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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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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.

Podcast: Play in new window | Download (Duration: 6:52 — 8.1MB)

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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.

Podcast: Play in new window | Download (Duration: 44:02 — 40.5MB)

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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

• • Resources for Health Care Providers
  • Resources for Parents

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

Podcast: Play in new window | Download (Duration: 11:57 — 11.2MB)

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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.

Podcast: Play in new window | Download (Duration: 34:02 — 31.4MB)

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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.

Podcast: Play in new window | Download (Duration: 10:07 — 9.5MB)

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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

#endtrafficking

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.

Podcast: Play in new window | Download (Duration: 42:09 — 38.8MB)

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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.

Podcast: Play in new window | Download (Duration: 9:47 — 9.2MB)

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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.

Podcast: Play in new window | Download (Duration: 24:07 — 22.3MB)

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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.

Podcast: Play in new window | Download (Duration: 36:04 — 33.2MB)

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Episode 2: Sold for a Chrysler 300

January is National Human Trafficking Awareness Month. In light of this, we have a very special episode for you. Annika Huff (formerly Annika Mack), a trafficking survivor, speaks with us about her experiences in the life, how she got out, and what she is doing now. Then, Dr. Bryn Mumma takes us through her research on how we can better identify potential victims in the ED. Dr. Rachel Robitz shares some advice on how to approach these patients, create a safe space, and offer support and resources, and our own Dr. Julia Magaña discusses how she manages this in pediatric patients.

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

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

Guests:

Annika Huff (formerly Annika Mack), Advocate, Speaker and Survivor

http://annikahuff.com/

Dr. Bryn Mumma, Assistant Professor of Emergency Medicine at UC Davis

Dr. Rachel Robitz, Assistant Clinical Professor of Psychiatry, Associate Training Director of Family Medicine/Psychiatry

Resources:

Screening for Victims of Sex Trafficking in the Emergency Department: A Pilot Program.

https://www.ncbi.nlm.nih.gov/m/pubmed/28611881/

Mumma BE, Scofield ME, Mendoza LP, Toofan Y, Youngyunpipatkul J, Hernandez B. West J Emerg Med. 2017 Jun;18(4):616-620. doi: 10.5811/westjem.2017.2.31924. Epub 2017 Apr 17. PMID: 28611881

National Human Trafficking Resource Center 1-888-373-7888

https://humantraffickinghotline.org/

WEAVE is the primary provider of crisis intervention services for survivors of domestic violence and sexual assault in Sacramento County

https://www.weaveinc.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.