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 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

 

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 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

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

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.

 

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