Episode 18b: Anti-trafficking and the role of the ED
Mar 18, 2019
Show notes
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 2 of a 2 part discussion. The highlights:
Definition of trafficking
recruitment, harboring, transportation, provision, and/or obtaining of a person
By the use of force, fraud, and/or coercion
For purposes of labor and/or sexual exploitation
Numbers and general info
Overall labor trafficking is most common
Under age 18 “survival” sex considered victim of trafficking
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.
On a 2016 survey of victims of trafficking, 55% had seen an ED/UC while trafficked
There is no comprehensive trafficking screening tool in existence
The Greenbaum tool is only for use in english speaking patients ages 13-17 and evaluates for risk of sex trafficking
Quotes from Makini’s published work that I loved
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.
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
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 18a: Anti-trafficking and the role of the ED
Mar 18, 2019
Show notes
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:
Definition of trafficking
recruitment, harboring, transportation, provision, and/or obtaining of a person
By the use of force, fraud, and/or coercion
For purposes of labor and/or sexual exploitation
Numbers and general info
Overall labor trafficking is most common
Under age 18 “survival” sex considered victim of trafficking
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.
On a 2016 survey of victims of trafficking, 55% had seen an ED/UC while trafficked
There is no comprehensive trafficking screening tool in existence
The Greenbaum tool is only for use in english speaking patients ages 13-17 and evaluates for risk of sex trafficking
Quotes from Makini’s published work that I loved
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.
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
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 17: Teeny Weeny Problems – Pediatric Urology
Feb 04, 2019
Show notes
On this episode, host Jason Woods speaks with Dr. Tanya Davis, pediatric urologist and all around superstar, about common pediatric urology problems that present to the emergency department. The highlights:
Testicular torsion is an emergency, and ultrasound should be performed when this is suspected. If the symptoms are highly suggestive call urology even with a normal ultrasound
It is suggested that urology is contacted before performing any repair of a laceration that is more than superficial.
Pediatric patients that develop epididymitis in the absence of sexual activity should be referred to urology, as this is unusual and may indicate an anatomic abnormality.
Dr. Davis feels that any patient with complex urogenital anatomy, indwelling catheters, or a surgically created catheterizable tract should NOT have antibiotics started for UTI without contacting their primary urologist.
Guests
Tanya Davis MD, Clinical Instructor, Department of Urology, Children’s National Health System
Pediatric Urologist, Mid-Atlantic Permanente Medical Group
Episode 16: Transgender Health Care
Dec 31, 2018
Show notes
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.
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.
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.
Olson-Kennedy J and Forcier M. Management of transgender and gender-diverse children and adolescents. UpToDate. Last Update Nov 2018. Accessed Nov 2018.
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
Episode 15b: Specific Renal Issues
Nov 08, 2018
Show notes
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
Nov 05, 2018
Show notes
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
Episode 14: UTICalc with Nader Shaikh
Sep 05, 2018
Show notes
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.
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.
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.
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.
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
Aug 14, 2018
Show notes
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.
Episode 12: High Altitude Illness with Elaine Reno
Jul 17, 2018
Show notes
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
Significant altitude illness is rare below 8000 feet
Pre-verbal children DO experience high altitude illness but can be more difficult to diagnose given the difficulty in communication.
Dr. Reno strongly prefers slow acclimatization for children, rather than prophylactic medication.
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
Jun 07, 2018
Show notes
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
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.
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.
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.
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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