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Peds-Centered — Arts
Peds-Centered

Peds-Centered provides leading-edge information and conversations with experts in the field of Pediatric Emergency Medicine and Urgent Care, and Pediatric Hospital Medicine.

Copyright: © 2023 Peds-Centered

Latest Episodes:

Signing Out Early - Mid-Career Transitioning and Grappling with Burnout Oct 16, 2024

In this episode, I speak with Dr. Jess Schnell, DO MBA, who transitioned from Pediatric Emergency Medicine and hospital administration to utilization management. We talk about career longevity, deciding to transition away from clinical medicine, and dealing with burnout.
Articles and Resources We Discuss:
Gettel CJ, Courtney DM, Agrawal P, Madsen TE, Rothenberg C, Mills AM, Lall MD, Keim SM, Kraus CK, Ranney ML, Venkatesh AK. Emergency medicine physician workforce attrition differences by age and gender. Acad Emerg Med. 2023 Nov;30(11):1092-1100. doi: 10.1111/acem.14764. Epub 2023 Jun 23. PMID: 37313983; PMCID: PMC10973949.
Chen YW, Orlas C, Kim T, Chang DC, Kelleher CM. Workforce Attrition Among Male and Female Physicians Working in US Academic Hospitals, 2014-2019. JAMA Netw Open. 2023 Jul 3;6(7):e2323872. doi: 10.1001/jamanetworkopen.2023.23872. Erratum in: JAMA Netw Open. 2023 Sep 5;6(9):e2334513. doi: 10.1001/jamanetworkopen.2023.34513. PMID: 37459094; PMCID: PMC10352856.
COVID Coach App
Psychologytoday.com

Coming to America - Vector-Born Illnesses and their Expanding Ranges Sep 16, 2024

In this episode, I speak with Dr. Allison Messina, an Assistant Professor of Pediatric Infectious Disease in Florida at Johns Hopkins All Children's Hospital. We talk about vector-born illnesses - their presentation and management, and where and when to look out for them. Ranges of many of these illnesses are expanding, both northward from the tropics, and for diseases like Lyme disease, to broadening regions within North America, so many of us will be seeing these illnesses in areas where they weren't previously found. Dr. Messina provides recommendations for us as treating physicians and for those of us planning to travel to areas with illnesses not endemic to where we're living.
We talk about the CDC Yellow Book as a guide for travel medicine and when treating patients who have recently traveled. Here is a link to the website - we both use this regularly and find it really helpful.
https://wwwnc.cdc.gov/travel/page/yellowbook-home

Emergency Management of Pediatric Diabetes Aug 05, 2024

In this episode, I speak with Dr. Kathy Sumpter, who is Division Chief of Pediatric Endocrinology at Le Bonheur Children's Hospital. We talk about diagnosing diabetes in children and risk-stratifying kids coming in with new-onset diabetes, as well as fluid and insulin management strategies for kids in DKA. Dr. Sumpter specializes in helping kids who struggle to control their diabetes improve their health, and shares insights about her successes and about the future of medical care for diabetes.
Some articles we mention in this episode include:
Kathleen M. Brown, et al, for the Pediatric Emergency Care Applied Research Network Diabetic Ketoacidosis FLUID Study Group; Rehydration Rates and Outcomes in Overweight Children With Diabetic Ketoacidosis. Pediatrics December 2023; 152 (6): e2023062004. 10.1542/peds.2023-062004
Kuppermann N, et al. Clinical Trial of Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis. N Engl J Med. 2018;378(24):2275-2287. doi:10.1056/NEJMoa1716816

PFX Isn't a Four-Letter Word: High-Value Care and Meeting the Quadruple Aim Jul 09, 2024

In this episode I meet with Dr. Jay Pershad from Children's National Hospital in Washington, DC. Dr. Pershad is an expert in high-value care and shares strategies for improving our quality of care to benefit patients, families, and healthcare providers together. A few studies that he mentions are here below for those who are interested in a deeper dive:
Bodenheimer T, Sinsky C. From Triple Aim to Quadruple Aim: Care of the Patient Requires Care of the Provider. Ann Fam Medicine 2014;12(6):573-576. doi: 10.1370/afm.1713
Foster C, et. al. Emergency Care Connect: Extending Pediatric Emergency Care Expertise to General Emergency Departments Through Telemedicine. Academic Pediatrics 2020;20(5):577-584. https://doi.org/10.1016/j.acap.2020.02.028
Paydar-Darien N, et al. Improving Discharge Safety in a Pediatric Emergency Department. Pediatrics 2022;150(5).

Sentinel Injuries and Reporting Child Abuse Apr 25, 2024

April is Child Abuse Awareness Month, so in this episode I am speaking with Dr. Antonia Chiesa, a Child Abuse Medicine Specialist. We discuss sentinel injuries and how to navigate evaluating and reporting these injuries, positive news about the demographics and trends in the US regarding child abuse rates, and the broader conversation about child abuse and child health outside of the acute setting.
I would like to add a clarification here regarding a statement I make in this episode - I talk about the low rates of child abuse in Costa Rica, where I live, and the social protective factors here. This is in reference to child physical abuse, but I did not talk about sex trafficking, including minors, which is rampant in Central America and Costa Rica. We will leave that topic for another conversation.
For a review of the TEN4-FACES Clinical Decision Rule for Sentinel Bruises, this recent article does a great job breaking down sensitivity, specificity, and predictive values:
Validation of a Clinical Decision Rule to Predict Abuse in Young Children Based on Bruising Characteristics

Hematologic Emergencies Mar 01, 2024

In this episode, I meet with Dr. Chinni Pokala to talk about the assessment and management of hematologic disorders in the acute setting. We discuss how to think about kids presenting with signs and symptoms of new hematologic disorders as well as thrombotic and hemorrhagic risks for kids with established heme/onc diagnoses or other chronic medical conditions.

Pediatric Readiness - Tackling Training, the C-suite, and Everything in Between Feb 01, 2024

In this episode, I talk with Dr. Alana Arnold about our experiences with pediatric readiness projects in community and urgent care settings, both as partnering with academic pediatric centers and via private consulting. Below, in order, are the seminal paper regarding pediatric readiness in general emergency departments, its associated assessment tool, the Wall Street Journal article about pediatric readiness referenced in this episode, findings from the ImPACTS project, and contact information for Dr. Arnold.
Gausche-Hill M, Ely M, Schmuhl P, et al. A national assessment of pediatric readiness of emergency departments [published correction appears in JAMA Pediatr. 2015 Aug;169(8):791]. JAMA Pediatr. 2015;169(6):527-534. doi:10.1001/jamapediatrics.2015.138
National Emergency Medical Services for Children Pediatric Readiness Assessment and Scoring Resource Document
https://www.wsj.com/health/healthcare/hospitals-emergency-rooms-cost-childrens-lives-d6c9fc23?reflink=desktopwebshare_permalink
Auerbach MA, Whitfill T, Montgomery E, et al. Factors Associated With Improved Pediatric Resuscitative Care in General Emergency Departments. Pediatrics. 2023;152(2):e2022060790. doi:10.1542/peds.2022-060790
Dr. Alana Arnold: email: Alana@PremierPediatricSolutions.com
website: www.linktr.ee/pempal

Leadership Dec 31, 2023

In this episode I meet up with Dr. Dan Park, who is the medical director of the pediatric emergency department at University of North Carolina. We'll be talking about the components of leadership and navigating careers in medicine. We discuss metacognition and cognitive biases, developing our expertise, leadership skills, and resiliency, and how these all interplay.
Here is Dan's article about cognitive biases that we discussed during this episode:
https://pubmed.ncbi.nlm.nih.gov/24488159/

Navigating the Fourth Quarter - Career Transitions and Exiting Medicine Nov 29, 2023

In this episode, I'm speaking with Drs. Fred Henretig (Penn) and Carl Baum (Yale) about career transitions and exiting medicine. We discuss the current literature surrounding retirement and attrition in medicine, reasons physicians cite for staying vs going, and strategies for handling major career and life transitions.
Below is the information for a few of the articles mentioned in this podcast:
Henretig F, et. al. PEM Physicians' Perceptions of Colleagues' Clinical Competencies Over Four Age Categories. Pediatrics (2022);149:457.
https://publications.aap.org/pediatrics/article/149/1%20Meeting%20Abstracts%20February%202022/457/186078/PEM-Physicians-Perceptions-of-Colleagues-Clinical
Pizzo PA. Navigating Transitions and Charting New Paths. JAMA (2017);317(16):1625-6.
https://jamanetwork.com/journals/jama/article-abstract/2620092

David Brooks - The New Old Age: https://www.theatlantic.com/culture/archive/2023/08/career-retirement-transition-academic-programs/675085/

Pediatric Transport Medicine Nov 01, 2023

In this episode, I'll be talking with Dr. Matt Harris from Cohen Children's Hospital about medical transport of kids, both in the prehospital and interfacility settings. We will discuss level of skills, training, and equipment available with various teams, factors to consider when choosing transport options, safety and legal concerns, and transport cost.
After recording this episode, Dr. Harris and I were discussing the components of the safety checklist his institution uses for transport of kids with behavioral health emergencies. His team does a huddle prior to transfer and answers these questions:

Who participates in huddle (referring doc, EMS clinicians, occasionally tele-psych physician).
Was a complete report given?
Was the patient aware of the intent to transfer (transparency with patients reduces discord)
Type of transfer (voluntary, involuntary, etc)
Any concerns from the sending physician?
Does the patient appear compliant and willing to transfer?
Is crew comfortable transporting the patient as presented?

Acetaminophen and Ibuprofen Overdoses - Strategies for Management in Kids, Teens, and Adults Oct 02, 2023

In this episode, I talk with Dr. Sing-Yi Feng, a Pediatric Emergency Medicine physician and Toxicologist, about ingestions of acetaminophen and ibuprofen, and general guidelines for evaluation of ingestions. We discuss important knowledge points for diagnosis, management, and continuation of care for our patients at home, in the inpatient unit, and in the critical care setting. Although Dr. Feng is a pediatrician first, she reviews care for patients of all ages, as ibuprofen and acetaminophen are among the most common ingestions of people at any age.

Sticks and Stones...and Banana Leaves? - Tips and Tricks for Fracture Management in Kids Aug 31, 2023

In this episode I chat with Dr. Chris Amato about pediatric fractures - management of pain, when to call Orthopedics, and practical tips on splinting and immobilization strategies.
Side note: I mention in this that a femur fracture will heal if you get the two ends "in the same room together" - I should clarify, "in the same room together AND in a spica cast." Cast those femur fractures, people!

Kidney Stones and Pyelonephritis- Not Just for the Grownups Anymore Aug 04, 2023

In this episode I talk with Dr. David Sas, a Pediatric Nephrologist from the Mayo Clinic, about kids and kidney stones, with a discussion of stone diagnosis, management, and complications. We also discuss pyelonephritis, dysfunctional voiding, and long-term management and recurrence prevention after the initial diagnosis of all of these issues.
Spoiler alert: Dr. Sas mentions briefly in this episode the work he has done to develop a CURE for a rare genetic cause of renal stones, and his team at Mayo has a special interest in the evaluation of kids with kidney stones for genetic and underlying causes that can be managed to prevent future stones and kidney injury. If you have a patient with renal stones who needs assessment, I have listed his contact information and department website here:
https://www.mayoclinic.org/departments-centers/pediatric-nephrology-clinic
Sas.David@Mayo.edu

Teens and STIs Jun 30, 2023

In this episode I speak with Dr. Deb Kahal, Medical Director of the Holloway Community Program in Delaware, which provides testing and treatment for HIV, AIDS, and Hep C, and with Dr. Steve Eppes, Pediatric Infectious Disease Physician. We'll be reviewing the epidemiology of adolescent STIs, screening recommendations, treatment, and why it's important for us non-PCPs to address adolescent STIs.
Here is the link for the USPSTF (US Preventive Services Task Force) Infectious Disease Screening Recommendations: uspreventiveservicestaskforce.org. These are the summary statements and are pretty detailed if you like in-depth reviews of the literature behind the decision making.
For a quicker reference table, the CDC has a table of screening guidelines: https://www.cdc.gov/std/treatment-guidelines/screening-recommendations.htm

Button Batteries and Kids Jun 02, 2023

In this episode, I'll be reviewing button battery ingestions and superficial/mucosal injuries, including risk factors, pathophysiology, and management of known and suspected ingestions. Below is the link I mentioned to a time-lapse video modeling a button battery's effects on tissue, made by Dr. Robert Kramer who is a pediatric gastroenterologist. It's pretty impressive to watch!
https://youtu.be/-wI_Vl3LH78

Toxidromes May 01, 2023

In this episode I'll be speaking with Carl Baum, a Pediatric Toxicologist and Emergency Medicine Physician from Yale School of Medicine about common pediatric toxidromes. We'll also cover assessment and management of the obtunded child, polysubstance ingestion, and some interesting toxicology tidbits.

Pediatric Anaphylaxis Care Apr 03, 2023

In this episode, I'll review pediatric anaphylaxis, including diagnosis, management best practice, and aftercare for kids treated in the acute care setting.

Pediatric Neurologic Emergencies Mar 20, 2023

In this episode, I'll be chatting with Pediatric Neurologists Drs. Richard Fischer and Mitra Assadi-Khansari about common neurologic emergencies in kids. We will focus on seizure evaluation and management (febrile, epileptic, and non-epileptiform) as well as a review of pediatric migraine headache.
For further reading about pediatric headache, the American Headache Society website provides practice guidelines summarizing literature on a variety of headache syndromes:
https://americanheadachesociety.org/news/?tag=pediatric-headache

Bronchiolitis Care - What Works and What Doesn't Feb 24, 2023

In this episode, I'll be reviewing best practice recommendations for bronchiolitis management, and evidence behind the advice for and against some of the most popular treatment options.

Pediatric Behavioral Health Emergencies Dec 27, 2022

In this episode, I talk with Jennifer Calahan and Jennifer Valdez, two behavioral health experts, about the process for evaluating behavioral health emergencies, with general tips on medical screening and assessment as well as specific requirements for Delaware and neighboring states, and for the ChristianaCare hospital system.
Links to the assessment tools described today are:
https://cssrs.columbia.edu/ - Columbia Suicide Severity Rating Scale
https://www.nimh.nih.gov/research/research-conducted-at-nimh/asq-toolkit-materials - ASQ Screener (Ask Suicide-Screening Questions) by the NIH

Steroids in Pediatric Respiratory Illness Dec 09, 2022

In this episode, I talk with Jenn Empfield, a pediatric emergency medicine pharmacist, about the use of steroids in croup, asthma, chronic lung disease exacerbations, and (not) bronchiolitis. We review literature and AAP recommendations regarding best medication choices, dosing, frequency, and cost/benefits of different regimens. If you're interested in reading further about these topics, click the links below for some of the literature reviewed in this session.
AAP Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis (free full text)
Single-Dose Dexamethasone is Not Inferior to 2 Doses in Mild to Moderate Pediatric Asthma Exacerbations in the Emergency Department

PMID: 35507383
DOI: 10.1097/PEC.0000000000002727

Two regimens of dexamethasone versus prednisolone for acute exacerbations in asthmatic Egyptian children (free full text)

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