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
Orthopedics

Elbow Fractures

This episode in the Fracture Season of PEM Currents, the Pediatric Emergency Medicine podcast focuses on elbow fractures. Did you know that the elbow has there joints? Did you know that supracondylar fractures can happen after a fall from something other than monkey bars? Don’t forget to listen to the Forearm and Wrist Episode if you’d like to brush up on your neuromuscular assessment.

I am now proud to offer CME through Cincinnati Children’s. To claim CME & ABP MOC Part 2, visit Cincinnati Children’s Online Courses and search ‘PEM Currents’.

Follow me on Twitter @PEMTweets

Check out my facebook page

Check out PEMBlog for more great educational content, including seven years worth of Fracture Fridays posts

References

 Mazda K, Boggione C, Fitoussi F, Penneçot GF. Systematic pinning of displaced extension- type supracondylar fractures of the humerus in children. A prospective study of 116 consecutive patients. J Bone Joint Surg Br 2001; 83:888.

Woon, C. Supracondylar Fracture – Pediatric: Ortho Bullets. Accessed 8/5/2019. https://www.orthobullets.com/pediatrics/4007/supracondylar-fracture–pediatric

Podcast: Play in new window | Download (16.7MB)

Subscribe: Apple Podcasts | RSS

Categories
Orthopedics

Forearm and Wrist Fractures

This summer, in honor of the 7th anniversary of PEMBlog and PEM Currents I will be releasing a mini-season of fracture focused podcasts.

This episode focuses on radius and ulna fractures, including buckle, greenstick, physis and more! learn about the neurovascular assessment of the upper extremity and general management pearls for some of the most common injuries that you will see in the Pediatric Emergency Department.

I am now proud to offer CME through Cincinnati Children’s. To claim CME & ABP MOC Part 2, visit Cincinnati Children’s Online Courses and search ‘PEM Currents’.

Follow me on Twitter @PEMTweets

Check out my facebook page

Check out PEMBlog for more great educational content, including seven years worth of Fracture Fridays posts

References

Abraham A, Handoll HH, Khan T. Interventions for treating wrist fractures in children. Cochrane Database Syst Rev 2008; :CD004576.

Drendel AL, Gorelick MH, Weisman SJ, et al. A randomized clinical trial of ibuprofen versus acetaminophen with codeine for acute pediatric arm fracture pain. Ann Emerg Med 2009; 54:553.

Douma-den Hamer D, Blanker MH, Edens MA, et al. Ultrasound for Distal Forearm Fracture: A Systematic Review and Diagnostic Meta-Analysis. PLoS One 2016; 11:e0155659.

Podcast: Play in new window | Download (25.0MB)

Subscribe: Apple Podcasts | RSS

Categories
Cardiology

SVT

Three of my favorite letters in the Pediatric Emergency Department are S, V and T. This episode of PEM Currents, the Pediatric Emergency Medicine Podcast focus on the diagnosis and management of paroxysmal supraventricular tachycardia in the ED. I discuss preparation, vagal maneuvers, cardioversion, disposition and more!

PEMBlog.com

@PEMTweets on Twitter

Facebook

References

Appelboam, et al. Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial. The Lancet, 2015.

Friedman. Intraosseous adenosine for the termination of supraventricular tachycardia in an infant. Annals of EM, 1996

Garson et al. Supraventricular tachycardia in children: Clinical features, response to treatment, and long-term follow-up in 217 patients. The Journal of Pediatrics, 1981.

Getschman SJ et al. Intraosseous adenosine. As effective as peripheral or central venous administration? Arch Pediatr Adolesc Med. 1994 Jun;148(6):616-9.

Goodman et al. Intraosseous infusion is unreliable for adenosine delivery in the treatment of supraventricular tachycardia. Peds Emerg Care, 2012.

Hayes, Tricks of the Trade: Combine Adenosine with the Flush. Academic Life in Emergency Medicine, 2012. Accessed June 3, 2019.

Müller et al. “Vagal maneuvers” and adenosine for termination of atrioventricular reentrant tachycardia. The American Journal of Cardiology, 1994.

Podcast: Play in new window | Download (19.7MB)

Subscribe: Apple Podcasts | RSS

Categories
Uncategorized

Measles

I never thought that this particular disease would make a comeback in the United States. But here we are. Measles. As of May 2019 there have been cases reported in over 20 states. Declining vaccine rates and international travel to areas with local measles epidemics have led to a sharp rise in the number of cases in the US. The goal of this epode of PEM Currents is to discuss the diagnosis, treatment and prevention of measles, as well as how you can recognize it and appropriately diagnose and report cases.

You should definitely check out the following resources – since measles is a visual illness with a memorable rash (not that most of us have actually seen it). as well as learn about local hospital and health department procedures for treating, isolating and reporting confirmed and suspected cases.

Check out PEMBlog for more great educational content.

Follow me on twitter @PEMTweets

References

CDC – Measles (Rubeola) – Main Page

CDC – Photos of People With Measles

CDC – Measles Cases and Outbreaks

AAP – RedBook Measles

Podcast: Play in new window | Download (26.1MB)

Subscribe: Apple Podcasts | RSS

Categories
gastroenterology

Constipation

Constipation is an incredibly common problem in the Pediatric Emergency Department and amongst children who visit the Emergency Department with complaints of abdominal pain. This episode of PEM Currents, the Pediatric Emergency Medicine podcast features an interview with Danny Mallon, a Gastroenterologist from Cincinnati Children’s @dannymallon24 who is an expert in managing pediatric constipation. Our discussion focused on diagnosis in the Emergency Department, management  and why you don’t need an X-Ray to make there diagnosis.

Check out PEMBlog.com for more great educational content

Follow me on Twitter @PEMTweets

References

Berger et al. Value of Abdominal Radiography, Colonic Transit Time, and Rectal Ultrasound Scanning in the Diagnosis of Idiopathic Constipation in Children: A Systematic Review. Journal of Pediatrics, 2012.

Hyams et al. Childhood Functional Gastrointestinal Disorders: Child/ Adolescent. Gastroenterology, 2016.

Zeevenhooven et al. The New Rome IV Criteria for Functional Gastrointestinal Disorders in Infants and Toddlers. Pediatr Gastroenterol Hepatol Nutr, 2017.

Podcast: Play in new window | Download (Duration: 17:19 — 24.1MB)

Subscribe: Apple Podcasts | RSS

Categories
Resuscitation

Anaphylaxis: Admit or Discharge?

You will no doubt see a child with anaphylaxis in the Emergency Department. Recognition, management and disposition are all key questions that feel incredibly fluid at this juncture. I had the pleasure of interviewing Tim Dribin, an Emergency Medicine Attending from Cincinnati Children’s who recently published a paper in PLUS ONE focusing on admissions for children with anaphylaxis. Should we move the observation time from four to two hours? Who is most at risk for biphasic reaction? And how can we use data form kids that were admitted, and received no interventions, to inform practice in the ED?

Read the article from Dribin et al. right here! 

PEMBlog

@PEMTweets on Twitter

References

Dribin TE, Michelson KA, Monuteaux MC, Stack AM, Farbman KS, et al. (2019) Identification of children with anaphylaxis at low risk of receiving acute inpatient therapies. PLOS ONE 14(2): e0211949. 

Podcast: Play in new window | Download (Duration: 8:08 — 11.3MB)

Subscribe: Apple Podcasts | RSS

Categories
Infectious Diseases

Sinusitis

Did you know that up to 9% of URIs are eventually complicated by acute sinusitis in children? This episode of PEM Currents, the Pediatric Emergency Medicine podcast focuses on making the diagnosis of acute bacterial rhinosinusitis clinically and when to pull the antibiotic prescription trigger.

PEMBlog.com

@PEMTweets

References

Chow AW, Benninger MS, Brook I, Brozek JL, Goldstein EJ, Hicks LA, Pankey GA, Seleznick M, Volturo G, Wald ER, File TM Jr, Infectious Diseases Society of America. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis. 2012;54(8):e72.

Hicks CW, Weber JG, Reid JR, Moodley M. Identifying and managing intracranial complications of sinusitis in children: a retrospective series. Pediatr Infect Dis J. 2011;30(3):222.

Wald ER, Applegate KE, Bordley C, Darrow DH, Glode MP, Marcy SM, Nelson CE, Rosenfeld RM, Shaikh N, Smith MJ, Williams PV, Weinberg ST, American Academy of Pediatrics. Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years. Pediatrics. 2013;132(1):e262.

Wald ER, Milmoe GJ, Bowen A, Ledesma-Medina J, Salamon N, Bluestone CD. Acute maxillary sinusitis in children. N Engl J Med. 1981;304(13):749.

Podcast: Play in new window | Download (Duration: 12:04 — 16.8MB)

Subscribe: Apple Podcasts | RSS

Categories
Urology

Testicular Pain

Acute testicular pain is a common presenting complaint in the Pediatric Emergency Department. In this episode of PEM Currents you will learn about testicular torsion, epididymitis, torsion of the appendix testis and appendix epididymis, inguinal hernias and more. And remember, first and foremost, time is testicle!

PEMBlog.com

@PEMTweets

References

Jefferies MT, Cox AC, Gupta A, Proctor A. The management of acute testicular pain in children and adolescents. BMJ 2015; 350:h1563.

Lewis AG, Bukowski TP, Jarvis PD, et al. Evaluation of acute scrotum in the emergency department. J Pediatr Surg 1995; 30:277.

Podcast: Play in new window | Download (Duration: 16:46 — 15.7MB)

Subscribe: Apple Podcasts | RSS

Categories
gastroenterology Infectious Diseases

Probiotics for Gastroenteritis

This episode of PEM Currents features an in-depth interview with the lead author on the recent New England Journal paper on the use of probiotics in gastroenteritis. David Schnadower was kind enough to sit down with me and James Gray, a Pediatric Emergency Medicine Fellow from Cincinnati Children’s to talk about the study and its implications for the care of children with infectious gastroenteritis. You will find a full transcript of the podcast on PEMBlog.com.

Read the full article from the New England Journal of Medicine.

References

Freedman et al. Multicenter Trial of a Combination Probiotic for Children with Gastroenteritis. N Engl J Med 2018; 379:2015-2026. DOI: 10.1056/NEJMoa1802597.

Schnadower et al. Lactobacillus rhamnosus GG versus Placebo for Acute Gastroenteritis in Children. NEJM 2018; 379:2002-2014. DOI: 10.1056/NEJMoa1802598.

Podcast: Play in new window | Download (Duration: 7:53 — 11.0MB)

Subscribe: Apple Podcasts | RSS

Categories
Orthopedics

Intranasal Ketamine

I am delighted to bring you this special episode of PEM Currents, the Pediatric Emergency Medicine podcast. It’s all about intranasal ketamine and its use for acute pain management in the Pediatric Emergency Department. I had the pleasure of interviewing Theresa Frey, Assistant Professor from the Division of Emergency Medicine at Cincinnati Children’s. Theresa is the 2016 winner of the Ken Graff Award from the AAP’s Section on Emergency Medicine. Funding from the award supported her study comparing intranasal fentanyl and intranasal ketamine in a randomized controlled trial for the treatment of acute, long bone fracture pain. We talk about the existing evidence, what’s to come in the future and how you can learn more about intranasal ketamine.

Check out PEMBlog for more great educational content

Follow me on Twitter @PEMTweets

Follow along on facebook

References

Graudins A, Meek R, Egerton-Warburton D, Oakley E, Seith R. The PICHFORK (Pain in Children Fentanyl or Ketamine) Trial: A Randomized Controlled Trial Comparing Intranasal Ketamine and Fentanyl for the Relief of Moderate to Severe Pain in Children With Limb Injuries. Annals of emergency medicine. 2015;65(3):248-254.e241.

Reynolds SL, Bryant KK, Studnek JR, et al. Randomized Controlled Feasibility Trial of Intranasal Ketamine Compared to Intranasal Fentanyl for Analgesia in Children with Suspected Extremity Fractures. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 2017.

Yeaman F, Oakley E, Meek R, Graudins A. Sub-dissociative dose intranasal ketamine for limb injury pain in children in the emergency department: a pilot study. Emergency medicine Australasia : EMA. 2013;25(2):161-167.

Podcast: Play in new window | Download (Duration: 23:43 — 32.9MB)

Subscribe: Apple Podcasts | RSS