pem

Pediatric Emergency Medicine (PEM) is a sub-speciality that many clinicians find intimidating. Are pediatric patients truly unique or are they simply "little adults"? In this podcast episode, we are joined by Dr. Dominique Diggs, board certified PEM physician, to demystify pediatric emergency care with 10 tips that will help you the next time you care for this patient population.

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Ashish and Jackson talk about the joys of the airway.  We go over some pitfalls of performing a stressful procedure, like how odd is a child's airway.  Making the decision to intubate a patient is always a scary one, hopefully we can help you feel a little better about it.

How did PEM Start? what is it like now? and where is it going? I discuss those questions and more with Dr. Jay Fisher, PEM Attending for almost 30 years.

How has the training in PEM changed over the years and what makes a good PEM fellow or provider. I discuss those questions with Mel and Noel, two very influential individuals in my career.

Pediatric emergencies are scary – and pediatric cardiac arrest tops the list of those scary scenes. There are thousands of pediatric cardiac arrests in the U.S. every year; 11.4% survive to hospital discharge – but only 5% of those children are neurologically intact. How can emergency physicians overcome these statistics? After spending a couple decades honing his PEM skills, Peter Antevy, MD, has narrowed down some key tips he shares with EMRA*Cast host Chris Reilly, MD.

Neste podcast eu conversei com o Marcelo Ramos (1º lugar), Marcondes Jr (2º lugar), Marcão Lemos (3º lugar) e com Carlos Eduardo (Organização). Em um bate-papo descontraído falamos sobre como foi participar do primeiro torneio de pesca 100% transmitido ao vivo no Brasil e das técnicas que cada um utilizou para chegar até o pódio.

SMACCMini: So you think you can dance? Play and purposeful skills in PEM by David Krieser

In part two of this podcast series on graphic facilitation and graphic recording, Whynde Kuehn and business and strategy architect, Michael Pemberton, explore real-life graphic technique examples that can be used as creative methods to engage participants, at every level of an organization, to improve communication, understanding, and retention of information.

Myths persist because they are essential to the human experience and our development as a society.

They fill the gap between what we know and what we think we know.

Where does this gap hurt us the most? In our vulnerable populations, for example, in our care of children.

The “myth incarnate” in medicine: defective dogma. Not all dogma is bad – after all, dogma means “that which is believed universally to be true”. The problem with medical dogma is that our critical thought processes are curtailed by wholesale acceptance.

Medical dogma is a special kind of myth, because it’s difficult to define. We repeat defective dogma for three reasons:

“It is known”. Sometimes the dogma is all that is known on the subject, or it is simply the majority consensus. Be careful with this one – because there may be a reason for this specific teaching – not all dogma is bad.

Dogma is sentimental. We learned from our teachers who learned from their teachers. We want to honor those who taught us, and we get attached to some ideas. Sometimes – even subconsciously – we allow our attachment to an idea to give it more credence than it deserves.

The third driver of dogma is insecurity. “I know what I know”. In other words, “don’t make me reveal my limitations.”

Myth: “They’re all fine”
Remedy: Remember to look for the subtleties in children. Early warning signs are there, in the history or in the physical exam. If it doesn’t add up, investigate.

Myth: “Only pediatricians are experts”
Remedy: Don’t delegate decisions. You can do this. You sometimes are the only one that can.

Myth: “I will break them”
Remedy: Children are not another species. Use all of your skills for all of your patients”

Powered by #FOAMed – Tim Horeczko, MD, MSCR, FACEP, FAAP

Ffion Davies gives her take on how to spot the sick child in the Emergency Department.

Paediatric medicine is no doubt hard and can at times be scary. There is nothing worse, in Ffion’s opinion, than sending a child home who later represents to the hospital in a worse condition, or even worse, later dies.

So, how does one spot the sick child amongst the droves of children who will present with fever and vomiting.

In this talk, Ffion gives a lesson on how to spot the sick children in the ‘grey’ zone – those that are not clearly sick and not clearly well.

Ffion breaks her thinking into two main areas: physiology and psychology.

Physiology matters. Scrutinising a full set of observations/vitals (in the context of the child’s age) will help avoid the feared crime of discharging a sick child.

Ffion discusses tachypnoea as a prime example of a simple physiological compensation to raise one’s suspicion of serious disease.

Similarly, psychology matters. Ffion talks in depth as to why she considers this to be true.

Talks on Paediatric Emergency Medicine are always popular because Emergency Medicine physicians are insecure about mismanaging a child. Are children precious? Are adults just big children? Therein lies the problem.

Less knowledge, less experience and perhaps less confidence. Compounding this is the complexities of having to deal with the stressed parents when you yourself are stressed because of the situation.

Ffion continues to talk about systems of thinking and decision making. She compares Type 1 thinking which is automatic and instinctive with Type 2 thinking, which is more considered. She explains the risks and benefits of relying more upon Type 2 thinking when considering the sick child in the Emergency Department.

Finally, Ffion concludes by talking about strategies to improve your own management of the paediatric population in the Emergency Department. She discusses improving your knowledge base, using resuscitation aids and checklists and training by using stress inoculation simulations.

For more like this, head to our podcast page. #CodaPodcast