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:

Cameron Wright, Men’s Water Polo Player at UC Berkeley

Dr. Roger Zemek, FRCPC Associate Professor Pediatrics and Emergency Medicine University of Ottawa, Vice chair pediatric emergency research Canada (PERC), Clinical Research chair in Pediatric Concussion University of Ottawa 

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

The National Institute of Neurological Disorders and Stroke and Department of Defense Sport-Related Concussion Common Data Elements Version 1.0 Recommendations.

Broglio SP, Kontos AP, Levin H, Schneider K, Wilde EA, Cantu RC, Feddermann-Demont N, Fuller G, Gagnon I, Gioia G, Giza CC, Griesbach GS, Leddy JJ, Lipton ML, Mayer A, McAllister T, McCrea M, McKenzie L, Putukian M, Signoretti S, Suskauer SJ, Tamburro R, Turner M, Yeates KO, Zemek R, Ala’i S, Esterlitz J, Gay K, Bellgowan PSF, Joseph K. J Neurotrauma. 2018 May 2. doi: 10.1089/neu.2018.5643. [Epub ahead of print] PMID: 29717643

Full Interview with Dr. Roger Zemek

Anchors Away

Anchors away

In this Heartbeat we talk with a child abuse pediatrician who has seen what happens when we can’t see past a single diagnosis. She defines anchoring bias, how it can trip us up, and how to see past it.

Join the conversation on Social Media @empulsepodcast or at ucdavisem.com

Host:

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

Guest:

Antoinette “Tony” Laskey MD, MPH, MBA Professor of Pediatrics and Division Chief University of Utah Pediatrics. She is also the medical director of Safe and Healthy Families, a child abuse assessment and treatment center.

Resources:

How doctors think by Jerome Groopman https://www.amazon.com/How-Doctors-Think-Jerome-Groopman-ebook/dp/B003JTHWGE/ref=sr_1_1?ie=UTF8&qid=1525122494&sr=8-1&keywords=how+doctors+think

Pat Croskerry, MD: Gating the holes in the Swiss cheese (part I): Expanding professor Reason’s model for patient safety. (link: https://www.ncbi.nlm.nih.gov/pubmed/29168290)

Seshia SS, Bryan Young G, Makhinson M, Smith PA, Stobart K, Croskerry P. J Eval Clin Pract. 2018 Feb;24(1):187-197. doi: 10.1111/jep.12847. Epub 2017 Nov 23

Read Jon Ilgen, MD (@Jon_Ilgen) EM tweet about cognitive biases.

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.

Not so FAST – Episode 5

Not so FAST – Episode 5

Should we be doing FAST exams on all pediatric trauma patients? In this episode, we hear about a case where the FAST may have saved a child’s life. Then we talk with peds trauma experts, Drs. Nate Kuppermann and Jim Holmes, about their recent study on the utility of the FAST exam in stable pediatric trauma patients. Ultrasound expert, Ken Kelley, shares his thoughts on the paper and the role of the FAST exam in kids.

Do you FAST all of your pediatric trauma patients? 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

Guest Host: Dr. Michael Schick, Assistant Professor of Emergency Medicine and Global Ultrasound Fellowship Director at UC Davis

Guests:

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

Dr. Jim Holmes, Professor of Emergency Medicine at UC Davis, SAEM Secretary-Treasurer

Dr. Ken Kelley, Associate Professor of Emergency Medicine and Ultrasound Fellowship Director at UC Davis

Case retold by Dr. Nathan Vanden Berge, Emergency Medicine Resident at UC Davis

Resources:

Effect of Abdominal Ultrasound on Clinical Care, Outcomes, and Resource Use Among Children With Blunt Torso Trauma: A Randomized Clinical Trial.

Holmes JF, Kelley KM, Wootton-Gorges SL, Utter GH, Abramson LP, Rose JS, Tancredi DJ, Kuppermann N. JAMA. 2017 Jun 13;317(22):2290-2296. doi: 10.1001/jama.2017.6322. PMID: 28609532

Use of the focused assessment with sonography for trauma (FAST) examination and its impact on abdominal computed tomography use in hemodynamically stable children with blunt torso trauma.

Menaker J, Blumberg S, Wisner DH, Dayan PS, Tunik M, Garcia M, Mahajan P, Page K, Monroe D, Borgialli D, Kuppermann N, Holmes JF; Intra-abdominal Injury Study Group of the Pediatric Emergency Care Applied Research Network (PECARN). J Trauma Acute Care Surg. 2014 Sep;77(3):427-32. doi: 10.1097/TA.0000000000000296. PMID: 25159246

Sonostuff.com

FAST in Trauma Part 1 Video

FAST in Trauma Part 2 Video

SAEM: FAST examination

ACEP Pediatric Emergency Ultrasound Update: The Unique Pediatric FAST

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.

 

The FAST exam from the case in this episode reveals a massive hemopericardium with tamponade, shown here in the subxiphoid view.

A safe place to come – Heartbeat

A SAFE PLACE TO COME – HEARTBEAT

In this Heartbeat we get a fresh perspective on how you can identify and help victims of human trafficking on your next shift and we revisit a few principles learned in episode #2 – Sold for a Chrysler 300. Join the conversation on Social Media @empulsepodcast or at ucdavisem.com

Host:

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

Guest:

Dr. Hanni Stoklosa, emergency medicine physician at Brigham and Women’s Hospital with appointments at Harvard Medical School and the Harvard T.H. Chan School of Public Health. In addition, she is the Executive Director of HEAL Trafficking. She is an expert in helping survivors of human trafficking.

Resources:

Find resources and join the community fighting human trafficking at https://healtrafficking.org

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.

The Game Has Changed – Episode 4

The Game Has Changed – Episode 4

Let’s talk about the opioid crisis. One woman tells her powerful story of opioid addiction, treatment, and recovery. Then, we discuss the role Emergency Physicians can play in controlling this epidemic with experts, Dr. Gail D’Onofrio and Dr. Josh Elder.

How do you manage opioid use disorder in your practice? 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. Gail D’Onofrio, Professor and Chair of the Department of Emergency Medicine at Yale

Dr. Josh Elder, Assistant Professor of Emergency Medicine at UC Davis Health

Resources:

Screening Brief Intervention & Referral to Treatment (SBIRT)

National Institute on Drug Abuse (NIDA) information on opioids

Buprenorphine vs. Methadone on atforum.com

Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial.

D’Onofrio G, O’Connor PG, Pantalon MV, Chawarski MC, Busch SH, Owens PH, Bernstein SL, Fiellin DA. JAMA. 2015 Apr 28;313(16):1636-44. doi: 10.1001/jama.2015.3474. PMID: 25919527

Emergency Department-Initiated Buprenorphine for Opioid Dependence with Continuation in Primary Care: Outcomes During and After Intervention.

D’Onofrio G, Chawarski MC, O’Connor PG, Pantalon MV, Busch SH, Owens PH, Hawk K, Bernstein SL, Fiellin DA. J Gen Intern Med. 2017 Jun;32(6):660-666. doi: 10.1007/s11606-017-3993-2. Epub 2017 Feb 13. PMID: 28194688

Cost-effectiveness of emergency department-initiated treatment for opioid dependence.

Busch SH, Fiellin DA, Chawarski MC, Owens PH, Pantalon MV, Hawk K, Bernstein SL, O’Connor PG, D’Onofrio G. Addiction. 2017 Nov;112(11):2002-2010. doi: 10.1111/add.13900. Epub 2017 Aug 16. PMID: 28815789

You can listen to the entire interview with “Rachel” here: Rachel’s Story

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.

 

 

 

Heartbeat: Flu Update

Heartbeat: Flu Update

EM Pulse “Heartbeats” are mini episodes focused on current, relevant topics. On this Heartbeat, Dr. Larissa May gives us a brief update on the 2017-18 flu season, recommendations for treating with oseltamivir, and why it’s not too late to get (or give!) the flu shot.

You can watch the Facebook Live version of this Heartbeat at facebook.com/UCDavisEM, and join the conversation on Social Media @empulsepodcast or at ucdavisem.com

Host:

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

Guest:

Dr. Larissa May, Associate Professor of Emergency Medicine and Director of Emergency Department Antibiotic Stewardship at UC Davis.

Resources:

The Center for Disease Control influenza page: www.cdc.gov/flu

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.

I’m just a Reanimatologist – Episode 3

I’m just a Reanimatologist – Episode 3

This month’s episode explores the controversial topic of Emergency Department initiated extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS). Dr. Jonathon Ford relives a challenging case of beta blocker and calcium channel blocker overdose. Then, we have a front row seat in the heated battle of words between Dr. John Rose and Dr. Dan Colby on the pros and cons of ED ECMO.

Where do you stand? Join the conversation on Social Media @empulsepodcast or at https://ucdavisem.com

Hosts:
Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis
Dr. Julia Magaña, Assistant Professor of Emergency Medicine at UC Davis – Pediatric Emergency Medicine

Guests:
Dr. Jonathon Ford, Assistant Professor of Emergency Medicine, and Medical Toxicologist at UC Davis Health
Dr. Dan Colby, Assistant Professor of Emergency Medicine, and Medical Toxicologist at UC Davis Health
Dr. John Rose, Professor of Emergency Medicine at UC Davis Health, and EMS Medical Director for Yolo County

Resources:
Massive diltiazem and metoprolol overdose rescued with extracorporeal life support
https://www.ncbi.nlm.nih.gov/pubmed/28705745
Chenoweth JA, Colby DK, Sutter ME, Radke JB, Ford JB, Nilas Young J, Richards JR. Am J Emerg Med. 2017 Oct;35(10):1581.e3-1581.e5. doi: 10.1016/j.ajem.2017.07.023. Epub 2017 Jul 6. PubMed PMID: 28705745.

The ED ECMO Project and Podcast with Doctors Joe Bellezzo, Zack Shinar, and Scott Weingart. http://edecmo.org

ECLS Registry Report on http://elso.org

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.