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

Episode 21: HIV Screening in the Pediatric ED

Adolescent Medicine, Emergency Medicine, Infectious Disease, Uncategorized

On this episode, host Jason Woods speaks with Dr. Amy Grover about HIV screening in the pediatric emergency department. Dr. Grover works in both the section of emergency medicine and hospital medicine and has an interest in HIV screening.

The highlights:

  • An estimated 50% of adolescents with HIV do not know they have contracted HIV
  • Acute retroviral syndrome has many non specific symptoms and can be difficult to diagnosis but includes the following
    • Fever
    • Fatigue
    • Myalgias
    • Nausea, vomiting, and/or diarrhea
    • Rash that can involve the hands and feed
    • Pharyngitis is typically not as exudative as EBV
  • CDC guidelines recommend that EVERY person ages 13-64 who is sexually active be screened for HIV at least once in their lives, and yearly if ongoing risk for exposure
  • One of the difficult aspects of setting up a screening program is deciding who is responsible for follow up of the results. Each institution will have to discuss what is appropriate for their setting
  • Do not forget to evaluate for risk of other STI, including Syphilis (prevalence is rising in the US)
  • Most rapid screening tests that do not use whole blood can not detect HIV infection until there is an antibody response (3 weeks – 3 months)
  • The 4th generation HIV test can detect infection starting as early as 15 days after infection. Note that there is still a latent period when detection is not possible.
  • One of the important reasons to screen patients is that there is evidence that knowledge of HIV infection decreases high-risk behavior.
  • The benefit and effect of HIV screening may depend on the regional HIV rates

Guests

Amy Grover MD – University of Colorado School of Medicine, Sections of Emergency Medicine and Hospital Medicine, Children’s Hospital Colorado

Important Resources

  1. CDC HIV Resource Library

References

  1. Wilson KM, Klein JD. Adolescents who use the emergency department as their usual source of care. Arch Pediatric Adolesc Med. 2000 Apr;154(4):361-5.
  2. Kitahadta MM, et al. Effect of Early vs Deferred Antiretroviral therapy for HIV on Survival. NEJM 2009;360(18):1815-26.
  3. Marks G, et al. Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: implications for HIV prevention programs. J Acquir Immune Defic Syndr.2005 Aug 1;39(4):446-53.
  4. Cohen MS, et al. Antiretroviral Therapy for the prevention of HIV-1 Transmission. NEJM 2016; 375(9):830-839.
  5. Marks G, et al. Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA. AIDS.2006 Jun 26;20(10):1447-50.
  6. Wood E, et al. Does this Adult Patient have Early HIV infection? JAMA 2014; 213 (3): 278-285.
  7. Mehta AS, et al. Practices, Beliefs, and Perceived Barriers to Adolescent Human Immunodeficiency Virus Screening in the Emergency Department. Pediatr Emerg Care 2015; 31:621-626.
  8. Akhter A, et al. Rapid Human Immunodeficiency Virus Testing in the Pediatric Emergency Department: A National Survey of Attitudes Among Pediatric Emergency Practitioners. Pediatr Emerg Care 2012; 28:1257-1262.
  9. Haines CJ, et al. Pediatric emergency department – based rapid HIV testing: adolescent attitudes and preferences. Pediatr Emerg Care.2011 Jan;27(1):13-6.

Episode 18a: Anti-trafficking and the role of the ED

Adolescent Medicine, Emergency Medicine, Pediatric Emergency Medicine, Trafficking, Uncategorized

On this episode, host Jason Woods speaks with Dr. Makini Chisolm-Straker, an ED physician in New York who is also a founder of HEAL Trafficking, an organization that works to fight human traffickingi n all forms. This is part 1 of a 2 part discussion. The highlights:

  1. Definition of trafficking
    1. recruitment, harboring, transportation, provision, and/or obtaining of a person
    2. By the use of force, fraud, and/or coercion
    3. For purposes of labor and/or sexual exploitation
  2. Numbers and general info
    1. Overall labor trafficking is most common
    2. Under age 18 “survival” sex considered victim of trafficking
    3. US reports 15-50k brought to US each year for trafficking, but tn 2014, US DOS reported 21,000 calls to its trafficking hotline, so it is likely far under-reported in the official numbers.
    4. On a 2016 survey of victims of trafficking, 55% had seen an ED/UC while trafficked
  3. There is no comprehensive trafficking screening tool in existence
    1. The Greenbaum tool is only for use in english speaking patients ages 13-17 and evaluates for risk of sex trafficking
  4. Quotes from Makini’s published work that I loved
    1. It is important NOT to employ the Greenbaum Tool until the clinician has had a frank conversation about mandated reporting with the patient. Too often clinicians envision trafficking as a crime from which which victims must be rescued or saved. That is not our job. And it does not work. Victims that are unwillingly rescued often end up back in exploitation circumstances. Many young people in trafficking situations do not identify as victims and some feel a strong sense of agency: others expect to be criminalized by authority figures because that has been their experience.
    2. We must apply the principles learned from because of IPV work. Survivors know more about their situation and needs than we do. Our rescue actions, intended with love, often have untoward unintended consequences for those we seek to serve.

Guests

Makini Chisolm-Straker MD, Assistant Professor of Emergendy Medicine, Mount Sinai Health System

Other Resources

  1. HEAL Trafficking
  2. Training for providers that Dr. Chisolm-Straker mentioned
  3. Human trafficking hotline:
    1. Phone: 1-888-373-7888
    2. SMS:233733 text HELP or INFO
    3. Humantraffickinghotline.org
  4. HumantraffickingED.com

References

1.     Greenbaum VJ, Livings MS, Lai BS et al. Evaluation of a Tool to Identify Child Sex Trafficking Victims in Multiple Healthcare Settings. Journal of Adolescent Health 2018;63(6):745–52. 

2.     Greenbaum VJ, Dodd M, McCracken C. A Short Screening Tool to Identify Victims of Child Sex Trafficking in the Health Care Setting. Pediatric Emergency Care 2018;34(1):33–7. 

3.     Chisolm Straker M, Baldwin S, Gaïgbé-Togbé B, Ndukwe N, Johnson PN, Richardson LD. Health Care and Human Trafficking: We are Seeing the Unseen. Journal of Health Care for the Poor and Underserved 2016;27(3):1220–33. 

4.     Shandro J, Chilsom-Straker M, Duber HC et al. Human Trafficking: A Guide to Identification and Approach for the Emergency Physician. YMEM 2016;68(4):501–1. 

5.     Chisolm Straker M. Measured steps: evidence‐based anti‐trafficking efforts in the E.D. Acad Emerg Med 2018.  doi: 10.1111/acem.13552 

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

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

Episode 14: UTICalc with Nader Shaikh

Calculators, Emergency Medicine, Infectious Disease, Uncategorized

On this episode, host Jason Woods speaks to Dr. Nader Shaikh about his recent paper on the development of a calculator (UTICalc) to estimate the probability of UTI in pediatric patients. The calculator itself is fantastic and easy to use (see link below) but the discussion centers on the methods behind the calculator. We dig into how these calculators are developed, how to determine if they are accurate/useful, and how to use them in clinical practice.

Important Links

  1. UTI Calculator link – UTICalc
  2. AAP UTI Guidelines, 2016 Reaffirmation of 2011 Guidelines
  3. AAP 2011 UTI Guidelines Update

References

  1. Shaikh N et al. “Development and Validation of a Calculator for Estimating the Probability of Urinary Tract Infection in Young Febrile Children”. JAMA Pediatr. 2018 Jun 1;172(6):550-556. doi: 10.1001/jamapediatrics.2018.0217.
  2. Roberts  KB; Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management.  Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months.  Pediatrics. 2011;128(3):595-610.Lavelle  JM, Blackstone  MM, Funari  MK,  et al.  Two-step process for ED UTI screening in febrile young children: reducing catheterization rates.  Pediatrics. 2016;138(1):e20153023.
  3. Shaikh  N, Morone  NE, Bost  JE, Farrell  MH.  Prevalence of urinary tract infection in childhood: a meta-analysis.  Pediatr Infect Dis J. 2008;27(4):302-308.
  4. Hoberman  A, Wald  ER, Reynolds  EA, Penchansky  L, Charron  M.  Pyuria and bacteriuria in urine specimens obtained by catheter from young children with fever.  J Pediatr. 1994;124(4):513-519.
  5. Hoberman  A, Chao  HP, Keller  DM, Hickey  R, Davis  HW, Ellis  D.  Prevalence of urinary tract infection in febrile infants.  J Pediatr. 1993;123(1):17-23.

Guests

Nader Shaikh MD, Associate Professor, General Academic Pediatrics, Children’s Hospital of Pittsburgh

 

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

 

Episode 9: Suicide Prevention and Firearms

Emergency Medicine, Firearm Violence, Pediatric Emergency Medicine, Uncategorized

The last in our current series on firearm violence looks at suicide prevention and the relation of firearms to suicide. Host Jason Woods MD talks with Dr. Emmy Betz, a researcher in suicide prevention, about what is currently know, strategies for harm reduction, and her efforts as the co-founder of the Colorado Coalition for Firearm Safety, which works to bring the medical community together with firearm owners, gun shops, and shooting ranges to improve safety.

Guests

Emmy Betz MD, MPH – Assistant Professor, Department of Emergency Medicine, University of Colorado School of Medicine.

Resources 

References

  1. Betz ME, Kautzman M, Segal DL, et al. Frequency of lethal means assessment among emergency department patients with a positive suicide risk screen. Psychiatry Research 2018;260:30–5.
  2. Betz ME, Wintersteen M, emergency EBAO, 2016. Reducing suicide risk: challenges and opportunities in the emergency department. annemergmedcom
  3. Pierpoint LA, Tung GJ, Brooks-Russell A, Brandspigel S, Betz M, Runyan CW. Gun retailers as storage partners for suicide prevention: what barriers need to be overcome? Inj Prev 2018;:injuryprev–2017–042700–5.
  4. McCourt AD, Vernick JS, Betz ME, Brandspigel S, Runyan CW. Temporary Transfer of Firearms From the Home to Prevent Suicide. JAMA Intern Med 2017;177(1):96–6.
  5. Wintemute GJ, Betz ME, Ranney ML. Yes, You Can: Physicians, Patients, and Firearms. Ann Intern Med 2016;165(3):205–10.

Episode 8: Firearm and Youth Violence in Canada

Education, Emergency Medicine, Firearm Violence, Medical Education, Pediatric Emergency Medicine, Podcast, Uncategorized

We continue our look at firearm and violent injury in the youth population by examing the issue outside of the United States. Host Jason Woods MD gathered Canadian physicians Carolyn Snider and Natasha Saunders, both researchers on violent injury (and specifically firearm-related injury), to discuss the scope of violent youth injury in Canada, ED-based intervention programs, risk factors, and the rising rates of injury due to air guns and BB guns.

Guests

Carolyn Snider MD, MPH – Associate Professor, Department of Emergency Medicine, University of Toronto, Staff Physician Winnipeg Health Sciences Center, founder of the Emergency Department Violent Injury Prevention program (EDVIP)

Natasha Saunders MD – Assitant Professor Department of Pediatrics University of Toronto, Staff Physician Hospital for Sick Children, Adjunct Scientist Institute for Clinical Evaluative Sciences

Resources

National Network of Hospital-based Violence Intervention Programs – http://nnhvip.org/

  1. Saunders NR, Lee H, Macpherson A, Guan J, Guttmann A. Risk of firearm injuries among children and youth of immigrant families. CMAJ. 2017;189(12):E452-E458.
  2. Snider CE, Ovens H, Drummond A, Kapur AK. CAEP Position Statement on Gun Control. Canadian Journal of Emergency Medicine. 2009;11(1):64-72
  3. Snider CE, Brownell M, Dufault B, Barrett N, Prior H, Cochrane C. A multilevel analysis of risk and protective factors for Canadian youth injured or killed by interpersonal violence. Inj Prev. July 2017:injuryprev–2016–042235–7
  4. Snider C, Woodward H, Mordoch E, et al. Development of an Emergency Department Violence Intervention Program for Youth: An Integrated Knowledge Translation Approach. Progress in Community Health Partnerships. 2016;10(2):285-291

Episode 7: Reframing how we think about firearm violence

Education, Emergency Medicine, Firearm Violence, Medical Education, Pediatric Emergency Medicine, Podcast, Uncategorized

Violent injury, particularly related to firearms, has been at the forefront of national discussion recently. Pediatric victims and survivors have begun to enter into the public discussion via a strong social media presence, and as clinicians who treat these patients’ injuries, we are also obligated to participate in prevention. This is the first in a series of episodes to address what we know about firearm violence, what interventions have been tried, and how we can reframe the discussion to focus less on political beliefs and more on harm reduction.

Host Jason Woods MD gathered national firearm violence experts Megan Ranney MD MPH, Patrick Carter MD, and Stephen Hargarten MD MPH to introduce where the research, policy, and political climate sits currently and to give some ideas on how to think and speak about this issue with patients and families.

Guests

Megan Ranney MD MPH- Associate Professor of Emergency Medicine at Brown University, violence prevention researcher, past chair of ACEP Trauma and Injury Prevention Section
Stephen Hargarten MD MPH – Professor and chair of Emergency Medicine of Medical College of Wiscone, Director of MCW Comprehensive Injury Center
Patrick Carter MD – Assistant Professor of Emergency medicine, and Assistant Director of the Injury Prevention Center at the University of Michigan

Resources

Videos from University of Michigan  “Open Michigan” site on how to talk to patients and families about firearms

Articles

  1. McCourt AD, Vernick JS, Betz ME, Brandspigel S, Runyan CW. Temporary Transfer of Firearms From the Home to Prevent Suicide. JAMA Intern Med 2017;177(1):96–6.
  2. Wintemute GJ, Betz ME, Ranney ML. Yes, You Can: Physicians, Patients, and Firearms. Ann Intern Med 2016;165(3):205–10.
  3. MPH MLRM, MD JF, MPH HAM, et al. A Consensus-Driven Agenda for Emergency Medicine Firearm Injury Prevention Research. YMEM 2017;69(2):227–40.
  4. Parikh K, Silver A, Patel SJ, Iqbal SF, Goyal M. Pediatric Firearm-Related Injuries in the United States. Hospital Pediatrics 2017;:hpeds.2016–0146–12.
  5. Hargarten S. Firearm Injury in the United States: Effective Management Must Address Biophysical and Biopsychosocial Factors. Ann Intern Med 2016;165(12):882–2.
  6. Carter PM, Cook LJ, Macy ML, et al. Individual and Neighborhood Characteristics of Children Seeking Emergency Department Care for Firearm Injuries Within the PECARN Network. Acad Emerg Med 2017;24(7):803–13.
  7. Goldstick JE, Carter PM, Walton MA, et al. Development of the SaFETy Score: A Clinical Screening Tool for Predicting Future Firearm Violence Risk. Ann Intern Med 2017;166(10):707–15.
  8. Carter PM, Walton MA, Goldstick J, et al. Violent firearm-related conflicts among high-risk youth: An event-level and daily calendar analysis. Preventive Medicine 2017;102(C):112–9.