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.

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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

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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.