Is that penicillin or amoxicillin allergy real? Probably not. In this episode, we explore how to assess risk, talk to parents, and refer for delabeling. You’ll also learn what happens in the allergy clinic, why the label matters, and how to be a better antimicrobial steward. Learning Objectives Describe the mechanisms and clinical manifestations of immediate and delayed hypersensitivity reactions to penicillin, including diagnostic criteria and risk stratification tools such as the PEN-FAST score. Differentiate between low-, moderate-, and high-risk penicillin allergy histories in pediatric patients and identify appropriate candidates for direct oral challenge or allergy referral based on current evidence and guidelines. Formulate an evidence-based approach for evaluating and counseling families in the Emergency Department about reported penicillin allergies, including when to recommend outpatient referral for formal delabeling. Connect with Brad Sobolewski PEMBlog: PEMBlog.com Blue Sky: @bradsobo X (Twitter): @PEMTweets Instagram: Brad Sobolewski References Khan DA, Banerji A, Blumenthal KG, et al. Drug Allergy: A 2022 Practice Parameter Update. J Allergy Clin Immunol. 2022;150(6):1333-1393. doi:10.1016/j.jaci.2022.08.028 Moral L, Toral T, Muñoz C, et al. Direct Oral Challenge for Immediate and Non-Immediate Beta-Lactam Allergy in Children. Pediatr Allergy Immunol. 2024;35(3):e14096. doi:10.1111/pai.14096 Castells M, Khan DA, Phillips EJ. Penicillin Allergy. N Engl J Med. 2019;381(24):2338-2351. doi:10.1056/NEJMra1807761 Shenoy ES, Macy E, Rowe T, Blumenthal KG. Evaluation and Management of Penicillin Allergy: A Review.JAMA. 2019;321(2):188–199. doi:10.1001/jama.2018.19283 Transcript Note: This transcript was partially completed with the use of the Descript AI and the Chat GPT 5 AI  Welcome to PEM Currents, the Pediatric Emergency Medicine podcast. As always, I'm your host, Brad Sobolewski, and today we are taking on a label that's misleading, persistent. Far too common penicillin allergy, it's often based on incomplete or inaccurate information, and it may end up limiting safe and effective treatment, especially for the kids that we see in the emergency department. I think you've all seen a patient where you're like. I don't think this kid's really allergic to amoxicillin, but what do you do about it? In this episode, we're gonna break down the evidence, walk through what actually happens during de labeling and dedicated allergy clinics. Highlight some validated tools like the pen FAST score, which I'd never heard of before. Preparing for this episode and discuss the current and future role of ED based penicillin allergy testing. Okay, so about 10% of patients carry a penicillin allergy label, but more than 90% are not truly allergic. And this label can be really problematic in kids. It limits first line treatment choices like amoxicillin, otitis media, or penicillin for strep throat, and instead. Kids get prescribed second line agents that are less effective, broader spectrum, maybe more toxic or poorly tolerated and associated with a higher risk of antimicrobial resistance. So it's not just an EMR checkbox, it's a label with some real clinical consequences. And it's one, we have a role in removing. And so let's understand what allergy really means. And most patients with a reported penicillin allergy, especially kids, aren't true allergies in the immunologic sense. Common misinterpretations include a delayed rash, a maculopapular, or viral exum, or benign, delayed hypersensitivity, side effects, nausea, vomiting, and diarrhea. And unverified childhood reactions that are undocumented and nonspecific. Most of these are not true allergies. Only a very small subset of patients actually have IgE mediated hypersensitivity, such as urticaria, angioedema, wheezing, and anaphylaxis. These are super rare, and even then they may resolve over time without treatment. If a parent or sibling has a history of a penicillin al

<br /> Limping is a common complaint in pediatric emergency care, but the differential is broad and the stakes are high. In this episode, we walk through a detailed, age-based approach to the evaluation of the limping child. You’ll learn how to integrate the Kocher criteria, when imaging and labs are truly necessary, and how to avoid being misled by small joint effusions on ultrasound. We also highlight critical mimics like appendicitis, testicular torsion, and malignancy—and remind you why watching a child walk is one of the most valuable parts of the exam. Whether it’s transient synovitis, septic arthritis, or something much more concerning, this episode gives you the tools to manage pediatric limps with confidence.<br /> <br /> <br /> <br /> Learning Objectives<br /> <br /> <br /> <br /> <br /> * Apply an age-based approach to the differential diagnosis of limping in children.<br /> <br /> <br /> <br /> * Demonstrate diagnostic reasoning by integrating history, physical exam, imaging, and lab findings to prioritize urgent conditions like septic arthritis and SCFE.<br /> <br /> <br /> <br /> * Appropriately select and interpret imaging and lab studies, including understanding the utility and limitations of ultrasound, MRI, and the Kocher criteria.<br /> <br /> <br /> <br /> <br /> Connect with Brad Sobolewski<br /> <br /> <br /> <br /> Mastodon: <a href="https://med-mastodon.com/@bradsobo">@bradsobo@med-mastodon.com</a><br /> <br /> <br /> <br /> PEMBlog: <a href="https://www.pemblog.com/">PEMBlog.com</a><br /> <br /> <br /> <br /> Blue Sky: <a href="https://bsky.app/profile/bradsobo.bsky.social">@bradsobo</a><br /> <br /> <br /> <br /> X (Twitter): <a href="https://twitter.com/PEMTweets">@PEMTweets</a><br /> <br /> <br /> <br /> Instagram: <a href="https://www.instagram.com/bradsobolewski/">Brad Sobolewski</a><br /> <br /> <br /> <br /> References<br /> <br /> <br /> <br /> <br /> * Kocher MS, Zurakowski D, Kasser JR. Differentiating between septic arthritis and transient synovitis of the hip in children: an evidence-based clinical prediction algorithm. J Bone Joint Surg Am. 1999;81(12):1662-70. doi:<a href="https://doi.org/10.2106/00004623-199912000-00002">10.2106/00004623-199912000-00002</a><br /> <br /> <br /> <br /> * UpToDate. Evaluation of limp in children. Accessed September 2025.<br /> <br /> <br /> <br /> * UpToDate. Differential diagnosis of limp in children. Accessed September 2025.<br /> <br /> <br /> <br /> * StatPearls. Antalgic Gait in Children. NCBI Bookshelf. Accessed September 2025.<br /> <br /> <br /> <br /> * Pediatric Emergency Care. “Approach to Pediatric Limp.” Pediatrics in Review. 2024.<br /> <br /> <br /> <br /> <br /> Transcript<br /> <br /> <br /> <br /> Note: This transcript was partially completed with the use of the Descript AI and the Chat GPT 5 AI<br /> <br /> <br /> <br /> Welcome to PEM Currents, the Pediatric Emergency Medicine podcast. As always, I&#8217;m your host, Brad Sobolewski, and in this episode we&#8217;re gonna tackle the evaluation of a child presenting with limp. We&#8217;ll cover, age-based differential diagnosis. How to take a high yield history and do a detailed physical exam, imaging strategies, lab tests, and when to worry about systemic causes.<br /> <br /> <br /> <br /> We&#8217;ll also talk about the Kocher criteria for se

<br /> Vaso-occlusive pain episodes are the most common reason children and adolescents with sickle cell disease present to the Emergency Department. Prompt, protocol-driven management is essential starting with early administration of IV opioids, reassessment at 15–30 minute intervals, and judicious hydration. Understanding the patient’s typical pain pattern, opioid history, and psychosocial context can guide more effective care. This episode walks through the pathophysiology, clinical presentation, pharmacologic strategy, discharge criteria, and complications to watch for helping you provide evidence-based, compassionate care that improves outcomes.<br /> <br /> <br /> <br /> Learning Objectives<br /> <br /> <br /> <br /> <br /> * Describe the pathophysiology of vaso-occlusive crises in children and adolescents with sickle cell disease and how it relates to clinical symptoms.<br /> <br /> <br /> <br /> * Differentiate uncomplicated vaso-occlusive crises from other acute complications of sickle cell disease such as acute chest syndrome, splenic sequestration, and stroke.<br /> <br /> <br /> <br /> * Implement evidence-based strategies for early and effective pain management in vaso-occlusive crises, including appropriate use of opioid analgesia, reassessment intervals, and disposition criteria.<br /> <br /> <br /> <br /> <br /> Connect with Brad Sobolewski<br /> <br /> <br /> <br /> <br /> * PEMBlog: <a href="https://www.pemblog.com/">PEMBlog.com</a><br /> <br /> <br /> <br /> * Blue Sky: <a href="https://bsky.app/profile/bradsobo.bsky.social">@bradsobo</a><br /> <br /> <br /> <br /> * X (Twitter): <a href="https://twitter.com/PEMTweets">@PEMTweets</a><br /> <br /> <br /> <br /> * Instagram: <a href="https://www.instagram.com/bradsobolewski/">Brad Sobolewski</a><br /> <br /> <br /> <br /> * Mastodon: <a href="https://med-mastodon.com/@bradsobo">@bradsobo@med-mastodon.com</a><br /> <br /> <br /> <br /> <br /> References<br /> <br /> <br /> <br /> <br /> * Kavanagh PL, Fasipe TA, Wun T. Sickle cell disease: a review. JAMA. 2022;328(1):57-68. doi:10.1001/jama.2022.10233<br /> <br /> <br /> <br /> * Yates AM, Aygun B, Nuss R, Rogers ZR. Health supervision for children and adolescents with sickle cell disease: clinical report. Pediatrics. 2024;154(2):e2024066842. doi:10.1542/peds.2024-066842<br /> <br /> <br /> <br /> * Bender MA, Carlberg K. Sickle Cell Disease. In: Adam MP, Everman DB, Mirzaa GM, et al, eds. GeneReviews®. University of Washington, Seattle; 1993–2024. Updated February 13, 2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK1377/<br /> <br /> <br /> <br /> * Brandow AM, Carroll CP, Creary S, et al. American Society of Hematology 2020 guidelines for sickle cell disease: management of acute and chronic pain. Blood Adv. 2020;4(12):2656-2701. doi:10.1182/bloodadvances.2020001851<br /> <br /> <br /> <br /> * Brandow AM, Carroll CP, Creary SE. Acute vaso-occlusive pain management in sickle cell disease. In: Hoffman R, Benz EJ, Silberstein LE, Heslop HE, Weitz JI, Anastasi J, eds. UpToDate. UpToDate; 2024. Accessed July 2025. https://www.uptodate.com<br /> <br /> <br /> <br /> * Glassberg JA, Strouse JJ. Evaluation of acute pain in sickle cell disease. In: Hoffman R, Benz EJ, Silberstein LE, Heslop HE, Weitz JI, Anastasi J, eds. UpToDate. UpToDate; 2024. Accessed July 2025. https://www.uptodate.com<br /> <br /> <br /> <br /> * DeBaun MR, Quinn C

<br /> Penetrating neck injuries in children are rare—but when they happen, the stakes are high. In this episode of PEM Currents: The Pediatric Emergency Medicine Podcast, we explore the clinical pearls behind “no-zone” management, how to distinguish hard and soft signs, when to image versus operate, and why airway always comes first. Get ready for a focused, evidence-based deep dive into pediatric neck trauma.<br /> <br /> <br /> <br /> Learning Objectives<br /> <br /> <br /> <br /> <br /> * Understand the shift from zone-based to “no-zone” management in pediatric penetrating neck injuries and describe the rationale behind this transition.<br /> <br /> <br /> <br /> * Apply ATLS principles to the initial assessment and stabilization of children with penetrating neck injuries, including decisions regarding imaging and airway management.<br /> <br /> <br /> <br /> * Evaluate clinical findings to determine the need for operative intervention versus observation in stable pediatric patients with soft versus hard signs of vascular or aerodigestive injury.<br /> <br /> <br /> <br /> <br /> Connect with Brad Sobolewski<br /> <br /> <br /> <br /> <br /> * PEMBlog: <a href="https://www.pemblog.com/">PEMBlog.com</a><br /> <br /> <br /> <br /> * Blue Sky: <a href="https://bsky.app/profile/bradsobo.bsky.social">@bradsobo</a><br /> <br /> <br /> <br /> * X (Twitter): <a href="https://twitter.com/PEMTweets">@PEMTweets</a><br /> <br /> <br /> <br /> * Instagram: <a href="https://www.instagram.com/bradsobolewski/">Brad Sobolewski</a><br /> <br /> <br /> <br /> * Mastodon: <a href="https://med-mastodon.com/@bradsobo">@bradsobo@med-mastodon.com</a><br /> <br /> <br /> <br /> <br /> References<br /> <br /> <br /> <br /> Stone ME Jr, Christensen P, Craig S, Rosengart M. Management of penetrating neck injury in children: A review of the National Trauma Data Bank. Red Cross Annals. 2017;32(4):171–177. doi:10.1016/j.rcsann.2017.04.003<br /> <br /> <br /> <br /> Callcut RA, Inaba K. Penetrating neck injuries: Initial evaluation and management. UpToDate. Waltham, MA: UpToDate Inc. [Accessed June 24, 2025]. Available from: https://www.uptodate.com<br /> <br /> <br /> <br /> Transcript<br /> <br /> <br /> <br /> Note: This transcript was partially completed with the use of the Descript AI and the Chat GPT 4o AI<br /> <br /> <br /> <br /> Welcome to PEM Currents: The Pediatric Emergency Medicine Podcast. As always, I’m your host, Brad Sobolewski, and in this episode we are diving into a high-stakes but fortunately rare topic in pediatric trauma — penetrating neck injuries. Now these injuries make up less than 1% of all pediatric trauma, but when they occur, they demand precision and vigilance in terms of diagnosis and management.<br /> <br /> <br /> <br /> As you know, the neck packs some vital organs, vessels, the airway, esophagus, and nerves into a tiny little area, so even a seemingly minor wound can injure multiple structures.<br /> <br /> <br /> <br /> Now you remember — way back when — where you learned about the zones of the neck, and this is the traditional teaching, which chopped the neck up into three zones.<br /> <br /> <br /> <br /> You’ve got Zone I, which is the area between the clavicle and cricoid. You’ve got the subclavian arteries and vein, the carotid, and the apices of the lungs.Zone II, the cricoid to the angle of the mandible — this includes the c

<br /> In this episode of PEM Currents: The Pediatric Emergency Medicine Podcast, Brad Sobolewski discusses advanced imaging in pediatric emergency care with Dr. Jennifer Marin (<a href="mailto:jennifer.marin@chp.edu">jennifer.marin@chp.edu</a>) from UPMC Children’s Hospital of Pittsburgh. They explore the evidence behind ultrasound, CT, and MRI, strategies to reduce low-value imaging, and the role of shared decision-making in selecting the appropriate diagnostic test.<br /> <br /> <br /> <br /> Learning Objectives<br /> <br /> <br /> <br /> <br /> * Demonstrate the ability to use shared decision-making strategies when discussing imaging options with families of pediatric patients presenting to the Emergency Department. (Bloom’s: Apply; Kirkpatrick Level 2 – Learning)<br /> <br /> <br /> <br /> * Evaluate the risks and benefits of ultrasound, CT, and MRI for common pediatric emergencies and identify appropriate imaging modalities based on clinical guidelines discussed in the podcast. (Bloom’s: Analyze; Kirkpatrick Level 3 – Behavior):<br /> <br /> <br /> <br /> * Assess the impact of implementing strategies for reducing low-value imaging in the pediatric emergency department on patient care outcomes, including diagnostic accuracy, radiation exposure, and healthcare costs. (Bloom’s: Evaluate; Kirkpatrick Level 4 – Results)<br /> <br /> <br /> <br /> <br /> Connect with Brad Sobolewski<br /> <br /> <br /> <br /> <br /> * PEMBlog: <a href="https://www.pemblog.com/">PEMBlog.com</a><br /> <br /> <br /> <br /> * Blue Sky: <a href="https://bsky.app/profile/bradsobo.bsky.social">@bradsobo</a><br /> <br /> <br /> <br /> * X (Twitter): <a href="https://twitter.com/PEMTweets">@PEMTweets</a><br /> <br /> <br /> <br /> * Instagram: <a href="https://www.instagram.com/bradsobolewski/">Brad Sobolewski</a><br /> <br /> <br /> <br /> * Mastodon: <a href="https://med-mastodon.com/@bradsobo">@bradsobo@med-mastodon.com</a><br /> <br /> <br /> <br /> <br /> References<br /> <br /> <br /> <br /> <br /> * Marin JR, Lyons TW, Claudius I, et al; American Academy of Pediatrics Committee on Pediatric Emergency Medicine, Section on Radiology; American College of Emergency Physicians Pediatric Emergency Medicine Committee; American College of Radiology. Optimizing Advanced Imaging of the Pediatric Patient in the Emergency Department: Policy Statement. Pediatrics. 2024;154(1):e2024066854. doi:10.1542/peds.2024-066854. <a href="https://pubmed.ncbi.nlm.nih.gov/38932710/">PubMed</a><br /> <br /> <br /> <br /> * Marin JR, Lyons TW, Claudius I, et al; American Academy of Pediatrics Committee on Pediatric Emergency Medicine, Section on Radiology; American College of Emergency Physicians Pediatric Emergency Medicine Committee; American College of Radiology. Optimizing Advanced Imaging of the Pediatric Patient in the Emergency Department: Technical Report. Pediatrics. 2024;154(1):e2024066855. doi:10.1542/peds.2024-066855. <a href="https://pubmed.ncbi.nlm.nih.gov/38932719/">PubMed</a><br /> <br /> <br /> <br /> <br /> Transcript<br /> <br /> <br /> <br /> Note: This transcript was partially completed with the use of the Descript AI and the Chat GPT 4o AI<br /> <br /> <br /> <br /> Welcome to PEM Currents: The Pediatric Emergency Medicine Podcast. As always, I&#8217;m your host, Brad Sobolewski, and in today&#8217;s episode, we are diving into a critical topic that eve

<br /> In this episode, we tackle the clinical mischief of Parvovirus B19, a common viral infection with a surprisingly wide range of manifestations—from the classic “slapped cheek” rash of erythema infectiosum to aplastic crises in children with hemolytic anemias and fetal hydrops in pregnant contacts. We’ll break down the virology, epidemiology, clinical presentation, and complications of Parvovirus B19. You’ll also learn how to manage exposures in the emergency department, especially when the child has a pregnant caregiver, and why isolation isn’t always necessary once the rash shows up.<br /> <br /> <br /> <br /> Learning Objectives<br /> <br /> <br /> <br /> <br /> * Describe the classic and atypical clinical presentations of Parvovirus B19 infection in pediatric patients, including erythema infectiosum, arthropathy, transient aplastic crisis, and chronic anemia in immunocompromised hosts.<br /> <br /> <br /> <br /> * Understand the epidemiology and transmission timeline of Parvovirus B19, especially its seasonal peaks and viral shedding period.<br /> <br /> <br /> <br /> * Recognize key diagnostic features that help differentiate Parvovirus B19 from other viral exanthems and systemic illnesses.<br /> <br /> <br /> <br /> * Formulate an evidence-based management plan for patients with suspected or confirmed Parvovirus B19, including those with underlying hemolytic disease or immunocompromise.<br /> <br /> <br /> <br /> * Counsel families and caregivers—including pregnant household contacts—on the risks, exposures, and infection control considerations related to Parvovirus B19.<br /> <br /> <br /> <br /> <br /> Connect with Brad Sobolewski<br /> <br /> <br /> <br /> <br /> * PEMBlog: <a href="https://www.pemblog.com/">PEMBlog.com</a><br /> <br /> <br /> <br /> * Blue Sky: <a href="https://bsky.app/profile/bradsobo.bsky.social">@bradsobo</a><br /> <br /> <br /> <br /> * X (Twitter): <a href="https://twitter.com/PEMTweets">@PEMTweets</a><br /> <br /> <br /> <br /> * Instagram: <a href="https://www.instagram.com/bradsobolewski/">Brad Sobolewski</a><br /> <br /> <br /> <br /> * Mastodon: <a href="https://med-mastodon.com/@bradsobo">@bradsobo@med-mastodon.com</a><br /> <br /> <br /> <br /> <br /> References<br /> <br /> <br /> <br /> Jordan, Jeanne A. “Treatment and Prevention of Parvovirus B19 Infection.” UpToDate, Jun. 14, 2024. https://www.uptodate.com/contents/treatment-and-prevention-of-parvovirus-b19-infection<br /> <br /> <br /> <br /> Edwards, Morven S. “Clinical Manifestations and Diagnosis of Parvovirus B19 Infection.” UpToDate, Jun. 14, 2024. https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-parvovirus-b19-infection<br /> <br /> <br /> <br /> Macri, Angela, and Crane, Jonathan S. “Parvoviruses.” StatPearls, NCBI Bookshelf, Jun. 28, 2023. https://www.ncbi.nlm.nih.gov/books/NBK482245/<br /> <br /> <br /> <br /> Kostolansky, Sean, and Waymack, James R. “Erythema Infectiosum.” StatPearls, NCBI Bookshelf, Jul. 31, 2023. https://www.ncbi.nlm.nih.gov/books/NBK513309/<br /> <br /> <br /> <br /> “Parvovirus B19 Infection and Pregnancy.” Centers for Disease Control and Prevention. https://www.cdc.gov/parvovirusb19/pregnancy.html<br /> <br /> <br /> <br /> Transcript<br /> <br /> <br /> <br /> Note: This transcript was partially completed with the use of the Descript AI and the Chat GPT 4o AI<

<br /> This episode of PEM Currents: The Pediatric Emergency Medicine Podcast focuses on the approach to unvaccinated or undervaccinated children aged 3–36 months presenting to the ED with fever. Host Brad Sobolewski reviews differences in immune response, risk for serious and invasive bacterial infections, and outlines evaluation strategies including labs, imaging, and empiric antibiotics. He highlights data showing increased interventions in this population and calls for local guideline development. The episode emphasizes thoughtful, individualized care in the context of rising vaccine hesitancy and declining immunization rates.<br /> <br /> <br /> <br /> Learning Objectives<br /> <br /> <br /> <br /> <br /> * Compare the clinical presentation of bacterial infections in unvaccinated and undervaccinated children versus fully immunized children in the Emergency Department<br /> <br /> <br /> <br /> * Assess the need for empiric antibiotics and diagnostic testing in an unvaccinated or undervaccinated child presenting with fever without source<br /> <br /> <br /> <br /> * <br /> <br /> <br /> <br /> <br /> Connect with Brad Sobolewski<br /> <br /> <br /> <br /> PEMBlog: <a href="https://pemblog.com/">PEMBlog.com</a><br /> <br /> <br /> <br /> Blue Sky: <a href="https://bsky.app/profile/bradsobo.bsky.social">@bradsobo</a><br /> <br /> <br /> <br /> X (Twitter): <a href="https://x.com/PEMTweets">@PEMTweets</a><br /> <br /> <br /> <br /> Instagram: <a href="https://www.instagram.com/bradsobolewski">Brad Sobolewski</a><br /> <br /> <br /> <br /> Mastodon: <a href="https://mastodon.social/@bradsobo">@bradsobo</a><br /> <br /> <br /> <br /> References<br /> <br /> <br /> <br /> Curtis M, Kanis J, Wagers B, et al. Immunization status and the management of febrile children in the pediatric emergency department: what are we doing? Pediatr Emerg Care. 2023;39(1):1-5. doi:10.1097/PEC.0000000000002864<br /> <br /> <br /> <br /> Finkel L, Ospina-Jimenez C, Byers M, Eilbert W. Fever without source in unvaccinated children aged 3 to 24 months: what workup is recommended? Pediatr Emerg Care. 2021;37(12):e882-e885. doi:10.1097/PEC.0000000000002249<br /> <br /> <br /> <br /> Herz AM, Greenhow TL, Alcantara J, et al. Changing epidemiology of outpatient bacteremia in 3- to 36-month-old children after the introduction of the heptavalent-conjugated pneumococcal vaccine. Pediatr Infect Dis J. 2006;25(4):293-300. doi:10.1097/01.inf.0000207485.39112.bf<br /> <br /> <br /> <br /> Kaufman J, Fitzpatrick P, Tosif S, et al. Faster clean catch urine collection (Quick-Wee method) from infants: randomised controlled trial. BMJ. 2017;357:j1341. doi:10.1136/bmj.j1341<br /> <br /> <br /> <br /> Kuppermann N, Fleisher GR, Jaffe DM. Predictors of occult pneumococcal bacteremia in young febrile children. Ann Emerg Med. 1998;31(6):679-687. doi:10.1016/S0196-0644(98)70225-2<br /> <br /> <br /> <br /> Rutman MS, Bachur R, Harper MB. Radiographic pneumonia in young, highly febrile children with leukocytosis before and after universal conjugate pneumococcal vaccination. Pediatr Emerg Care. 2009;25(1):1-7. doi:10.1097/PEC.0b013e318191dab2<br /> <br /> <br /> <br /> Trippella G, Galli L, De Martino M, Lisi C, Chiappini E. Procalcitonin performance in detecting serious and invasive bacterial infections in children with fever without apparent source: a systematic review and meta-analysis. Expert Rev Anti Infect Ther. 2017;15(

<br /> In this episode we dive into the resurgence of Mycoplasma pneumoniae—an atypical bacterial cause of community-acquired pneumonia that’s making waves in pediatric emergency medicine. We’ll cover its clinical presentation, epidemiology, diagnostic approach, and management, including why standard beta-lactam antibiotics won’t work. Plus, we’ll discuss whether M. pneumoniae even needs to be treated in the first place!<br /> <br /> <br /> <br /> Learning Objectives<br /> <br /> <br /> <br /> <br /> * Describe the clinical presentation, epidemiology, and complications of Mycoplasma pneumoniae infections in pediatric patients, including its atypical manifestations.<br /> <br /> <br /> <br /> * Differentiate Mycoplasma pneumoniae pneumonia from typical bacterial and viral pneumonia based on history, physical exam findings, and diagnostic testing.<br /> <br /> <br /> <br /> * Assess the current evidence for antibiotic treatment of Mycoplasma pneumoniae and justify treatment decisions based on patient presentation, severity, and potential complications.<br /> <br /> <br /> <br /> <br /> Connect with Brad Sobolewski<br /> <br /> <br /> <br /> PEMBlog: <a href="https://pemblog.com/">PEMBlog.com</a><br /> <br /> <br /> <br /> Blue Sky: <a href="https://bsky.app/profile/bradsobo.bsky.social">@bradsobo</a><br /> <br /> <br /> <br /> X (Twitter): <a href="https://x.com/PEMTweets">@PEMTweets</a><br /> <br /> <br /> <br /> Instagram: <a href="https://www.instagram.com/bradsobolewski">Brad Sobolewski</a><br /> <br /> <br /> <br /> Mastodon: <a href="https://mastodon.social/@bradsobo">@bradsobo</a><br /> <br /> <br /> <br /> References<br /> <br /> <br /> <br /> Vallejo, Jesus G. “Mycoplasma Pneumoniae Infection in Children.” UpToDate, 1 Nov. 2024, www.uptodate.com/contents/mycoplasma-pneumoniae-infection-in-children.<br /> <br /> <br /> <br /> Garcia T, Florin TA, Leonard J, Shah SS, Ruddy RM, Wallihan R, Desai AP, Alter S, El-Assal O, Marzec S, Keaton M, Yun KW, Leber AL, Mejias A, Cohen DM, Ramilo O, Ambroggio L; Children’s Hospitals Initiative for Research in Pneumonia (CHIRP). Clinical Features and Management Strategies in Children With Mycoplasma Pneumoniae. Pediatr Emerg Care. 2025 Feb 17. doi: 10.1097/PEC.0000000000003338. Epub ahead of print. PMID: 39960098.<br /> <br /> <br /> <br /> Gao L, Sun Y. Laboratory diagnosis and treatment of Mycoplasma pneumoniae infection in children: a review. Ann Med. 2024 Dec;56(1):2386636. doi: 10.1080/07853890.2024.2386636. Epub 2024 Aug 3. PMID: 39097794; PMCID: PMC11299444.<br /> <br /> <br /> <br /> Shah SS. Mycoplasma pneumoniae as a Cause of Community-Acquired Pneumonia in Children. Clin Infect Dis 2019; 68:13.<br /> <br /> <br /> <br /> “Mycoplasma Pneumoniae Infections Have Been Increasing.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 18 Oct. 2024, www.cdc.gov/ncird/whats-new/mycoplasma-pneumoniae-infections-have-been-increasing.html.<br /> <br /> <br /> <br /> Transcript<br /> <br /> <br /> <br /> Note: This transcript was partially completed with the use of the Descript AI<br /> <br /> <br /> <br />  Welcome to PEMCurrents, the Pediatric Emergency Medicine Podcast. As always, I&#8217;m your host, Brad Sobolewski, and today we&#8217;re focusing on a pathogen that has been making waves in pediatric emergency departments across the country. Mycoplasma pneumoniae. Whet

<br /> In this episode of PEM Currents: The Pediatric Emergency Medicine Podcast, we explore the complex and often underrecognized issue of inhalant misuse. From the early days of glue sniffing to the recent rise of nitrous oxide misuse, fueled by brands like Galaxy Gas and viral trends on TikTok and Instagram, inhalant misuse has evolved into a growing concern among adolescents.<br /> <br /> <br /> <br /> We’ll dive into the clinical presentations, including acute and chronic symptoms, the dangers of “sudden sniffing death,” and the specific risks associated with nitrites, hydrocarbons, and nitrous oxide. Learn how to recognize and manage cases in the emergency department, ask the right questions to uncover inhalant use, and provide critical resources for prevention and support. Whether you’re a seasoned pediatrician or new to emergency medicine, this episode offers essential insights into tackling this hidden epidemic.<br /> <br /> <br /> <br /> Learning Objectives<br /> <br /> <br /> <br /> By the end of this episode, listeners will be able to:<br /> <br /> <br /> <br /> <br /> * Recognize the clinical signs and symptoms of inhalant misuse, including acute intoxication and long-term complications.<br /> <br /> <br /> <br /> * Differentiate between the risks and toxic effects associated with specific inhalants, such as hydrocarbons, nitrites, and nitrous oxide.<br /> <br /> <br /> <br /> * Formulate effective strategies for identifying, managing, and preventing inhalant misuse in pediatric patients.<br /> <br /> <br /> <br /> <br /> Connect with Brad Sobolewski<br /> <br /> <br /> <br /> PEMBlog: <a href="https://pemblog.com/">PEMBlog.com</a><br /> <br /> <br /> <br /> Blue Sky: <a href="https://bsky.app/profile/bradsobo.bsky.social">@bradsobo</a><br /> <br /> <br /> <br /> X (Twitter): <a href="https://x.com/PEMTweets">@PEMTweets</a><br /> <br /> <br /> <br /> Instagram: <a href="https://www.instagram.com/bradsobolewski">Brad Sobolewski</a><br /> <br /> <br /> <br /> Mastodon: <a href="https://mastodon.social/@bradsobo">@bradsobo</a><br /> <br /> <br /> <br /> References<br /> <br /> <br /> <br /> Perry H, Burns MM. Inhalant misuse in children and adolescents. UpToDate. Ganetsky M (ed). Updated February 26, 2024. Accessed January 13, 2025. https://www.uptodate.com/contents/inhalant-misuse-in-children-and-adolescents<br /> <br /> <br /> <br /> Hogge RL, Spiller HA, Kistamgari S, et al. Inhalant misuse reported to America&#8217;s Poison Centers, 2001-2021. Clin Toxicol (Phila) 2023; 61:453.<br /> <br /> <br /> <br /> Marcus E. The next drug epidemic is blue raspberry flavored: How Galaxy Gas became synonymous with the country’s burgeoning addiction to gas. Intelligencer. Published January 6, 2025. Accessed January 13, 2025. https://nymag.com/intelligencer/article/galaxy-gas-flavored-nitrous-oxide-drug-epidemic.html<br /> <br /> <br /> <br /> Transcript<br /> <br /> <br /> <br /> Note: This transcript was partially completed with the use of the Descript AI<br /> <br /> <br /> <br />  Welcome to PEMCurrents, the Pediatric Emergency Medicine Podcast. As always, I&#8217;m your host, Brad Sobolewski, and today we&#8217;re diving into an important topic, inhalant misuse, with a special focus on nitrous oxide. Welcome Recently, there&#8217;s been a concerning rise in recreational use of nitrous oxide, often referred to as Galaxy Gas, which is a

<br /> In lieu of a traditional episode this holiday season I wanted to share a reading of the Pediatric Emergency Medicine version of a famous Christmas poem.<br /> <br /> <br /> <br /> Transcript<br /> <br /> <br /> <br /> ‘Twas the night before Christmas, and I’m working a shift,The symptoms were varied, the pace was quite swift.The screens glowed with orders, the rooms filled with care,In hopes that discharge summaries soon would be there.<br /> <br /> <br /> <br /> The nurses were moving with hustle and speed,While families recounted each child’s urgent need.And I at my computer, my coffee in hand,Prepared for the onslaught that none could have planned.<br /> <br /> <br /> <br /> When out in the lobby there arose such a clatter,I sprang from my chair to see what was the matter.Away to the triage I flew like a flash,Dodging spilled apple juice and a child with a rash.<br /> <br /> <br /> <br /> The ambulances were wailing, the scene quite a sight,As the complaints rolled in on this hectic night.When what to my weary eyes did appear,But a febrile infant, his parents in fear.<br /> <br /> <br /> <br /> A nursemaid’s elbow in need of a tug,And a kid with a cough wrapped tight in a hug.A forehead lac with blood streaming red,And a teen who proclaimed, “I think I’m half-dead!”<br /> <br /> <br /> <br /> With quick-thinking teamwork, the cases we tamed,And I whistled and shouted and called them by name:“Now flu! Now croup! Now migraines and pain!On seizures! On sepsis! That ankle is sprained!<br /> <br /> <br /> <br /> To the trauma bay stat, through triage with speed,Move quickly, move calmly, and meet every need!”As the snow flakes that fall when wild winter winds fly,We hustled and triaged as new patients arrived.<br /> <br /> <br /> <br /> And then, in a twinkling, I heard down the hall,The sound of retching &#8211; a vomiting call.Ondansetron ordered, the nurse prepping the dose,I saw a pale toddler, looking morose.<br /> <br /> <br /> <br /> He was sick from his tummy to the tip of his nose,And the sounds of his misery steadily rose.His eyes were all sunken, his cheeks far too pale,But a popsicle bribe led to a triumphant exhale.<br /> <br /> <br /> <br /> The shift rolled along with splints left and right,Broken forearms galore on this holiday night.And ketamine laughter soon filled the air,As a lac repair finished with great skill and care.<br /> <br /> <br /> <br /> Abdominal pains brought more to the bays,With parents repeating, “He’s been sick for days.”A scan ruled out danger, the appendix intact,While the next patient arrived with an asthma attack.<br /> <br /> <br /> <br /> The hours wore on, the crowd didn’t cease,Yet amidst all the chaos, we found moments of peace.A mom’s grateful smile, a child’s sleepy yawn,Reminded us why we keep carrying on.<br /> <br /> <br /> <br /> So I sat at the computer and typed one last note,Cleared my inbox of tasks and the orders I wrote.And I heard myself whisper as I turned off the light,“Merry Christmas to all, and to all a calm night!”<br />

<br /> In this episode of PEM Currents: The Pediatric Emergency Medicine Podcast, we explore pertussis, also known as whooping cough &#8211; a disease that remains a public health challenge despite widespread vaccination efforts. We will review the clinical presentation, diagnostic strategies, management protocols, infection control practices, and vaccination updates. This episode also covers what healthcare providers need to know about post-exposure prophylaxis, respiratory precautions, and managing occupational exposures.<br /> <br /> <br /> <br /> Learning Objectives<br /> <br /> <br /> <br /> <br /> * Understand the clinical progression of pertussis through its three distinct stages and identify key symptoms, including age-specific presentations in infants and older children.<br /> <br /> <br /> <br /> * Implement effective management strategies for pertussis, including supportive care, appropriate antibiotic regimens, and post-exposure prophylaxis for contacts and healthcare providers.<br /> <br /> <br /> <br /> * Promote pertussis prevention by understanding vaccination schedules (DTaP vs. Tdap), addressing vaccine hesitancy, and adhering to infection control protocols in clinical settings.<br /> <br /> <br /> <br /> <br /> Connect with Brad Sobolewski<br /> <br /> <br /> <br /> PEMBlog: <a href="https://pemblog.com/">PEMBlog.com</a><br /> <br /> <br /> <br /> Blue Sky: <a href="https://bsky.app/profile/bradsobo.bsky.social">@bradsobo</a><br /> <br /> <br /> <br /> X (Twitter): <a href="https://x.com/PEMTweets">@PEMTweets</a><br /> <br /> <br /> <br /> Instagram: <a href="https://www.instagram.com/bradsobolewski">Brad Sobolewski</a><br /> <br /> <br /> <br /> Mastodon: <a href="https://mastodon.social/@bradsobo">@bradsobo</a><br /> <br /> <br /> <br /> How about a fun AI song about whooping cough?<br /> <br /> <br /> <br /> <a href="https://youtube.com/shorts/Ye755M5O5yk">YouTube Shorts</a><br /> <br /> <br /> <br /> <a href="https://www.tiktok.com/@bradsobo/video/7444361350832278814?is_from_webapp=1&amp;sender_device=pc&amp;web_id=7370346571555522079">TikTok</a><br /> <br /> <br /> <br /> References<br /> <br /> <br /> <br /> StatPearlsLauria AM, Zabbo CP. Pertussis. [Updated 2022 Oct 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519008/<br /> <br /> <br /> <br /> AAP Pediatrics in ReviewHeather L. Daniels, Camille Sabella; Bordetella pertussis (Pertussis). Pediatr Rev May 2018; 39 (5): 247–257. <a href="https://doi.org/10.1542/pir.2017-0229" target="_blank" rel="noreferrer noopener">https://doi.org/10.1542/pir.2017-0229</a><br /> <br /> <br /> <br /> UpToDate<br /> <br /> <br /> <br /> Yeh S et al. Pertussis infection in infants and children: Clinical features and diagnosis. UpToDate. Available at: https://www.uptodate.com. Accessed December 3, 2024.<br /> <br /> <br /> <br /> MMWR<br /> <br /> <br /> <br /> Seither R, Yusuf OB, Dramann D, et al. Coverage with Selected Vaccines and Exemption Rates Among Children in Kindergarten — United States, 2023–24 School Year. MMWR Morb Mortal Wkly Rep 2024;73:925–932. DOI: <a href="http://dx.doi.org/10.15585/mmwr.mm7341a3" target="_blank" rel="noreferrer noopener&quo

<br /> In this episode of PEM Currents: The Pediatric Emergency Medicine Podcast, I explore the complexities of gastroesophageal reflux (GER) and gastritis in children and adolescents. I&#8217;ll make the important distinction between gastritis &#8211; which is diagnosed only via endoscopy &#8211; and dyspepsia, the term best used to describe the symptoms many patients experience. I&#8217;ll dive into the latest clinical practice guidelines and discuss evidence-based approaches to diagnosis and treatment.<br /> <br /> <br /> <br /> Topics covered include:<br /> <br /> <br /> <br /> <br /> * The pathophysiology of GER and GERD in the pediatric population.<br /> <br /> <br /> <br /> * Understanding dyspepsia and its clinical presentation.<br /> <br /> <br /> <br /> * Diagnostic strategies and when to consider further evaluation.<br /> <br /> <br /> <br /> * The role of lifestyle and dietary modifications in management.<br /> <br /> <br /> <br /> * Pharmacological interventions, including the use of proton pump inhibitors (PPIs), H2 blockers, and antacids.<br /> <br /> <br /> <br /> * Current controversies and updates in pharmacological treatments.<br /> <br /> <br /> <br /> * Management of gastritis and the consideration of Helicobacter pylori infection.<br /> <br /> <br /> <br /> <br /> Join me as I scope out the nuances of gastroesophageal reflux and gastritis and provide practical insights for clinicians in the emergency setting.<br /> <br /> <br /> <br /> <a href="http://www.pwmblog.com" target="_blank" rel="noreferrer noopener">PEMBlog</a><br /> <br /> <br /> <br /> <a href="http://twitter.com/PEMTweets">@PEMTweets on&#8230; sigh &#8220;X&#8221; (Twitter)</a><br /> <br /> <br /> <br /> <a href="https://www.instagram.com/bradsobolewski/" target="_blank" rel="noreferrer noopener">My Instagram</a><br /> <br /> <br /> <br /> <a href="https://med-mastodon.com/@bradsobo" target="_blank" rel="noreferrer noopener">My Mastodon account @bradsobo</a><br /> <br /> <br /> <br /> References<br /> <br /> <br /> <br /> Rosen R, Vandenplas Y, Singendonk M, et al. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2018;66(3):516-554. doi: <a href="https://doi.org/10.1097/MPG.0000000000001889">10.1097/MPG.0000000000001889</a><br /> <br /> <br /> <br /> Lightdale JR, Gremse DA; Section on Gastroenterology, Hepatology, and Nutrition. Gastroesophageal Reflux: Management Guidance for the Pediatrician. Pediatrics. 2013;131(5):e1684-1695. doi: <a href="https://doi.org/10.1542/peds.2013-0421">10.1542/peds.2013-0421</a><br /> <br /> <br /> <br /> Tighe M, Afzal NA, Bevan A, et al. Pharmacological Treatment of Children with Gastro-oesophageal Reflux. Cochrane Database Syst Rev. 2014;2014(11):CD008550. doi: <a href="https://doi.org/10.1002/14651858.CD008550.pub2">10.1002/14651858.CD008550.pub2</a><br /> <br /> <br /> <br /> Sintusek P, Mutalib M, Thapar N. Gastroesophageal Reflux Disease in Children: What’s New Right Now? World J Gastrointest Endosc. 2023;15(3):84-102. doi: <a href="https://doi.org/10.4253/wjge.v15.i3.84">10.

<br /> This episode of PEM Currents discusses ECPR (Extracorporeal Cardiopulmonary Resuscitation), an advanced procedure used in cases of cardiac arrest when traditional CPR fails. ECPR involves using ECMO (Extracorporeal Membrane Oxygenation) to take over heart and lung functions, offering a last-resort option that is becoming more common in large pediatric hospitals. While ECPR shows promise in improving survival rates, particularly in pediatric patients with conditions like congenital heart disease, it is resource-intensive and carries significant risks. Establishing an ECPR program requires robust infrastructure, multidisciplinary teamwork, and extensive training. The episode highlights the importance of understanding eCPR as a critical therapy for both in-hospital and out-of-hospital cardiac arrests.<br /> <br /> <br /> <br /> <a href="http://www.pwmblog.com" target="_blank" rel="noreferrer noopener">PEMBlog</a><br /> <br /> <br /> <br /> <a href="http://twitter.com/PEMTweets">@PEMTweets on&#8230; sigh &#8220;X&#8221; (Twitter)</a><br /> <br /> <br /> <br /> <a href="https://www.instagram.com/bradsobolewski/" target="_blank" rel="noreferrer noopener">My Instagram</a><br /> <br /> <br /> <br /> <a href="https://med-mastodon.com/@bradsobo" target="_blank" rel="noreferrer noopener">My Mastodon account @bradsobo</a><br /> <br /> <br /> <br /> References<br /> <br /> <br /> <br /> Gajkowski EF, Herrera G, Hatton L, et al. ELSO guidelines for adult and pediatric extracorporeal membrane oxygenation circuits. ASAIO J. 2022; 68:133–152. <br /> <br /> <br /> <br /> Stratton, M., &amp; Edmunds, K. (2024). Extracorporeal Cardiopulmonary Resuscitation. Pediatric Emergency Care, 40(8), 618-622. <br /> <br /> <br /> <br /> ECC Committee, Subcommittees, and Task Forces of the American Heart Association. 2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2005;112(suppl):IV1–IV203. <br /> <br /> <br /> <br /> Yannopoulos D, Kalra R, Kosmopoulos M, et al. Rationale and methods of the advanced R2Eperfusion STrategies for refractory cardiac ARREST (ARREST) trial. Am Heart J. 2020;229:29–39. <br /> <br /> <br /> <br /> Bartos JA, Yannopoulos D. Starting an extracorporeal cardiopulmonary resuscitation program: success is in the details. Resuscitation. 2023; 187:109792.<br />

<br /> Syphilis has gone by many nicknames over the years including &#8220;The Great Pretender&#8221; and &#8220;The Great Imitator.&#8221; Emily Labudde, MD, a Pediatric Emergency Medicine fellow at Children&#8217;s Healthcare of Atlanta and recent pediatric residency graduate from Cincinnati Children’s discusses the various manifestations of this sexually transmitted infection, and how we can&#8217;t miss this very treatable, but sneaky malady. <br /> <br /> <br /> <br /> <a href="http://www.pwmblog.com" target="_blank" rel="noreferrer noopener">PEMBlog</a><br /> <br /> <br /> <br /> <a href="http://twitter.com/PEMTweets">@PEMTweets on… sigh “X” (Twitter)</a><br /> <br /> <br /> <br /> <a href="https://www.instagram.com/bradsobolewski/" target="_blank" rel="noreferrer noopener">My Instagram</a><br /> <br /> <br /> <br /> <a href="https://med-mastodon.com/@bradsobo" target="_blank" rel="noreferrer noopener">My Mastodon account @bradsobo</a><br /> <br /> <br /> <br /> References<br /> <br /> <br /> <br /> Emily J. Labudde, Jane Lee; A Review of Syphilis Infection in Pediatric Patients. Pediatr Rev. July 2024; 45 (7): 373–380. <a href="https://doi.org/10.1542/pir.2023-006309" target="_blank" rel="noreferrer noopener">https://doi.org/10.1542/pir.2023-006309</a><br /> <br /> <br /> <br /> Centers for Disease Control and Prevention. &#8220;Sexually Transmitted Disease Surveillance 2021.&#8221; Centers for Disease Control and Prevention, 2021. Available from: <a href="https://www.cdc.gov/std/statistics/2021/default.htm">https://www.cdc.gov/std/statistics/2021/default.htm</a>.<br /> <br /> <br /> <br /> Centers for Disease Control and Prevention. &#8220;Sexually Transmitted Infections Treatment Guidelines 2021.&#8221; Centers for Disease Control and Prevention, 2021. Available from: <a href="https://www.cdc.gov/std/treatment-guidelines/syphilis.htm">https://www.cdc.gov/std/treatment-guidelines/syphilis.htm</a>.<br /> <br /> <br /> <br /> Centers for Disease Control and Prevention. &#8220;Youth Risk Behavior Surveillance System.&#8221; Centers for Disease Control and Prevention, 2021. Available from: <a href="https://www.cdc.gov/healthyyouth/data/yrbs/index.htm">https://www.cdc.gov/healthyyouth/data/yrbs/index.htm</a>.<br /> <br /> <br /> <br /> Transcript<br /> <br /> <br /> <br /> Note: This transcript was partially completed with the use of the Descript AI<br /> <br /> <br /> <br /> Welcome to PEMCurrents, the Pediatric Emergency Medicine Podcast, as always, I&#8217;m your host Brad Sobolewski. Today&#8217;s episode is all about the great pretender, syphilis. And let&#8217;s face it, it&#8217;s not just a disease for Medieval royalty. It&#8217;s on the rise in the United States and abroad. So let&#8217;s talk about the manifestations and management.<br /> <br /> <br /> <br /> And I&#8217;ve got a special guest host. This is Emily Labudde, originally from Detroit, at the time of recording this episode, a third year categorical pediatric resident at Cincinnati Children&#8217;s and a soon to be pediatric emergency medicine fellow in Atlanta. I&#8217;m going to pass the mic to you, Emily. My name is Emily Labudde, and I&#8217;m a third year pediatric resident at Cincinnati Children&#8217;s Hospital, and I&#8217;ll be starting fellowship in pediatric emergency medicine this summ

<br /> Cervical Spine Injuries are fortunately rare in children. this episode is all about learning when to suspect them, how to immobilize the C-spine properly, and which imaging test to choose. It was inspired by a hot-off-the-presses publication from the Pediatric Emergency Care Applied Research Network (PECARN) focused on clinical decision rules for cervical spine imaging in children. <br /> <br /> <br /> <br /> <a href="https://nam02.safelinks.protection.outlook.com/?url=https%3A%2F%2Furldefense.com%2Fv3%2F__https%3A%2Fwww.thelancet.com%2Fjournals%2Flanchi%2Farticle%2FPIIS2352-4642(24)00104-4%2Ffulltext__%3B!!NiUAmZJ8c1GNWg!TXHO4TrAETLKA4Kt0_TcGQTc9avNklWNtrcZYNpwzn8lePWzmC_gYJyXigBCkU1aZzakKffI0LFCx0IU64iX66ebGLrpmHEJL0w%24&amp;data=05%7C02%7CBrad.Sobolewski%40cchmc.org%7C54dc9757d3d642c3599c08dc818d32e1%7C680254d4278b4aa1aca8c2600f79c533%7C0%7C0%7C638527690935900600%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=GyccBCuiceU7rKoU%2FRWgyVTvo22IQosS5%2BhxddGe5Q4%3D&amp;reserved=0">Check out the paper by Leonard et al. entitled “PECARN prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study” at Lancet Child &amp; Adolescent Health from Leonard et al here! </a><br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <a href="https://youtube.com/shorts/UciIc6cDhSQ">Maybe there&#8217;s a funky music video that will teach you how to clear the C-spine? </a><br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <a href="http://www.pwmblog.com" target="_blank" rel="noreferrer noopener">PEMBlog</a><br /> <br /> <br /> <br /> <a href="http://twitter.com/PEMTweets">@PEMTweets on&#8230; sigh &#8220;X&#8221; (Twitter)</a><br /> <br /> <br /> <br /> <a href="https://www.instagram.com/bradsobolewski/" target="_blank" rel="noreferrer noopener">My Instagram</a><br /> <br /> <br /> <br /> <a href="https://med-mastodon.com/@bradsobo" target="_blank" rel="noreferrer noopener">My Mastodon account @bradsobo</a><br /> <br /> <br /> <br /> References<br /> <br /> <br /> <br /> Leonard, J. C., Harding, M., Cook, L. J., Leonard, J. R., Adelgais, K. M., Ahmad, F. A., Browne, L. R., Burger, R. K., Chaudhari, P., Corwin, D. J., Glomb, N. W., Lee, L. K., Owusu-Ansah, S., Riney, L. C., Rogers, A. J., Rubalcava, D. M., Sapien, R. E., Szadkowski, M. A., Tzimenatos, L., Ward, C. E., Yen, K., Kuppermann, N. (2024). PECARN prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study. Lancet Child &amp; Adolescent Health. <a href="https://doi.org/10.1016/S2352-4642(24)00104-4">https://doi.org/10.1016/S2352-4642(24)00104-4</a>.<br /> <br /> <br /> <br /> Sasser SM, Hunt RC, Faul M, Sugerman D, Pearson WS, Dulski T, Wald MM, Jurkovich GJ, Newgard CD, Lerner EB; Centers for Disease Control and Prevention (CDC). Guidelines for field triage of injured patients: recommendations of the National Expert Panel on Field Triage, 2011. MMWR Recomm Rep. 2012 Jan 13;61(RR-1):1-20. PMID: 22237112.<br /> <br /> <br /> <br /> Leonard JR, Jaffe DM, Kuppermann N, Olsen CS, Leonard JC; Pediatric Emergency Care Applied Research Network (PECARN) Cervical Spine Study Group. Cervical spine injury patterns in children. Pediatrics. 2014 M

<br /> Febrile Seizures are among the most common neurological problema in young children, occurring in 1 out of 50 children between the ages of 6 months and 5 years of age. This episode of PEM Currents: The Pediatric Emergency Medicine Podcast is a Question and Answer style exploration of some of the most common learning points in this incredibly important topic.<br /> <br /> <br /> <br /> <a href="http://www.pwmblog.com" target="_blank" rel="noreferrer noopener">PEMBlog</a><br /> <br /> <br /> <br /> <a href="http://twitter.com/PEMTweets">@PEMTweets on&#8230; sigh &#8220;X&#8221; (Twitter)</a><br /> <br /> <br /> <br /> <a href="https://www.instagram.com/bradsobolewski/" target="_blank" rel="noreferrer noopener">My Instagram</a><br /> <br /> <br /> <br /> <a href="https://med-mastodon.com/@bradsobo" target="_blank" rel="noreferrer noopener">My Mastodon account @bradsobo</a><br /> <br /> <br /> <br /> References<br /> <br /> <br /> <br /> Xixis KL, Samanta D, Smith T, et al. Febrile Seizure. [Updated 2024 Jan 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448123/<br /> <br /> <br /> <br /> Feenstra B, Pasternak B, Geller F, et al. Common variants associated with general and MMR vaccine-related febrile seizures. Nat Genet 2014; 46:1274.<br /> <br /> <br /> <br /> Mullan PC, Levasseur KA, Bajaj L, Nypaver M, Chamberlain JM, Thull-Freedman J, Ostrow O, Jain S. Recommendations for Choosing Wisely in Pediatric Emergency Medicine: Five Opportunities to Improve Value. Ann Emerg Med. 2024 Feb 11:S0196-0644(24)00017-9. doi: 10.1016/j.annemergmed.2024.01.007. Epub ahead of print. PMID: 38349290.<br /> <br /> <br /> <br /> Guedj R, Chappuy H, Titomanlio L, De Pontual L, Biscardi S, Nissack-Obiketeki G, Pellegrino B, Charara O, Angoulvant F, Denis J, Levy C, Cohen R, Loschi S, Leger PL, Carbajal R. Do All Children Who Present With a Complex Febrile Seizure Need a Lumbar Puncture? Ann Emerg Med. 2017 Jul;70(1):52-62.e6. doi: 10.1016/j.annemergmed.2016.11.024. Epub 2017 Mar 2. PMID: 28259480.<br /> <br /> <br /> <br /> Shinnar S, Hesdorffer DC, Nordli DR Jr, Pellock JM, O&#8217;Dell C, Lewis DV, Frank LM, Moshé SL, Epstein LG, Marmarou A, Bagiella E; FEBSTAT Study Team. Phenomenology of prolonged febrile seizures: results of the FEBSTAT study. Neurology. 2008 Jul 15;71(3):170-6. doi: 10.1212/01.wnl.0000310774.01185.97. Epub 2008 Jun 4. PMID: 18525033.<br /> <br /> <br /> <br /> Murata S, Okasora K, Tanabe T, Ogino M, Yamazaki S, Oba C, Syabana K, Nomura S, Shirasu A, Inoue K, Kashiwagi M, Tamai H. Acetaminophen and Febrile Seizure Recurrences During the Same Fever Episode. Pediatrics. 2018 Nov;142(5):e20181009. doi: 10.1542/peds.2018-1009. Epub 2018 Oct 8. PMID: 30297499.<br /> <br /> <br /> <br /> Transcript<br /> <br /> <br /> <br /> Note: This transcript was partially completed with the use of the Descript AI<br /> <br /> <br /> <br /> Welcome to PEMCurrents, the Pediatric Emergency Medicine Podcast. As always, I&#8217;m your host, Brad Sobolewski. This episode is all about febrile seizures, one of the most common neurological problems that you will see in the emergency department in children. And you know what? I&#8217;m going to structure this episode like a bit of a question and answer session.<br /> <br /> <br /> <br /> I&#8217;ll ask a question, and then I&#8217;ll answer it. So the first and perhaps mo

<br /> This episode will help you better prepare for and manage children with inborn errors of metabolism in the Emergency Department. Consider it a supplement to what you remember from Biochemistry and the instructions on the family&#8217;s laminated care plan sheet. My special guest podcaster, Emily Groopman, is an actual Pediatric Geneticist in training and we hope that you will find this episode useful.<br /> <br /> <br /> <br /> <a href="http://www.pwmblog.com" target="_blank" rel="noreferrer noopener">PEMBlog</a><br /> <br /> <br /> <br /> <a href="http://twitter.com/PEMTweets">@PEMTweets on&#8230; sigh &#8220;X&#8221; (Twitter)</a><br /> <br /> <br /> <br /> <a href="https://www.instagram.com/bradsobolewski/" target="_blank" rel="noreferrer noopener">My Instagram</a><br /> <br /> <br /> <br /> <a href="https://med-mastodon.com/@bradsobo" target="_blank" rel="noreferrer noopener">My Mastodon account @bradsobo</a><br /> <br /> <br /> <br /> Emily Groopman, MD, PhD<br /> <br /> <br /> <br /> Emily Groopman, MD, PhD is a first-year resident in the Combined Pediatrics-Medical Genetics Residency Program at Children&#8217;s National Hospital/NIH. She did her MD/PhD at Columbia University, where she investigated the diagnostic utility of exome sequencing for kidney disease. She is a member of the Clinical Genome Resource Inborn Errors of Metabolism (IEM) Clinical Domain Working Group, where as a biocurator she assesses the pathogenicity of variants in IEM-associated genes to facilitate expedited genetic diagnosis for IEMs. She aims to become a physician-scientist in pediatrics and medical genetics, engaging in bench-to-bedside research that utilizes multi-omics-based approaches to provide a molecular diagnosis and support personalized care for individuals with suspected rare genetic diseases and their families. You can contact her via email at egroopman@childrensnational.org.<br /> <br /> <br /> <br /> References<br /> <br /> <br /> <br /> Jeanmonod R, Asuka E, Jeanmonod D. Inborn Errors of Metabolism. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459183/#<br /> <br /> <br /> <br /> Rice GM, Steiner RD. Inborn Errors of Metabolism (Metabolic Disorders). Pediatr Rev. 2016 Jan;37(1):3-15; quiz 16-7, 47. doi: 10.1542/pir.2014-0122. PMID: 26729777.<br /> <br /> <br /> <br /> Burton BK. Inborn errors of metabolism in infancy: a guide to diagnosis. Pediatrics. 1998 Dec;102(6):E69. doi: 10.1542/peds.102.6.e69. PMID: 9832597.<br /> <br /> <br /> <br /> Transcript<br /> <br /> <br /> <br /> Note: This transcript was partially completed with the use of the Descript AI<br /> <br /> <br /> <br /> Welcome to PEM Currents, the Pediatric Emergency Medicine Podcast. As always, I&#8217;m your host, Brad Sobolewski, and this episode focuses on the management of children with metabolic disorders who present to the emergency department. I know that this is a subject that makes us all a little bit nervous, and you&#8217;re just hoping that the parents have a good laminated sheet to tell you everything that you need to do.<br /> <br /> <br /> <br /> Unfortunately, that&#8217;s not always the case. And, let&#8217;s face it, there are some great principles that you can apply across metabolic diseases to make sure that you are safely taking care of these children. And you&#8217;re thinking, hey! Brad&#8217;s not a pe

<br /> Newborn infants need intramuscular injections of Vitamin K in order to produce critical clotting factors. If they don&#8217;t get it they can have potentially life threatening bleeding.<br /> <br /> <br /> <br /> <a href="http://www.pwmblog.com" target="_blank" rel="noreferrer noopener">PEMBlog</a><br /> <br /> <br /> <br /> <a href="http://twitter.com/PEMTweets">@PEMTweets on&#8230; sigh &#8220;X&#8221; (Twitter)</a><br /> <br /> <br /> <br /> <a href="https://www.instagram.com/bradsobolewski/" target="_blank" rel="noreferrer noopener">My Instagram</a><br /> <br /> <br /> <br /> <a rel="noreferrer noopener" href="https://med-mastodon.com/@bradsobo" target="_blank">My Mastodon account @bradsobo</a><br /> <br /> <br /> <br /> References<br /> <br /> <br /> <br /> <br /> * <a href="http://aappolicy.aappublications.org/cgi/content/full/pediatrics;112/1/191">American Academy of Pediatrics, Committee on Fetus and Newborn. Controversies Concerning Vitamin K and the Newborn. Pediatrics 2003 July; 112(1):191-2.</a><br /> <br /> <br /> <br /> * Ross, JA, Davies SM. Vitamin K prophylaxis and childhood cancer. Med Pediatr Oncol. 2000 Jun;34(6):434-7.<br /> <br /> <br /> <br /> * Cornelissen, M., et al. Prevention of vitamin K deficiency bleeding: efficacy of different multiple oral dose schedules of vitamin K. Eur J Pediatr. 1997 Feb; 156(2):126-30.<br /> <br /> <br /> <br /> * Greer, FR, et al. Improving the vitamin K status of breastfeeding infants with maternal vitamin K supplements. Pediatr. 1997 Jan;99(1).<br /> <br /> <br /> <br /> * Kher P, Verma RP. Hemorrhagic Disease of Newborn. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558994/#<br /> <br /> <br /> <br /> <br /> Transcript<br /> <br /> <br /> <br /> Note: This transcript was partially completed with the use of the Descript AI<br /> <br /> <br /> <br /> Welcome to PEM Currents, the pediatric emergency medicine podcast. As always, I&#8217;m your host, Brad Sobolewski. Today, we&#8217;re gonna talk about vitamin k deficient bleeding, also known as hemorrhagic disease of the newborn. This is a bleeding disorder that manifests in the first few days to weeks of life after delivery. Under the umbrella are a whole range of hemorrhagic diseases, but the most important is vitamin k deficient bleeding.<br /> <br /> <br /> <br /> I&#8217;ll get into why in a moment. Vitamin k itself is a fat soluble vitamin mainly synthesized by gut bacteria. Newborns have minimal vitamin k reserves in a sterile gut. And there&#8217;s insufficient placental transfer and breast milk is deficient in vitamin K, so that&#8217;s why infants need vitamin K at birth. Without it, they can&#8217;t produce clotting factors 2, 7, 9, and 10.<br /> <br /> <br /> <br /> You need all those. In brand newborns, the levels are about 20 percent or less of adult values, but within a month after birth, they arise to within normal limits. Other causes of hemorrhagic disease of the newborn include hereditary clotting factor deficiencies such as hemophilia A or B. And the most common item on the differential, especially for late onset, which we&#8217;ll talk about in a moment, is trauma, non accidental or accidental trauma. So why am I covering this topic?<br /> <br /> <br /> <br /> Well, a lot of

<br /> This episode will help you recognize cellulitis and even differentiate it from erysipelas which is totally a different thing. You&#8217;ll also learn about treatment, whether or not a blood culture is necessary, and a whole lot more!<br /> <br /> <br /> <br /> <a href="http://www.pwmblog.com" target="_blank" rel="noreferrer noopener">PEMBlog</a><br /> <br /> <br /> <br /> <a href="http://twitter.com/PEMTweets">@PEMTweets on&#8230; sigh &#8220;X&#8221; (Twitter)</a><br /> <br /> <br /> <br /> <a href="https://www.instagram.com/bradsobolewski/" target="_blank" rel="noreferrer noopener">My Instagram</a><br /> <br /> <br /> <br /> <a rel="noreferrer noopener" href="https://med-mastodon.com/@bradsobo" target="_blank">My Mastodon account @bradsobo</a><br /> <br /> <br /> <br /> References<br /> <br /> <br /> <br /> Chen AE, Carroll KC, Diener-West M, Ross T, Ordun J, Goldstein MA, Kulkarni G, Cantey JB, Siberry GK. Randomized controlled trial of cephalexin versus clindamycin for uncomplicated pediatric skin infections. Pediatrics. 2011 Mar;127(3):e573-80. doi: 10.1542/peds.2010-2053. Epub 2011 Feb 21. PMID: 21339275; PMCID: PMC3387913.<br /> <br /> <br /> <br /> Daniel J. Pallin, William D. Binder, Matthew B. Allen, Molly Lederman, Siddharth Parmar, Michael R. Filbin, David C. Hooper, Carlos A. Camargo, Clinical Trial: Comparative Effectiveness of Cephalexin Plus Trimethoprim-Sulfamethoxazole Versus Cephalexin Alone for Treatment of Uncomplicated Cellulitis: A Randomized Controlled Trial, Clinical Infectious Diseases, Volume 56, Issue 12, 15 June 2013, Pages 1754–1762, https://doi.org/10.1093/cid/cit122<br /> <br /> <br /> <br /> Liu C, Bayer A, Cosgrove SE, et al. Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis 2011; 52:e18.<br /> <br /> <br /> <br /> Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis 2014; 59:e10.<br /> <br /> <br /> <br /> Transcript<br /> <br /> <br /> <br /> Note: This transcript was partially completed with the use of the Descript AI<br /> <br /> <br /> <br />  Welcome to another episode of PEM Currents, the Pediatric Emergency Medicine Podcast. As always, I&#8217;m your host, Brad Sobolewski, and today&#8217;s episode is all about cellulitis. What is it? Well when a break in the skin occurs, normal skin, flora, and bacteria can enter the subcutaneous tissue, where they do not belong, and they can also invade the lymphatic system.<br /> <br /> <br /> <br /> And although this podcast episode is entitled cellulitis, I&#8217;m also going to talk about erysipelas. The two terms are not interchangeable. but both manifest as areas of skin, erythema, edema, and warmth. Cellulitis involves the deeper dermis and subcutaneous fat. Whereas erysipelas involves the upper dermis and there&#8217;s a more clear demarcation between the involved and uninvolved tissue.<br /> <br /> <br /> <br /> There&#8217;s a fun fact, since the ear doesn&#8217;t have deep or dermal tissue, it&#8217;s always. ear-a-sipelas. I&#8217;ll pause for laughter. Anyway, a skin abscess, which is not the focus of this episode, is a collection of pus deep within the dermis or subcutaneous space. Impetigo, also not included in t

<br /> Laryngomalacia, is the most common cause of infant stridor. Early diagnosis is crucial as it can impact a child&#8217;s growth and development. Most infants get better on their own, but those with severe symptoms need surgical interventions like supraglottoplasty. Learn all about diagnosis and management of this common problem in this brief podcast episode.<br /> <br /> <br /> <br /> <a href="http://www.pwmblog.com" target="_blank" rel="noreferrer noopener">PEMBlog</a><br /> <br /> <br /> <br /> <a href="http://twitter.com/PEMTweets">@PEMTweets on&#8230; sigh &#8220;X&#8221; (Twitter)</a><br /> <br /> <br /> <br /> <a href="https://www.instagram.com/bradsobolewski/" target="_blank" rel="noreferrer noopener">My Instagram</a><br /> <br /> <br /> <br /> <a rel="noreferrer noopener" href="https://med-mastodon.com/@bradsobo" target="_blank">My Mastodon account @bradsobo</a><br /> <br /> <br /> <br /> References<br /> <br /> <br /> <br /> Klinginsmith M, Goldman J. Laryngomalacia. [Updated 2022 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK544266/<br /> <br /> <br /> <br /> Hartl TT, Chadha NK. A systematic review of laryngomalacia and acid reflux. Otolaryngol Head Neck Surg. 2012 Oct;147(4):619-26.<br /> <br /> <br /> <br /> Boogaard R, Huijsmans SH, Pijnenburg MW, Tiddens HA, de Jongste JC, Merkus PJ. Tracheomalacia and bronchomalacia in children: incidence and patient characteristics. Chest. 2005 Nov;128(5):3391-7.<br /> <br /> <br /> <br /> Isaac A, Zhang H, Soon SR, Campbell S, El-Hakim H. A systematic review of the evidence on spontaneous resolution of laryngomalacia and its symptoms. Int J Pediatr Otorhinolaryngol. 2016 Apr;83:78-83.<br /> <br /> <br /> <br /> Transcript<br /> <br /> <br /> <br /> Note: This transcript was partially completed with the use of the Descript AI<br /> <br /> <br /> <br /> Welcome to another episode of PEMCurrents, the pediatric emergency medicine podcast. As always, I&#8217;m your host, Brad Sobelewski. Your time is valuable and was mine, and that&#8217;s why I release these brief episodes, focus on a single topic, get you in, get you out, teach you something. Today, let&#8217;s talk about The most common cause of noisy breathing in newborns and infants, laryngomalacia. You&#8217;ve all seen this, or should I say you&#8217;ve all heard this, And you will hear the symptoms of stridor and noisy breathing, often positional, and it can impact growth and development.<br /> <br /> <br /> <br /> Now I always thought it was just because airways are small and they&#8217;re floppier and therefore noisier, but All infants have small airways and all of their cartilage is soft, so there&#8217;s more to the picture. So why does this happen? Well, it could be neurologic function. You could have abnormal tone of the laryngeal nerve. You might have an imbalance of demand supply during inhalation in some infants.<br /> <br /> <br /> <br /> And reflux isn&#8217;t a direct cause, but approximately sixty percent of infants with laryngomalacia do also have gastroesophageal acid reflux disease. And we know that reflux can irritate and swell the upper airway, potentially worsening obstructive symptoms. So the incidence is unknown, but it&#8217;s probably about one in two to three thousand infants. But it might underestimate it because lots of mild cases don&#8217;t actually present