PEM Rules: Recent Episodes
Yaron Ivan
PEM Rules is a dedicated Pediatric Emergency Medicine podcast designed to help medical students, residents, physicians or anyone who cares for children in the acute setting.
Visit my website at pemrules.com
*Content does not constitute medical advice. Please read the full disclaimer at: https://pemrules.com/disclaimer/
Copyright PEM Rules LLC
As in the past, PEM Rules is going to take a summer break to allow me to gather some more material and invite more guests. As always, thank you for the support.
Please consider contributing to PEM Rules at the following link
https://ko-fi.com/pemrules
If you are interested in some PEM Rules merchandise, check out the PEM Rules store.
https://www.redbubble.com/shop/ap/164385928
Sometimes the H&P is clouded (for whatever reason) that is a good time to get some objective data (easier said than done) why I think of what other doctors will do and why it is important to plan with the nurse.
The newborn with a new onset (some kind of) metabolic disease is a rare event in the Pediatric ER. Add that to the fact that there are so many different types of diseases with so much basic science to remember and you got a pretty bad situation in your hands. That is why I invited Dr. Austin Larson an Associate Professor of Pediatrics-Clinical Genetics and Metabolism on the show to discuss how we can do a better job identifying and treating those children.
Your demeanor often sets the stage of the encounter which is why it is important to have the opposite one of the patients (usually). How to empower parents to be "doctor like" and why it is important to relate to the caregivers.
Hematological emergencies though uncommon can be a significant problem and is something we should all be familiar with. That is why I asked Dr. Kenneth Bujold (previous intern of mine) to come on the show and tell us how can we do a better job handling true emergencies in Sickle Cell Disease patients.
In this new (not so new anymore) segment of PEM Rules Dr. Jay Fisher, who has been practicing PEM since 1992 came back to discuss an interesting case of something we don't see very often in the Peds ER and NEVER want to miss.
Despite working in a very busy Pediatric Emergency Department, Urological emergencies are not too common and often those patients challenge us. That is why I invited Dr. Jessica Casey whom I sometimes consult from the Pediatric ER to talk about common urological emergencies. Here are two links Jessica recommends us PEM providers
Article on Priapism in children
https://pubmed.ncbi.nlm.nih.gov/24135215/
The TWIST score calculator.
https://www.mdcalc.com/calc/10440/testicular-workup-ischemia-suspected-torsion-twist
Please consider contributing to PEM Rules at
https://ko-fi.com/pemrules
And check out www.pemrules.com
Copyright PEM Rules LLC
DISCLAIMER
By listening to this podcast, you agree not to use these resources as medical advice to treat any medical conditions in either yourself or others, including, but not limited to, patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast or website. Under no circumstances shall PEM Rules, the PEM Rules podcast or any guests or affiliated entities be responsible for damages arising from their use.
This podcast should not be used in any legal capacity whatsoever, including, but not limited to, establishing "standard of care" in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the website or in the podcast.
Good rule for physical exam, why seeing patients in fast track is so important (as a trainee or an attending) and what I think of blood pressure in pediatric patients.
It is not often that I see a child with possible rheumatologic disease in the pediatric ER. What to ask, what to check for and what labs to order are always important things to think about. That is why I asked Dr. Robert Lowe to come on the show and discuss the management of those patients.
Dr. Lowe Advice on Labs to order when suspecting Rheumatological condition:
For suspected JIA.
Most important to confirm joint swelling on physical exam AND a history of one or more joints being swollen continuously for 6 weeks or longer.
Systemic JIA (only 15% of kids with JIA)
ESR and CRP are both elevated like you would see with an infection or with inflammatory bowel disease with the added presence of significant joint swelling and daily recurring high fevers (>102F usually) without other symptoms of infection for Systemic JIA.
For other systemic autoimmune disease
High ESR with normal or near normal CRP can suggest the presence of another systemic autoimmune disease such as SLE
- D-dimer
- Ferritin
- LDH
- UA with Random protein to Cr ratio
Dont order ANA and instead check ONLY the following:
- · Double Stranded DNA (dsDNA) Ab,
- · Smith antibody (not Smooth muscle antibody),
- · Ribonuclear protein Ab (RNP Ab),
- · SSA and SSB Abs (Sjogrens syndrome antibodies)
Please consider contributing to PEM Rules at
https://ko-fi.com/pemrules
And check out www.pemrules.com
Copyright PEM Rules LLC
DISCLAIMER
By listening to this podcast, you agree not to use these resources as medical advice to treat any medical conditions in either yourself or others, including, but not limited to, patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast or website. Under no circumstances shall PEM Rules, the PEM Rules podcast or any guests or affiliated entities be responsible for damages arising from their use.
This podcast should not be used in any legal capacity whatsoever, including, but not limited to, establishing "standard of care" in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the website or in the podcast.
What should your next step be if your screening tests are negative. How worried should you be about child abuse in the setting of a femur fracture and when to pay attention to the exceptions.
Here is the link to the study I refer to in the episode.
https://pubmed.ncbi.nlm.nih.gov/20373153/
Please consider contributing to PEM Rules at
https://ko-fi.com/pemrules
And check out www.pemrules.com and the PEM Rules Store at
https://www.redbubble.com/shop/ap/164385928
Copyright PEM Rules LLC
DISCLAIMER
By listening to this podcast, you agree not to use these resources as medical advice to treat any medical conditions in either yourself or others, including, but not limited to, patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast or website. Under no circumstances shall PEM Rules, the PEM Rules podcast or any guests or affiliated entities be responsible for damages arising from their use.
This podcast should not be used in any legal capacity whatsoever, including, but not limited to, establishing "standard of care" in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the website or in the podcast.
ENT related illness are very high on the list of conditions I treat from the mild AOM or Strep Pharyngitis and beyond. That is why I asked Dr. Jeremy Prager to come on PEM Rules and discuss some common ENT related problems.
Why is it important to leave your shift with NO unresolved issues. How to advance your education and be your own best advocate and what is an important questions on any afebrile (or febrile) child.
Listen to the discussion I had with EM physician Dr. Patricia Capone and PEM physician Delia Gold from Nationwide children's Hospital about the field of Pediatric EM and what advice we, PEM specialists, have for the medical students, residents and anyone who is "scared" of children
We heavily relay on radiologists these days so why not helping them out and making it easy for them to help you? What to be aware of when you are ordering tests on your patients and a bit about X ray views.
Probably one of the most important (and most challenging) situation in PEM is how do we identify the child with none accidental trauma among the see of true / innocent accidental injuries. That is why I asked Toni Laskey, a child abuse physician in Utah to come and talk about this very important topic.
Sometimes it is worth going the extra mile in order to (maybe) prevent the next ED visit. Always try to take the Chief Complaint seriously though it is not always as easy as it sounds and why it is important to validate the parents or patient's concerns
Please consider contributing to PEM Rules at
https://ko-fi.com/pemrules
And check out www.pemrules.com and the PEM Rules Store at
https://www.redbubble.com/shop/ap/164385928
Copyright PEM Rules LLC
DISCLAIMER
By listening to this podcast, you agree not to use these resources as medical advice to treat any medical conditions in either yourself or others, including, but not limited to, patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast or website. Under no circumstances shall PEM Rules, the PEM Rules podcast or any guests or affiliated entities be responsible for damages arising from their use.
This podcast should not be used in any legal capacity whatsoever, including, but not limited to, establishing "standard of care" in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the website or in the podcast.
Trauma is often scary and small children may be intimidating. Admitting to this is a good first step. In this Episode Dr. Nir Samuel and I talk about how to fall on our feet, get better about treating injured children (or at least effectively cheat!)
Dr. Jay Fisher is back on PEM Rules to discuss his experience with Bacterial Meningitis, a rare (and terrible) condition that is high on my list of "I Never Want to Miss It".
Here are the articles Jay discussed:
References
Clinical Features Suggestive of Meningitis in Children:A Systematic Review of Prospective Data. Pediatrics 2010;126(5);952-960.
https://pubmed.ncbi.nlm.nih.gov/20974781/
Bulging fontanelle in febrile infants as a predictorof bacterial meningitis. European Journal of Pediatrics (2021) 180:1243–1248.
https://pubmed.ncbi.nlm.nih.gov/33169238/
Here is the link to the picture of the CSF of the patient discussed in the episode.
https://pemrules.com/wp-content/uploads/2024/12/csf.png
As a PEM physician I am fairly good (and confident) about intubating children and passing that ET tube beyond the vocal cords. Managing the vent, however is a whole different ballgame. That is why I asked Jared to come and teach us some basic vent setting for our children.
Many PEM physicians I meet have some rules of their own or interesting interpretations of my PEM Rules. Here are some of Carla Laos's (a PEM Physician and medical director in Las Vegas) rules she uses in her practice.
As a leader it is important to take responsibility for anything that happened “under your watch”. Yes, you can check many things but do you actually need to? And what should you think about when you initiate treatment with antibiotics on an admitted patient.
With the concerning rise of antibiotic resistance I asked Dr. Fatima Levent to come back to PEM Rules and review with us the appropriate choice of antibiotics for our patients.
Pediatric Gastroenterological Chief Complaints is something we do in the Pediatric Emergency Department a considerable part of our time. That is why I invited Howard Baron to come on the show and talk about his advice for investigating and treating common GI conditions.
PEM Rules will take a short summer break for the months of July and August and will be back in September again with (hopefully) more exciting episodes. Thank you for all the support.
Please check out the PEM Rules store at
https://www.redbubble.com/shop/ap/164385928
at the Facebook page
https://www.facebook.com/PEMRules
And please keep in touch.
Like many other "adult diagnosis" Cannabinoid hyperemesis syndrome is something we see in the Pediatric ER more and more of. That is why I invited Biren to come on the show and talk to us about this condition.
What is fever? and do we always have to treat it? how much attendant should the triage level get and what can we do to learn (and teach) better?
What happens when you are a "general practitioner" but are passionate about Emergency Medicine or PEM. Listen to Dr. Allen Herman's story on practicing Emergency Medicine despite completing his training in Family Medicine.
Though teaching is something I love doing, sometimes teaching PEM to an ED resident is challenging (for many reasons). Dr. Steven Nazario has been a physician and an educator for many years which is why I invited him on the show to talk about the challenges of teaching PEM to EM residents.
Here is the link to the Video Stephen was referring to. The EKG Changes of hyperkalemia.
https://pemrules.com/hk/
Please consider contributing to PEM Rules at
https://ko-fi.com/pemrules
And check out www.pemrules.com
Copyright PEM Rules LLC
DISCLAIMER
By listening to this podcast, you agree not to use these resources as medical advice to treat any medical conditions in either yourself or others, including, but not limited to, patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast or website. Under no circumstances shall PEM Rules, the PEM Rules podcast or any guests or affiliated entities be responsible for damages arising from their use.
This podcast should not be used in any legal capacity whatsoever, including, but not limited to, establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the website or in the podcast.
Newborns are small and examining them the “right way” does not take much and is worth doing, and why it is important (and helpful) to look at Pediatric Emergency Medicine as Simple.
The further away I am from my general pediatric training the more I forget how to manage chronic complaints and “primary care like” presentations. That is why I brought Dr. Noah Makovsky again to help us (PEM clinicians) do a better job with those patients.
Sometimes enemas are not just for treatment only. Why is it important to keep making decision and not dwell and contemplate for too long and what is the best thing to do after intubations.
We all meet some people in our life that inspire us to do better. For me Dr. Ellen Fitzpatrick is one of those people. Listen to her truly amazing life story.
Why is it useful to sometimes “consult” with your patient’s parents. What tests you should really never do and why cant we just make everyone happy
In this new segment of PEM Rules Dr. Jay Fisher, who has been practicing PEM since 1992 is back to discuss intussusception and how can we all do a better job identifying those children among the sea of children with constipation.
With the exception of corneal abrasions and conjunctivitis, ophthalmological presentations always make me a bit nervous. That is why I invited Dr. Mitchell Strominger to talk about some common ophthalmological emergencies.
Please consider contributing to PEM Rules at
https://ko-fi.com/pemrules
And check out www.pemrules.com
Copyright PEM Rules LLC
DISCLAIMER
By listening to this podcast, you agree not to use these resources as medical advice to treat any medical conditions in either yourself or others, including, but not limited to, patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast or website. Under no circumstances shall PEM Rules, the PEM Rules podcast or any guests or affiliated entities be responsible for damages arising from their use.
This podcast should not be used in any legal capacity whatsoever, including, but not limited to, establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the website or in the podcast.
Distracting injuries can be tricky but should always be taken into account. What should you think about in a child with LLQ abdominal pain and odd Neurological complaints and more about giving yourself a break.
Thank you all for listening and supporting PEM Rules. I will be taking a short winter break to collect more material and enjoy the cold Nevada Winter (which I love). PEM Rules will be back in four weeks with more information, more medicine, more rules and, of course more music.
I (finally) got a pediatric surgeon to come and talk on the show. Most importantly I was curious to know what he thinks about my Rule of 6. Listen to Dr. Erik Pearson and his wonderful advice.
Here is the link to Erik's Website
https://www.citizensurgeon.com/recourses
consider contributing to PEM Rules at
https://ko-fi.com/pemrules
And check out www.pemrules.com
Copyright PEM Rules LLC
DISCLAIMER
By listening to this podcast, you agree not to use these resources as medical advice to treat any medical conditions in either yourself or others, including, but not limited to, patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast or website. Under no circumstances shall PEM Rules, the PEM Rules podcast or any guests or affiliated entities be responsible for damages arising from their use.
This podcast should not be used in any legal capacity whatsoever, including, but not limited to, establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the website or in the podcast.
How prepared should you be? Maybe Over-prepared? What to do with your trainees and why it wise to buy time (if you can).
It seems to me that due to the obesity epidemic more and more children suffer from "adult problems" such as Type 2 diabetes, hypertension etc. That is why I decided to bring Seth Ball, a PEM physician who is also trained in General EM to the show to discuss the management of those children.
Please consider contributing to PEM Rules at
https://ko-fi.com/pemrules
And check out www.pemrules.com
Copyright PEM Rules LLC
DISCLAIMER
By listening to this podcast, you agree not to use these resources as medical advice to treat any medical conditions in either yourself or others, including, but not limited to, patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast or website. Under no circumstances shall PEM Rules, the PEM Rules podcast or any guests or affiliated entities be responsible for damages arising from their use.
This podcast should not be used in any legal capacity whatsoever, including, but not limited to, establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the website or in the podcast.
So apparently I am not the only one with "rules". Dr. Rammy Assaf contacted me via the PEM Rules website and wanted to share some of the rules and wisdom he has learned over the year. Thank you Rammy for coming on the show and sharing you knowledge.
The goal of our long (and exhausting) training is to find the ultimate job. Here are some tips from Dr. Rick Saladino (my fellowship mentor and the inspiration behind PEM Rules) on the process.
What is the “best way” to take history, talking about patients expectations and what you must do before calling your consultants.
Children with Neurological complaints represent a significant portion of what we see in the Peds ED. From Status Epilepticus to febrile seizures to the child who (maybe) had a seizure at home. This is a discussion I had with Dr. Amy Goldstein, a Pediatric Neurologist at CHOP.
Please consider contributing to PEM Rules at
https://ko-fi.com/pemrules
And check out www.pemrules.com
Copyright PEM Rules LLC
DISCLAIMER
By listening to this podcast, you agree not to use these resources as medical advice to treat any medical conditions in either yourself or others, including, but not limited to, patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast or website. Under no circumstances shall PEM Rules, the PEM Rules podcast or any guests or affiliated entities be responsible for damages arising from their use.
This podcast should not be used in any legal capacity whatsoever, including, but not limited to, establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the website or in the podcast.
There are many “unanswered” questions in Pediatric EM where the scientific literature does not have a good, definitive answer. Whether to use or not to use steroids in anaphylaxis is one of them. Sophia Wang (our PEM fellow from previous episodes) looked into it.
Here are some of the articles Sophia used in her research
Alqurashi W, Ellis AK. Do Corticosteroids Prevent Biphasic Anaphylaxis?. J Allergy Clin Immunol Pract. 2017;5(5):1194-1205. doi:10.1016/j.jaip.2017.05.022
Gaffney LK, Porter J, Gerling M, Schneider LC, Stack AM, Shah D, Michelson KA. Safely Reducing Hospitalizations for Anaphylaxis in Children Through an Evidence-Based Guideline. Pediatrics. 2022 Feb 1;149(2):e2020045831. doi: 10.1542/peds.2020-045831. PMID: 35059724; PMCID: PMC9250079.
Lieberman P, Nicklas RA, Randolph C, et al. Anaphylaxis--a practice parameter update 2015. Ann Allergy Asthma Immunol. 2015;115(5):341-384. doi:10.1016/j.anai.2015.07.019
Michelson KA, Dribin TE, Vyles D, Neuman MI. Trends in emergency care for anaphylaxis. J Allergy Clin Immunol Pract. 2020;8(2):767-768.e2. doi:10.1016/j.jaip.2019.07.018
Shaker MS, Wallace DV, Golden DBK, et al. Anaphylaxis-a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis. J Allergy Clin Immunol. 2020;145(4):1082-1123. doi:10.1016/j.jaci.2020.01.017
Please consider contributing to PEM Rules at
https://ko-fi.com/pemrules
And check out www.pemrules.com
Copyright PEM Rules LLC
DISCLAIMER
By listening to this podcast, you agree not to use these resources as medical advice to treat any medical conditions in either yourself or others, including, but not limited to, patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast or website. Under no circumstances shall PEM Rules, the PEM Rules podcast or any guests or affiliated entities be responsible for damages arising from their use.
This podcast should not be used in any legal capacity whatsoever, including, but not limited to, establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the website or in the podcast.
Sometimes it is good to give your patients (or parents) some options regarding their care (some people call it shared decision making). How a short conversation can help you better understand your patients and their needs.
After many months of work and some requests I am excited to open my online PEM Rules Store where listeners can order some fun PEM Rules merchandise. Please click the link below to check out the store and maybe purchase a T-shirt, a hat or whatever product you like.
Thank you for all the support, the downloads, comments and requests.
Yaron Ivan
PEM Rules Online Store.
https://www.redbubble.com/shop/ap/164385928
www.pemrules.com
Every once in a while I meet a physician who does a great job “taking care of himself / herself”. He or she are engaged in multipule activities or hobbies and don’t seem to be suffering “burnout”. Listen to my discussion with Dr. Snow and his advice on how to achieve wellness.
Having a goal before you see the patient is crucial and it should not be to find a diagnosis. It is ok to fail but not so ok not to try and what about the patient's mental status?
If you are like me you probably do most of your guitar learning online or using videos. So here is an opportunity to learn some classic guitar riffs and get a discount via this link. Check out Guitar Coach and all the resources they have and use the link below to get a discounted price for the 42 All-Time Classic Guitar Riffs program using muscle memory. It's a great way to up your guitar playing game.
bit.ly/3Wv6R72
Please consider contributing to PEM Rules at
https://ko-fi.com/pemrules
And check out www.pemrules.com
Copyright PEM Rules LLC
DISCLAIMER
By listening to this podcast, you agree not to use these resources as medical advice to treat any medical conditions in either yourself or others, including, but not limited to, patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast or website. Under no circumstances shall PEM Rules, the PEM Rules podcast or any guests or affiliated entities be responsible for damages arising from their use.
This podcast should not be used in any legal capacity whatsoever, including, but not limited to, establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the website or in the podcast.
Like most professionals, physicians and clinicians can always use a good advice. Especially on approach to the challenging patient when you seem to be doing everything right but nothing seems to work. That is why I invited Josh to the show.
Please consider contributing to PEM Rules at
https://ko-fi.com/pemrules
And check out www.pemrules.com
Copyright PEM Rules LLC
DISCLAIMER
By listening to this podcast, you agree not to use these resources as medical advice to treat any medical conditions in either yourself or others, including, but not limited to, patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast or website. Under no circumstances shall PEM Rules, the PEM Rules podcast or any guests or affiliated entities be responsible for damages arising from their use.
This podcast should not be used in any legal capacity whatsoever, including, but not limited to, establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the website or in the podcast.
Why knowing statistics is important for us EM providers, what is the “best” way to treat the patient and being curious. Here are the studies I speak of in the episode
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5359077/
https://pubmed.ncbi.nlm.nih.gov/20627219/
Please consider contributing to PEM Rules at
https://ko-fi.com/pemrules
And check out www.pemrules.com
Copyright PEM Rules LLC
DISCLAIMER
By listening to this podcast, you agree not to use these resources as medical advice to treat any medical conditions in either yourself or others, including, but not limited to, patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast or website. Under no circumstances shall PEM Rules, the PEM Rules podcast or any guests or affiliated entities be responsible for damages arising from their use.
On episode 100 coming this November, Dr. Saladino will be discussing his advice on how to maximize your chances of finding the best job in PEM, EM or just in medicine. Please take a minute to fill up this survey so Dr. Saladino and I can have a beneficial discussion for the listeners.
https://www.surveymonkey.com/r/8WP7DQB
Please consider contributing to PEM Rules at
https://ko-fi.com/pemrules
And check out www.pemrules.com
Copyright PEM Rules LLC
DISCLAIMER
By listening to this podcast, you agree not to use these resources as medical advice to treat any medical conditions in either yourself or others, including, but not limited to, patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast or website. Under no circumstances shall PEM Rules, the PEM Rules podcast or any guests or affiliated entities be responsible for damages arising from their use.
This podcast should not be used in any legal capacity whatsoever, including, but not limited to, establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the website or in the podcast.
None accidental ingestions and overdoses are common scenarios in the Pediatric Emergency Department. Now (unfortunately) driven by some social media posts. Knowing how to recognize and manage these patients is critical. That is why I invited Dr. Daria Falkowitz to discuss some of these common Tik-Tok Challenges
Please check out PEM Rules on Facebook and become a follower. I finally found the time to put some educational material for you to learn from.
https://www.facebook.com/PEMRules
Toxic ingestions are always on my differential diagnosis of any child with acute onset "odd symptoms". That is why I invited Dr. Brian Schultz to discuss this important (and often challenging) topic.
Sometimes (it is not often), a normal physical exam is actually more concerning, why it is a good idea to be pessimistic? and how to be comfortable with risks?
What do our “future bosses” look for in their candidate and how can we become a more competitive applicants for our next job?. I discuss that and other important questions with Dr. Todd Zimmerman a PEM attending in Las Vegas.
Sometimes there are "odd reasons" for using a test, Getting a good history is key and some questions are more important than others and a bit about knowing what not to do.
Please consider contributing to PEM Rules at
https://ko-fi.com/pemrules
And check out www.pemrules.com
Copyright PEM Rules LLC
DISCLAIMER
By listening to this podcast, you agree not to use these resources as medical advice to treat any medical conditions in either yourself or others, including, but not limited to, patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast or website. Under no circumstances shall PEM Rules, the PEM Rules podcast or any guests or affiliated entities be responsible for damages arising from their use.
This podcast should not be used in any legal capacity whatsoever, including, but not limited to, establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the website or in the podcast.
Just like I lost many of my “primary care” skills many primary care pediatrician feel uncomfortable treating emergencies or urgencies in their office. That is why I had a discussion with Dr. Noah (from a previous PEM Rules episode) about what to do when these situations arise.
Please consider contributing to PEM Rules at
https://ko-fi.com/pemrules
And check out www.pemrules.com
Copyright PEM Rules LLC
DISCLAIMER
By listening to this podcast, you agree not to use these resources as medical advice to treat any medical conditions in either yourself or others, including, but not limited to, patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast or website. Under no circumstances shall PEM Rules, the PEM Rules podcast or any guests or affiliated entities be responsible for damages arising from their use.
This podcast should not be used in any legal capacity whatsoever, including, but not limited to, establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the website or in the podcast.
What do you do when the patient in front of you has no symptoms (at the moment). Why you should enjoy being in training and what all of us PEM clinicians should know very well.
Please consider contributing to PEM Rules at
https://ko-fi.com/pemrules
And check out www.pemrules.com
Copyright PEM Rules LLC
DISCLAIMER
By listening to this podcast, you agree not to use these resources as medical advice to treat any medical conditions in either yourself or others, including, but not limited to, patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast or website. Under no circumstances shall PEM Rules, the PEM Rules podcast or any guests or affiliated entities be responsible for damages arising from their use.
This podcast should not be used in any legal capacity whatsoever, including, but not limited to, establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the website or in the podcast.
What do you do when a teenager with odd (and concerning) neurological symptoms walks into you ER and how do you apply the PEM Rules to work him up step by step?
Often times I see none verbal patients (be it newborns or children who are neurologically devastated) who come in by EMS or perhaps their parents / caregiver. In those situations, I find it important to be more conservative. How do I gain the parent’s trust? Simple gain the child’s first.
Hours after last weeks episode was published I heard from Dr. Jay Fisher about a very similar (and unfortunate) case one of his APP's had in their ED. I decide to bring Jay to the show (again) to discuss the case so we can all learn from this experience.
Below is the link to the patient's Chest X rays.
https://pemrules.com/pneumonia-patient/
Please consider contributing to PEM Rules at
https://ko-fi.com/pemrules
And check out www.pemrules.com
Copyright PEM Rules LLC
DISCLAIMER
By listening to this podcast, you agree not to use these resources as medical advice to treat any medical conditions in either yourself or others, including, but not limited to, patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast or website. Under no circumstances shall PEM Rules, the PEM Rules podcast or any guests or affiliated entities be responsible for damages arising from their use.
This podcast should not be used in any legal capacity whatsoever, including, but not limited to, establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the website or in the podcast.
What is the appropriate differential diagnosis for a well appearing child with fever for over 5 days and what is the best way to work these patients up? I discuss this important Issue with my Former colleague Dr. Fatma Levent, a pediatric Infectious Disease Attending.
There is a certain way to address the chief complaint in the ED and it is often advantageous to do it this way. Why is it important to know what syndrome the child has? and how can we all give better care to our patients?
As a PEM Physician, I get to take care of children with neurosurgical problems fairly often. Sometimes it is children with known issues such as hydrocephalus with a shunt and sometimes it is a patient with traumatic injury. Pediatric neurosergeons are often life savers in those situations. Here is a conversation I had with Dr. Todd Hankinson, a Pediatric Neurosurgeon at Children’s Hospital of Colorado.
As a good leader there are certain ways you can work with your team to let them excel. How do we work up our patients “appropriately”? and what can we learn from our patients?
Probably the Pediatric Sub-specialists I interact with the most are the pediatric hospitalists. Not only they accept my admissions but often give advice about the work up that the patient needs and serve as an extension of the Pediatric Emergency Department.
That is why I invited Jason Zamkoff, a Pediatric Hospitalist from Denver CO to talk about the relationship between PEM Clinicians and the Peds Hospitalists.
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Copyright PEM Rules LLC
DISCLAIMER
By listening to this podcast, you agree not to use these resources as medical advice to treat any medical conditions in either yourself or others, including, but not limited to, patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast or website. Under no circumstances shall PEM Rules, the PEM Rules podcast or any guests or affiliated entities be responsible for damages arising from their use.
This podcast should not be used in any legal capacity whatsoever, including, but not limited to, establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the website or in the podcast.
It is important to communicate to your consultants and hospitalists the way they want to be communicated to and “speak their language”. Why is it important not to think linearly and when is it “Not OK” to use antibiotics.
As a PEM physician, treating pain is a big part of my life and sometimes it is easier said than done. This why I invited Dr. Alan Bielskay, a Pediatric Anesthesiologist (and pain expert) from Denver CO to talk about pain treatment in children.
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Copyright PEM Rules LLC
DISCLAIMER
By listening to this podcast, you agree not to use these resources as medical advice to treat any medical conditions in either yourself or others, including, but not limited to, patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast or website. Under no circumstances shall PEM Rules, the PEM Rules podcast or any guests or affiliated entities be responsible for damages arising from their use.
This podcast should not be used in any legal capacity whatsoever, including, but not limited to, establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the website or in the podcast.
Sometimes decisions are hard to make, nonetheless, in the ED world it is important to make a decision and sometimes sooner rather than later. Why getting a blood culture (without giving antibiotics) makes no sense to me and more about going with your gut feeling.
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And check out www.pemrules.com
Copyright PEM Rules LLC
DISCLAIMER
By listening to this podcast, you agree not to use these resources as medical advice to treat any medical conditions in either yourself or others, including, but not limited to, patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast or website. Under no circumstances shall PEM Rules, the PEM Rules podcast or any guests or affiliated entities be responsible for damages arising from their use.
This podcast should not be used in any legal capacity whatsoever, including, but not limited to, establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the website or in the podcast.
As a PEM Physician, child abuse, sexual abuse and child neglect cases are those cases I never want to miss or overlook. That is often easier said than done. This is a discussion I had with Dr. Stephen Boos, a child abuse doctor in Western MA.
Probably the best advice I got in my career was to take care of myself before I take care of any patients and how I address some over-medicalized issues.
I am excited to announce the launch of the PEM Rules Facebook page. Please visit, become a follower and communicate what you like, wish to hear or just keep in touch.
Here is the link to the page
https://www.facebook.com/PEMRules
Please consider contributing to PEM Rules at
https://ko-fi.com/pemrules
And check out www.pemrules.com
Copyright PEM Rules LLC
DISCLAIMER
By listening to this podcast, you agree not to use these resources as medical advice to treat any medical conditions in either yourself or others, including, but not limited to, patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast or website. Under no circumstances shall PEM Rules, the PEM Rules podcast or any guests or affiliated entities be responsible for damages arising from their use.
This podcast should not be used in any legal capacity whatsoever, including, but not limited to, establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the website or in the podcast.
What medicolegal aspects of medicine should we PEM Providers be familiar with and how can we all better protect ourselves while providing excellent care for our patients? I discuss these question and more with Dr. Brady Pregerson an expert in the field.
Copyright PEM Rules LLC
DISCLAIMER
By listening to this podcast, you agree not to use these resources as medical advice to treat any medical conditions in either yourself or others, including, but not limited to, patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast or website. Under no circumstances shall PEM Rules, the PEM Rules podcast or any guests or affiliated entities be responsible for damages arising from their use.
This podcast should not be used in any legal capacity whatsoever, including, but not limited to, establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the website or in the podcast.
My apologies to all of you who tried purchasing merchandise from Pickaso Guitar Bow and use PEM Rules Promo code. It came to my attention that the promo code stop working. Please be patient, check out the following link https://www.pickasobow.com , decide what you want to buy and be on the lookout for a new method of getting a discount via PEM Rules. The Pickaso Guitar Bow is fun to have and use to enrich your musical skills.
What should you do when things don’t seem to work they you want them to, what happens when a patient visits the Peds ED 3 times (or more) in a short time interval and what endorphins can potentially be.
What makes a good PEM teacher and how can we PEM providers be better educators for the next generation. I discuss this and More with Dr. Michael Mojica a PEM attending and educator for over 30 years.
Why fever in children does not really scare me much how I recommend you speak to the parents and what I do when the patient has had a fever for over 5 days.
Due to the pediatric Mental Health Crisis and increase in psychiatric presentations to the Pediatric Emergency Departments across the nation, I decide to have this off-schedule / bonus episode and interview Dr. Victor Fornari, an experienced Child Psychiatrist from New York.
If you liked the outro and the sound of the guitar check http://www.pickasobow.com/pemrules and you will receive 10% discount on anyting you buy using the promo code PEMRULES
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Sophia Wang is a PEM Fellow in Mississippi who has been on the show once before and told us how she applied the PEM Rules in her clinical work as a PEM Fellow. She returned to share some more interesting stories about the times she applied other PEM Rules.
In the Pediatric ER (like in life) there is always more than one way to do things. I try to remind that to myself. How do I manage (almost) all knee injuries, and what I try to be always be prepared for.
I am excited to announce my new collaboration with Pickaso Guitar Bow.
This item is a really cool tool that makes your guitar sound like a violin or a cello. It’s a lot of fun and you will be hearing it soon on some of my outros as I get better at using it.
If you like playing guitar (or know someone who does) this is a really cool way to expand your guitar sound and it makes a great gift.
Please use my affiliate link below or simply use the promo code PEMRULES to receive 10% discount on any of the products you purchase.
www.pickasobow.com/pemrules
Thanks for listening to PEM Rules and helping take care of children.
Best,
Yaron Ivan
PEM Rules
PEM Rules (and I) will be taking a short break for July 2023. THANK YOU ALL for your support, your emails and interest. Will see you again on July 31st 2023. Hope everyone has a safe, restful, fun summer.
While some of us who take care of children for a living feel comfortable around sick kids’ others disagree and get a bit nervous under the same circumstances. Why is that? and how can we change that? This is a discussion I had with my EM friends from the Podcast EM Over easy at the ACOEP scientific assembly.
I entertain the possibility of Colic in many patients but try to keep in mind it is a diagnosis of exclusion. It is important for me to follow some guidelines when I take care of patients and this is how I “know” (hopefully) the child in front of me has a none displaced (aka "splint and send") fracture.
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Sophia Wang is a PEM Fellow in Mississippi who applied the PEM Rules and wanted to share her story. Thank you, Sophia, for sharing your thoughts and thank you for listening to PEM Rules.
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.
Sometimes it is helpful to start thinking about patient disposition early so you can make plans appropriately. Here is what I teach parents about fever and what it really means and a very important rule for fracture reduction.
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.
What is a good starting point for treatment of most metabolic emergencies? How not to miss a serious diagnosis, and what to do with your team so you can all do a better job next time.
It is the General Pediatricians that often sends the child to the Pediatric ED. How the PCP and PEM doctor better communicate to help their patients.
I don’t know what I would do without Ketamine. My favorite drug to use for procedures. Here is how I use it and what I tell the parents…
Dear Listener,
If you are a PEM provider in the US in a Pediatric ER that has rotating residents and/or fellows please take a moment and click on the link below and help Sophia Wang (a PEM fellow in the University of Mississippi Medical Center) with her research project regarding patient handoff during transition of care.
Sophia is an active contributor to PEM Rules who has produced several episodes of the podcast (coming up this summer).
Thank you in advance,
Yaron Ivan, PEM Rules
Link to PEM Rules and the survey below
https://pemrules.com/news/
Probably the most common procedure I perform in the Pediatric ER and one I particularly like. Suturing. Which rules do I use and what is my anticipatory guidance for these parents.
Rashes always makes us, none dermatologist worry and maybe a bit anxious. Which rashes are worrisome? and what should we look for as the red flags of pediatric rashes. I discuss this and more With Dr. Tace Rico our Pediatric Dermatologist.
Talking to a consultant so your patient can benefit the most is an art and a science. Here are some rules I have already discussed (and some new ones) that help me make the best of those contestations on the phone.
Please consider contributing to PEM Rules at https://ko-fi.com/pemrules And check out www.pemrules.com Copyright PEM Rules LLC
There is a certain art to how to document to your advantage? And what s&s should scare you more. Are Bilateral complaints really worse? Most importantly, how to speak to parents and trainees.
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Copyright PEM Rules LLC
What is the best approach to the patient with the difficult airway? and how can we improve our sedations? I discuss these topics (and others) with Dr. Adam Adler, a pediatric Anesthesiologist and a friend.
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PEM Rules will be taking a short winter vacation for the month of December. Really appreciate everyone's support over the last 2 years. Will see you again in the new year.
PEM Rules will be taking a short winter vacation for the month of December. Really appreciate everyone's support over the last 2 years. Will see you again in the new year.
Does every child who is vomiting need Zofran? What is the “best” thing to do for a vomiting child and how do we set our PO challenge for success? What do we do when things don’t go as planned?
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Despite so much research and evidence there are still so many questions and uncertainties. Victoria and I review the clinical presentation, diagnosis, current and future treatment.
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Copyright PEM Rules LLC
As a PEM physician I must worry (and therefore rule out and treat) the true emergencies first. That is why I first check for what is emergent and what I can fix. Since my patient population varies greatly with regards to age I find it very important to know the epidemiology, in other words, what is the most common cause of X based on the patient’s age.
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Copyright PEM Rules LLC
Research is one of the most intimidating aspects of medicine for us clinicians. Why is that ? and where is a good place to start? I discuss these topics and much more with Dr. Bob Hickey from the Children's Hospital of Pittsburgh
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Copyright PEM Rules LLC
What is the best way to view mistakes and how to reap some benefits from them. How I go about "working up" smiling children and what to do first with that IV access.
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Copyright PEM Rules LLC
What is the best way to view mistakes and how to reap some benefits from them. How I go about "working up" smiling children and what to do first with that IV access.
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https://ko-fi.com/pemrules
And check out www.pemrules.com
Copyright PEM Rules LLC
My Nephrology professor in Medical school used to say that “The kidney is an easy organ to master, but you truly need to understand it”. My friend Craig Woda (an astute Pediatric Nephrologist) helps me better understand how we can do a better job identify nephrological issues in children.
As usual, Please consider supporting PEM Rules by clicking below
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And make sure to check out www.pemrules.com
Copyright PEM Rules LLC
My Nephrology professor in Medical school used to say that “The kidney is an easy organ to master, but you truly need to understand it”. My friend Craig Woda (an astute Pediatric Nephrologist) helps me better understand how we can do a better job identify nephrological issues in children.
As usual, Please consider supporting PEM Rules by clicking below
https://ko-fi.com/pemrules
And make sure to check out www.pemrules.com
Copyright PEM Rules LLC
Hope you like the news I have to share and check out the link below.
As usual please check out www.pemrules.com and consider contributing by clicking below. https://ko-fi.com/pemrules Best, Yaron Ivan PEM Rules LLC.
Hope you like the news I have to share and check out the link below.
As usual please check out www.pemrules.com and consider contributing by clicking below. https://ko-fi.com/pemrules Best, Yaron Ivan PEM Rules LLC.
Jaron Smith is a PEM Fellow in Dallas Texas who applied the PEM Rules and wanted to share his story. Thank you Jaron for sharing your thoughts and thank you for your music request.
What are the red flags for cardiological presentations and how can we better identify children with cardiological issues in the Pediatric Emergency Department. I discuss that and more with my good friend and colleague, Dr. Kelvin Lee.
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Some words of wisdom I learned from Dr. Bob Hickey, one of my favorite Attendings in fellowship. A clinician and avid researcher.
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Not particularly based on any evidence-base study I am aware of, but this is how I approach the Ill-appearing (previously well) newborn / baby in the Pediatric Emergency Department
Check out the following video I created to help you remember the EKG changes of hyperkalemia
https://pemrules.com/hk/
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What makes a good PEM physician? (from a PICU standpoint) and how can we all work better together to benefit our patients? My former co resident, and now PICU attending Suzie Barry and I break it down.
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My nurses and my team often appreciate some of these rules and they are also the right thing to do for our patients.
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Sometimes the people who help me the most in the ER are not even clinicians. They are the child life specialists who help my patients (and therefore me) have a better / easier experience. Jessie is one of our child life specialists who helps me be a more compassionate physician.
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Premature closure is something that all clinician deal with. This rule helped me avoid it in the past. In the end, it all boils down to rule number 47 (see episode 11).
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What is the role of the PEM nurses in the Pediatric ED? and how do they help me do a better job? Who is the ideal PEM attending? I discuss this and other topics with one of our fantastic Pediatric EM nurses, Elizabeth
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This episode is about knowing who (not what) to monitor, helping your team by pin-pointing and naming the problem and how to (hopefully) have good outcome in resuscitations by having the parents present.
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Thank you all for listening to the podcast in the last 15 months. I am excited to announce that PEM Rules is now a column in the journal EP monthly. Please check out the link below to read the "PEM Rules Philosophy".
http://epmonthly.com/article/you-dont-have-to-win-just-dont-lose/
Also please consider supporting PEM Rules by clicking on the link below.
https://ko-fi.com/pemrules
How to give yourself credit for all the work you do, what to “look at” during your shift and how to manage your time
APP’s are the people I can’t do without. They are helpful, motivated and often teach me more than I teach them. I love having them around.
It is not very often that I intubate an asthmatic but when I do I always think about PEM rule number 91. Rule Number 92 is meant to help me be more efficient and do what is right for my patients and rule number 93 helps me to things one step at a time.
When you are faced with a problem try to keep it small, remember your patients are yours as long as they are in the department. And keep in mind, During the initial stages of resuscitations, you simply can’t go wrong
Thank you for listening to PEM Rules and for the emails and support. Please check out www.pemrules.com and consider supporting my educational project using the link below (or on the website) and sign up for the newsletter which is (finally) up and running.
https://ko-fi.com/pemrules
Fever is one of the most common chief complaint in the Pediatric Emergency Department and tends to scare many parents, myself included. My previous scribe (and now an astute medical student) Victoria, researched what fever is? what it does? and answered the ultimate question, to treat or not to treat??
Worrying about you or your patients is usually just a bad idea that does not serve us well, but what about just being concerned? What does PGY really mean? and why you should sometime be more than just an Emergency Medicine Physician.
It has been over a year since I started PEM Rules and I would love to have some feedback. Have you used the rules in your practice? check out www.pemrules.com and submit any feedback you wish.
We all know rule number 82 but sometimes forget to use it. Practicing protective medicine is something we all do but hopefully we keep it to a minimum and how to be a step ahead during the most crucial times.
I had the privilege to work with Dr. Rick Saladino when I was a fellow at the Children’s Hospital of Pittsburgh when he served as the division chief. Rick taught me a lot of clinical medicine, research methods and most importantly he is the man behind many of the rules I now teach my residents and discuss in this podcast.
Some good rules about musculoskeletal chief complaints, how they relate to previous rules, how to always improve your skills and a reminder to think outside the box.
Pediatric Orthopedics is probably the subspecialty I consult most often and Dr. Sean Keyes is one of my favorites consultants to talk to. In this discussion I pick his brain about some important Pediatric Ortho principles.
Why I don’t recommend you ever run in the ER. How to spend your money during your training and how a doctor should really worry.
Though Infectious Diseases is not a very common subspecialty I consult from the ED, it is still one of my favorites. Great discussion with Dr. Levent about vaccination, fever and when antibiotics is truly needed.
Sometimes there is just nothing to lose, so why not try? What do you do when you make mistakes? And how do you deal with the chaos of the ED?
This is how I make sure the abdomen is not surgical, what helps me with the disposition of children with bronchiolitis and how do I decide what ET tube size I need.
Some of my favorite patients are those newborns with new parents who have many questions and concerns. I try to address the acute concerns of that encounter and take care of the issue (whatever it may be) but I always take the 10 minutes to give those parents my “Newborn Talk”.
Talking about ventilating a child using bag and mask, the way I go about conscious sedations and how I get ready, and recognizing the fact that some rules were meant to be broken.
My former scribe, Victoria, who is now an astute medical student and I discuss an evidence based approach to the treatment and management of anaphylactic reaction.
I love my job but rule number 64 is so important as a person, father and husband. I also discuss the importance of listening and paying attention to the PMH and HPI and why a chest x ray is a good idea on that child who had Pneumonia so many times
Probably one of the most researched diseases in Pediatrics. Bronchiolitis is an issue for us PEM physicians every winter. Here is my approach to the wheezing child with bronchiolitis.
As an Emergency Physician, my biggest concern (and the first thing I need to address) is the airway. I like to think of the Pediatric airway as simple. Upper and lower. Viral croup is a very common upper airway obstruction.
We all want to work in an ED that is running smoothly. We all want to have good relationships with our consultants and none of us want to see the same patient two days in a row. These rules help with all those issues.
Some more helpful rules to help you communicate to worried parents, consultants and trainees. I use these every day with great success, Most of the time
Communicating effectively to your colleagues, trainees, consultants and patients is a key element of what I do. Effective communication drives better patient care, patient satisfaction and simply makes the day better
My personal experience is that rashes often intimidate us EM providers. I know that because I often work with trainees who get a bit nervous when they see a child with a rash. I encourage them to think of a child with a rash the way they think of any other patient. This episode is all about my approach to a child with a rash in the Peds ED.
What is the right thing to do? When does a leader take “time off” Here are some more PEM rules, about you (the provider). These have to do with how I lead my team, mentor my trainees and treat my patients.
These are some more rules that helped me make better career choices and working in a team as a team leader
Some More PEM rules, about you (or me, the provider). These have to do with how I try to act as a leader and communicate to my patients and colleagues. One may call it professionalism.
These are some rules that help me with the assessment and plan of my patients and the most appropriate disposition for them.
Taking a break from the Rules. Here I share my personal approach to the pediatric patient including how I obtain history, perform physical exam and work up my patients.
Here are some rules that help with the assessment of patients, their plan of care and disposition. Remember, every patient needs an assessment and every patient needs a plan (that is actually one of the rules).
Procedures are some of my favorite things to do and teach as a PEM physician. These rules are about approaching and performing procedures in the Pediatric ED.
Some more rules in the Clinical Care category that help with the assessment and plan of patients with musculoskeletal complaints and vomiting. These are two very common presentations to the Pediatric ED
Despite being an emergency physician, it is uncommon for me to actually encounter true emergencies. As mentioned in previous episodes most of what I do is not emergent or even urgent and many times less is more. However, every once in a while, I do encounter true emergencies and find myself managing shock cardiac arrest as well as other emergent conditions. The next set of rules provide some advice when encountering such situations.
What constitutes constipation in a newborn? When is spitting up a concern? What is the most important detail to obtain in a newborn history? listen now and find out.
Here are the first five rules in the first category (Clinical Care Tips) starting with the most important of them all "Its not the patient's job to prove that they are sick, it is your job to prove they are not"
What is PEM Rules? what is it all about and what will come in the future? Let's get started.