Podcast

Little Big Little: What is Vaping?

Adolescent Medicine, Education, Emergency Medicine, Podcast, Pulmonology, Uncategorized

This is the first segment in a series of “shorts” – smaller quick hit episodes on a focused topic. I’m going to affectionately call them “Little Big Littles”.

On this Little Big Little, host Jason Woods speaks with Dr. Heather Hoch about what we might need to know about vaping to take care of our patients.

Guests

Heather Hoch MD – Assistant Professor, Dept. of Pediatrics, Section of Pulmonary and Sleep Medicine, University of Colorado School of Medicine and Children’s Hospital Colorado

Important Resources

  1. CDC Electronic Cigarette Information
  2. Smokefree.gov

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Episode 19: In-flight Emergencies

Emergency Medicine, Podcast

On this episode, host Jason Woods speaks with Dr. TJ Doyle, medical director of the communicaton center at the University of Pittsburgh Medical Center (UPMC) and medical director for STAT-MD, a ground based consulting group for airlines. The discussions encompasses that frequency and types of in-flight medical emergencies (IME), what is in the medical kit on airplanes, what resources are available in-flight, and the legal ramifications for medical vounteers.

The highlights:

  • Worldwide ~ 2.75 billion persons fly annually.
  • IME occur in roughly 1 per 604 US flights, or 24-130 IME per 1 million passengers.
    1. 69% had EMS requested, 25% transported to hospital, 8.6% admitted, 0.3% died.
    2. Aircrafts divert in about 4$ of IME
  • Airplane cabins are pressurized to between 5000 and 8000 ft altitude
  • Minimum equipment in the US (see graphic)
  • AED
    • Hemorrhage control
    • IV line
    • Gloves
    • Medications to treat “basic conditions”
      1. Pain
      2. Allergic reactions
      3. Bronchoconstriction
      4. Hypoglycemia
      5. Dehydration
      6. “Some” cardiac conditions
    • Equipment for initial assessment
  • Most common IME
    • Syncope or near 32.7%
    • GI 14.8%
    • Resp 10.1%
    • CV 7.0 %
  • Medical volunteer role
    • Individual airline policies may have different guidance
    • Not generally required to carry proof of medical license
    • Primary role is to gather info, provide assessment, and communicate with ground support. May need to admin medicines or perform procedures but direction of care is by ground medical.
  • Legal and ethical issues
    • US Aviation Medical Assistance Act
      1. Protects passengers who provide medical assistance from liability except in cases of negligence or willful misconduct.
      2. Medical volunteers who seek compensation for this service may jeopardize their protections under this law, though now lawsuit of such has been filed
    • Duty to respond
      1. In US, Canada, England, Singapore, no legal duty
      2. In Australia, many European countries, physicians are required to render assistance.
    • Other countries may have different protections or no protections at all

Guests

Thomas J. Doyle, Clinical Assistant Professor of Emergency Medicine, University of Pittsburgh Medical Center; Associate Medical Director, STAT MedEvac; Medical Director, Command Center, STAT-MD.

References

  1. Christian Martin-Gill, MD, MPH; Thomas J. Doyle, MD, MPH; Donald M. Yealy, MD. In-Flight Medical Emergencies: A Review. JAMA. 2018;320(24):2580-2590. doi:10.1001/jama.2018.19842
  2. Peterson DC, Martin-Gill C, Guyette FX, et all. Outcomes of Medical Emergencies on Commercial Airline Flights. NEJM. 2013:368(22):2075-2083. doi:10.1056/NEJMoa1212052

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Episode 16: Transgender Health Care

Emergency Medicine, Podcast

First, apologies for the delay in this episode! We’ve got a 2-month-old at home and it turns out, those little amazing terrorists take a lot of time!

On this episode, host Jason Woods speaks to Dr. Natalie Nokoff, a pediatric endocrinologist who works with transgender patients. The discussion centers on the health care needs of these patients, preferred language, safety, and how to approach the discussion of gender in our population.

Important Links

  1. Human Rights Campaign
  2. National LGBT Health Education Center
  3. GLAAD
  4. World Professional Association for Transgender Health
  5. Transgender Law Center

References

  1. Wylie K, Knudson G, Khan SI, et al. Serving transgender people: clinical care considerations and service delivery models in transgender health. Lancet 2016; 388:401.
  2. Turban J, Ferraiolo T, Martin A, Olezeski C. Ten Things Transgender and Gender Nonconforming Youth Want Their Doctors to Know. J Am Acad Child Adolesc Psychiatry 2017; 56:275.
  3. Olson-Kennedy J and Forcier M. Management of transgender and gender-diverse children and adolescents. UpToDate. Last Update Nov 2018. Accessed Nov 2018.
  4. Olson-Kennedy J and Forcier M. Gender development and clinical presentation of gender diversity in children and adolescents. Last Update Nov 2018. Accessed Nov 2018.

Guests

Natalie Nokoff MD, Assistant Professor of Pediatrics, Section of Endocrinology, Children’s Hospital Colorado and the University of Colorado

 

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Episode 15b: Specific Renal Issues

Education, Nephrology, Podcast, Uncategorized

This is part 2 of a discussion with Dr. Danielle Soranno, on specific renal issues in the ED. She discusses hyperkalemia, end-stage renal disease, and HUS among others. If you haven’t listened to Part 1 yet, got back an episode in the feed.

Guests

Danielle Soranno MD,  Assistant Professor, Pediatrics, Bioengineering & Medicine
University of Colorado and Children’s Hospital Colorado

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Episode 15a: Nephrology Overview with Danielle Sorrano

Education, Emergency Medicine, Nephrology, Pediatric Emergency Medicine, Podcast, Uncategorized

On this episode, host Jason Woods tries to tackle all things renal. This is part 1 of a discussion with Dr. Danielle Soranno, who gives an overview of how she approaches the kidney and what things we need to know in general. She talks about common renal issues in the emergency department and what information she wants to hear when called for a consult

Part 2 will post later this week and digs into some specific illnesses such as HUS, hyperkalemia, and end-stage renal disease.

Guests

Danielle Soranno MD,  Assistant Professor, Pediatrics, Bioengineering & Medicine
University of Colorado and Children’s Hospital Colorado

Important Information

  1. Fab Four – FABU
    1. Function
    2. Anatomy
    3. Blood Pressure
    4. Urine

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Episode 13: Adolescent Sexual Health and Education

Adolescent Medicine, Medical Education, Pediatric Emergency Medicine, Podcast, Sexual Health

On this episode, host Jason Woods speaks to Daniela Fellman and Alison Macklin, leaders from the Responsible Sex Education Institute, about a topic that can sometimes be difficult for patients, parents, and care providers…sex! Sexual and reproductive health education is hugely important and frequently politicized. Both interviewees are leading the way when it comes to education and outreach programs in the field of sex education. We talk about a variety of resources which are listed below, as well as get a sneak peek at two books which are being published soon.

Important Links

  1. Responsible Sex Education Institute
  2. ICYC Instagram
  3. ICYC – In Case You’re Curious
  4. Making Sense of “It” by Alison Macklin (available for pre-order now!)

Additional Resources

  1. Glsen
  2. Scarleteen
  3. Healthy Teen Network
  4. Advocates for Youth
  5. Amaze

Guests

Alison Macklin – Vice President of Education and Innovation, Responsive Sex Education, Planned Parenthood of the Rocky Mountains

Daniela Fellman – Program Manager of Texting Initiatives, Planned Parenthood of the Rocky Mountains

 

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Episode 12: High Altitude Illness with Elaine Reno

Education, Emergency Medicine, Medical Education, Pediatric Emergency Medicine, Podcast, Uncategorized, Wilderness Medicine

On this episode, host Jason Woods speaks with Dr. Elaine Reno, an emergency medicine physician who is also a wilderness medicine expert, about high altitude illness in pediatrics. We focus on risk factors, identification of illness, and recommendations for initial treatment.

Important points

  1. Significant altitude illness is rare below 8000 feet
  2. Pre-verbal children DO experience high altitude illness but can be more difficult to diagnose given the difficulty in communication.
  3. Dr. Reno strongly prefers slow acclimatization for children, rather than prophylactic medication.

Point of Care Resources

  1. Wilderness Medical Society
  2. Colorado Wilderness Medicine
  3. Lake Louise Acute Mountain Sickness Score
  4. Children’s Lake Louise Score

Guests

Elaine Reno MD – Assistant Professor of Emergency Medicine, University of Colorado School of Medicine, Department of Emergency Medicine, Section of Wilderness and Environmental Medicine

 

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Episode 11b: Acute Illness and Known Metabolic Disease with Austin Larson

Emergency Medicine, Metabolic Disorders, Pediatric Emergency Medicine, Podcast

On this episode, host Jason Woods speaks with Dr. Austin Larson, a specialist in pediatric inherited metabolic disorders (and also someone way smarter than I), about what do do with the crashing neonate if there are concerns for a metabolic disorder. We review the diagnostic approach, emergent treatment, and what resources are available to read/consult in this situation.

Important points

  1. Most children with known inherited metabolic disorder will have a letter with them, from their metabolic doc, about what to do if they show up to the with a new illness. If they do not, then the New England Consortium website is a great resource.
  2. Most protocols recommend starting D10 fluids at 1.5 x maintenance is generally the recommendation, unless there is a reason why glucose/fluids will otherwise harm the patient.
  3. Be careful with patients who are on a ketogenic diet as treatment for their seizures, as giving them glucose can cause refractory status epilepticus. In those patients, the preferred calorie support would be lipids.

Point of Care Resources

  1. New England Consortium for treatment protocols
  2. Vademecum Metabolicum handbook in book form
  3. App version of Vademecum Metabolicum – eVM

Guests

Austin Larson, MD – Assistant Professor of Pediatrics and Metabolic and Clinical Genetics, University of Colorado School of Medicine and Children’s Hospital Colorado

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Episode 11a: Crashing Neonate and Metabolic Disorders with Austin Larson

Emergency Medicine, Metabolic Disorders, Pediatric Emergency Medicine, Podcast

On this episode, host Jason Woods speaks with Dr. Austin Larson, a specialist in pediatric inherited metabolic disorders (and also someone way smarter than I), about what do do with the crashing neonate if there are concerns for a metabolic disorder. We review the diagnostic approach, emergent treatment, and what resources are available to read/consult in this situation.

Important points

  1. If an ill neonate presents and there is any concern for inherited metabolic disorder, starting D10 fluids at 1.5 x maintenance is generally the recommendation, unless there is a reason why glucose/fluids will otherwise harm the patient.
  2. If there are concerns for inherited metabolic disorder, in addition to glucose, checking ketones (urine or serum, though serum preferred), ammonia, and lactate can be very helpful.
  3. If the ammonia level is >200 micromols/L and rising, dialysis will likely be needed and you need to start making plans for this.
  4. Neonates generally can not generate a significant ketosis, even if fasting or ill, without an inherited metabolic disorder.
  5. Other labs to consider obtaining in an ill child with hypoglycemia or concern for metabolic disorder
    1. Cortisol
    2. Serum Amino Acids
    3. Urine Organic Acids
    4. Serum ketones
    5. Free fatty acids
    6. Growth Hormone
    7. Insulin
    8. Acylcarnitine profile

Point of Care Resources

  1. New England Consortium for treatment protocols
  2. Vademecum Metabolicum handbook in book form
  3. App version of Vademecum Metabolicum – eVM

Guests

Austin Larson, MD – Assistant Professor of Pediatrics and Metabolic and Clinical Genetics, University of Colorado School of Medicine and Children’s Hospital Colorado

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Episode 10: Post-resuscitation Hypotension After Cardiac Arrest with Alexis Topjian

Cardiac Arrest, Emergency Medicine, Medical Education, Pediatric Emergency Medicine, Podcast

On this episode we discuss the rates and risks of post-resuscitation hypotension after cardiac arrest. Host Jason Woods MD talks with Dr. Alexis Topjian, a critical care doc from Children’s Hospital of Philadelphia with special interests in neuro-critical care and post-arrest care, about her recent article on post arrest hypotension. This article was published in JAMA in 2018 (see references below) and evaluated outcomes based on presence of hypotension, and hypotensive burden, after out-of-hospital cardiac.

Guests

Alexis Topjian MD, Associate Professor of Anesthesia and Critical Care Medicine, University of Pennsylvania School of Medicine, Children’s Hospital of Philadelphia

References

  1. Topjian AA, Telford R, Holubkov R, et al. Association of Early Postresuscitation Hypotension With Survival to Discharge After Targeted Temperature Management for Pediatric Out-of-Hospital Cardiac Arrest. JAMA Pediatr. 2018;172(2):143–11. doi:10.1001/jamapediatrics.2017.4043.
  2. Topjian AA, French B, Sutton RM, et al. Early Postresuscitation Hypotension Is Associated With Increased Mortality Following Pediatric Cardiac Arrest*. Critical Care Medicine. 2014;42(6):1518-1523. doi:10.1097/CCM.0000000000000216.
  3. Bhanji F, Topjian AA, Nadkarni VM, et al. Survival Rates Following Pediatric In-Hospital Cardiac Arrests During Nights and Weekends. JAMA Pediatr. 2017;171(1):39–7. doi:10.1001/jamapediatrics.2016.2535.
  4. Moler FW, Silverstein FS, Holubkov R, et al. Therapeutic Hypothermia after In-Hospital Cardiac Arrest in Children. N Engl J Med. 2017;376(4):318-329. doi:10.1056/NEJMoa1610493.

 

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