Episode 97: EBM Review with Sophia Wang, Are Steroids Necessary for Anaphylaxis?
Release Date: 09/23/2024
Episode 131: Pediatric Rheumatology in the Pediatric ER, What to Ask, What to Check and What Studies to Obtain.
PEM Rules
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...
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Episode: 130: Screening Tests, Femurs and the Exceptions
PEM Rules
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. Please consider contributing to PEM Rules at And check out and the PEM Rules Store at 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,...
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Episode 129: Pediatric Otolaryngology in the Pediatric ED. Discussion with Dr. Jeremy Prager
PEM Rules
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.
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Episode: 128: Sleeping Well at Night, Being an Advocate and Asking About Antipyretics
PEM Rules
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.
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Episode 127: Why is PEM So Special and What Advice Do I Have for “Beginners”
PEM Rules
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
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Episode 126: Clinical Care Tips – Being kind, False Negatives and the Minimum X ray Views.
PEM Rules
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.
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Episode 125: Child Abuse in the Pediatric ED with Dr. Toni Laskey
PEM Rules
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.
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Episode: 124 - Clinical Care Tips – Future Visits, Taking Complaints Seriously and Validating the Concerns.
PEM Rules
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 and the PEM Rules Store at 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...
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Episode 123: Pediatric Trauma: Same-Same or Different? with Dr. Nir Samuel
PEM Rules
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!)
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Episode 122: My List of "I Never Want To Miss It" with Jay Fisher - Bacterial Meningitis
PEM Rules
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. Bulging fontanelle in febrile infants as a predictorof bacterial meningitis. European Journal of Pediatrics (2021) 180:1243–1248. Here is the link to the picture of the CSF of the patient discussed in the episode.
info_outlineThere 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
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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.
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