Author: bradsobo

Brad Sobolewski, MD, MEd is a Professor of Pediatric Emergency Medicine and an Associate Director for the Pediatric Residency Training Program at Cincinnati Children's Hospital Medical Center. He is on Twitter @PEMTweets and authors the Pediatric Emergency Medicine site PEMBlog and produces and hosts the PEM Currents: The Pediatric Emergency Medicine Podcast.

Categories
Infectious Diseases Surgery

Neutropenic enterocolitis

Bad things happen when you don’t have enough neutrophils. After getting cytotoxic chemotherapy you tend to have even fewer neutrophils. This can put you at risk for neutropenic enterocolitis which should be suspected in an immunocompromised child with fever and abdominal symptoms. Treatment is broad spectrum antibiotics and the imaging test of choice is CT with contrast. Learn all about this potentially catastrophic condition in this brief podcast episode. 

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References

Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, Raad II, Rolston KV, Young JA, Wingard JR. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america. Clin Infect Dis. 2011 Feb 15;52(4):e56-93. doi: 10.1093/cid/cir073. PubMed PMID: 21258094.

McQueen A, et al. Oncologic Emergencies. In: Shaw KN, et al. Fleisher & Ludwig’s Textbook of Pediatric Emergency Medicine. 8th ed. 2021:901-935.

Moran H, Yaniv I, Ashkenazi S, Schwartz M, Fisher S, Levy I. Risk factors for typhlitis in pediatric patients with cancer. J Pediatr Hematol Oncol. 2009 Sep;31(9):630-4. doi: 10.1097/MPH.0b013e3181b1ee28. PMID: 19644402.

Kirkpatrick ID, Greenberg HM. Gastrointestinal complications in the neutropenic patient: characterization and differentiation with abdominal CT. Radiology. 2003 Mar;226(3):668-74. doi: 10.1148/radiol.2263011932. Epub 2003 Jan 24. PMID: 12601214.

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Categories
Infectious Diseases

Chicken Pox

Dewdrops on a rose petal. You’ve all heard the description, right? But how many of you have actually seen chicken pox in the wild. And what about monkey pox – does it look the same? How can I tell them apart? I wish there was a brief podcast episode focused on varicella that would help answer some of these questions…

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References

CDC for Healthcare Professionals: Chicken Pox (Varicella). https://www.cdc.gov/chickenpox/hcp/index.html. Accessed 8/11/2022.

Freer G, Pistello M. Varicella-zoster virus infection: natural history, clinical manifestations, immunity and current and future vaccination strategies. New Microbiol. 2018 Apr;41(2):95-105. PMID: 29498740.

Sauerbrei A. Diagnosis, antiviral therapy, and prophylaxis of varicella-zoster virus infections. Eur J Clin Microbiol Infect Dis. 2016 May;35(5):723-34. PMID: 26873382.

Podcast: Play in new window | Download (Duration: 8:25 — 11.6MB)

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Categories
Infectious Diseases

Hand, Foot, & Mouth Disease

Hand, Foot, and Mouth (and Butt) disease is incredibly popular in the summer/warm weather months in the Northern Hemisphere (August through October). It is so popular that I guarantee you will see it many times. This brief episode will teach you how to make the diagnosis and review strategies for management – which are largely supportive.

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References

Guerra AM, Orille E, Waseem M. Hand Foot And Mouth Disease. [Updated 2022 May 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431082/

Woodland DL. Hand, Foot, and Mouth Disease. Viral Immunol. 2019 May;32(4):159.

Podcast: Play in new window | Download (Duration: 6:47 — 9.3MB)

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Categories
Procedures

Pain management for laceration repair in children

Laceration repair is one of the quintessential procedures that children undergo in Emergency Departments. Minimizing pain and anxiety for children is a much better idea than just holding them down and getting it done. This episode will teach you all about local anesthetics, when to use anxiolytics and procedural sedations s well as the considerable value of nonpharmacologic intervention – including Child Life Specialists.

This episode is a co-production of the Emergency Medical Services for Children Innovation and Improvement Center whose mission is to minimize morbidity and mortality of acutely ill and injured children across the emergency continuum. We have developed a series of pain focused episodes.

Other Episodes in the Series

The Pediatric EMS Podcast: Ouch-less Pediatrics

EM Pulse: Please Don’t Hurt Me!

EM Guidewire: Pediatric Pain Management – EMSC Improvement Project

PediaCast CME: Pediatric Pain… from the Family Perspective

Follow my work

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The Facebook page

Instagram @BradSobolewski

Disclaimer

The Emergency Medical Services for Children Innovation and Improvement Center is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award (U07MC37471) totaling $3M with 0 percent financed with nongovernmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov

To learn more about the Emergency Medical Services for Children Innovation and Improvement Center visit https://emscimprovement.center

Email km@emscimprovement.center

Follow on Twitter @EMSCImprovement

References

EMSC IIC Pain Toolkit

Frank et al. How acidic is the lidocaine we are injecting, and how much bicarbonate should we add? Can J Plast Surg. 2012 Summer; 20(2): 71–73. PMCID: PMC3383550

Kennedy RM, Luhmann JD The “ouchless emergency department”. Getting closer: advances in decreasing distress during painful procedures in the emergency department. Pediatr Clin North Am. 1999;46(6):1215. 

Momsen OH et al. Neutralization of lidocaine-adrenaline. A simple method for less painful application of local anesthesia. Ugeskr Laeger. 2000 Aug 14;162(33):4391-4.

Resch K, Schilling C, Borchert BD, Klatzko M, Uden D. Topical anesthesia for pediatric lacerations: a randomized trial of lidocaine-epinephrine-tetracaine solution versus gel. Ann Emerg Med. 1998;32(6):693. 

Sinha M, Christopher NC, Fenn R, Reeves L. Evaluation of nonpharmacologic methods of pain and anxiety management for laceration repair in the pediatric emergency department. Pediatrics. 2006;117(4):1162. 

Podcast: Play in new window | Download (Duration: 20:36 — 28.3MB)

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Categories
Infectious Diseases

Lyme Disease

Update 6/6/22 – there is ongoing work to determine the optimal treatment for meningitis in Lyme between doxy and ceftriaxone. The original episode recording did not make this clear – my apologies. The 2021 IDSA guideline suggests that you could use either agent. This episode was edited to reflect this change.

Lyme disease prevalence continues to rise – especially in places where we didn’t see it before (like Ohio!). this podcast episode focuses on making the diagnosis, the different stages of disease, as well as when to prophylaxis, treat, and how testing works – all in under 15 minutes.


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Helpful Diagnostic Resources

CDC Lyme Disease Resource

CDC Tick ID – which tick bit me?

References

Shapiro ED. Lyme disease. N Engl J Med 2014; 371:684.

Lantos PM, Rumbaugh J, Bockenstedt LK, et al. Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis, and Treatment of Lyme Disease. Arthritis Rheumatol 2021; 73:12.

American Academy of Pediatrics. Lyme disease. In: Red Book, 31, Kimberlin DW, Brady MT, Jackson MA, Long SS (Eds), 2018. p. 515.

Nigrovic LE, Bennett JE, Balamuth F, Levas MN, Chenard RL, Maulden AB, Garro AC; for Pedi Lyme Net. Accuracy of Clinician Suspicion of Lyme Disease in the Emergency Department. Pediatrics. 2017 Dec;140(6):e20171975. doi: 10.1542/peds.2017-1975. PMID: 29175973; PMCID: PMC5703778.

Podcast: Play in new window | Download (Duration: 14:34 — 20.0MB)

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Categories
Infectious Diseases

Toxic Shock Syndrome

Toxic Shock Syndrome can be hard to recognize and differentiate from clinical entities such as Kawasaki, MIS-C, and DRESS. This brief podcast episode will raise awareness of situations in which TSS can occur and drive home important management pearls – like why you need to add Clindamycin.


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References

Gaensbauer JT et al. Epidemiology and Clinical Relevance of Toxic Shock Syndrome in US Children. Pediatr Infect Dis J. 2018 Dec;37(12):1223-1226. PMID: 29601458. 

Javouhey et al. Similarities and Differences Between Staphylococcal and Streptococcal Toxic Shock Syndromes in Children: Results From a 30-Case Cohort. Front Pediatr. 2018 Nov 28;6:360. PMID: 30547021

Rodríguez-Nuñez et al. Streptococcal Toxic Shock Syndrome collaborative group of Spanish Society of Pediatric Intensive Care. Clinical characteristics of children with group A streptococcal toxic shock syndrome admitted to pediatric intensive care units. Eur J Pediatr. 2011 May;170(5):639-44. PMID: 20981441.

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Categories
Toxicology

Toxicology Season 3 Episode 3: Iron

Iron ingestions always show up on standardized tests and are definitely one of those “many kids are fine but some aren’t and it’s hard to figure out who’s fine and who isn’t” ingestions. Suzan Mazor from Seattle Children’s helps iron out the details…

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CME and MOC Part II

I am delighted to offer free CME and MOC Part II through Cincinnati Children’s for the entirety of Toxicology Season 3. Just listen to all three episodes and access the CME/MOC portal via this link.

References

Gumber MR, Kute VB, Shah PR, Vanikar AV, Patel HV, Balwani MR, Ghuge PP, Trivedi HL. Successful treatment of severe iron intoxication with gastrointestinal decontamination, deferoxamine, and hemodialysis. Ren Fail. 2013;35(5):729-31. PMID: 23635030.

Chang TP, Rangan C. Iron poisoning: a literature-based review of epidemiology, diagnosis, and management. Pediatr Emerg Care. 2011 Oct;27(10):978-85. PMID: 21975503.

Podcast: Play in new window | Download (Duration: 16:04 — 14.7MB)

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Categories
Toxicology

Toxicology Season 3 Episode 2: Calcium Channel Blockers

Now this is a frightening ingestion! Calcium channel blockers are hard to manage with refractory shock being one of my main “please don’t let this come to the ED” nightmares. Suzan Mazor breaks it all down and discusses management of this challenging ingestion.

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CME and MOC Part II

I am delighted to offer free CME and MOC Part II through Cincinnati Children’s for the entirety of Toxicology Season 3. Just listen to all three episodes and access the CME/MOC portal via this link.

References

Bartlett, J. W., & Walker, P. L. (2019). Management of Calcium Channel Blocker Toxicity in the Pediatric Patient. The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG, 24(5), 378–389. https://doi.org/10.5863/1551-6776-24.5.378

Chakraborty RK, Hamilton RJ. Calcium Channel Blocker Toxicity. [Updated 2022 Feb 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537147/

Podcast: Play in new window | Download (Duration: 9:13 — 12.7MB)

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Categories
Toxicology

Toxicology Season 3 Episode 1: Bupropion

There are some scary ingestions out there and I think we’d all agree that bupropion (Wellbutrin) is on the short list of drugs that should make us worry. Learn how to recognize and manage toxicity, especially the neurogenic and cardiac effects of bupropion in the first episode of the third season of Toxicology podcasts from Suzan Mazor and I.

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CME and MOC Part II

I am delighted to offer free CME and MOC Part II through Cincinnati Children’s for the entirety of Toxicology Season 3. Just listen to all three episodes and access the CME/MOC portal via this link.

References

Huecker MR, Smiley A, Saadabadi A. Bupropion. [Updated 2021 Oct 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470212/

Farkas J. Bupropion intoxication. EMCrit. October 1, 2021. Accessed April 11, 2022. https://emcrit.org/ibcc/bupropion/

Podcast: Play in new window | Download (Duration: 11:34 — 15.9MB)

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Categories
Radiology Surgery

Ultrasound for Appendicitis

This episode of PEM Currents: The Pediatric Emergency Medicine podcast is focused on the use of ultrasound to make the diagnosis of acute appendicitis. You’ll learn about how a right lower quadrant ultrasound is performed, what we look for on the images, how to interpret positive, negative, and intermediate/equivocal results and much more! This episode was co-produced by Liz Lendrum, a senior pediatric resident at Cincinnati Children’s. She developed the learning objectives, compiled the references, and did a stellar job preparing the script and show notes that we used to record this episode. You can follow her on Twitter @liz_lendrum.

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CME & MOC Part 2

We are proud to offer CME and MOC Part 2 from Cincinnati Children’s. Click this link to go to the page for credit. Credit is free and registration is required.

Click here to claim CME and MOC part 2 Credit

Appendicits Clinical Scores

Pediatric Appendicitis Score – MD Calc

Alvarado Score for Acute Appendicitis – MD Calc

Pediatric Appendicitis Risk Calculator – MD Calc

References

Kharbanda AB, Vazquez-benitez G, Ballard DW, et al. Development and Validation of a Novel Pediatric Appendicitis Risk Calculator (pARC). Pediatrics. 2018;141(4).

Cotton DM, Vinson DR, Vazquez-benitez G, et al. Validation of the Pediatric Appendicitis Risk Calculator (pARC) in a Community Emergency Department Setting. Ann Emerg Med. 2019.

Samuel M. Pediatric Appendicitis Score. Journal of Pediatric Surgery, Vol 37,No 6 (June),2002: pp 877-881.

Goldman RD. The Paediatric Appendicitis Score (PAS) was useful in children with acute abdominal pain. Evid Based Med 2009;14:26 doi:10.1136/ebm.14.1.26

Kharbanda, AB. Validation and Refinement of a Prediction Rule to Identify Children at Low Risk for Acute Appendicitis. Arch Pediatr Adolesc Med 2012;166(8):738-744. doi:10.1001/archpediatrics.2012.490

Shah SR, Sinclair KA, Theut SB, Johnson KM, Holcomb GW 3rd, St Peter SD. Computed Tomography Utilization for the Diagnosis of Acute Appendicitis in Children Decreases With a Diagnostic Algorithm. Ann Surg. 2016 Sep;264(3):474-81.

Becker C, Kharbanda A. Acute appendicitis in pediatric patients: an evidence-based review. Pediatr Emerg Med Pract. Sep 2019;16(9):1-20.

Trout AT, Towbin AJ, Fierke SR, Zhang B, Larson DB. Appendiceal diameter as a predictor of appendicitis in children: improved diagnosis with three diagnostic categories derived from a logistic predictive model. Eur Radiol. Aug 2015;25(8):2231-8. doi:10.1007/s00330-015-3639-x

Anandalwar SP, Callahan MJ, Bachur RG, et al. Use of White Blood Cell Count and Polymorphonuclear Leukocyte Differential to Improve the Predictive Value of Ultrasound for Suspected Appendicitis in Children. J Am Coll Surg. Jun 2015;220(6):1010-7. doi:10.1016/j.jamcollsurg.2015.01.039

Gendel I, Gutermacher M, Buklan G, et al. Relative value of clinical, laboratory and imaging tools in diagnosing pediatric acute appendicitis. Eur J Pediatr Surg. Aug 2011;21(4):229-33. doi:10.1055/s-0031-1273702

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