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